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Maternity > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

What does methergine (Methylergonovine) do?

A

uterine stimulant

promotes uterine contractions
expels retained fragments of placenta

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2
Q

What are the nursing actions for Methylergonovine?

A

assess uterine tone and vaginal bleeding

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3
Q

Who do you NOT give Methylergonovine to?

A

do not give to HTN pt

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4
Q

What are the adverse effects of Methylergonovine?

A

htn
n/v
headache

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5
Q

Before administering methylergonovine (Methergine), the nurse checks the

a. color of the lochia.
b. blood pressure.
c. location of the fundus.
d. last administration of analgesics.

A

b. blood pressure.

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6
Q

To evaluate the desired response of methylergonovine (Methergine), the nurse would assess the patient’s

a. uterine tone.
b. pain level.
c. blood pressure.
d. last voiding.

A

a. uterine tone.

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7
Q

Which medications could potentially cause hyperstimulation of the uterus during labor? (Select all that apply.)

a. Oxytocin (Pitocin)
b. Misoprostol (Cytotec)
c. Dinoprostone (Cervidil)
d. Methylergonovine maleate (Methergine)

A

a. Oxytocin (Pitocin)
b. Misoprostol (Cytotec)
c. Dinoprostone (Cervidil)
d. Methylergonovine maleate (Methergine)

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8
Q

What fetal position is labor dystocia associated with?

A

posterior

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9
Q

What are the 5 Ps that dystocia is related to?

A

-passenger
-passageway
-powers
-position
-psychological response

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10
Q

Which fetal position may cause the laboring patient increased back discomfort?

a. Left occiput anterior
b. Left occiput posterior
c. Right occiput anterior
d. Right occiput transverse

A

b. Left occiput posterior

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11
Q

During the course of the birth process, the physician suspects that a shoulder dystocia is occurring and asks the nurse for assistance. Which priority action should be taken in response to this request?

a. Put pressure on the fundus.
b. Ask the physician if he or she would like you to prepare for a surgical method of birth.
c. Tell the patient not to push until you prepare the vacuum extraction device for physician.
d. Reposition the patient to facilitate birth.

A

b. Ask the physician if he or she would like you to prepare for a surgical method of birth.

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12
Q

The nurse notes that the fundus of a postpartum patient is boggy, shifted to the left of the midline, and 2 cm above the umbilicus. What is the nurse’s priority action?

a. Massage the fundus of the uterus.
b. Assist the patient out of bed to void.
c. Increase the infusion of oxytocin (Pitocin).
d. Ask another nurse to bring in a straight catheter tray.

A

a. Massage the fundus of the uterus.

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12
Q

Postpartal overdistention of the bladder and urinary retention can lead to which complication?

a. Fever and increased blood pressure
b. Postpartum hemorrhage and eclampsia
c. Urinary tract infection and uterine rupture
d. Postpartum hemorrhage and urinary tract infection

A

d. Postpartum hemorrhage and urinary tract infection

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13
Q

The nurse observes a patient on her first postpartum day sitting in bed while her newborn lies awake in the bassinet. Which action is most appropriate for the nurse to take at this time?

a. Hand the baby to the woman.
b. Explain “taking-in” to the woman.
c. Offer to hand the baby to the woman.
d. No action, because this situation is perfectly acceptable.

A

a. Hand the baby to the woman.

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14
Q

What is the taking in phase? What should the nurse do?

A

the mother may be passive and dependent

encourage bonding when the infant is in the quiet alert stage by giving the baby to the mother

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15
Q

What is the priority for a postpartum pt who feels sad?

A

Mom and baby safety

Harming baby and self harm

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16
Q

A postpartum patient calls the clinic and reports to the nurse feelings of fatigue, tearfulness, and anxiety. What is the nurse’s most appropriate response at this time?

a. “When did these symptoms begin?”
b. “Sounds like normal postpartum depression.”
c. “Are you having trouble getting enough sleep?”
d. “Are you able to get out of bed and provide care for your baby?”

A

d. “Are you able to get out of bed and provide care for your baby?”

