Obstetrics Flashcards
How do genetics improve our ability to predict susceptibility, onset, and progression of disease and the response to treatment?
It provides genetic markers, indicating response to medication
Study of a single gene disorder
Genetics
Study of all the genes in the human genome together including including interactions with each other, influence of psychological factors and cultural factors
Genomics
Why are genetic diseases now more difficult to diagnose?
Intermingling of races
What is the nurse’s role in genetics?
Preconception counseling and testing, neonatal screening, palliative care, and specialized care
Which genetic abnormality requires immediate palliative care?
Ancephally
Which genetic test has a high false positive rate for open spinal disorders?
Alfa fetal protein
Why do people not like to do genetic testing?
Insurances can raise their rates or drop them based on the result
When is the heart formed?
3-5 weeks after conception
A major cause of reproductive loss, congenital problems and gynecologic disorders
Chromosomal abnormalities
When do chromosomal abnormalities occur?
During mitosis or meiosis
What are the sex chromosomal abnormalities?
Turner, Klinefelter’s, and XXY
What type of genetic testing is direct or molecular?
Linkage analysis
What type of genetic testing is biochemical?
Cytogenetic testing
What are the types of prenatal genetic testing?
Maternal serum screening, fetal ultrasound, amniocentesis, and chronic villus sampling
What is the chromosomal abnormality associated with Turner syndrome?
Monosomy X
What does Turner’s syndrome present as?
Female has underdeveloped ovaries, is short, has webbing of the neck, a low hairline in the back, low set ears, lymphedema of the hands and feet and may have impaired intelligence
What does Klinefelter’s syndrome present as?
Male has poorly developed secondary sex characteristics and small testes, is infertile, tall, effeminate and slow to learn
What is the XXY abnormality linked to ?
Aggression
Single gene controlling a trait, disorder or defect
Unifactorial
What are examples of unifactorial defects?
Autosomal dominant inheritance, autosomal recessive disorder, inborn errors of metabolism, X-linked dominant inheritance, and X-linked recessive inheritance
Which disease is an inborn error of metabolism?
PKU
What does PKU present as?
Light skin, hair, and eyes, delayed mental and social skills, small head, hyperactivity, intellectual disability, seizures, and rashes
A disease caused by a defective gene that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body
Cystic Fibrosis
What does CF present as?
No bowel movements in the first 24-48 hours, delayed growth, salty skin, distended abdomen, pale or clay colored stools, infertility, clubbed fingers
What are the screening tests for CF?
Immunoreactive trypsinogen, chest x-ray, CT, fecal at test, lung function test, measurement of pancreatic function, secretin stimulation test, trypsin and chymotrypsin in stool and upper GI and small bowel series
What is the diagnostic test for CF?
Sweat chloride test
Genetic disorder in which one copy of the gene is needed for expression
Autosomal dominant
Genetic disorder in which two copes of the gene is needed
Autosomal recessive
A type of genetic disorder in which females are carriers and males express the disease
X-linked dominant inheritance
Name examples of X-linked recessive inheritance
Color blindness, hemophilia, and muscular dystrophy
Parents are known to be at risk for producing a child with the disease
Occurrence risk
Parents once they have produced a child with the disease
Recurrence risk
Bleeding disorder most common in males
Hemophilia
Most common genetic malfunction that is a combination of environmental and genetic factors
Multifactorial
Name examples of multifactorial genetic abnormalities
Cleft lip and palate, congenital heart disease, neural tube defeats, and pyloric stenosis
What is the nurse’s role in genetic counseling?
Inform, educate, support
Where does conception take place?
In the fallopian tubes
How common is color blindness?
1 in 10 boys
When does the lip form?
4-7 weeks
How many chromosomes does each gamete bring to conception?
23
At what point does ancephaly occur?
Between the 23rd and 26th days of conception
A problem with a baby’s stomach that causes forceful vomiting, this is caused by the pylorus swelling and thickening
Pyloric Stenosis
At what age do the symptoms of pyloric stenosis present?
Between birth and 5 months
How is pyloric stenosis treated?
Surgery
How is cleft lip treated?
Plastic surgery
What abnormalities are present with congenital heart disease?
Vertebral abnormalities, anal atresia, cardiovascular abnormalities, trachioesophageal fistulas, esophageal atresia, renal and radial abnormalities, and limb defects
What is the presenting symptom of congenital heart disease?
Low oxygen saturation within the blood supply
What week does the brain develop?
24
During what weeks do the kidneys develop?
5-9 weeks
During what weeks do the ears develop?
9-30 weeks
What is the endometrium called after implantation?
Decidua
Where does the chorionic cilli tap into the maternal blood vessels?
Decdidua Basalis
A 16-cell morula embedded in the endometrium that develops into two parts, the trophoblast and embryoblast
Blastocyst
What does the trophoblast give rise to?
The placenta
What does the embryoblast give rise to?
The embryo
When does the blastocyte develop?
Within three days of conception
What three germ layers does the embryo differentiate into?
Ectoderm, mesoderm and endoderm
When does the embryo differentiate?
Week 3
What does the ectoderm develop into?
Epidermis, glands, nails and hair, central and peripheral nervous systems, lens of the eye, tooth enamel and flor of the amniotic cavity
What does the mesoderm develop into?
Bones and teeth, muscles, dermis and connective tissue, cardiovascular system, spleen, and urogenital system
What does the endoderm develop into?
Epithelium lining in the respiratory and digestive tracts, liver and pancreas, urethra, bladder, and vagina
Finger-like projections that extend into the blood-filled spaces of the endometrium to obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products
Chorionic Villi
What is the purpose of the fetal intestines?
They make meconium
When is meconium released?
When the baby is in distress
When do fetal intestines begin to develop?
Eight weeks
Where do the fetal intestines develop?
The umbilical cord
When do the fetal intestines move into the baby’s abdomen?
When its big enough, at about 10 weeks
When do the fetal intestines start working?
At 11 weeks
When does the large intestine start making and storing meconium?
16 weeks
How long does the embryo take to develop?
Day 15 until week 8
What does the chorion contain?
The major vessels of the umbilical cord
When do the fetal kidneys begin working?
Between weeks 13 and 15
What is urine output at 22 weeks?
2.2 mL/hour
What is urine output at 32 weeks?
12.2 mL/hour
What is urine output at term?
28 mL/hour
What indicates a possible renal abnormality?
Too little amniotic fluid (oligohydramnios)
What is the function of amniotic fluid?
Protection
How does the amniotic fluid protect the fetus?
Maintains temperature, maintains fluid and electrolyte imbalance, cushions the fetus, allows for movement, barrier to infections, allows fetal lung development, and facilitates smmetric growth
What is hydramnios associated with?
GI malformations
What does the amniotic fluid contain?
Albumin, urea, uric acid, creatinine, lecithin, sphingomyelin, bilirubin, fructose, fat, leukocytes, proteins, epithelial cells, enzymes, and lanugo hair
What part of the embryo becomes the primitive digestive system?
The yolk
What vasculature is contained within the umbilical cord?
Two arteries and one vein
Why is it very important to make sure the umbilical cord contains two arteries and one vein after birth?
To screen for congenital abnormalities
What do the arteries in the umbilical cord do for the baby?
Carry blood away from the embryo and to the chorionic villi
What does the vein in the umbilical cord for the baby?
Brings blood to the embryo
What is the life span of the placenta?
40 weeks and 6 days
When does maternal-placental-embryonic circulation develop?
Day 17
What is the function of the placental?
It acts as the fetal endocrine gland, metabolic regulator, and stores nutrients
What parts of maternal health affect the placenta?
Nutrition and hypertension
What organ secretes hCG and hCS?
The placenta
What hormone enables the gestation of the fetus?
Progesterone
What does hCG do?
Preserves the function of the corpus luteum, ensuring a continued suppoly of estrogen and progesterone
What does hCS do?
Stimulates the maternal metabolism to supply needed nutrients for fetal growth, increases resistance to insulin, and facilitates glucose transport
Where does deoxygenated blood come into fetal circulation?
Placenta
What allows the most oxygenated blood to go from the right to left atrium and out the aorta to the brain?
