Practice Questions - Cumulative Flashcards
A nurse is assessing the lochia discharge on a 1 day postpartum woman. The nurse notes that the lochia is red & has a fleshy odor. The nurse determines that this assessment finding indicates what?
a.) A normal finding.
b.) The presence of infection.
c.) The need for increasing oral fluids.
d.) The need for increasing ambulation.
Exam 1
a.) A normal finding
A postpartum patient asks the nurse about the occurence of afterpains. The nurse informs the mother that afterpains will be especially noticeable…
a.) When ambulating
b.) While taking a sitz bath
c.) During breastfeeding
d.) Once the patient arrives home & activities are increased
Exam 1
c.) While breastfeeding
What might the presence of free-flowing, bright red blood indicate?
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Exam 1
Cervical laceration
A vagina should return to its normal, pre-pregnancy size within how many weeks of delivery?
6 - 8 weeks
Pregnancy is considered to be what type of state?
Exam 1
Hypercoaguable
What is a common postpartum complication that can be caused by hormonal shifts as well as pathological etiology such as spinal anesthesia or postpartum onset of preeclampsia?
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Exam 1
Headache
What is the most common cause of excessive postpartum bleeding?
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Exam 1
Uterine Atony
- failure of the uterine muscle to contract
How long does it take for the ductus arteriosus to close?
Exam 1 (Fetal A&P)
first 24 hours of life
* takes 2 - 3 months otherwise fully close
Do veins or arteries carry oxygen to the baby?
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Exam 1 (Fetal A&P)
VEINS
How many veins & arteries are in fetal circulation?
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Exam 1 (Fetal A&P)
2 Arteries & 1 Vein (AVA)
What is the most important physiologic change in a newborn?
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Exam 1
Initiation of breathing
What induces mild hypercapnia, hypoxia, & acidosis [normal is 7.30 - 7.40] that stimulates the respiratory center?
Exam 1
Labor
If the baby isn’t breathing, what measures should be taken?
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Exam 1
Positive Pressure Ventilation
- NOT CPR
What maternal hormone does NOT pass the placenta?
Exam 1 (Fetal A&P)
Insulin
At what point after birth will a newborn’s blood sugar drop to the lowest level?
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Exam 1 (Fetal A&P)
2 hours
Infection risk increases in a mom who has been ruptured for over how many hours?
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Exam 1
18+ hours
When does the anterior fontanelle close?
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Exam 1 (Fetal A&P)
12 - 18 months
When does the posterior fontanelle close?
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Exam 1 (Fetal A&P)
2 - 3 months
A new father wants to know what medication was put into his infant’s eyes & why it is needed. How does the nurse explain the purpose of erythromycin ointment?
a.) Erythromycin opthalmic ointment destroys an infectious exudate caused by Staphylococcus that could make the infant blind.
b.) This opthalmic ointment prevents gonorrheal & chlamydial infetion of the infant’s eyes, potentially acquired from the birth canal.
c.) The ointment prevents the infant’s eyes from sticking together & helps the infant see.
d.) Erythromycin prevents potentially harmful exudate from invading the tear ducts of the infant’s eyes, leading to dry eye.
Med Math Quiz
b.) This ointment prevents gonorrheal & chlamydial infection of the infant’s eyes, potentially acquired from the birth canal.
A nursing student is describing how to apply erythromycin ointment to a newborn’s eyes. Which answer indicates a need for additional teaching?
a.) “I will wipe the eyes after instilling the ointment.”
b.) “Administration of the eye ointment may be delayed for an hour or so after birth so that eye contact & parent-infant attachment & bonding can occur.”
c.) “I will instill 1-2 cm of eye ointment into each of the neonate’s conjunctival sacs.”
d.) None of the above
Med Math Quiz
a.) “I will wipe the eyes after instilling the ointment.
A nursing student tasks about IM injections in newborns because her only practice experiences have been with adults. What is the correct injection site for an IM injection for a newborn?
a.) Vastus lateralis muscle
b.) None of the above
c.) Gluteal muscle
d.) Vastus deltoid muscle
Med Math Quiz
a.) Vastus Lateralis Muscle
Pain should be regularly assessed in all newborns. Your newborn patient is to have a circumcision. Which intervention is an example of non-pharmacologic pain management in the newborn?
a.) Acetaminophen
b.) Feeding the newborn
c.) Give Sucrose during the procedure
d.) Loosening the newborn’s clothing
Med Math Quiz
c.) Give sucrose during the procedure
Which statement regarding the practice of giving newborns Vitamin K immediately after birth is most accurate?
a.) Newborns’ GI systems are sterile, resulting in a lack of vitamin K production.
b.) Hemolysis of the fetal red blood cells increases coagulation problems.
c.) Newborns are susceptible to avitaminosis.
d.) Newborns have mature livers that produce clotting factors.
