OB - Exam Three

Question 1

First sign of hypovolemic shock

Answer 1

Increase heart and respiratory rate

Question 2

What do you do for a boggy fundus that is deviated?

Answer 2

Massage uterus until firm

Have woman urinate or catheterize

Question 3

What would the physician order if we could not get boggy fundus firm?

Answer 3

Pitocin
Methylergonovine
Prostaglandins

Question 4

Discharge teaching for postpartum moms that delivered vaginally

Answer 4

a. Follow up appointments at week 2 and 6
b. Daily shower
c. Perineal care until lochia stops
d. No sex until episiotomy healed and lochia stops
e. Use protection
f. High fiber foods
g. Well-balanced diet
h. Moderate exercise
i. Continue prenatal for 6 weeks
j. Report the following
1. Fever higher than 100.4
2. Persistent lochia rubra or lochia with foul odor
3. Bright red bleeding, especially if lochia has changed from serosa or alba
4. Prolonged after pains, pelvic, abdominal pain, or constant backache
5. Signs of UTI
6. Pains, tenderness, redness in calf
7. Localized breast tenderness, or redness
8. Prolonged and pervasive feelings or depression and being let down, not enjoying life

Question 5

Signs of late postpartum hemorrhage

Answer 5

a. Happens 24 hours to 6 weeks after childbirth
b. Causes= retention of placenta fragments and subinvolution of uterus
c. Persistent red bleeding
d. Return of red bleeding after it has changed to pinkish or white

Question 6

Teaching for moms with mastitis

Answer 6

Heat promotes blood flow to the area

a. Wash hands thoroughly before breastfeeding
b. Maintain breast cleanliness with frequent breast pad changes
c. Expose nipples to air when possible
d. Ensure correct newborn latch and removal from breast
e. Enourage newborn to empty breast
f. Frequently breastfeed
g. Breastfeed from uninfected side first at each feeding to initiate let down in affected breast
h. Massage distended area as newborn nurses
i. Report redness and fever to healthcare provider
j. Apply ice packs or most heat to relieve discomfort

Question 7

Postpartum complications if mom delivers a large baby vaginally

Answer 7

a. More at risk for uterine atony
b. More at risk for postpartum hemorrhage
c. May have a large episiotomy or laceration

Question 8

What do we suspect if the uterus is firm but mom is still bleeding?

Answer 8

a. Blood clots retained

b. Infection

Question 9

Where does a patient feel the pain with a positive Homan’s sign?

Answer 9

Pain in calf when leg is dorsiflexed

Question 10

Risk factors for postpartum shock

Answer 10

o   Placental abruption. The early detachment of the placenta from the uterus.
o   Placenta previa. ...
o   Overdistended uterus. ...
o   Multiple pregnancy.
o   High blood pressure disorders of pregnancy.
o   Having many previous births.
o   Prolonged labor.
o   Infection.

Question 11

Signs and symptoms for mastitis

Answer 11

	Redness and heat in the breast
	Tenderness
	Edema and a heaviness in the breast
	Purulent drainage
	May have fever and chills

Question 12

What would a nurse expect to assess if the peri-pad has no lochia on it shortly after delivery?

Answer 12

o Normal postpartum changes
 Lochia rubra should be bright red
 Amount during first few hours should be no more than on saturated perineal pad per hour
 A few small clots may appear but large clots are NOT normal

Check fundus - if it’s not contracting, it can’t get rid of blood

Question 13

Interventions for hypovolemic shock

Answer 13

o Stop the blood loss
o Give IV fluids to maintain the circulating blood volume and to replace fluids
o Give blood transfusions to replace lost erythrocytes
o Give oxygen to increase the saturation of remaining blood cells
 Place pulse ox on patient
o Place an indwelling (Foley) catheter to assess urine output, which reflects kidney function

Question 14

Molding

Answer 14

 Conforming of the fetal head to the size and shape of the birth canal

Question 15

Caput succedeum

Answer 15

 Swelling of the soft tissues of the scalp

 (Glossary – pg 807) swelling or edema of the newborn scalp that crosses the suture lines

Question 16

Cephalohematoma

Answer 16

 Subperiosteal swelling containing blood, found on the head of some newborns
 The swelling does not cross the suture lines
• Often appears unilateral
 Usually disappears within a few weeks to 2 months without treatment

