After delivery, progesterone levels fall causing what acid/base change?
Increase pco2
With what disorder would AFP be elevated?
Esophageal atresia, neural tube defects
Women with a history of GDM have increased risk of diabetes at what rate?
Onset within 20 years in 35-60%
Glucose screen is done when?
24-28 weeks
If a mother has Insulin dependent diabetes during pregnancy, what electrolyte imbalance is the neonate at risk for?
Magnesium deficiency
In which trimester is new onset of GHTN most common?
3rd trimester
In a pregnancy complicated by hypertension, what is a sign of deteriorating status?
Increased serum creatinine
What difference can be expected between manual and electronic diastolic BP?
Manual are 5-7 mm HG higher
On admission to L&D , a woman has 2+ reflexes. After IV mag, DTRs are absent. What is your immediate nursing intervention?
Stop mag and notify provider
With no apparent HSV lesions what is the recommendation?
Oral acyclovir 4 weeks prior to delivery
+IgG antibodies in PP period?
The recurrence is unlikely, no further action is required. (IgG chronic, IgM is active)
The most common rheumatic valvular lesion in pregnancy is?
Mitral stenosis
Cardiac defect with most complications in labor?
Mitral stenosis
Methamphetamines are expected to last?
7-24 hrs
What is recommended L/S ratio?
2:1 – lungs are probably mature
3:1 – indicative of maturity
What causes a sinusoidal FHR tracing?
Fetal anemia
What is the parenteral analgesic with most rapid peak effect?
Fentanyl
What neonatal complication is increased with cesarean delivery?
Respiratory morbidity
A woman who has a c/s is more likely to be re-hospitalized with what pp complication?
Wound infection
During the postpartum period, low levels of placental lactogen, estrogen, cortisol, growth hormone and insulinase result in?
Lower glucose levels
Due to the catabolic process of involution postpartum, which lab value is expected to be elevated postpartum?
BUN
Avg weight loss with delivery?
12 lbs
Where would you expect to palpate fundus 24h pp?
1cm below umbilicus
What is the term for lochia appearing 3-10 days pp and pink or brown in colora
Lochia serosa
The process of involution that allows for healing of the placental site preventing scarring is?
Exfoliation
True or false 2500cc urine 2 days pp is a normal physiologic response to delivery
True
If pp woman’s fundus is deviated from midline first RN intervention is?
Empty bladder
Why is UTI common in 1st few weeks pp?
Dilated ureters and renal pelvis
By which pp day has circulating blood volume diminished secondary to diuresis, returning to prepregnancy volume?
Day 5
What intervention can increase physiological jaundice?
Delayed cord clamping
A woman is 12 days pp and has WBC of 25,000. This indicates?
Expected range
What is the antidote for Coumadin?
Vitamin k
What is antidote to MAg?
Calcium glucinate
What med for malignant hyperthermia?
Dantrolene sodium
Uterotonic med contraindicated for elevated BP?
Methergine
Following delivery, insulin requirements I’d diabetic woman….
Decrease rapidly
Rhinitis and nasal stuffiness increase in pregnancy are due to?
Estrogen
A newly delivered postpartum woman received terbutaline and corticosteroids during labor is at risk for what potential drug interaction?
Hyperglycemia
Antidote for heparin?
Protamine sulfate
Two IV anti hypertensives that may be used to treat severe maternal hypertension?
Hydralazine, labatelol
Severe BP values
Over 160 sbp or over 110 dbp
Another name for hydralazine?
Apresoline
Another name for labatelol?
Trandate, normodyne
At 12 hrs pp a breastfeeding mom is 180/114, what does the RN anticipate the provider will order?
Labatelol
A common side effect of pitocin is?
Anti diuretic effect/water intoxication
CDC requirement for a TDAP for a pt who had tetanus shot two years ago?
Administer prior to d/c. All pts should have booster in pregnancy
Pp woman has order for rubella vaccine and Rh immune globulin. The nurse knows they should be given?
At the same time
Unsensitized Rh- mom whose baby is Rh+ should?
Receive 300 mcg of rhogham within 72hrs of delivery
A pp woman has large hemorrhoid. She may be instructed to?