Med Math Quiz
a.) Newborns’ GI systems are sterile, resulting in a lack of vitamin K production.
The primary care provider ahs ordered Vitamin K 0.5 mg IM for a newborn. The medication is available as 2 mg/mL. How many mL should the nurse administer to the baby? (Calculate to the nearest hundreth)
a.) 4.00
b.) 2.50
c.) 0.52
d.) 0.25
Med Math Quiz
d.) 0.25 mL
0.5 mg / 2 mg = 0.25 mL
A client is to receive morphine 4 mg Q3-4 hours subcutaneously for pain. The morphine is available on the unit in premeasured syringes of 10 mg/mL. When the nurse administers the medication, how many mL of morphine will be wasted? (Calculate to the nearest tenth).
a.) 0.4
b.) 6.0
c.) 4.0
d.) 0.6
Med Math Quiz
d.) 0.6 mL
- 4 / 10 **= ** 0.4 mL administered
- 1.0 - 0.4 = 0.6 mL wasted
A neonatologist prescribes gentamicin for a 2 day old septic preterm infant who weighs 1,653 grams & is 38 cm long. The drug reference states: Neonatal dosage of gentamicin for babies less than 1 week of age is 2.5 mg/kg Q12-24 hours. Calculate the safe daily dosage of this medication. (Calculate to the nearest hundreth).
a.) 4.13
b.) 413.25
c.) 41.3
d.) 0.41
Med Math Quiz
a.) 4.13
- 1,653 g / 1,000 = 1.653 kg
- 2.5 x 1.653 = 4.13
Cloxacillin 500 mg by mouth 4 times a day for 10 days has been ordered for a patient with a breast abscess. The patient states that she is unable to swallow pills. The oral solution is available as 125 mg / 5 mL. How many mL of medicine should the woman take per dose? (Calculate to the nearest whole).
a.) 4
b.) 2.0
c.) 20
d.) 40
Med Math Quiz
c.) 20
- 125 / 5 = 25
- 500 / 25 mg = 20 mL
A client who has been diagnosed with deep vein thrombosis has been ordered to receive 12 units heparin/min. The nure receives a 500 mL bag of D5W with 20,000 units of heparin added from the pharmacy. At what rate in mL/hr should the nruse set the infusion pump? (Calculate to the nearest whole).
a.) 1.8
b.) 0.3
c.) 18
d.) 30
Med Math Quiz
c.) 18
The primary healthcare provider caring for a pregnant client diagnosed with gonorrhea writes the following order: ceftriaxone 250 mg IM x one dose. The medication is available in 1 gram vials. The nurse adds 8 mL of normal saline to the vial. How many mL of the medication should the nurse administer? (Calcualte to the nearest whole).
a.) 2
b.) 0.25
c.) 20
d.) 2,000
Med Math Quiz
a.) 2
- 1 gram = 1,000 mg
- 1000 mg / 8 mL = 250 mg / x mL
- 1000 x = 2,000
- x = 2
What is the first step a nurse should take before administering any medication?
a.) Check the patient’s vital signs.
b.) Verify the provider’s order & the medication label against the patient’s identification.
c.) Ensure the patient is fasting.
d.) Call the pharmacy to confirm the prescription.
Med Math Quiz
b.) Verify the provider’s order & the medication label against the patient’s identification.
When performing medication reconciliation, which of the following actions should the nurse include?
a.) Only document changes in prescribed medications.
b.) Disregard over the counter medications.
c.) Compare the patient’s new medication orders with the list of medications they have been taking.
d.) Asume the patient’s current medications are correct without validation.
Med Math Quiz
c.) Compare the patient’s new medication orders with the list of medications they have been taking.
After a vaginal delivery, it is determined that the newborn requires fluid resuscitation. The dose for normal saline is 10 mL/kg. The newborn weighs 3500 g. Calculate the intravenous dose for the newborn.
a.) 10 mL
b.) 20 mL
c.) 35 mL
d.) 50 mL
Med Math Quiz
c.) 35 mL
- 3500 g = 3.5 kg
- 10 mL x 3.5 kg = 35 mL
How do you convert kilograms to grams?
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1 kg = 1,000 g
How do you convert kilograms to pounds?