A patent foramen ovale
How does blood travel through the umbilical vasculature of a fetus?
Poorly oxygenated blood goes from the fetal arteries into umbilical arteries to get oxygen from the placenta and then is returned to fetal circulation via the umbilical vein
At what age is a fetus viable?
20 weeks
What limits viability before 20 weeks?
CNS function and oxygenation capability of the lungs
What is a normal fetal heart rate?
110-160 beats/minute
What is the first organ system to develop in a fetus?
Cardiovascular
When do fetal blood vessels and blood cells begin to form and function?
Week 3
How are the fetal lungs bypassed during gestation?
Ductus Arteriosus
At what age are rH (-) fetuses at risk for contamination?
Six weeks
When do respiratory surfactants appear?
Between 24 weeks and birth
When does a baby have enough surgactant for survival?
32 weeks except in white males
What is essential for thermoregulation?
Brown fat and glycogen storage
At what age is glycogen able to be stored in the liver?
9 weeks
At what age does brown fat appear on the baby’s back?
26-30 weeks
What is the glycogen stores of a baby at birth?
Twice that of an adult
Where does a fetus’s urine go?
Into the amniotic fluid
How is fetal waste removed from the body?
It goes into the mother’s blood and is filtered out by the mother’s kidneys
At what age can fetal respiratory movements be seen on ultrasound?
Week 11
What does surfactant do?
It expands the air spaces in the lungs
What process squeezes out excess surfactant?
Birth
Women who is pregnant
Gravida
Women who has completed pregnancy to viability
Para
At what age is a fetus post-term?
Beyond 42 weeks
At what age is a fetus pre-term?
20-37 weeks
Women pregnant for the first time
Primigravida
Woman who has completed one pregnancy with fetus or fetuses who have reached the stage of viability
Primipara
At what age is a fetus term?
38-42 weeks
Changes from pregnancy that are felt by the woman
Presumptive signs
Name examples of presumptive signs of pregancy
Amenorrhea, breast changes, nausea and vomiting, quickening, urinary frequency, and fatigue
Changes from pregancy that are observed by the examiner
Probable signs
Name examples of probably signs of pregnancy
Chadwick’s, Goodell’s, and Hegar’s signs, positive pregnancy test, Braxton-Hicks contractions, and ballottement
Softening of the cervix
Goodell’s sign
Blueish discoloration of the cervix
Chadwick’s sign
Softening of the uterus
Hegar’s sign
Increased fluid in the suprapettallar pouch
Ballottement
Signs of pregnancy attributed only to the presence of the fetus
Positive signs
Name examples of positive signs of pregnancy
Ultrasound and fetal heart tones
At what age does fetal sensory awareness develop?
3-24 weeks
When does the fetal thyroid develop?
3-4 weeks
What does the fetus of a diabetic mother look like?
Macrosomic
When does the musculoskeletal system begin to develop?
Week 4
What immunoglobulins can pass through the placenta?
Only igG
What immunoglobulins can pass through the colostrum?
Only IgA
A women is 8 months pregnant. She tells the nurse that she knows her baby listens to her but her husband thinks she is imagining things. The most appropirate response by the nurse is:
Babies in utero do respond to their mother’s voice
What best describes the pattern of genetic trasnmission known as autosomal recessive interitance?
Disorders in which both genes of a pair must be abnormal for the disorder to be expressed
The student nurse is giving a presentation about milestone in embryonic development. Which infomation should he or she include?
At 20 weeks, the vernix caseosa and lanugo appear
A nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should:
Discuss options with the couple, including amniocentesis to determine whether the fetus is affected
A couple has been counseled for genetic abnormalities. They ask you, “What is karyotyping?” Your best response is:
Karyotyping will provide information about the gender of the baby, and the number and structure of the chromosomes
With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that:
The risk factor remains the same no matter how many affected children are already in the family
With regard to abnormalities of chromosomes, nurses should be aware that:
Abnormalities of number are the leading cause of pregnancy loss
A key finding from the Human Genome Project is:
Approximately 20,000 to 25,000 genes make up the genome
Most of the genetic tests now offered in clinical practice are tests for:
Single-gene disorders
A woman’s cousin gave birth to an infant with a congenital heart abnormality. The woman asks the nurse when such abnormalities occur during development. Which response by the nurse is most accurate?
3-5 weeks
A maternity nurse should be aware of which fact about amniotic fluid?
It serves as a source of oral fluid and as a repository for waste from the fetus
A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates:
Lung maturity
The nurse should teach a pregnant woman that which substances are teratogens?
Cigarette smoke, Isotretinoin, and Rubella
How is the due date of a baby determined?
Date of last menstrual period, fundal height, and ultra sound
What is a positive pregnancy test based on?
Recognition of hCG or a Beta subunit of hCG
What are urine pregnancy tests based on?
ELISA testing
When is nipple discharge during pregnancy normal?
12-14 weeks
What happens to a mother’s blood pressure during pregnancy?
It should remain stable
What happens to a mother’s heart rate during pregnancy?
It increases 10-15 beats/minute
What happens to a mother’s blood volume during pregnancy?
It increases 1500 mL
What happens to a mother’s hemoglobin and hematocrit during pregnancy?
They decrease
What happens to a mother’s cardiac output during pregnancy?
It increases 30-50% so blood can reach the fetus’s tissues
How should a pregnant woman lay?
On her left side
What happens to a mother’s clotting factors during pregnancy?
They increase
What happens to a mother’s pulmonary function during pregnancy?
It increases
What kind of respiratory balance is a pregnant woman generally in?
Respiratory alkalosis
How can a pregnant woman maintain her renal health?
Drink water
As a baby gets bigger, what renal problem is the mother at risk for?
Renal caliculi
Mask of pregnancy
Chloasma
What causes the chloasma?
Increased estrogen levels
Broken blood vessel that go away after pregnancy
Angioma
What integumentary system changes occur during pregnancy?
Chloasma, linea nigra, striae gravidarum, angiomas, palmar erythema
What changes occur to the musculoskeletal system during pregnancy?
Softening of ligaments, widening of pelvis, increased fat storage, splitting of abdominal muscles, and lordosis
What changes occur to the neurologic system during pregnancy?
Pregnancy brain, heightened sensitivity, and nesting
What changes occur to the endocrine system during pregnancy?
Diabetes, hypothyroidism and rarely hyperthyroidism
If exhibited by a pregnant woman, what represents a positive sign of pregnancy?
Fetal heartbeat
Which H&H result represents the lowest acceptable values for a woman in the third trimester of pregnancy?
33% and 11g/dL
When assessing the fetal heart rate of a woman at 30 weeks of gestation, the nurse counts a rate of 82 beats/minute. Initially the nurse should:
Assess the woman’s radial pulse
OTC pregnancy tests usually rely on which technology to test for hCG?
ELISA
A nurse teaches a pregnancy woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates an understanding of the nurse’s instructions if she states that a positive sign of pregnancy is:
Fetal movement
During a client’s physical exam, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this as:
Hegar sign
Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?
Increased pulse
A woman who has completed on pregnancy with a fetus reaching the stage of viability is called:
Primipara
Which presumptive signs or positive sign of pregnancy is not matched with another possible cause?
Goodell sign and cervical polyps
In order to reassure and educate pregnant clients about change in their blood pressure, maternity nurses should be aware that:
Compression of the iliac veins and interior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy
What is the nurse’s most important role for a pregnant client?
Education
What is Nagele rule?
Add 7 days to last missed period and count forward nine months
When does the father start to realize and accept the pregnancy?
At birth
What type of care should the nurse emphasize during pregnancy?
Preventative and optimal self care
Why are herbal drugs not safe for use during pregnancy?
Because they have not been studied
What type of lab tests should be routinely performed on pregnant women?
CBC with diff and thyroid function
When is fetal viability confirmed with an ultra sound?
8th week
When should a pregnant woman stop traveling?
37-39 weeks
What immunizations does a pregnant woman need?
Tdap, flu shots, rubella, and varicella
During the first trimester, the pregnant woman would be most motivated to learn about:
Measures to reduce nausea and fatigue so she can feel better
An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. “One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?” The nurse’s BEST response would be:
“This is called emotional liability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant.”