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17
Q

Which statement by a postpartum patient indicates that further teaching regarding thrombus formation is unnecessary?

a. “I’ll keep my legs elevated with pillows.”
b. “I’ll sit in my rocking chair most of the time.”
c. “I’ll stay in bed for the first 3 days after my baby is born.”
d. “I’ll put my support stockings on every morning before rising.”

A

d. “I’ll put my support stockings on every morning before rising.”

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18
Q

Hx of PE, what is the priority after delivery?

A

Ambulation/ walking

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19
Q

If momma cant walk, what do you do?

A

initiate passive range of motion exercise

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20
Q

What is a sign of a DVT?

what do you do?

A

Pain in the calf
Elevate

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21
Q

If a DVT (deep vein thrombosis) is suspected, the nurse should

a. perform a Homans sign on the affected leg.
b. dorsiflex the foot of the affected leg.
c. palpate the affected leg for edema and pain.
d. place the patient on bed rest, with the affected leg elevated.

A

d. place the patient on bed rest, with the affected leg elevated.

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22
Q

What is an episiotomy?

A

an incision on perineum to enlarge the vaginal opening to facilitate birth and minimize soft tissue damage.

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23
Q

What are indications an episiotomy?

A
  • shorten the second stage of labor
  • facilitate forceps-assisted delivery
  • prevent cerebral hemorrhage in a fragile preterm fetus
  • facilitate birth of a macrosomic infant
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24
Q

The nerve block used in labor that provides anesthesia to the lower vagina and perineum is referred to as a(n)

a. local.
b. epidural.
c. pudendal.
d. spinal block.

A

c. pudendal.

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25
Q

When assessing the A of the acronym REEDA, the nurse should evaluate the

a. skin color.
b. degree of edema.
c. edges of the episiotomy.
d. episiotomy for discharge.

A

c. edges of the episiotomy.

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26
Q

What does REEDA stand for?

A

redness
edema
ecchymosis
drainage
approximation

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27
Q

What 2 blocks can be done for an episiotomy?

A

pudendal block
epidural block

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28
Q

What does a firm fundus indicate?

A

uterus is contracting and compressing the open blood vessels at the placental site

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29
Q

To monitor for potential hemorrhage in the patient who has just had a cesarean birth, which action should the recovery room nurse implement?

a. Monitor her urinary output.
b. Maintain an intravenous infusion at 1 mL/hour.
c. Assess the abdominal dressings for drainage.
d. Assess the uterus for firmness every 15 minutes.

A

d. Assess the uterus for firmness every 15 minutes.

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30
Q

The nurse is planning care for a patient during the fourth stage of labor. Which interventions should the nurse plan to implement? (Select all that apply.)

a. Offer the patient a warm blanket.
b. Place an ice pack on the perineum.
c. Massage the uterus if it is boggy.
d. Delay breastfeeding until the patient is rested.
e. Explain to the patient that the lochia will be light pink in color.

A

a. Offer the patient a warm blanket.
b. Place an ice pack on the perineum.
c. Massage the uterus if it is boggy.

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31
Q

After 1 hour of delivery, where should the fundus be?

A

level of umbilicus

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32
Q

What will be done if the fundus is boggy?

A

massage in circular motion

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33
Q

What does betamethasone do?

A

enhance fetal lung maturity and surfactant production in fetuses between 24-34 weeks gestation

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34
Q

What should be assess after giving betamethasone?

A

Assess for maternal hyperglycemia and the preterm infants lung sounds

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35
Q

What does terbutaline do?