Question 17

Moro reflex

Answer 17

 Sudden jarring causes extension and abduction (an embracing motion) of the extremities and spreading of the fingers, with the index finger and thumb forming a C shape
 If unilateral – could indicate a clavicle fracture
 Appears at birth; disappears around 3-6 months

Question 18

Tonic neck reflex

Answer 18

 Turn infant’s head to one side and the arm and leg will extend on that side with a flexion of the opposite arm and leg
 Appears at birth; disappears around 5-7 months

Question 19

Palmar grasp reflex

Answer 19

 Place object in the hand of the newborn, and the newborn will grasp it tightly
 Appears at birth; disappears around 4 months

Question 20

Babinski reflex

Answer 20

 Stroke the side of the foot, the big toe will dorsiflexion and the toes will flare out
 Appears at birth; disappears before infant begins walking (variable)

Question 21

Blinking response

Answer 21

 Infant blinks when hearing a loud noise

 Appears at birth; never disappears

Question 22

Turning response

Answer 22

 Infant will turn its head towards the source of the noise

 Appears at birth; never disappears

Question 23

Eye opening (Infant reflex)

Answer 23

 Holding the newborn infant upright, under the arms, and tipping the infant forward will induce eye opening
 Appears at birth; disappears at 3 months

Question 24

Blinking to threat

Answer 24

 Bringing an object close to the eye at a fast pace will induce blinking
 Appears around 6-7 months; never disappears

Question 25

Horizontal following

Answer 25

 Moving an object side to side within the infant’s visual field will elicit this response
 Appears around 4-6 weeks; never disappears

Question 26

Vertical following

Answer 26

 Moving a colorful object up and down within the visual field of the infant will induce this response
 Appears around 2-3 months; never disappears

Question 27

Rooting response

Answer 27

 Infant’s head turns in the direction of anything that touches the cheek in anticipation of food
 Appears at birth; disappears around 3-4 months

Question 28

Sucking response

Answer 28

 Infant will suck on a finger or nipple placed in the mouth

 Appears at birth; disappears around 7-12 months

Question 29

Stepping reflex/”dancing reflex”

Answer 29

 Hold infant upright above a table; the infant will life the foot up on contact with the firm surface of the table
 Appears at birth; disappears around 4-5 months

Question 30

What should the fontanels feel like in a normal healthy newborn?

Answer 30

o Fontanelles are unossified spaces or soft spots on the cranium of a young infant. They protect the head during delivery by permitting the process of molding and allow for further brain growth during the next 1.5 years
o Anterior fontanelle is a diamond shape and located at the junction of the two parietal and two frontal bones
 Usually closes by age 12-18 months
o Posterior fontanelle is triangular and is located between the occipital and parietal bones
 Smaller than the anterior fontanelle
 Usually ossified by the end of the second month

Depressed = dehydration
Bulging = ICP
Should be soft

Question 31

Normal vital signs of a newborn

Answer 31

o Temperature = 97.1 – 99.8 degrees Fahrenheit/36.2 – 37.7 degrees Celsius
o Heart rate = 110 – 160 beats/min
o Average blood pressure at birth is 80/46 mm Hg
o Respirations = 30 – 60 breaths/min

Question 32

What causes the blood vaginal discharge of a newborn baby girl?

Answer 32

o Psuedomenstruation

o This discharge is caused by hormonal withdrawal from the mother at birth

Question 33

How many hours a day does a newborn baby sleep?

Answer 33

Approximately 15-20 hours

Question 34

What should a parent call their physician regarding their newborn?

Answer 34

o	Temperature greater than 100.4 F by axilla
o	Refusal of two feedings in a row
o	Two green watery stools
o	Frequent or forceful vomiting
o	Lack of voiding or stooling

Question 35

Steps of using a bulb syringe to suction baby’s nose and mouth

Answer 35

o Compress the ball of the bulb syringe
o Insert narrow portion into the side of the infant’s mouth to avoid stimulating the gag reflex. suction mouth first! Then nose
 Prevents inhalation and aspiration of mucus during a gasp reflex stimulated by nasal suctioning
o Release the pressure on the ball of the bulb syring and listen for the sound of mucus being suctioned
o Remove the bulb syringe and empty the contents into a receptacle by compressing the bulb
o Compress the bulb syringe and insert into one nostril; then release the pressure on the bulb to suction the mucus out
o Remove the bulb syringe and empty it into a receptacle. Repeat for other nostril
o Demonstrate to parents the technique and review cleaning and storage of bulb syringe

Question 36

Components of APGAR score

Answer 36

o Standardized method of evaluating the newborn’s condition immediately after delivery. Assessed at 1 min and again at 5 min.
o Measure signs: heart rate, respiration, muscle tone, reflexes, and color
o Scored 0, 1, or 2

Question 37

What does “level of maturation” mean for a preterm infant?