Gently attempt to push back into rectum
After birth pains usually last?
2-3 days
A woman readmitted for wound infection shows signs of sleep disturbance, irritability, agitation and confusion. The nurse suspects?
Post partum psychosis
What is the chance of pregnancy when using the lactational amenorrhea method (LAM) at 12 months?
Can approach 7%
Woman wants to use breastfeeding as a contraceptive. The best response is?
What have you heard or read about this method?
When teaching a pt about the use of the sponge, the pt should be advised to leave in place for how many hours following intercourse?
6 hours
The hormone responsible for stimulation of the alveolar cells to produce milk?
Prolactin
The lactation initiation stage is dependent on?
A cascade of hormones
Compared to term breast milk, preterm breast milk is composed of?
Higher protein content
In comparison to mature breast milk, the relative content of transitional breast milk has?
Increased protein content
Immunoglobulin secreted in breast milk is
IgA
Not getting recommended 2500-2700 kcal per day while breastfeeding can lead to?
Decreased milk production
Minimum number of kcal for breastfeeding woman is?
1800 kcal
A 36 hr old BF infant has nursed 8 times in the last 24hrs on one breast per feeding. The infant has had 2 wet diapers and 2 moderate sized green BM. The baby has rhythmic suck with audible swallow during feeds. This baby is?
Eating well and as expected for this age
It is important to breastfeed at night in the early weeks when lactation is being established because?
Prolactin levels are highest at night
Most common reason fore sore nipples when breastfeeding?
Improper latch
A pt reports sore nipples. The nurse knows that the characteristics of the pain will help to?
Identify the cause
A pp woman who is breastfeeding delivered 48 hours ago and is reporting breast engorgement. The cause of this engorgement is?
Vascular changes
Pp breastfeeding mom states baby is not satisfied after feeding. States the baby nurses 15 min on each breast then screams. Appropriate intervention?
Observe the baby at the breast during feeding
A nursing mom needs an antihypertensive. A good choice is?
Nifedipine
A woman on methadone wants to breastfeed. She should be advised that?
Supervised methadone is considered safe
The type of neonatal jaundice caused by inadequate breast milk intake is?
Breastfeeding jaundice
Extracellular fluid as % of body weight for a term neonate is?
A approx 40%
Soy based formula is recommended for infants who have?
Galactosemia
Which of the following may indicate a delay in bonding?
When baby is fussy, mom sends to nursery
The phase of maternal adjustment that typically starts on the 2nd or 3rd day pp where the mother focuses on care of the baby and resumes control of her body is?
Taking hold
Lasts about ten days
Mothering tasks take priority
Emphasis on present
Impatient and drive. To organize self
Teach baby care
The phase of maternal adjustment for the first day or two after birth. Mothers need rest and “mothering”.
Taking in
Primary concern is own needs, sleep and food. Talkative about birth experience. Perceptive, passive, teach self care
The phase of maternal adjustment in which couples try to return to pre baby relationship and siblings get to know baby
Letting go
Must accept baby as separate person
Establish new norms for family
A nurse makes a home visit to pt who is overwhelmed from nursing baby all the time. Physical assessment of mom and baby are normal. The nurse knows this a manifestation of?
Postpartum blues
Maternal role attainment?
Occurs within 3-10 months following birth
A fathers reaction to stress
Is just as important as the mothers reaction
Resources for adoptive vs biological parents are?
Less available
Which of the following is true for a mother following the loss of one infant of a multiple birth?
There is usually less support for grieving parents because the frequent response is they should be thankful for the survival of the living child
A supportive intervention for the parents of a dying infant is?
Offer to stay with family until asked to leave
The grief response associated with permanent, progressive, recurring and cyclic loss is?
Chronic sorrow
When speaking to parents about impending neonatal death, the most appropriate term to use is?
Natural death
A pp pt is diagnosed with sheehans syndrome. This is caused by?
Pituitary necrosis. Damage is from lack of oxygenation caused by massive blood loss and severe low BP during or after birth. Causes permanent hypopituitarism, sometimes called “postpartum hypopituitarism”. Rare in industrialized nations
Clinical signs of hemorrhage such as BP 90/70, pulse 118, and tachypnea can be seen when blood loss reaches
1500ml
1 hour after delivery of fetal demise, pt becomes tachypnecic, cold, and begins to lose consciousness. Labs are crit 28, fibrinogen 350, plt 75,000. What is the most likely issue?