If exhibited by an expectant father, what would be a warning sign of ineffective adaptation to his partner’s first pregnancy?
Consistently changes the subject when the topic of the fetus/newborn is raised
What laboratory results would be a cause for concern if exhibited by a woman at her first prenatal visit during the second month of her pregnancy?
Rubella titer 1:6
A maternal serum alpha-fetoprotein (MSAFP) test is performed at 16 to 18 weeks of gestation. An elevated level has been associated with:
Open neural tube defects such as spina bifida.
An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that:
Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.
A pregnant woman at 32 weeks of gestation complains of feeling dizzy and light-headed while her fundal height is being measured. Her skin is pale and moist. The nurse’s initial response would be to:
Turn the woman on her side.
A pregnant woman demonstrates understanding of the nurse’s instructions regarding relief of leg cramps if she:
Extends her leg and dorsiflexes her foot during the cramp.
A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her:
“You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”
A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be:
Alteration in the pattern of fetal movement.
A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse tells her:
“Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”
With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that:
Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that:
She must be having a low-risk pregnancy.
Which statements about multifetal pregnancy are most appropriate?
The expectant mother often develops anemia because the fetuses have a greater demand for iron; The mother should be counseled to increase her nutritional intake and gain more weight; Backache and varicose veins are often more pronounced.
What is the biggest complication from amniocentesis?
Infection
When is chorionic villus sampling done instead of amniocentesis?
When there is a need for earlier diagnosis and rapid results
When can CVS be performed?
10-13 weeks
How does CVS give information about the fetus?
The tissue biopsied reflects the genetic makeup of the fetus
What are the dangers of CVS?
Infection and miscarriage
Direct access to fetal circulation through the umbilical cord
Percutaneous umbilical blood sampling
Which test shows Rh compatibility?
Coombs’ test
What is the goal of electronic fetal monitoring?
To determine if the intrauterine environment is supportive to the fetus
What non-invasive methods are used to stimulate the fetus?
Vibroacoustic stimulation, orange juice
A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman would indicate a correct understanding of the test?
“This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”
For which test is a full bladder a requirement?
Ultrasound
What is an indicator for performing a contraction stress test?
Maternal diabetes mellitus and postmaturity
A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?
Transvaginal ultrasound
A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):
Is considered negative if no late decelerations are observed with the contractions.
The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?
Doppler blood flow analysis
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that:
MSAFP is a screening tool only; it identifies candidates for more definitive procedures.
Prior to the patient undergoing amniocentesis, the most appropriate nursing intervention is to:
Administer RhoD immunoglobulin.
The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. The nurse should assess which specific lab result?
Indirect Coombs test
The health care provider has ordered a magnetic resonance imaging (MRI) study to be done on a pregnant patient to evaluate fetal structure and growth. The nurse should include which instructions when preparing the patient for this test?
Jewelry must be removed before the test; Remain still throughout the test.
A nonstress test (NST) is ordered on a pregnant women at 37 weeks gestation. What are the most appropriate teaching points to include when explaining the procedure to the patient?
Vibroacoustic stimulation may be used during the test; Drinking orange juice before the test is appropriate; Two sensors are placed on the abdomen to measure contractions and fetal heart tones.
What is the most common endocrine disorder associated with pregnancy?
Diabetes mellitus
What is the key to an optimal outcome for a woman with preexisting diabetes mellitus?
Strict maternal glucose control
What are the risks for a pregnant woman who has preexisting diabetes mellitus?
Macrosomia, hydramnios, ketoacidosis, hyperglycemia, hypoglycemia, congenital malformations and sudden still birth
For a pregnant woman, what is worse, hyperglycemia or hypoglycemia?
Hypoglycemia
What is a normal a1c level?
> 6
Why are women with pre gestational diabetes mellitus often induced early?
To prevent the baby from becoming too big
How is gestational diabetes screened for?
Urine dip sticks at every office visit and a postprandial study at 27 weeks
What is the pharmacological therapy for a woman with gestational diabetes?
Insulin and oral hypoglycemics only if they can’t take insulin
Which oral hypoglycemics are relatively safe for use during pregnancy?
Glyburide and metformin
What is the leading cause of hyperthyroidism during pregnancy?
Graves’ disease
Why does phenylkentonuria cause fetal mental retardation?
Toxic accumulations of phenylalanine in the blood interferes with brain development and function
Why do maternal cardiovascular disorders lead to preterm labor and birth?
Because when the heart is in distress it sends a message to get the cause (fetus) out
Why is intrauterine growth restriction more common in women with cardiovascular disorders?
Decreased maternal cardiac output leads to decreased tissue perfusion in the fetus
Why are heart murmurs identified during pregnancy?
The increased blood volume increases the heart’s work load, making murmurs louder
How long should heart transplant patients wait to have get pregnant?
One year after the transplant
What do women with cardiac disorders need to be monitored for postpartum?
Cardiac decompensation
Why do women with cardiac disorders decompensate after giving birth?
Most of the body’s ATP and O2 stores are used up
What foods contain folic acid?
Leafy greens and milk
Patients with asthma are at an increased risk for what complication?
Postpartum hemorrhage
Why are patients with cystic fibrosis not recommended to get pregnant?
Pregnancy is often complicated by chronic hypoxia and frequent pulmonary infections
Allergic reaction to baby
Pruritic uticarial papules and plaques
Why do patients with MG need forceps or vacuum delivery?
They don’t have the strength to push the baby out
What are the barriers to substance abuse treatment for pregnant women?
Fear losing custody and prosecution
In which patients is breastfeeding contraindicated?
Those using amphetamines, alcohol, cocaine, heroin, or marijuana
Why do substance abusers have a particularly hard time during the intra an postpartum periods?
They have a very low pain tolerance
During a prenatal visit, the nurse is explaining dietary management to a woman with pre gestational diabetes. The nurse evaluates that teaching has been effective when the woman states:
Diet and insulin needs change during pregnancy
The nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function?
Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics
Maternal and neonatal risks associated with gestational diabetes mellitus are:
Maternal preeclampsia and fetal macrosomia.
In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the:
Degree of glycemic control during pregnancy.
Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:
The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.
A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that:
Dietary management involves distributing nutrient requirements over three meals and two or three snacks.
During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of:
Cardiac decompensation.
Thalassemia is a relatively common anemia in which:
An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs).
From 4% to 8% of pregnant women have asthma, making it one of the most common preexisting conditions of pregnancy. Severity of symptoms usually peaks:
Between 24 to 36 weeks of gestation.
A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often:
Decreasing energy levels.
Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes?
Herion
During pregnancy, alcohol withdrawal may be treated using:
Benzodiazepines
A pregnant woman is being examined by the nurse in the outpatient obstetric clinic. The nurse suspects systemic lupus erythematosus (SLE) after revealing which symptoms?
Muscle aches, weight changes, and fever
A pregnant woman in her first trimester with a history of epilepsy is transported to the hospital via ambulance after suffering a seizure in a restaurant. The nurse expects which health care provider orders to be included in the plan of care?
Serum lab levels of medications; Abdominal ultrasounds; Prenatal vitamins with vitamin D.
Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for:
Miscarriage; gestational hypertension; placental abruption; stillbirth
How common is preeclampsia?
It complicates 5-10% of pregnancies
What is the most common medical complication reported during pregnancy?
Hypertension
Onset of hypertension without proteinuria after the 20th week of pregnancy
Gestational hypertension
Hypertension develops after the 20th week of pregnancy in a previously normotensive woman
Preeclampsia
Seizure activity or coma in a woman diagnosed with preeclampsia
Eclampsia
What causes preeclampsia?
Disruptions in placental perfusion and endothelial cell dysfunction
How does preeclampsia cause renal damage?
Proteinuria
What are the hallmarks of preeclampsia?
Headache, blurred vision, and proteinuria
Varient of severe preeclampsia that involves hemolysis, elevated liver enzymes, and low platelets
HELLP Syndrome
What are the elevated risks associated with the HELLP Syndrome?
Pulmonary edema, renal failure, liver hemorrhage, disseminated intravascular coagulation, placental abruption, acute respiratory distress syndrome, sepsis, stroke, and death
How is the HELLP syndrome diagnosed?