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1 kg =2.2 lbs
A newborn requires medication B, which is prescribed at 0.1 mg/kg/dose. If the newborn weighs 2.8 kg, how much medication should be administered per dose?
a.) 0.18 mg
b.) 0.30 mg
c.) 0.25 mg
d.) 0.28 mg
Med Math Quiz
d.) 0.28 mg
- 0.1 x 2.8 = 0.28 mg
The prescribed dose for medication C is 5 mg/kg/day, to be administered in 3 divided doses. If the newborn weighs 4000 g, how much medication should be administered per dose?
a.) 5 mg
b.) 6.67 mg
c.) 10 mg
d.) 20 mg
Med Math Quiz
b.) 6.67 mg
- 4,000 g = 4 kg
- 5 mg x 4 kg = 20 mg
20 mg / 3 = 6.67 mg
A woman in preterm labor is prescribed betamethasone to enhance fetal lung maturity. The prescribed dose is 12 mg IM every 24 hours for 2 doses. The available concentration of betamethasone is 6 mg/mL. How many mL are needed per dose?
a.) 1.5 mL
b.) 2 mL
c.) 1 mL
d.) 3 mL
Med Math Quiz
b.) 2 mL
A woman is prescribed misoprostol (Cytotec) 600 mcg orally for postpartum hemorrhage. The available tablet strength is 200 mcg. How many tablets should she take to achieve the prescribed dose?
a.) 4
b.) 5
c.) 3
d.) 2
Med Math Quiz
c.) 3
A pregnant woman with preeclampsia is prescribed magnesium sulfate for seizure prophylaxis. The loading dose is 4 g IV over 20 minutes, followed by a maintenance infusion fo 2 g per hour. How many mL of a 50% magnesium sulfate solution (which is 500 mg/mL) should be given for the loading dose?
a.) 4
b.) 6
c.) 8
d.) 10
Med Math Quiz
c.) 8
4 g = 4,000 mg
* 4,000 mg / 500 mg = 8
A pregnant woman is prescribed IV cefazolin for surgical prophylaxis prior to a cesarean section. The prescribed dose is 2 grams, and the available concentration of cefazolin is 1 gram per 50 mL. How many mL of the solution should be administered to deliver the prescribed dose?
a.) 25
b.) 50
c.) 75
d.) 100
Med Math Quiz
d.) 100
- 1 g / 50 mL = 2 g / x mL
50 x 2 = 100 mL
The nurse is assessing a newborn at 5 hours ofage and finds a soft mass over the infant’s occiput. The mass crosses the suture line. The nurse documents this finding as which of the following?
a.) Subgaleal hemorrhage
b.) Caput succedaneum
c.) Cephalohematoma
d.) Hydrocephalus
Exam 1
b.) Caput succedaneum
What is the difference in primary and secondary powers?
Exam 1
Primary = involuntary
* responsible for cervical dilation, effacement, & fetal descent
Secondary = voluntary
* maternal bearing down efforts
Interpret the following:
3 cm / 50% / -3
Exam 1
- 3 cm = 3 cm dilated
- 50% = 50% effaced
- -3 = -3 station
Interpret the following:
4 cm/ 80% / +2
Exam 1
- 4 cm = 4 cm dilated
- 80% = 80% effaced
- +2 = +2 fetal station
With regard to fetal position during labor, nurses should be aware that:
a.) Position is ameasureo f the degree of descent of the presenting part of the fetus through the birth canal.
b.) Birth is imminent when the presenting part of the fetus is at +4 to +5, below the spine.
c.) The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter.
d.) Engagement is the term used to describe the beginning of labor.
Exam 1
b.) Birth is imminent when the presenting part of the fetus is at +4 to +5, below the spine.
What is the difference in an ultrasound transducer and a tocotransducer?
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Exam 1
**Tocotransducer = ** measures uterine contractions and is placed over uterine fundus
*
Ultrasound Transducer = measures the fetal heart rate (FHR) and is placed over fetal back, BELOW mother’s umbilicus
Describe the 4 types of fetal heart rate variability.
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Exam 1
- Absent: none (distress, hypoxic, sleeping)
- Minimal: ≤ 5 bpm difference from baseline
- Moderate: 6 - 25 bpm difference from baseline
- Marked: > 25 bpm difference from baseline
Referring to changes in amplitude range
What is VEAL CHOP?
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- Variable decelerations = Cord compression
- Early decelerations = Head compression
- Accelerations = OK
- Late decelerations = Placental insufficiency
How are abnormal fetal heart rates managed?
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LIONS PIT
*
- Left side lying
- IV fluid bolus
- Notify physician
- 1.) Stop Pitocin
*
STOP PITOCIN = FIRST STEP
What is tachysystole & what is the treatment?
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Exam 2
5+ contractions in a 10 minute window averaged over 30 minutes
- too many contractions
Tx = terbutaline
What is preeclampsia?