Hemorrhage
Obstetric hemorrhage is defined by what parameter?
Hemodynamic status of the patient
G5 with large newborn for GA is likely to have what complication
Hemorrhage
48 hrs post c/s, RN notes pt left calf and foot are cool and pale. Left pedal pulse is diminished and there is a decrease in capillary refill. Homans sign is neg bilaterally. Pt reports l leg tenderness. Most important initial intervention is?
Place pt on bed rest and elevate left leg
Pt diagnosed with pp infection denies pain but seems confused, agitated. VS T 99.9, BP 98/50, p 125. Urine output is decreased. Most likely diagnosis?
Septic shock
Most persistent fevers after childbirth are caused by?
Genital tract infections
4 hrs pp, pt reports severe vulvar pain and severe rectal pressure. Most likely symptoms for?
Vulvar hematoma
What kind of follow up for pt with GDM?
Will test blood sugars at 6 weeks then q 3 years from delivery
Pp psychosis generally presents by what time frame?
Within 2 weeks from delivery
Pp pt c/o HA and heartburn. She has not voided in 4 hrs. Bladder scan shows empty bladder. RN is concerned about?
Preeclampsia
Following c/s for abruption a clot observation test is initiated. Placing a small amt of blood in a test tube for 30 min yields a soft clot that dissolves easily. This is consistent with?
Hypofibrinogenemia
A pt is 24hr pp, BP 100/60, T 99. Lochia has steady flow of red bleeding since delivery without odor or pain. RN should consider?
Pp hemorrhage
What are the characteristics of a dizygotic pregnancy?
2 placentas, 2 chorions, 2 sacs
Assigning a ten min apgar is done when?
When 5 min < 7
To differentiate peripheral from acrocyanosis in a 2 hr old neonate, the best action to initiate is?
Warm infant and observe for improvement in color
Serum glucose levels fluctuate for how many hours following birth?
2
Increased perfusion of the newborns liver is initiated by closure of the?
Ductus venosus
36 week infant apgars 8/8 and appears to be physiologically stable. RN notes infant has assumed a fetal tuck position, yawns and engages in finger splays. These are signs of?
Stress
The RN auscultates lung sounds on one hour old newborn after nsvd. Moist sounds are heard on auscultation. This is a?
Normal finding, fluid will absorb naturally
At birth the most potent stimulus for closure of the patent ductus arteriosis is?
PO2
In the fetus, patentcy of the ductus arteriosis is maintained by?
Low oxygen tension and prostaglandin E
When resuscitating a neonate with suspected diaphragmatic hernia, the most appropriate intervention is?
Insertion of an endotracheal tube should be done as quickly as possible to prevent gas from entering the intestines
During neonatal resuscitation finger placement using the two thumb method for external cardiac compression should be where?
On the lower 3rd of the sternum
How should a baby with mec staining who is responsive be managed?
No suction if baby is active and does not require resuscitation
A neutral thermal environment helps support basic physiologic function and growth in the neonate by?
Conserving metabolic activity
The process that triggers the metabolism of brown fat in the neonate occurs for what purpose?
Thermoregulation
The initial process a newborn uses to regulate heat is?
Non shivering thermogenesis
A newborn with hypothermia should be assessed for?
Metabolic acidosis
When performing a GA assessment the RN should recognize that a finding that correlates with advancing GA is?
Resistance with scarf sign maneuver
During GA assessment a 90degree square window sign is consistent with?
Preterm
Assessment of newborn GA should be done?
Within 4 hrs of birth
In assessing reflexes of a term infant, the nurse lifts the newborn slightly from the bed and slow.y lowers the baby back to the surface. What is the expected response?
Fingers for a C and arms returning to chest as if in embrace – Moro reflex
The most distinct characteristic of active sleep state in the neonate is?
Rapid eye movement
The finding of a 3rd fontanelle along the sagittal suture suggests?
Congenital anomaly (downs)
In the assessment of the BP of the newborn which of the following is true regarding upper and lower extremities?