A

weakens or stops contractions

is used to RELAX the uterus aka diminish uterine activity

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36
Q

Which is the priority nursing assessment for the patient undergoing tocolytic therapy with terbutaline (Brethine)?

a. Intake and output
b. Maternal blood glucose level
c. Internal temperature and odor of amniotic fluid
d. Fetal heart rate, maternal pulse, and blood pressure

A

d. Fetal heart rate, maternal pulse, and blood pressure

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37
Q

Which finding would be indicative of an adverse response to terbutaline (Brethine)?

a. Fetal heart rate (FHR) of 134 bpm
b. Heart rate of 122 bpm
c. Two episodes of diarrhea
d. Fasting blood glucose level of 100 mg/dL

A

b. Heart rate of 122 bpm

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38
Q

Emergency measures used in the treatment of a prolapsed cord include which of the following? (Select all that apply.)

a. Administration of oxygen via face mask at 8 to 10 L/minute
b. Maternal change of position to knee-chest
c. Administration of tocolytic agent
d. Administration of oxytocin (Pitocin)
e. Vaginal elevation
f. Insertion of cord back into vaginal area

A

a. Administration of oxygen via face mask at 8 to 10 L/minute
b. Maternal change of position to knee-chest
c. Administration of tocolytic agent
e. Vaginal elevation

39
Q

Who is terbutaline NOT given to?

A

pts with:
- hx of cardiac disease
- pregestational or gestational diabetes
- preeclampsia with severe features of eclampsia
- severe gestational htn
- hyperthyroidism
- significant hemorrhage

40
Q

What is painful swelling in one breast?

A

mastitis

41
Q

The patient calls to report her findings to the clinical nurse because this is not her typical result. What action should the nurse perform next?

a. Refer the patient to an oncologist because the results are suspicious.
b. Ask the patient to come in for an office visit so that the findings can be validated but tell her that this information is within the normal range of presentation.
c. Have the patient wear a tight-fitting bra and tell her that the tenderness is
associated with ovulation and will pass.
d. Have the patient repeat the self-breast exam in 2 weeks and call back with findings
to provide a basis for comparison.

A

b. Ask the patient to come in for an office visit so that the findings can be validated but tell her that this information is within the normal range of presentation.

42
Q

Which measure may prevent mastitis in a breastfeeding patient?

a. Wearing a tight-fitting bra.
b. Applying ice packs prior to feeding.
c. Initiating early and frequent feedings.
d. Nursing the infant for 5 minutes on each breast.

A

c. Initiating early and frequent feedings.

43
Q

Which information should the nurse recognize as contributing to mastitis in the breastfeeding mother? (Select all that apply.)

a. Insufficient emptying
b. Feeding every 2 hours
c. Supplementing feedings
d. Blisters on both nipples
e. Alternating breastfeeding positions

A

a. Insufficient emptying
c. Supplementing feedings
d. Blisters on both nipples

44
Q

A breastfeeding patient who was discharged yesterday calls to ask about a tender hard area on her right breast. What should the nurse’s first response be?

a. “This is a normal response in breastfeeding mothers.”
b. “Notify your doctor so he can start you on antibiotics.”
c. “Stop breastfeeding because you probably have an infection.”
d. “Try massaging the area and apply heat; it is probably a plugged duct.”

A

d. “Try massaging the area and apply heat; it is probably a plugged duct.”

45
Q

What are the four Ts for bleeding?

A

Tone/Uterine atony= laceration, hematoma, inversion, rupture
Trauma
Thrombolytic (DIC)
Tissue

46
Q

Which finding in the assessment of a patient following an abruption placenta could indicate a major complication?

a. Urine output of 30 mL in 1 hour
b. Blood pressure of 110/60 mm Hg
c. Bleeding at IV insertion site
d. Respiratory rate of 16 breaths per minute

A

c. Bleeding at IV insertion site

47
Q

A laboratory finding indicative of DIC is one that shows

a. decreased fibrinogen.
b. increased platelets.
c. increased hematocrit.
d. decreased thromboplastin time.

A

a. decreased fibrinogen.

48
Q

A patient with polyhydramnios is admitted to a labor-birth-recovery-postpartum (LDRP) suite. Her membranes rupture and the fluid is clear and odorless; however, the fetal heart monitor indicates bradycardia and variable decelerations. Which action should be taken next?

a. Perform Leopold maneuvers.
b. Perform a vaginal examination.
c. Apply warm saline soaks to the vagina.
d. Place the patient in a high Fowler position.

A

b. Perform a vaginal examination.