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Exam 2
Development of hypertension AND proteinuria after 20 weeks gestation in a previously normotensive woman
Can also be HTN +
* thrombocytopenia
* renal insufficiency
* impaired liver funciton
* pulmonary edema
* cerebral or visual symptoms
in the absence of proteinuria
What medication is used to prevent & treat seizure activity (eclampsia) in pregnancy? What is the antidote for this medication?
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Exam 2
Magnesium Sulfate
- antidote = Calcium Gluconate
What is the most common cause of postpartum hemorrhage?
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Uterine atony
Failure of the uterus to contract firmly to pre-pregnancy size
What medications are used to treat postpartum hemorrhage? What are the contraindications?
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Exam 2
Hemabate
* contra = Asthma
Methergine
* contra = HTN
- Cytotec
- Oxytocin
A woman presents to the clinic because she missed her last menstrual period (LMP) & thinks she may be pregnant. She reports fatigue, breast tenderness, urinary frequency, & N/V in the morning. The HCP will interpret these findings as which of the following changes of pregnancy?
a.) Positive
b.) Probable
c.) Presumptive
d.) Possible
c.) Presumptive
- subjective
A patient is diagnosed with gestational hypertension & is receiving magnesium sulfate. Which findings would the nurse interpret as indicating a therapeutic level fo medication?
a.) Urinary output of 20 mL per hour.
b.) Respiratory rate of 10 breaths per minute.
c.) Deep tendon reflexes 2+.
d.) Difficulty in arousing.
Exam 2
c.) Deep tendon reflexes 2+
With magnesium sulfate, DTRs of 2+ are considered normal & therefore therapeutic level of the drug
The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which of the following because of the woman’s increased risk?
a.) Oligohydramnios
b.) Preeclampsia
c.) Post-term labor
d.) Chorioamnionitis
Exam 2
b.) Preeclampsia
A 1-day-old neonate, 32 weeks gestation, is in an overhead warmer. The nurse assesses the morning axillary temperature as 96.9 F. Which of the following could explain this assessment finding?
a.) This is a normal axillary temperature for a neonate.
b.) Axillary temperatures are not valid for preterm babies.
c.) The supply of brown adipose tissue is incomplete.
d.) Conduction heat loss is pronounced in the baby.
Exam 2
c.) The supply of brown adipose tissue is incomplete.
Which vital sign deviates from the normal reading as a result of puerperal sepsis?
a.) Temperature
b.) Respirations
c.) Blood pressure
d.) Pulse
Exam 2
a.) Temperature
- Fever is > 100.4 F
A number of changes in the integumentary system occur during pregnancy. WHich change persists after birth?
a.) Epulis
b.) Chloasma
c.) Stiae gravidarum
d.) Telangiectasia
Exam 2
c.) Striae gravidarum
With regard to follow-up visits & the physical examination for women receiving prenatal care, nurses should be aware that…
a.) The interview portions become more intensive as the visits become more frequent over the course of the pregnancy.
b.) Monthly visits are scheduled for 1st trimester, every 2 weeks for 2nd trimester, & weekly for 3rd trimester.
c.) During the abdominal examination, the nurse should be alert for supine hypotension.
d.) For pregnant women, a systolic BP of 130/80 is sufficient to be considered hypertensive.
Exam 2
c.) During the abdominal examination, the nurse should be alert for supine hypotension.
Supine hypotension: occurs when a pregnant person’s uterus compresses the inferior vena cava & aorta while they are lying on their back
Women with hyperemesis gravidarum…
a.) Are a majority, because 80% of all women suffer from it at some time.
b.) Have vomiting severe & persistent enough to cause weight loss, dehydration, & electrolyte imbalance.
c.) Need IV fluid & nutrition for most of their pregnancy.
d.) Often inspire similar, milder symptoms if their male partners & mothers
Exam 2
b.) Have vomiting severe & persistent enough to cause weight loss, dehydration, & electrolyte imbalance.
What are the 3 most common medications used to control HTN during pregnancy? (NOT for preeclampsia)?
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Exam 2
- Labetalol
- Hydralazine (IV only)
- Nifedipine (procardia)
What are the 3 Tocolytic drugs & what are they used for?
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Exam 2
Tocolytic = inhibit contractions
Not My Time
- Nifedipine
- Magnesium sulfate
- Terbutaline
What medications are used for postpartum hemorrhage?
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Exam 2
- Cytotec (misoprostol)
- Hemabate – do NOT use w/ asthma
- Methergine – do NOT use w/ HTN
- Oxytocin / pitocin