A slight difference is normal
If a neonate has CHF, the nurse should recognize that this is a manifestation of?
Underlying disease
Infants with hr <90 or > 200 should be first evaluated with?
Electrocardiogram
Gases ph 7.29, p02 22mmhg, pCO2 47, base excess -4
Normal values
Decrease in 02 concentration that is responsible for the initiation of newborn respirations occurs in the?
Brain
A normal breathing pattern in a 2 hour old neonate may include?
Episodic breathing
Which of the following diagnoses is a result of delayed reabsorption of fetal lung fluid production?
Transient tachypnea of the newborn
A newborn is noted to have cyanosis when quiet but is pink when crying. The most likely diagnosis is?
Choanal atresia
On physical exam of the newborn abdomen a normal finding is?
Lower edge is palpated up to 2.5 cm below the right costal margin in the midclavicular line
A preterm pts at 30 weeks received indocin. Her baby should be observed for?
Necrotizing enterocolitis
If a newborn is born with a port wine stain the RN should watch for problems involving what system?
Neurologic
A new mother asks about a mark that looks like a bruise. Physical exam reveals large gray non blanching macules over buttocks. This is most likely?
Mongolian spot
In a 32 week neonate expected muscle development would include?
A good grasp reflex
To assess the fontanelles a newborn should be in what position?
Sitting
What is craniotabes?
Finding of softening or thinning of the skull. Can be normal esp preterm but may be first sign of rickets/ vit d deficiency
Craniotabes is typically found in what region of the skull?
Parietal and occipital
The primary mechanism of action of glucagon when given for tx of hypoglycemia is?
Stimulation of glycogen release from the liver
A neonate has scrotal swelling which is soft, nontender and transilluminates and there are no palpable masses. The the most likely diagnosis?
Hydrocele
After delivery, a newborn exhibits flaccidity of both the lower arm and hand. The birth was complicated by shoulder dystocia and subsequent forceps. The expected diagnosis?
Klumpkes paralysis
Breastfeeding mom asks when iron supplements should be given to her baby?
Adequate in breastfeeding until about 6 months of age
Hygiene care of the uncircumcised neonate?
Avoid retraction of the foreskin until separation naturally occurs
AAP recommends supplementation of 400IU of vitamin D/day for breastfed and partially breastfed infants.
Within a few days of birth
PP d/c instructions given to mother whose newborn received Hep B at birth include flu vaccines to be given at what age?
2&4 months
Neonate born to a mom with HBsAg+ should have?
Hep B immunoglobulin and Heb B vaccine within 12 hours of birth
A few hours after administering eye prophylaxis to the newborn, The nurse notes edema and a greenish yellow discharge. This reaction is due to?
Silver nitrate
1 day old neonate demonstrates temp. Instability, lethargy, and poor muscle tone. Sepsis is suspected. The nurse anticipates that prophylactic antibiotics prescribed is?
Ampicillin and gentamicin
Natal teeth are often seen in?
Native population
A newborn is diagnosed with cyanotic heart disease. This would indicate which of the following?
Epsteins anomaly
The most appropriate diagnostic procedure to confirm a pneumothorax is?
X-ray
A mother calls the mother baby unit 2 weeks following delivery and reports that her baby is crying inconsolably for periods of 1-2 hours. Otherwise the baby is healthy and eating well. The nurse should explain that if the baby has colic, it is?
Generally resolved with continued behavior
After delivery, a term neonate begins gagging on secretions and has episodes of vomitting. An orogastric tube is passed and 30ml of gastric aspirated is obtained. The maternal hx is likely to include?
Polyhydramnios
At birth the newborn is noted have absent breath sounds on the left with heart sounds shifted to the right, the abdomen is noted to be scaphoid and ventilation is difficult. The most likely diagnosis?
Diaphragmatic hernia
The delivery record of a newborn pt reports hydramnios in the 3rd trimester. The newborn should be closely assessed for anomalies of the?
Intestinine
When the nurse examines the umbilical cord of a newborn, she notes an umbilical cord hernia. This is more commonly seen in ethnic populations?
