Sim Lab CTR Cards

Question 1

Vaginal bleeding with or without discomfort

Answer 1

Spontaneous abortion
Placenta previa
Placental abruption
Lesions of the cervix or vagina
Bloody show

Question 2

Swelling of fingers or puffiness of face or around eyes

Answer 2

Excessive edema
Preeclampsia

Question 3

Continuous pounding headache

Answer 3

Chronic HTN
Preeclampsia

Question 4

Visual disturbances (blurred vision, dimness, flashing lights, spots before the eyes)

Answer 4

Worsening preeclampsia

Question 5

Persistent or severe abdominal or epigastric pain

Answer 5

Ectopic pregnancy
Worsening preeclampsia
Placental abruption

Question 6

Chills or fever

Answer 6

Infection

Question 7

Persistent vomiting

Answer 7

Hyperemesis gravidarum

Question 8

Change in frequency or strength of fetal movements

Answer 8

Fetal compromise or death

Question 9

Signs or symptoms of preterm labor

Answer 9

Uterine contractions
Cramps
Constant or irregular low backache
Pelvic pressure
Watery vaginal discharge

Question 10

How short is too short for intervals between contractions?

Answer 10

Should not be shorter than 45-60 seconds

Question 11

What would happen due to maternal hypotension?

Answer 11

May divert blood flow away from the placenta to ensure adequate perfusion to maternal brain and heart

Question 12

What would happen due to maternal hypertension?

Answer 12

May be associated with vasospastic in spiral arteries, which supply the intervillous spaces of the placenta

Question 13

PPH risk factors

Answer 13

Grand multi parity (5 or more)
Over distention of the uterus (large baby, twins, hydramnios)
Precipitous labor (less than 3 hours)
Prolonged labor
Retained placenta
Placenta previa or accrete or placental abruption
Drugs (tocolytics, magnesium sulfate, general anesthesia, prolonged use of oxytocin)
Operative procedures (c/s, vacuum extraction, forceps)

Question 14

Risks for infection

Answer 14

Operative procedures
Multiple cervical examinations
Prolonged labor
Prolonged rupture of membranes
Manual extraction of placenta or retained fragments
Diabetes
Catheterization
Bacterial colonization in lower genital tract

Question 15

Symptoms of a distended bladder

Answer 15

Location of fundus above baseline level
Fundus displaced to side from midline
Excessive lochia
Bladder discomfort
Bulge of bladder above symphasis
Frequent voiding of less than 150 mL (may indicate urinary retention with overflow)

Question 16

Hazards of cold stress in newborn

Answer 16

Increased oxygen need
Decreased surfactant production
Respiratory distress
Hypoglycemia
Metabolic acidosis
Jaundice

Question 17

Signs of inadequate thermoregulation in newborn

Answer 17

Axillary temp <36.3C or > 36.9C (<97.3F or >97.7F)
Poor feeding or feeding intolerance
Irritability followed by lethargy
Weak cry or suck
Decreased muscle toe
Cool skin temperature
Mottled, pale, or acrocyanotic skin
Signs of hypoglycemia
Signs of respiratory difficulty (apnea, retractions, etc)
Poor weight gain, if chronic

Question 18

Symptoms of concealed hemorrhage in placental abruption

Answer 18

Increase in fundal height
Hard, board-like abdomen
High uterine baseline tone on electronic monitoring strip
Persistent abdominal pain
Systemic signs of early hemorrhage (tachycardia, tachypnea, falling BP, falling UOP, restlessness)
Slight or absent vaginal bleeding

Question 19

Symptoms of excessive uterine activity

Answer 19

Contraction duration > 120 seconds
<60 seconds between contractions in first labor stage, <45-50 seconds between in later labor stage
Uterine resting tone firm by palpation
More than 5 contractions in a 10 minute window, averaged over 30 minutes

Question 20

Nursing actions for excessive uterine activity

Answer 20

Position pt on side
Administer IV fluid bolus of at least 500 mL
If tachysystole does not resolve in 10-15 mins, oxytocin infusion should be decreased by half
If still persists after another 10-15 mins, oxytocin infusion should be stopped until uterine activity is normal

Question 21

If a pt is on oxytocin and has abnormal fetal heart rate patterns:

Answer 21

Stop the oxytocin infusion and administer bolus of at least 500 mL
Keep woman side lying to prevent artocaval compression and increase placental blood flow
Consider oxygen administration at 10L/min via nonrebreather face mask until FHR pattern improves
Notify provider and anticipate order for terbutaline if no improvement occurs with other interventions

Question 22

Symptoms of triple I

Answer 22

Maternal fever
Fetal tachycardia
Maternal WBC > 15,000
Purulent fluid emanating from cervix os
Cloudy, yellowish, thick discharge coming from cervical canal

Question 23

Factors that increase risk for prolapsed umbilical cord

Answer 23

Ruptured membranes and:
Fetal presenting part at high station
Fetus that poorly fits the pelvic inlet because of small size or abnormal presentation
Excessive volume of amniotic fluid

Question 24

Symptoms of PPH

Answer 24

Uterus that does not contract or does not remain contracted
Large gush or slow, steady trick of blood from vagina
Saturation of one peripad per 15 min
Severe, unrelieved perineal or rectal pain
Tachycardia