Answer 37

o Refers to how well developed the infant is at birth and the ability of the organs to function outside the uterus

Question 38

An infant with jaundice is at risk for what?

Answer 38

o The liver of a newborn is immature
o Liver is unable to clear the blood of bile pigments that result from the normal postnatal destruction of blood cells
o The amount of bile pigment in the blood serum is expressed as mg/dL
o The higher the blood bilirubin level, the deeper the jaundice, and the greater the risk for neurological damage
o An increase of more than 5 mg/dL within 24 hours or a level of 12.9 mg/dL require further investigation
o At risk for hyperbilirubinemia, or excessive bilirubin levels in the blood

a. Neurological damage
b. Kernicterus- serious neurological complication that can cause brain damage, which is also known as bilirubin encephalopathy

Question 39

Reason for gavage feeding a premature infant

Answer 39

o The ability to coordinate breathing, sucking, and swallowing does not develop before 34 weeks of gestation; therefore, a very preterm infant may require gavage feedings (via a tube placed through the nose or mouth into the stomach)

Question 40

What is ordered to speed up fetal lung maturity?

Answer 40

o Physician may order the woman steroid drugs (glucocorticoids) to increase the fetal lung maturity if gestation is between 24 and 34 weeks

Question 41

Signs of respiratory distress in an infant

Answer 41

o Typically apparent after delivery but may not manifest for several hours after delivery
o Respirations increase to 60 beats/min or more
o Gruntlike sounds
o Nasal flaring
o Cyanosis
o Intercostal and eternal retractions
o Edema, lassitude, and apnea occur as the condition worsens

Question 42

Signs of hypoglycemia

Answer 42

	Tremors
	Weak cry
	Lethargy
	Convulsions
	Plasma glucose level lower than 40 mg/dL (term) or 30 mg/dL (preterm)

Question 43

Signs of necrotizing enterocolitis (NEC)

Answer 43

 Abdominal distention
 Bloody stools
 Diarrhea
 Bilious vomitus

Question 44

What does a premature infant catch up with his peers?

Answer 44

o In the absence of severe birth defects and complications, the growth rate of the preterm newborn nears that of the term infant by about the second year

Question 45

What might a postterm infant look like?

Answer 45

o Long and thin
o Looks as if weight has been lost
o Skin is loose, especially around thighs and buttocks
o Little lanugo (downy hair) or vernix caseosa
o Loss of cheese like vernix caseosa leaves the skin dry; it cracks, peels, and is almost like parchment texture
o Nails are long (may be stained with meconium)
o Thick head of hair
o Looks alert

Question 46

How fast does surfactant work to improve the lungs of an infant?

Answer 46

o Surfactant can be administered through an ET tube at birth or when symptoms of RDS occur, with improvement of lung function seen within 72 hours

Question 47

What assessment findings of a premature infant should be reported?

Answer 47

a. Increase or decrease in movements, lethargy, twitching, frequency and quality of cry, hyperactivity
b. Fontanelle- sunken, flat, or bulging
c. Discharge from eyes
d. Respirations- apnea, sternal retractions, labored breathing
e. Pulse rate- rate and refularity
f. Discharge and odor from cord
g. Feeding- sucking ability, vomiting or regurgitation, degree of satisficaiton
h. Voiding- initial, frequency
i. Stools- frequency, color, consistency
j. Mucus membranes- dryness of lips and mouth, signs of thrush
k. Color- paleness, cyanosis, jaundice
l. Skin- rashes, irritations, pustules, edema

Question 48

What is a postterm infant at risk for?

Answer 48

o Asphyxia caused by chronic hypoxia while in the uterus because of a deteriorated placenta
o Meconium aspiration – hypoxia and distress may cause relaxation of the anal sphincter, and meconium can be aspirated into the fetal lungs
o Poor nutritional status; depleted glycogen reserves causes hypoglycemia
o Increase in RBC production because of intrauterine hypoxia
o Difficult delivery because of increased size of infant
o Birth defects
o Seizures as a result of hypoxic state

Question 49

What is an appropriate urine output for a premature infant?

Answer 49

1-3 mL/hr