Platelet count, liver enzymes, and elevated bilirubin
What happens with coagulation in patients with HELLP syndrome?
They have a low platelet count but PT, PTT, and bleeding times remain normal
Hyperreflexia occurs in which hypertensive disorders?
Severe preeclampsia and eclampsia
What type of edema is concerning in a woman with preeclampsia?
Hand and face edema
How are mild gestational hypertension and mild preeclampsia treated?
Activity restriction
How are severe gestational hypertension and severe preeclampsia treated?
Magnesium sulfate
Drug used to prevent or control convulsions and relax smooth muscles
Magnesium sulfate
What needs to be monitored for a patient on magnesium sulfate?
Blood pressure, pulse, respirations, and urine output
What is a positive prognostic sign associated with magnesium sulfate?
Diuresis within 24-48 hours of administration
What is the toxic serum level of magnesium sulfate?
> 9.6 mg/dL
What is the antidote to magnesium sulfate?
Calcium gluconate
What is the major concern associated with hypertension during pregnancy?
Decreased placental perfusion
What antihypertensive medications can be used for women who are breastfeeding?
Methyldopa or hydralazine
Excessive vomiting accompanied by dehydration, electrolyte imbalance, ketosis and acetonuria
Hyperemesis Gravidarum
How should hyperemesis gravidarum be treated?
Banana bag, saline, then D5NS; NPO; antiemetics
What indicates maternal starvation?
Keytones in the urine
What is the normal value for hematocrit?
37-47%
What is the normal value for hemoglobin?
12-16 g/dL
What is the normal value for platelets?
150,000 - 350,000 mm3
What are the risks to the fetus during maternal hemorrhage?
Blood loss, anemia, hypoxemia, hypoxia, anoxia, and preterm birth
Closed cervical os, spotting
Threatened Miscarriage
Open cervical os, moderate to heavy bleeding
Inevitable Miscarriage
Fetus expelled, placenta retained
Incomplete Miscarriage
All fetal tissue expelled, cervix closed
Complete Miscarriage
Fetus died but products retained
Missed Miscarriage
What are the signs and symptoms of a miscarriage?
Uterine bleeding, contractions, or pain
How can a miscarriage be treated?
If it is threatened, you can put the mom on bed rest. If its any other type, there is nothing you can do.
How long should a woman wait to get pregnant again after a miscarriage?
6 weeks
Fertilized ovum implanted outside the uterine cavity
Ectopic pregnancy
Where do ectopic pregnancies usually occur?
In the fallopian tubes
What can cause an ectopic pregnancy?
Infection or inflammation (chlamydia), scar tissue, previous surgery, or an abnormally shaped tube
What are the signs of an ectopic pregnancy?
Missed period, tenderness, abdominal pain, and dark red or brown vaginal bleeding?
How is an ectopic pregnancy diagnosed?
Serum hCG, transvaginal ultrasound, or vaginal exam
How is an ectopic pregnancy treated?
Salpingectomy or methotraxate
Abnormal fertilization without a viable fetus
Hydatidiform mole
What are the two types of hydatidiform moles?
Complete and partial
Mole results from fertilization of egg with lost or inactivated nucleus
Complete hydatidiform mole
Mole results of two sperm fertilizing a normal ovum
Partial hydatidiform mole
What is found in a molar pregnancy?
Hair, skin, and nails, but no heart
When is a molar pregnancy diagnosed?
When the heartbeat can’t be heard at 8 weeks
Invasive mole causing choriocarcinoma
Gestational Trophoblastic disease
How long after a choriocarcinoma can a woman resume trying to become pregnant?
One year
Why must a woman wait to have a baby for a year after a choriocarcinoma?
The only way to see if that has metastasized to the lungs is monthly hCG levels, which will be elevated with pregnancy
Placenta implanted in lower uterine segment near or over internal cervical os
Placenta previa
What is the hallmark sign of placenta previa?
Painless bleeding
What are the risk factors for placenta previa?
Previous c-section, multiple gestation, old age, smoking/cocaine use, irish twins
How is placenta previa diagnosed?
Transabdominal and transvaginal ultrasound
What should never be performed on a woman with suspected placenta previa?
Vaginal exam
What are the complications associated with placenta previa?
PROM, preterm labor, postpartum hemorrhage, anemia, thrombophlebitis, and infection
Premature separation of the placenta from the implantation site
Abruptio placentea
What is the hallmark sign of abruptio placentea?
Painful bleeding
What are the risk factors for abruptio placentea?
Hypertension, cocaine, blunt abdominal trauma, maternal smoking, poor nutrition, twins
What are the signs and symptoms of abruptio placentea?
Shock, blood in amniotic fluid, H&H drop, coagulation factors drop, clotting defects, intense uterine pain
What is the difference in the blood colors of placenta previa and abruptio placentea?
Previa is bright red, abruptio is dark red
Consumptive coagulopathy where all of the clotting factors are consumed after a bleeding episode so that normal clotting can no longer take place
Disseminated intravascular coagulation (DIC)
What is DIC caused by?
Severe preeclampsia, HELLP, and gram negative sepsis
Why does DIC cause widespread internal and/or external bleeding?
Because clotting is taking place in the intravascular places instead of making a plug to stop the bleeding
What happens to the PT and PTT of a patient with DIC?
They increase
What are the signs of DIC?
Spontaneous bleeding from the gums/nose, petechiae around BP cuff, tachycardia, and diaphoresis
How is DIC treated?
Correct the underlying cause, replace fluid volume lost, replace clotting factors
A pregnant woman is being discharge from the hospital after placement of a cerclage because of a history of recurrent pregnancy loss secondary to an incompetent cervix. Discharge teaching should emphasize that:
The presence of any uterine cramping or low backache may indicate preterm labor and should be reported
The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman would indicate a correct understanding of the discharge instructions?
“I should eat foods that are high in iron and protein to help my body heal.”
A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:
A respiratory rate of 10 breaths/min.
A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if:
Seizures do not occur.
A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:
Hydralazine
The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:
Intense abdominal pain
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of:
Placental abruption
What are the signs and symptoms of uterine rupture?
Hypotonic uterine activity, signs of hypovolemia, and no pain
In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?
Administration of blood
Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion?
Prepare the woman for an ultrasound and blood work.
A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for:
Hemorrhage
The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse expect to observe?
Decreased urinary output and irritability; Ankle clonus and epigastric pain; Platelet count of less than 100,000/mm3 and visual problems
The emergency department nurse is assessing a pregnant trauma victim who just arrived at the hospital. What are the nurse’s MOST appropriate actions?
Assess for point of maximal impulse at fourth intercostal space; Collect urine for urinalysis and culture; Frequent vital sign monitoring.
A pregnant woman presents to the emergency department complaining of persistent nausea and vomiting. She is diagnosed with hyperemesis gravidarum. The nurse should include which information when teaching about diet for hyperemesis?
Eat a high-protein snack at bedtime; Ice cream may stay down better than other foods; Eat what sounds good to you even if your meals are not well-balanced
During a normal pregnancy, the maternal cardiovascular system undergoes many changes, which puts physiologic strain on what?
The heart
What is the fourth overall cause of maternal death?
Cardiac disease
What is the primary fuel used by the fetus?
Glucose
Women with hyperthyroidism are at an increased risk for developing what?
Severe preeclampsia
A woman’s sudden inability to perform activities she previously was comfortable doing may indicate what?
Cardiovascular decompensation
What is the primary goal of medical therapy for a pregnant woman with diabetes?
Achieving eugylcemia
What are the autoimmune disorders of concern in pregnancy?
Lupus, MG, and RA
What is the recommended antiviral drug used for treatment of HIV infected women and their infants to prevent transmission?
AZT
What is the most common medical disorder of pregnancy?
Anemia
What can smoking during pregnancy lead to?
Bleeding complications, miscarriage, stillbirth, prematurity, placenta previa, placental abruption, low birth weight and SIDS
What are the common bleeding disorders of early pregnancy?
Miscarriage, premature dilation of the cervix, ectopic pregnancy, and hydatidiform mole
What kind of dysfunction is associated with HELLP syndrome?