49
Q

Which factor should alert the nurse to the potential for a prolapsed umbilical cord?

a. Oligohydramnios
b. Pregnancy at 38 weeks of gestation
c. Presenting part at a station of –3
d. Meconium-stained amniotic fluid

A

c. Presenting part at a station of –3

50
Q

Which finding on vaginal examination would be a concern if a spontaneous rupture of the membranes has occurred?

a. Cephalic presentation
b. Left occiput position
c. Dilation 2 cm
d. Presenting part at +3 station

A

d. Presenting part at +3 station

51
Q

What are risk factors of umbilical cord prolapse?

A
  • amniotomy
  • cesarean
  • respiratory distress syndrome
  • asphyxia
  • meconium
  • aspiration
  • PROM/ROM
52
Q

What are adverse effects of terbutaline?

A

Maternal
- tachycardia
- palpitations
- chest pain
- hypokalemia, hyperglycemia
- hypotension
- pulmonary edema
- cardiac arrhythmias

Fetal Complications: Tachycardia

53
Q

What should the nurse tell a mom who is taking terbutaline?

A

warn about tachycardia and palpitations

put on pulse ox

54
Q

Which is the priority nursing assessment for the patient undergoing tocolytic therapy with terbutaline (Brethine)?

a. Intake and output
b. Maternal blood glucose level
c. Internal temperature and odor of amniotic fluid
d. Fetal heart rate, maternal pulse, and blood pressure

A

d. Fetal heart rate, maternal pulse, and blood pressure

55
Q

What are the s/s of mag sulfate toxicity?

A
  • loss of deep tendon reflexes
  • urinary output less than 30 ml/hr or 100 ml/4hr
  • respirations less than 12/min!!!!!
  • pulmonary edema
  • severe hypotension
  • chest pain
56
Q

Which assessment in a patient diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication?

a. Drowsiness
b. Urinary output of 20 mL/hour
c. Normal deep tendon reflexes
d. Respiratory rate of 10 to 12 breaths per minute

A

c. Normal deep tendon reflexes

57
Q

A patient taking magnesium sulfate has a respiratory rate of 10 breaths per minute. In addition to discontinuing the medication, which action should the nurse take?

a. Increase the patient’s IV fluids.
b. Administer calcium gluconate.
c. Vigorously stimulate the patient.
d. Instruct the patient to take deep breaths.

A

b. Administer calcium gluconate.

58
Q

The nurse is monitoring a patient with severe preeclampsia who is on IV magnesium sulfate. Which signs of magnesium toxicity should the nurse monitor for? (Select all that apply.)

a. Cool, clammy skin
b. Altered sensorium
c. Pulse oximeter reading of 95%
d. Respiratory rate of less than 12 breaths per minute
e. Absence of deep tendon reflexes

A

b. Altered sensorium
d. Respiratory rate of less than 12 breaths per minute
e. Absence of deep tendon reflexes

59
Q

What does it mean if the baby is losing weight?

A

dehydration due to not feeding enough

60
Q

Which patient has correctly increased her caloric intake from her recommended pregnancy intake to the amount necessary to sustain breastfeeding in the first 6 postpartum months?

a. From 1800 to 2200 calories per day
b. From 2000 to 2500 calories per day
c. From 2200 to 2530 calories per day
d. From 2500 to 2730 calories per day

A

c. From 2200 to 2530 calories per day

61
Q

How many kilocalories per kilogram (kcal/kg) of body weight does a full-term formula-fed infant need each day?

a. 50 to 75
b. 100 to 110
c. 120 to 140
d. 150 to 200

A

b. 100 to 110

62
Q

A mother conveys concern over the fact that she is not certain if her newborn is receiving enough nutrients from breastfeeding. This is the baby’s first clinic visit after birth. What information can you provide that will help alleviate her fears regarding nutrient status for her newborn?

a. Monitor the infant’s output; as long as at least six or more diapers are changed in a 24-hour period, the baby is receiving sufficient intake.
b. Tell the mother that if a baby is satisfied with feeding, she or he will be content and not fussy.
c. Tell the mother that breast milk contains everything required for the infant and not to worry about nutrition.
d. Provide nutrition information in the form of pamphlets for the mother to take home with her so that she uses them as a point of reference.