African Americans
Pts whose neonate in pavlik harness (for hip dysplasia) should be taught at discharge that the harness?
Should not exceed 1 hour per day
Non-symmetrical crease over the back of the thigh. The Barlow maneuver is performed to?
Detect a dislocated hip
Diagnostic study used to r/o brachial plexus injury in the neonate is?
U/s
Which clinical event can increase the neutrophil count?
Prolonged crying
A hematological change in pregnancy that predisposes a pt to venous thrombosis is i
Hypercoagulability
A physiologic change that predisposes pregnant women to venous thrombosis is
Venous stasis
A pregnant woman with New York heart association NYHA class II cardiac disease is symptomatic with
Mild exertion
A newborn of an insulin defendant mother is at risk for?
Polycythemia
Generalized petechiae could be a sign of?
Clotting disorder
Physiologic jaundice is d/t a combination of increased bilirubin load to the liver and?
Decreased excretion of bilirubin
A neonate at 36 weeks weighing 3000 grams is at risk for?
Jaundice
The appropriate management of a breastfeeding newborn with physiologic jaundice is?
Frequent effective breastfeeding
A woman and her infant are being d/c’d 12 hrs after birth. Metabolic screening for PKU was done at 6 hours of age on d/c the nurse should advise that the 2nd screening be obtained?
Within 1-2 weeks
A newborn born to a mom who is an insulin controlled diabetic, a common malformation that the newborn should be evaluated for is?
Cardiomegaly
GBS+, what other organisms are currently the most common pathogens seen in neonatal sepsis?
E. Coli
Which of the following tests would be appropriate for a newborn whose mom has HIV?
DNA and polymerase chain reaction test 48 hours of age
Congenital varicella syndrome is characterized by?
Early death
In the newborn a tense fontanelle is a?
Late meningitis
A woman diagnosed with chlamydia delivers a newborn who is treated with erythromycin ointment. The woman should be advised to watch for what symptoms once they are home?
Persistent cough, rales and wheezes
Informed consent rests on the assumption of competence and?
Capacity
The foundation for nursing education, practice and documentation is?
Nursing process
The means of insuring enforcement of the nursing practice act is through the?
State board of nursing
Most medical and nursing errors occur because of?
Non-adherence system failures
Validity as applied to a research instrument demonstrates?
Degree to which the instrument measures what it was purported to measure
Parasympathetic vs sympathetic work together to regulate variability
Pokey slow = p, s= stimulus
When the sympathetic nervous system is dominant, fetal variability….
Decreases
Cord compression can cause accelerate true or false
True
Overshoot/shoulder
No longer a term. Cause by umbilical vein compression
Cerebral blood flow interruption causes
Early decal think head compression Vagal response
As fetus matures which branch of the nervous system has more influence over FHR variability
Parasympathetic takes over after 32 weeks
Max 24 hour IV dose labetelol
220
Hyperventilation is caused by what hormone?
Progesterone
Fetal attitude
Relation of fetal parts to each other – I.e. Flexed or not flexed
Leopolds 1 st manueveur
Presentation
FLM using lamellalar body count
30,000-50,000 = mature
Nitrazine
Blue 7.1 rupture
7.5 blood or mucus
Burr cells
Hemolysis on smear = HELLP
Gaskin manueveur
All 4’s for shoulder
Normally during pregnancy, maternal sitting and standing blood pressure readings
Decrease, then increase
What happens to maternal PaO2 and PaCO2 during pregnancy?
PaO2 increases and PaCO2 decreases
The slight increase in pH that occurs during pregnancy is due to
An increase in ventilatory rate
During pregnancy, serum urea and creatinine levels
Decrease
During pregnancy cardiac out put increases approx
30-50%
By term blood flow to the uterus is approximately
500ml/min
Metabolic changes in pregnancy are
Anabolic -1st half, catabolic 2nd half
The primary determinant of volume hemostasis
Renal sodium
Increased absorption of calcium is due to increased
Vitamin D (or calciferol)
Placental production of this hormone requires interaction of the mother, fetus and placenta
Estriol
The 5 diabetogenic hormones of pregnancy
Prolactin, estrogen, progesterone, human placental lactogen, cortisol
Congenital cardiac disease occurs in what approximate percentage of live births?