Hepatic
Recognition of what in the antepartum period may decrease hemorrhagic problems?
Clotting
Where does separation occur in a placental abruption?
In the area of the decidua
What is a common intervention for the prevention of preterm labor?
Bed rest
What affects the relationship among uterine contractions, the fetus, and the mother’s pelvis?
Maternal position
A long or abnormal labor
Dystocia
What is the primary reason for a C-section?
Dystocia
What is given as an IM injection to a pregnant woman to accelerate fetal lung maturity?
Antenatal glucocorticoids
What do antenatal glucocorticoids decrease the instance of?
Intraventricular hemorrhage
What are the types of breech presentation?
Incomplete, Frank, and footlong
Normal progress of cervical dilation, effacement, or descent is prevented because of abnormal contractions
Dysfunctional labor
The chemical or mechanical initiation of uterine contractions before their spontaneous onset
Induction of labor
The rupture of the amniotic sac and leakage of fluid, beginning at least 1 hour before the onset of labor at any gestational age
Premature Rupture of Membranes (PROM)
What can lead to a higher success rate for the induction of labor, the need for lower dosage of oxytocin during induction, and shorter induction times?
Prostaglandins E1 and E2
What is the leading cause of postpartum hemorrhage?
Uterine atony
What separates postpartum blues from postpartum depression?
Intense fears, anger, anxiety, and despondency that persist for several weeks
Breast infection
Mastitis
At what age does the fetus start to move?
18 weeks
At what age can ultrasound tell if the baby is a boy?
18 weeks
What test can be used to determine fetal lung maturity?
Amniocentesis
What are the 5 P’s of labor?
Passenger, passageway, powers, position of mother, psychologic response
What causes severe back labor?
Sunnyside up babies
What are the primary powers of labor?
Effacement, dilation, ferguson reflex
What are the secondary powers of labor?
Bearing down efforts
Why are frequent position changes good during labor?
Relieves fatigue, increases comfort, and improves circulation
The process of moving a fetus, placenta, and membranes out of the uterus and through the birth canal
Labor
What are the signs predicting labor?
Lightening or dropping, bloody show, nesting
Onset of contractions to full dilation of the cervix
First stage
Full dilation of the cervix to birth
Second stage
Birth of the fetus until delivery of the placenta
Third stage
First two hours post delivery of the placenta
Fourth stage
How long should contractions last?
1.5-2 minutes
What kind of IV fluid is used for women in labor?
Lactated Ringers
What is the cardiac output of a women in labor?
51%
When is proteinuria normal during pregnancy?
During labor due to muscle breakdown
What GI change indicates onset of labor?
Diarrhea
What GI change indicates at least 6 cm dilation?
Nausea and belching
What hormones increase during labor?
Estrogen, prostaglandins, and oxytocin
What hormones decrease during labor?
Progesterone
What does metabolism due during labor?
Increases
What happens to blood sugar during labor?
Decreases
A pregnant woman is at 38 weeks of gestation. She wants to know if any signs indicate that “labor is getting closer to starting.” The nurse informs her that what is a sign labor will begin soon?
Surge of energy
What happens to a woman’s weight just before labor?
It decreases
A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe:
Bloody show
The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be:
Progressive uterine contractions with cervical change.
On completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, –1. What is a correct interpretation of the data?
The fetal presenting part is 1 cm above the ischial spines.
In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that:
The endogenous endorphins released during labor raise the woman’s pain threshold and produce sedation.
The nurse knows that the second stage of labor, the descent phase, has begun when:
The woman experiences a strong urge to bear down.
Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate?
Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours
Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased?
Squatting
Concerning the third stage of labor, nurses should be aware that:
The duration of the third stage may be as short as 3 to 5 minutes
The charge nurse on the maternity unit is orienting a new nurse to the unit and explains that the 5 Ps of labor and birth are:
Passenger, passageway, postion, powers, psychological response
Nurses can advise their patients that which of these signs precede labor?
Stronger and more frequent uterine (Braxton Hicks) contractions; Persistent low backache from relaxed pelvic joints; A return of urinary frequency as a result of increased bladder pressure
The maternity nurse should notify the health care provider about which assessment findings during labor?
Positive urine drug screen; Increased systolic blood pressure during first stage; and reparatory rate of 10
Where does the visceral pain associated with labor initiate from?
Cervical changes, distention of the lower uterine segment, and uterine ischemia
Where can referred pain be felt during labor?
Abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down thighs
Where does the somatic pain associated with labor initiate from?
Stretching and dissension of pelvic tissues and floor
When is visceral pain felt during labor?
First stage
When is somatic pain felt during labor?
Second stage
What is lightening?
Baby drops into pelvis
What are the non pharmacological methods of pain relief during labor?
Dick-Read, Lamaze, Bradley, hypno-birthing, and birthing from within
What opioid agonist analgesics are used for pain during labor?
Demerol and Fentanyl
What opioid antagonist analgesics are used for pain during labor?
Stadol and Nubain
What are the disadvantages of a spinal nerve block?
Hypotension, impaired placental perfusion, and ineffective breathing patterns
When is a spinal nerve block used during labor?
For C-Sections
When is an epidural contraindicated?
Hemorrhage, hypotension, coagulopathy, infection, allergy, maternal cardiac conditions
What is an alternative to an epidural?
Nitrous oxide
What is given with general anesthesia to neutralize gastric secretions if aspiration has occurred?
Bicitra
What is necessary to have before administering any invasive pain reduction procedure?
Informed consent
The most important nursing intervention after the injection of epidural anesthesia is monitoring:
Maternal blood pressure
How are headaches associated with nerve blocks treated?
Blood patch
A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse’s immediate response would be to:
Help the woman breathe into a paper bag.
A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman’s blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take?
Turn the woman to the left lateral position or place a pillow under her hip.
A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse’s MOST appropriate analgesic for pain control is:
Fentanyl (Sublimaze)
A woman is experiencing back labor and complains of constant, intense pain in her lower back. An effective relief measure is to use:
Counterpressure against the sacrum
Nurses should be aware of the difference experience can make in labor pain, such as:
Sensory pain for nulliparous women often is greater than for multiparous women during early labor
With regard to what might be called the tactile approaches to comfort management, nurses should be aware that:
Hand and foot massage may be especially relaxing in advanced labor when a woman’s tolerance for touch is limited
With regard to systemic analgesics administered during labor, nurses should be aware that:
Effects on the fetus and newborn can include decreased alertness and delayed sucking
After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is:
Referred
When monitoring a woman in labor who has just received spinal analgesia, the nurse should report which assessment findings to the health care provider?
Fetal heart rate of 100 beats/min; Minimal variability on a fetal heart monitor
After delivering a healthy baby boy with epidural anesthesia, a woman on the postpartum unit complains of a severe headache. The nurse should anticipate which actions in the patient’s plan of care?
Administration of oral analgesics; Assisting with a blood patch procedure; Frequent monitoring of vital signs
When is there a decreased blood supply to the fetus during labor?
During contractions
How is fetal well being measured during labor?
Response of FHR to uterine contractions
What are non reassuring FHR patterns associated with?
Fetal hypoxemia
What can minimal or absent FHR patterns indicate?
Cord is around the baby’s neck or is compressed, or the baby is sleeping
What is the number one cause of fetal tachycardia?
Infection
What can cause FHR accelerations?
Movement or contractions
How high is safe for FHR accelerations?
15 beats/min for less than 2 minutes
What are early FHR decelerations a response to?
Fetal head compression
What are late FHR decelerations a response to?
Uteroplacental insufficiency
When do late FHR decelerations occur?
After the contraction has begun
What causes variable FHR decelerations?
Cord compression
What causes prolonged FHR decelerations?
Hypoxia
When does fetal bradycardia occur?
With cardiac defects, viral infections, hypoglycemia or maternal hypothermia
What are the nursing interventions for a patient with decelerations?
Turn mom on her left side, put O2 on her, lower the HOB slightly, and possibly C-Section that baby out
What is the purpose of early fetal monitoring?
It evaluates whether the FHR is normal, anticipates the time interval until birth, and determines if intervention is needed
What drug will stop labor?