A

a. Monitor the infant’s output; as long as at least six or more diapers are changed in a 24-hour period, the baby is receiving sufficient intake.

63
Q

A new mother asks the nurse, “How will I know early signs of hunger in my baby?” The nurse’s best response is which of the following? (Select all that apply.)

a. Crying
b. Rooting
c. Lip smacking
d. Decrease in activity
e. Sucking on the hands

A

b. Rooting
c. Lip smacking
e. Sucking on the hands

64
Q

sucking and rooting reflex

A

stroking the cheek or edge of mouth

Newborn turns head toward the side that it touched and starts to suck

Usually disappears after 3-4 months but can persist up to a year

65
Q

palmar reflex

A

newborn’s fingers curls around persons finger

Birth to 3-4 months

66
Q

plantar reflex

A

newborn curls toes downward

Birth to 8 months

67
Q

moro reflex

A

Scaring baby, baby puts hands up

absent by 6 months

68
Q

tonic neck reflex

A

Fencing position

Birth to 3-4 months

69
Q

babinski reflex

A

Toes will fan upward and out

Birth to 1 year

70
Q

stepping reflex

A

holding the newborn upright with feet touching a flat surface, baby stepping movements.

Birth- 4 weeks

71
Q

Which newborn reflex is elicited by stroking the lateral sole of the infant’s foot from the heel to the ball of the foot?

a. Babinski
b. Stepping
c. Tonic neck
d. Plantar grasp

A

a. Babinski

72
Q

The nurse is conducting a body system assessment of the newborn. Which are abnormal findings that the nurse should report? (Select all that apply.)

a. Low-set ears
b. Yellow sclera
c. A doll’s eye sign
d. Edema of the eyelids
e. Absence of the grasp reflex

A

a. Low-set ears
b. Yellow sclera
e. Absence of the grasp reflex

73
Q

Newborns whose mothers are substance abusers frequently exhibit which of the following behaviors?

a. Hypothermia, decreased muscle tone, and weak sucking reflex
b. Excessive sleep, weak cry, and diminished grasp reflex
c. Circumoral cyanosis, hyperactive Babinski reflex, and constipation
d. Decreased amounts of sleep, hyperactive Moro reflex, and difficulty feeding

A

d. Decreased amounts of sleep, hyperactive Moro reflex, and difficulty feeding

74
Q

When does breast milk come in?

A

3-5 days after delivery

colostrum 1-3 days after

75
Q

A nurse is caring for a client who is postpartum who asks the nurse when her breast milk will “come in”. Which of the following responses should the nurse make?

A. within 2 days
B. 3-5 days
C. 6-8 days
D. in about 10 days

A

B. 3-5 days

76
Q

When do we introduce foods to a baby?

A

6 months

solids: no earlier than 4-6 months

77
Q

Do we want air in the nipple when bottle feeding?

A

NO

78
Q

A new mother wants to be sure that she is meeting her daughters needs while feeding her commercially prepared infant formula. The nurse should evaluate the mothers knowledge about appropriate infant care. The mother meets her childs needs when she:

a. Adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition.
b. Warms the bottles using a microwave oven.
c. Burps her infant during and after the feeding as needed.
d. Refrigerates any leftover formula for the next feeding.

A

c. Burps her infant during and after the feeding as needed.

79
Q

A nurse is caring for a client who is breastfeeding her newborn. The nurse encourages the client to induce burps in her infant to:

a) Help expel air ingested during feeding
b) Reduce respiratory-related disorders
c) Ensure proper digestion of food
d) Reduce gastrointestinal infection

A

a) Help expel air ingested during feeding

80
Q

The postpartum multipara is breastfeeding her new baby. The patient states that she developed mastitis with her first child, and asks if there is something she can do to prevent mastitis this time. The best response of the nurse is:

A. “Massage your breasts on a daily basis, and if you find a hardened area, massage it towards the nipple to unblock that duct.”
B. “Most first-time moms experience mastitis. It is really quite unusual for a woman having her second baby to get it again.”
C. “Apply cold packs to any areas that feel thickened or firm in order to relieve the swelling and stasis of the milk in that area.”
D. “Take your temperature once a day. This will help you to pick up the infection early, before it becomes severe.”