0.8%
Mitral and aortic stenosis are examples of cardiac diseases caused by
Rheumatic fever
During pregnancy, predicted values of peak expiratory flow rates are
Unchanged
During a asthma exacerbation there is
Increased peripheral vascular resistance
A complication seen in up to 26% of women with varicella pneumonia in the first 20weeks of gestation is
Intrauterine infection
The prenatal diagnostic screening test most accurate in multiple gestations is
Nuchal translucency
Multiple congenital anomalies have been associated with maternal obesity such as
Cleft lip and palate
Fetal programming refers to
Process in which an in utero stimulus establishes a permanent fetal response that can lead to increased susceptibility to disease throughout life
Uterine crontactility may be what in overweight and obese women
Decreased
Extremely obese women have a what % higher risk of stillbirth than a woman of normal weight
40%
The normal length of the pre gravid cervix is
3.5 to 4 cm
Bishop score evaluates
Dilation
Effacement
Station
Consistency
Position
Oxygen is transferred from mother to fetus by
Passive diffusion
Most fetal dysthymias are benign. The exception is which dysthymia that may lead to fetal congestive heart failure?
Supraventricular tachycardia
The greatest complication of tocolytic therapy for women with multiple gestations is
Pulmonary edema
Pain in 1st stage of labor is caused by
Cervical and lower uterine segment stretching and traction on ovaries, Fallopian tubes and uterine ligaments
The release of maternal catecholamines during labor results in
Uterine hypoperfusion and decreased blood flow to the placenta
Baroreceptors mediate what kind of decel
Variable
Normal metabolic changes during the postpartum period include increased levels of
Plasma renin and angiotensin II
Peak cardiac output at birth occurs at
10 to 15 minutes
Intrauterine infection should be suspected when newborn has elevated
IgM
Maternal transmission of which antibodies protects the newborn from bacterial and viral infections for which the mother has already produced antibodies
IgG
Non shivering thermogenesis generates heat In the newborn through
Brown fat
Tears are normally absent in a baby until
4 to 6 months
Newborn femoral pulses should characteristically be decreased or absent in
Hip dysplasia
A persistent newborn heart rate of less than 100 is consistent with
Congenital Heart block
In the neonate blood pressure in the lower extremities is usually
Higher than in the upper extremities
To measure fontanelles accurately a ruler or measuring tape is placed
Diagonally Bone to bone
Bowel sounds are expected to be present in the newborn
After passage of the first meconium stool
The most common abnormal neck finding in newborns
Cystic hygroma
Popping sensations (similar to indenting a ping pong ball) felt when palpating the parietal or occipital bones of the newborn are called
Craniotabes
The anterior fontanelle normally closes at
18 months
The posterior fontanelle normally closes at about
2 to 4 months
Apnea refers to pauses in respiration that last
20 seconds or longer
Newborns cam clearly see an object that is
8 to 10 inches away
What is phimosis
The inability to completely retract the foreskin of the penis
An asymmetric neck deformity in which the head is noted to be pulled toward the affected side, with the chin pointing towards the opposite shoulder, due to injury to the sternocleidomastoid
Torticollis
What causes acrocyanosis
Vasomotor instabilty – worsens if chilled
The onset of milk production in a postpartum woman is triggered by
Sudden decrease in progesterone
The hormone responsible for milk ejection
Oxytocin
In order to prevent damage to the fetus, syphyllis should be treated by…
16-18 weeks gestation
The ischial tuberosity diameter considered adequate for delivery of the fetal head is
11 cm
Distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis
Diagonal conjugate – should be more than 12.5 cm
Distance between the anterior surface of the sacral prominence and the posterior surface of the inferior margin of the symphysis pubis
True conjugate – 10.5-11cm
How much weight should a pregnant pt with twins or triplets gain
25-35 lbs
Damage to brachial plexus (c5-c7)
Erb palsy
Before compressing the uterus to expel clots it is essential to:
Make sure uterus is contracted . Applying external pressure on a non contracted uterus may result in uterine inversion
Newborn polycythemia
Hematocrit over 65%. Occurs in response to hypoxia or intrauterine transfusion. Risk factors include preeclampsia, post dates, poorly controlled GDM, twin to twin transfusion, delayed umbilical cord clamping, chromosomal disorders
One factor that predisposes an epileptic woman to seizures during pregnancy
Sleep deprivation
Long term inhaled corticosteroid therapy to treat asthma has been implicated in increased incidence of
Preeclampsia
A 24 yr old Caucasian woman at 28 weeks gestation presents for regular prenatal visit. According to the American diabetes association, what is the appropriate screening for gestational diabetes?