Tocolytic Therapy
Fetal tachycardia is most common during:
Maternal fever
When assessing a fetal heart rate (FHR) tracing, the nurse notes a decrease in the baseline rate from 155 to 110. The rate of 110 persists for more than 10 minutes. The nurse could attribute this decrease in baseline to:
Initiation of epidural anesthesia that resulted in maternal hypotension
On review of a fetal monitor tracing, the nurse notes that for several contractions, the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should:
Describe the finding in the nurse’s notes.
Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern?
Variability averages between 6 to 10 beats/min.
Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse’s IMMEDIATE action would be to:
Stop the Pitocin
You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take?
Notify the primary health care provider immediately (HCP)
When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that:
The examiner’s hand should be placed over the fundus before, during, and after contractions
A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by:
Methamphetamines
The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by:
Change in position
Fetal well-being during labor is assessed by:
The response of the fetal heart rate (FHR) to uterine contractions (UCs)
What are the three phases of the first stage of labor?
Latent, active, and transition
How long does the latent stage of labor last?
Until woman is 3cm dilated
How long does the active stage of labor last?
Until woman is 7cm dilated
How long does the transition stage of labor last?
Until mom is 10cm dilated
What is the difference between true and false labor?
True labor is timbale, and it increases in frequency and intensity. False labor is relieved by walking.
How can supine hypotension be prevented with a woman is in labor?
Place a pillow under the woman’s lower back
What can a woman eat during labor?
Only ice chips and clear liquids
How often should a woman be straight cathed during labor?
Every 2 hours
How long does the second stage of labor last?
2-4 hours
What are the phases of the second stage of labor?
Latent and Descent
Relatively calm phase of labor with passive descent of the baby through the birth canal
Latent
Active pushing phase of labor with a strong urge to bear down
Descent
What is the hallmark sign of impending birth?
Bulged, rounded perineum
What should occur during the fourth stage of labor?
Assessment of mom and baby
The nurse would assist the laboring woman into a hands-and-knees position when:
The occiput of the fetus is in a posterior position
Which characteristic is associated with false labor contractions?
Decreases with ambulation
A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent’s class. Which aspect of their birth plan would be considered unrealistic and require further discussion with the nurse?
“We do not want the fetal monitor used during labor since it will interfere with movement and doing effleurage.”
The nurse should realize that the most common and potentially harmful maternal complication of epidural anesthesia is:
Hypotension
When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include:
Encouraging the woman to try various upright positions, including squatting and standing
Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period?
Encourage skin-to-skin contact of mother and baby.
Which description of the phases of the second stage of labor is accurate?
Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies
Which test is performed to determine if membranes are ruptured?
Fern Test
A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse’s best response is:
“It’s normal to be anxious about labor. Let’s discuss what makes you afraid.”
Vaginal examinations should be performed by the nurse under which of these circumstances?
When membranes rupture; On maternal perception of perineal pressure or the urge to bear down; An admission to the hospital at the start of labor
For the labor nurse, care of the expectant mother begins with which situations?
The onset of progressive, regular contractions; The bloody, or pink, show; The spontaneous rupture of membranes
Cervical changes and uterine contraptions occurring between 20 and 37 weeks of pregnancy
Preterm labor
What is considered low birth weight?
Less than 2500g
Inadequate fetal growth due to any number of reasons; can be symmetric or asymmetric
Intrauterine Growth Restriction
What are the risk factors for spontaneous preterm birth?
African-American, genital tract infection, multifetal gestation, second trimester bleeding. low pregnancy weight
How can spontaneous preterm birth be predicted?
Fetal fibronectin and cervical length
Acts as the glue during pregnancy, attaching the amniotic sac to the uterus
Fetal Fibronectin
What can premature rupture of membranes lead to?
Fetal infection and mortality
What test on the mother will indicate when labor will begin?
Estiol Saliva Test
How long after the membranes rupture does the mother have to deliver?
48 hours
If the membranes rupture prematurely, how is the mother treated?
Give antibiotics and antenatal glucocorticoids
What are the pharmacological interventions to stop uterine activity?
Tocolytics, magnesium sulfate, terbutaline, NSAIDS, and procardia
Which drug to stop uterine activity can cause tachycardia, decreased cardiac output, hypertension, and chest pain
Terbutaline
Why is malpresentation common in preterm babies?
They have lots of room to move around
How is PPROM managed?
Hospitalization
Bacterial infection of the amniotic cavity
Chorioamnionitis
What are the signs and symptoms of chorioamniotitis?
Maternal fever, fetal tachycardia, uterine tenderness, foul oder of amniotic fluid
Why is hemorrhage more common in post term babies?
The overstretched uterus cannot bounce back
Labor lasting less than three hours because of hypertonic uterine contractions
Precipitous labor
What is the major complication associated with version?
Could abrupt the uterus
What is the Bishop score used for?
Predicts the successfulness of labor induction
What can be used to ripen the cervix?
Prostaglandins E1 and E2
How dilated must a woman be before her water can be manually broken?
3-4 cm
If the membranes rupture, what is the priority nursing assessment?
Monitor fetal heart rate, look for meconium in the amniotic fluid
When are forceps indicated?
If the second stage of labor is prolonged
A client is to have an amniotomy to induce labor. The nurse recognizes that the priority intervention after the anmiotomy is to:
Assess FHR
A woman is evaluated to be using an effective bearing-down effort if she:
Takes two deep, cleansing breaths at the onset of a uterine contraction and at the end of the contraction
In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, the nurse includes which information?
“Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures.”
For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse?
One fetal movement noted in 1 hour of assessment by the mother
A pregnant woman’s amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse’s top priority?
Place the woman in the knee-chest position
A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of:
A fetal heart rate (FHR) of 180 with absence of variability
With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that:
Its most important function is to afford the opportunity to administer antenatal glucocorticoids
With regard to dysfunctional labor, nurses should be aware that:
Women experiencing precipitous labor are about the only “dysfunctionals” not to be exhausted
A nurse providing care to a woman in labor should be aware that cesarean birth:
Is performed primarily for the benefit of the fetus
Which statement is most likely to be associated with a breech presentation?
High rate of neuromuscular disorders
A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What findings indicate that preterm labor may be occurring?
Estriol is found in maternal saliva; The cervix is effacing and dilated to 2 cm
The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth?
Unstable coronary artery disease; Previous cesarean birth; Placenta previa
If the fundus doesn’t start moving after birth, what could be the problem?
A full bladder
The interval between birth and the return of reproductive organ to their non-pregnant state
Postpartum
How long does the postpartum period last?
Six weeks
How is postpartum hemostatis is achieved?
Compression of intramyometrial blood vessels
What hormone stimulates postpartum hemostatis?
Oxytocin
Return of the uterus to a non-pregnant state following birth
Involution
Postbirth uterine discharge
Lochia
How long should lochia rubia last?
3-4 days
At what point in the fundus no longer palpable?
2 weeks after birth
What is included in lochia serosa?
Old blood, serum, leukocytes, and debris
How long is lochia serosa discharged?
22-27 days
What is included in lochia alba?
Leukocytes, decidua, epithelial cells, mucus, serum, and bacteria
How long is lochia serosa discharged?
2-6 weeks
How long do episotomies take to heal?
2-3 weeks
When do hemorrhoids go away?
6 weeks
How long does it take for the cervix to regain prepregnant form?
12-18 hours
How long does it take for the vagina to regain prepregnant tone?
6 months
What exercises help the tone to vagina?
Kegels
When does the thickening of the vaginal mucosa return?
When the ovaries start to function again
When does postpartum diuresis occur?
Within 12 hours and lasts for 2-3 days, mostly at night
How long does it take for a woman to move her bowels after giving birth?
2-3 days
How long does it take for menstruation to resume after childbirth?
27 days to 12 weeks
What are some things that help the let down reflex?
Beer, crying, and hot water
What is an acceptable amount of blood loss during a vaginal birth?
300-500 mL
What is an acceptable amount of blood loss during a C-Section?
500-1000 mL
How long does cardiac output remain increased after birth?