A

A. “Massage your breasts on a daily basis, and if you find a hardened area, massage it towards the nipple to unblock that duct.”

81
Q

When a pt loses blood what are the VS gonna do?

A

HR increase
BP drops
Respirations increase then decrease
O2 sat drops

82
Q

What are late signs of bleeding? What should the nurse do?

A

blood on pads = look at pads

Massage the fundus while assessing bleeding

83
Q

The priority nursing intervention when admitting a pregnant patient who has experienced a bleeding episode in late pregnancy is to

a. monitor uterine contractions.
b. assess fetal heart rate and maternal vital signs.
c. place clean disposable pads to collect any drainage.
d. perform a venipuncture for hemoglobin and hematocrit levels.

A

b. assess fetal heart rate and maternal vital signs.

84
Q

A patient with no prenatal care delivers a healthy male infant via the vaginal route, with minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted. When the patient is questioned, she relates that there is history of heart disease in her family; but, that she has never been treated for hypertension. Blood pressure is treated in the hospital setting and the patient is discharged. The patient returns at her scheduled 6-week checkup and is found to be hypertensive. Which type of hypertension is the patient is exhibiting?

a. Pregnancy-induced hypertension (PIH)
b. Gestational hypertension
c. Preeclampsia superimposed on chronic hypertension d. Undiagnosed chronic hypertension

A

d. Undiagnosed chronic hypertension

85
Q

Early postpartum hemorrhage is defined as a blood loss greater than

a. 500 mL within 24 hours after a vaginal birth.
b. 750 mL within 24 hours after a vaginal birth.
c. 1000 mL within 48 hours after a cesarean birth.
d. 1500 mL within 48 hours after a cesarean birth.

A

b. 750 mL within 24 hours after a vaginal birth.

86
Q

The nurse should expect medical intervention for subinvolution to include

a. oral fluids to 3000 mL/day.
b. intravenous fluid and blood replacement.
c. oxytocin intravenous infusion for 8 hours.
d. oral methylergonovine maleate (Methergine) for 48 hours.

A

d. oral methylergonovine maleate (Methergine) for 48 hours.

87
Q

What should the nurse do if a patient has a low BP reading?

A

assess for bleeding
massage the fundus

88
Q

If a woman’s fundus is soft 30 minutes after birth, the nurse’s first action should be to

a. massage the fundus.
b. take the blood pressure.
c. notify the physician or nurse-midwife.
d. place the woman in Trendelenburg position.

A

a. massage the fundus.

89
Q

What is bright painless red vaginal bleeding?

A

placenta previa

90
Q

If a mom has a low BP and tachycardia, is there an emergency?

A

YES

massive blood loss

do C section to stop bleeding

91
Q

What should be done before a C section?

A

IV access

92
Q

If an NST has a nonreactive strip, what should the nurse do?

A

reposition mom
give mom water, juice, or snack

93
Q

A nurse in a hospital is caring for a client who is at 38 weeks of gestation and has a large amount of painless, bright red vaginal bleeding. The client is placed on a fetal monitor indicating a regular fetal heart rate of 138/min and no uterine contractions. The client’s vital signs are: blood pressure 98/52 mm Hg, heart rate 118/min, respiratory rate 24/min, and temperature 36.4 degrees celsius (97.6 degrees Fahrenheit). Which of the following is the priority nursing action?

A. Insert an indwelling urinary catheter.
B. Initiate IV access.
C. Witness the signature for informed consent for surgery.
D. Prepare the abdominal and perineal areas

A

B. Initiate IV access.

94
Q

Which nursing action should be initiated first when there is evidence of prolapsed cord?

a. Notify the health care provider.
b. Apply a scalp electrode.
c. Prepare the mother for an emergency cesarean birth.
d. Reposition the mother with her hips higher than her head.

A

d. Reposition the mother with her hips higher than her head.

Maternity (6 decks)

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