No need for testing
What is the most common maternal congenital cardiac lesion with a left-to-right shunt that is detected during pregnancy?
Mitral stenosis
During pregnancy which of the following cardiovascular parameters decreases by at least 20%
Systemic vascular resistance
A pt has been moved to the surgery suite for a cesarean birth. There is an internal fetal scalp electrode in place. This should be removed when the
Abdominal prep is initiated
Ultrasound for antepartum testing uses high frequency sound waves to produce an image that varies based on
Density of the structure under the transducer
A fetus at 36 weeks receives a BPP score of 6. The amniotic fluid was scored as normal. The expected management is
Repeat the test in 24 hours
A woman at 37 weeks with no risk factors and no complications to date. She calls because she thinks the baby is not moving as much as previously. She should be instructed to
Come in for evaluation
Which FHR pattern characteristic determines fetal oxygen reserve?
Presence of variability
With an fse with artifact, what nursing intervention is appropriate?
Auscultate to r/o arrhythmia
Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor?
Early decel
Vagal stimulation would be manifested as what type of FHR pattern?
Early
A risk of aminofusion is
Uterine overdistension
A fetal hr pattern that can occur with a prolapsed cord is?
Prolonged
Palpating the uterus is best performed by using the
Fingertips
At a prenatal visit, a woman’s uterus is palpated at the xiphoid process. This would normally be found at how many weeks gestation?
36
In evaluating a cord blood gas, if the ph is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic?
HCO3
For what gestational ages would you test FFN?
22-35
In post term preg, the most important u/s parameter is
AFI
One theory of labor initiation is an increase in?
Progesterone
A pt had an unsuccessful external cephalic version. How soon can this be repeated?
7 days if <37 weeks, reactive tracing, adequate fluid
During the bearing down phase of 2nd stage labor , the nurse should help facilitate the woman’s perineum to stretch by?
No action
An episiotomy is selectively used for?
Abnormal FHR pattern
Compared to a mediolateral episiotomy, a midline episiotomy results in?
Less blood loss
A newborn is at higher risk of jaundice when?
Delivery is assisted by vacuum extraction
When a vacuum procedure is unsuccessful the max number of attempts or pop offs recommended before declaring the procedure unsuccessful is?
3 in 20 minutes
The risk of water intoxication is decreased during induction of labor if oxytocin is given in a
Balanced electrolyte solution
The mechanism of action of sterile water injections for labor pain
Gate control theory
Discontinuing an epidural when a woman has the urge to push may
Lead to dysfunctional uterine activity
A characteristic of velementous cord insertion is
Lack of whartons jelly
What type of breech has the highest risk of cord prolapse
Footling
A 36 weeks woman needs cpr for cardiac arrest. Recommended action to facilitate cardiac output during resuscitation is
Uterine displacement
A placental condition that occurs when the fetal vessels course through the amniotic membranes and are present at the cervical os is
Vasa previa
When 2nd stage labor lasts longer than 2 hours with normal FHR current recommendations are to
Continue to watch if there is evidence of descent
One absolute contraindication to epidural anesthesia is
Coagulapathy
A woman with hydramnios is experiencing abdominal pain and dyspnea. Treatment with indomethacin will
Decrease fetal urine production
Research has shown that administration of IV fluids during preterm labor
Increases risks when combined with tocolytics
A clinical sign of plancental abruption is
Pain with ctx not congruent with ctx intensity
A pt with previa is scheduled for c/s. The RN can anticipate what kind of incision
Low segment vertical
Treating the preterm pt with bed rest increases
Glucose intolerance
FDA warns against oral or injectible terbutaline longer than 72 hrs due to
Cardiac complications and death