48 hours
To provide optimum care for the postpartum woman, the nurse understands that the most common cause of sub involution are:
Retained placental fragments and infection
Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that:
The expected weight loss immediately after birth averages about 11 to 13 lbs
The breasts of a bottle-feeding woman are engorged. The nurse should tell her to:
Wear a snug, supportive bra
A woman gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the woman’s bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is:
Excessive uterine bleeding
What statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth?
“My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”
With regard to afterbirth pains, nurses should be aware that these pains are:
More noticeable in births in which the uterus was overdistended
Postbirth uterine/vaginal discharge, called lochia:
Should smell like normal menstrual flow unless an infection is present
Which description of postpartum restoration or healing times is accurate?
Rugae reappear within 3 to 4 weeks.
With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that:
Fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium
As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1-day postpartum. Expected findings include:
Little if any change
After completing a postpartum assessment on woman who delivered 20 hours ago, the nurse should report which assessment findings to the health care provider?
Pulse 110 beats/min; Temperature 38° C
How should education be delivered to patients?
In writing
What is the best pharmacological pain relief for postpartum women?
NSAIDS
What non pharmacological methods are used for pain relief postpartum?
Walking, peeing, ice, sitz bath
When should the Rh immunoglobulin be given to Rh-negative patients who deliver Rh-positive babies?
Within 72 hours of birth
When palpating the fundus of a woman 18 hours after birth, the nurse notes that it is firm, 2 fingerbreadths above the umbilicus, and deviated to the left of midline. The nurse should:
Assist the woman to empty her bladder
The nurse examines a woman 1 hour after birth. The woman’s fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse’s initial action would be to:
Massage her fundus
Perineal care is an important infection control measure. When evaluating a postpartum woman’s perineal care technique, the nurse would recognize the need for further instruction if the woman:
Uses the peribottle to rinse upward into her vagina
Which measure would be least effective in preventing postpartum hemorrhage?
Massage the fundus every hour for the first 24 hours following birth
On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse’s first action is to:
Massage the woman’s fundus
Excessive blood loss after childbirth can have several causes; however, the most common is:
Failure of the uterine muscle to contract firmly
Baby-friendly hospitals mandate that infants be put to breast within what time frame after birth?
1 hour
Two hours after giving birth a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm at the umbilicus and midline. Her lochia is moderate rubra with no clots. The nurse suspects:
Hematoma formation
Which findings would be a source of concern if noted during the assessment of a woman who is 12 hours’ postpartum?
Pain in left calf with dorsiflexion of left foot; Lochia rubra with foul odor
A postpartum woman preparing for discharge asks the nurse about resuming sexual activity. Which information is appropriate to include in the patient teaching?
Fatigue may affect interest in sexual activity; Sexual activity can usually be safely resumed by 5 to 6 weeks after birth; Water-soluble lubrication may increase comfort; The female-on-top position may be more comfortable than other positions
What indicates autism in a newborn?
Unwillingness to make eye contact
When should skin to skin contact be initiated between the mother and newborn?
Immediately following birth
What are the steps to “becoming a mother”
Dependent behavior, dependent-independent behavior, and interdependent behavior
When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically:
Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn
Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should:
Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.
Parents can facilitate the adjustment of their other children to a new baby by:
Having the children choose or make a gift to give to the new baby on its arrival home
A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, the nurse should:
Provide time for the mother to reflect on the events of and her behavior during childbirth
The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, does the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?
Seldom makes eye contact with her son
In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. What is a facilitating behavior?
The parents hover around the infant, directing attention to and pointing at the infant.
Which statement regarding postpartum depression (PPD) is essential for the nurse to be aware of when attempting to formulate a plan of care?
PPD can easily go undetected.
When working with parents who have some form of sensory impairment, nurses should consider which information when writing a plan of care?
One of the major difficulties visually impaired parents experience is the skepticism of health care professionals; The best approach for the nurse is to assess the parents’ capabilities rather than focusing on their disabilities; Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information; Childbirth education and other materials are available in Braille
The maternity nurse promoting parental-infant attachment should incorporate which appropriate cultural beliefs into the plan of care?
Jordanian mothers have a 40-day lying-in after birth; Japanese mothers rest for the first 2 months after childbirth.
When helping a woman cope with postpartum blues, the nurse should offer what appropriate suggestions?
Get plenty of rest; Plan to get out of the house occasionally; Use La Leche League or community mental health centers
What does BUBBLE-H stand for?
Breasts, uterus, bowel sounds, bladder, lochia, episiotomy, hematoma
What causes postpartum blues?
A drop in progesterone
What is the number one cause of postpartum hemorrhage?
Uterine atony dues to retained placenta or full bladder
How is uterine atony treated?
Firm massage of the fundus
What drug is given to make the uterus contract?
Oxytocin
What are the nursing interventions for uterine atony?
Fundal massage, 2 large bore IVs, NSS, FFP, monitor vitals, call doctor, type and cross and prepare for a transfusion
What are the most common infectious agents in postpartum women?
Streptococcal and anaerobic organisms
Protrusion of the bladder downward into the vagina
Cystocele
Herniation of anterior rectal wall through relaxed or ruptured vaginal fascia and rectovaginal septum
Rectocele
How is postpartum depression managed?
Antidepressants, anxiolytic agents, mood stabilizers, and electroconvulsive therapy
What is the grief process?
Acute distress, intense grief, and reorganization
The most effective and least expensive treatment of puerperal infection is prevention. What is important in this strategy?
Strict aseptic technique, including hand-washing by all health care personnel
Postpartum women experience an increased risk for urinary tract infection. A prevention measure the nurse could teach the postpartum woman would be to:
Perform perineal care on a regular basis
The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to:
Palpate the uterus and massage it if it is boggy
Which postpartum conditions are considered medical emergencies that require immediate treatment?
Inversion of the uterus and hypovolemic shock
Which postpartum infection is most often contracted by first-time mothers who are breastfeeding?
Mastitis
Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is:
Desmopressin
Herbal remedies have been used with some success to control PPH after initial management. Some herbs have homeostatic actions, whereas others work as oxytocic agents to contract the uterus. What herbal remedy is a commonly used oxytocic agent?
Blue cohosh
The priority nursing intervention for a woman who suffered a perineal laceration is to:
Establish hemostasis
Thromboembolic conditions that are of concern during the postpartum period include
Superficial venous thrombosis; Deep vein thrombosis; Pulmonary embolism
Nursing care management for mothers and fathers suffering grief from the loss of their baby includes:
Using therapeutic communication and caring techniques; using therapeutic communication and caring techniques
What is usually the causative agent of mastitis?
Staph aureus
What are the signs and symptoms of mastitis?
High fever; bleeding, cracked nipples; chills
What can be used to dry up engorged breasts?
Cabbage
How can a newborn be stimulated to pass meconium?
Rectal temperature
What causes an infant to take its first breath?
Temperature change
After not breathing for how long should an infant be resuscitated?
One minute
What can cause jaundice in a baby?
Rh and A-O incompatibility
How is an infant’s acid base balance maintained?
Through the renal system
What is a sign of cardiac problems in a newborn?
Turning blue when feeding
How is jaundice in a newborn treated?
Sunlight
Cottage cheese like coating that protects newborns
Vernix caseosa
How do babies lose heat?
Through their heads
Blue spots on darkly skinned children due to excess pigmentation
Mongolian spots
Stork bite
Nevi
Fine coating of hair covering a newborn
Lanugo
What is baby acne caused by?
Fluctuating hormones
Whitish-yellow nodules on the gums of the roof of the mouth of a newborn
Epstein Pearls
A port wine stain occurring on a newborn’s head or neck
Nevus flammeus
How does the foramen ovale close?
The infant’s first breath expands the lung, rerouting the blood and closing the foramen ovale
How long does it take for the umbilical veins and arteries to close?
2 minutes after birth
Why is cold-stress so dangerous?
The blood is shunted from the brain and heart and devoted to thermoregulation
What medication is given in a baby’s eyes?
Erythromycin
What type of infection do erythromycin prevent?
Gonorrhea
What medication is given in a baby’s thigh?
Vitamin K
What are the newborn reflexes?
Sucking and rooting, swallowing, grasp, tonic neck, Moro, walking, crawling, and Babinski
How long should a newborn sleep?
20 hours a day
Which of a newborn’s senses is strongest?
Smell
A newborn is placed under a radiant heat warmer. The nurse knows that thermoregulation presents as a problem for newborns because:
They have a relatively thin layer of subcutaneous fat that provides poor insulation
What would be a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge?
Apical heart rate of 90 beats/min, slightly irregular, when awake and active
When caring for a newborn, the nurse must be alert for signs of cold stress, including:
Increased respiratory rate
The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern since the large amount of thick, sticky stool is very dark green, almost black in color. She asks the nurse if something is wrong. The nurse should respond to this mother’s concern by:
Explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements
When weighing a newborn, the nurse should:
Weigh the newborn at the same time each day for accuracy
Vitamin K is given to the newborn to:
Enhance ability of blood to clot
The nurse notes that, when placed on the scale, the newborn immediately abducts and extends the arms, and the fingers fan out with the thumb and forefinger forming a “C.” This response is known as a:
Moro reflex
A newborn male, estimated to be 39 weeks of gestation, would exhibit:
Testes descended into scrotum
A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is:
Vision
An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver:
Alerts the physician that the infant has a dislocated hip
The newborn’s nurse should alert the health care provider when which newborn reflex assessment findings are seen?
Newborn turns head toward stimulus when eliciting rooting reflex.
What are the five components of the APGAR score?
Appearance, pulse, grimace, activity, respiratory
When is the APGAR score obtained?
1 minute and 5 minutes
What problems to late preterm babies encounter?
Respiratory distress, temperature instability, feeding difficulties, sepsis, hypoglycemia, and hyperbilirubinemia
What is included in an infant’s biophysical profile?
Fetal monitoring, ultrasound, kidney function, hyperthyroidism, bleeding, and diabetes
How can a heel stick be made more successful?
Heat up foot and let gravity work
What immunization is an infant given immediately following birth?
Hepatitis B
How should the umbilical cord be cared for?
Keep it dry and out of the diaper, use rubbing alcohol to clean it
What should the umbilical stump be assessed for?
Edema, redness, and purulent drainage
The nurse must administer erythromycin ophthalmic ointment to a newborn after birth. The nurse should:
Cleanse eyes from inner to outer canthus before administration
Newborns are at high risk for injury if appropriate safety precautions are not implemented. Parents should be taught to:
Use a rear-facing car seat
Following circumcision of a newborn, the nurse provides instructions to his or her parents regarding postcircumcision care. The nurse should tell the parents to:
Expect a yellowish exudate to cover the glans after the first 24 hours
When placing a newborn under a radiant heat warmer to stabilize the temperature after birth, the nurse should:
Prewarm the radiant heat warmer and place the undressed newborn under it
With regard to umbilical cord care, nurses should be aware that:
The stump can easily become infected
A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infant’s parents should be based on the knowledge that petechiae:
Are benign if they disappear within 48 hours of birth
A mother expresses fear about changing her infant’s diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home?
Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change.
Which of these statements are helpful and accurate nursing advice concerning bathing the new baby?
Tub baths may be given before the infant’s umbilical cord falls off and the umbilicus is healed; Powders are not recommended because the infant can inhale powder
As part of their teaching function at discharge, nurses should tell parents that the baby’s respiratory status should be protected by the following procedures:
Avoid loose bedding, waterbeds, and beanbag chairs; Keep the infant away from secondhand smoke; Prevent exposure to people with upper respiratory tract infections
What are the nutrient needs of a newborn?
Fluids, energy, carbs, fat, protein, vitamins, and minerals
What hormones promote breastfeeding?
Oxytocin and prolactin
How often should a baby be fed?
On demand or every two hours
How many extra calories should a woman who is breast feeding ingest?
350-600
What medical disorder interferes with the let down reflex?
Hypertension
Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. What statement is valid?
A premature infant more easily digests breast milk than formula
The birth weight of a breastfed newborn was 8 lbs, 4 oz. On the third day the newborn’s weight was 7 lbs, 12 oz. On the basis of this finding, the nurse should:
Encourage the mother to continue breastfeeding since it is effective in meeting the newborn’s nutrient and fluid needs
Which action of a breastfeeding mother indicates the need for further instruction?
Leans forward to bring breast toward the baby
The nurse taught new parents the guidelines to follow regarding the bottle-feeding of their newborn. They will be using formula from a can of concentrate. The parents would demonstrate an understanding of the nurse’s instructions if they:
Wash the top of the can and can opener with soap and water before opening the can
In helping the breastfeeding mother position the baby, nurses should keep in mind that:
Whatever the position used, the infant is “belly to belly” with the mother
The maternity nurse must be cognizant that cultural practices have significant influence on infant feeding methods. Many regional and ethnic cultures can be found within the United States. One cannot assume generalized observations about any cultural group will hold for all members of the group. Which statement related to cultural practices influencing infant feeding practice is correct?
A common practice among Mexican women is known as los dos
Which statement regarding infant weaning is correct?
Weaning can be mother or infant initiated.
With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese client that the best strategy to decrease the risk for childhood obesity for her infant is:
Breastfeeding
What is the PRIORITY teaching tip the nurse should provide about bottle-feeding?
Hold infant semiupright while feeding.
Which of these statements indicate the effect of breastfeeding on the family or society at large?
Breastfeeding requires fewer supplies and less cumbersome equipment; Breastfeeding saves families money; Breastfeeding benefits the environment; Breastfeeding results in reduced annual health care costs
The nurse should include which instructions when teaching a mother about the storage of breast milk?
Wash hands before expressing breast milk; Milk thawed in the refrigerator can be stored for 24 hours.
What is a sign of sepsis?
Temperature drop
How should an opioid addiction be treated during pregnancy?
Methadone
How are hemolytic disorders during pregnancy treated?
Administration of RhIG
How are infants of diabetic mothers treated after birth?
Thermoregulation, carbohydrate feeding, and monitoring of serum glucose levels
What are the characteristics of preterm infants?
Small, scrawny, large head, translucent skin, lanugo
When planning care for an infant with a fractured clavicle, the nurse should recognize that, in addition to gentle handling:
No special treatment is necessary
Which laboratory test result would be a cause for concern if exhibited by an Rh-positive newborn 12 hours after birth?
Rapid Plasma Reagin (RPR)/Venereal Disease Research Laboratories (VDRL): reactive
The nurse is caring for an infant who is suspected to have neonatal sepsis. Which neonatal risk factor for an infant with suspected neonatal sepsis would the nurse expect to observe?
Multiple gestation and low birth weight
With regard to hemolytic diseases of the newborn, nurses should be aware that:
The indirect Coombs’ test is performed on the mother before birth; the direct Coombs’ test is performed on the cord blood after birth.
Congenital heart defects (CHDs) are anatomic abnormalities in the heart that are present at birth, although they may not be diagnosed immediately. The most common type of CHD is:
Ventricular septal defect (VSD)
Concerning congenital abnormalities involving the central nervous system, nurses should be aware that:
A major preoperative nursing intervention for a neonate with myelomeningocele is to protect the protruding sac from injury
A male infant at 26 weeks of gestation arrives from the delivery room intubated. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. The nurse’s most appropriate action is to:
Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician.
Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include:
Abdominal distention, temperature instability, and grossly bloody stools
With regard to the classification of neonatal bacterial infection, nurses should be aware that:
Health care–associated infection can be prevented by effective handwashing; early onset cannot
Which TORCH infection could be contracted by the infant because the mother owned a cat?
Toxoplasmosis
In caring for a mother who has abused (or is abusing) alcohol and for her infant, nurses should be aware that:
Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school
Antidepressant medication is the mainstay treatment for maternal depression, with selective serotonin reuptake inhibitors (SSRIs) being the first line of pharmacotherapy. Reports of cardiac defects have been associated with the use of which SSRI?
Paroxetine
An infant weighing 4.1 kg was born 2 hours ago at 37 weeks of gestation. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of:
Hypoglycemia
The nurse is caring for an infant born at 28 weeks of gestation. Which complication could the nurse expect to observe during the course of the neonate’s hospitalization?
Respiratory distress syndrome; Periventricular hemorrhage; Patent ductus arteriosus