While the exact mechanism of action is not fully known, mag sulfate inhibits smooth muscle contractions by direct effect on myometrial
Calcium activity
Neurological injury in a twin who survives the IUFD of the co-twin is most likely due to
Significant hypotension at the time of the demise
The interactive process of the father with the newborn is termed
Engrossment
Maternal contraindication to breastfeeding
HIV,
Is infected with human T-cell lymphotropic virus type I or type II
Active untreated tuberculosis
Current AWHONN recommendation for umbilical cord cleaning are initially
Sterile water, then plain water
What neonatal complication is reduced with vaginal delivery
Respiratory morbidity
A woman with hx of anencephaly should be advised to supplement her diet with foods high in folate along with what dose of folic acid
4.0 mg
2nd Leopold
Palpate fetal back
3rd Leopold
Determine if engaged
4th Leopold
Fetal descent and fetal attitude
1st Leopold manuever
To determine presenting part at the fund us
Respiratory acidosis
Results from a build up of CO2 in the blood by lungs retaining
Main cause of respiratory acidosis
Apnea, poor ventilation
In respiratory acidosis
CO2 is increased, bicarbonate (HCO3-)is either normal (uncompensated) or increased (compensated)
Respiratory alkalosis is
Hyperventilation is the main cause,resulting in a loss of CO2
Metabolic acidosis
Increased production of H+ by the body or increased excretion of bicarb by the kidney
Metabolic acidosis main causes
Hypoxia, lactic acidosis, ketoacidosis, and chronic renal failure
Labs in metabolic acidosis
PH is low, bicarb is decreased, CO 2 decreased, O2 increased
In metabolic acidosis,
Due to respiratory compensation (hyperventilation)’, Co2 decreased, O2 increased
In metabolic alkalosis
Kidneys retain HC03, causes dehydration, labor, disease
The pt in triage is diagnosed with PTL the RN should expect the physician will order?
A) betamethasone 12mg, IM
B) discharge with orders for off work
C) mgsulfate IV and pro cardio PO
Betamethasone 12mg IM
The new pt in triage is a 32 week 18yo G3P0110 African American woman. She presents with complaints of intermittent lower back pain. You are awaiting the FFN results. What other hx factors may be contributory?
A. Further obstetrical hx details
B. Non gynecologic surgery hx
c. 6 week u/s result from the ER
Further obstetrical history details
The tocolytic that is contraindicated in the diabetic woman is
A. Mag sulfate
B. Nifedipine
C. Terbutaline (beta-mimetic)
Terbutaline (beta-MIMETICS)
A woman received mag sulfate during labor GHTN. What effect can this have on the newborn?
Muscle weakness
Prenatal hx shows a quad screen with a maternal serum alpha protein (MSAFP) lower than normal and higher than normal HCG and inhibin A. The nurse can expect what diagnosis of the newborn?
Trisomy 21
What is associated with elevated maternal serum alpha protein?
Neural tube defects
Subsequent to a massive hemorrhage after delivery of a macerated fetus, a woman appears to stabilize. Suddenly a 1hr postpartum, her respirations become shallow and rapid. She states she feels cold and begins to lose consciousness. Lab tests are: Hct 34, fibrinogen 350, plt 125,000. The most appropriate management includes
Blood products
Pt diagnosed with a pp infection states she has no pain. She seems confused and agitated. 98/50, pulse 125, and output is decreased
Septic shock
A postpartum pt is diagnosed with sheehans syndrome which is caused by
Postpartum necrosis
A woman 4 hours postpartum reports sudden, excruciating vulvar pain and severe rectal pressure. This pt is likely exhibiting symptoms of
Vulvar hematoma
Functional closure of the ductus arteriosis occurs as a result of
Increased arterial oxygen tension
A woman with hydramnios is experiencing abdominal pain and dyspnea. Treatment with indomethacin will
Decrease fetal urine production
A pregnant woman on a continuous mag sulfate infusion for preeclampsia exhibits the following: rr 14, decreased deep tendon reflexes clonus absent
Maintain the infusion rate
A woman with a BMI of 18 gains 25 pounds during her pregnancy. The pregnancy is at increased risk for
Low birthweight infant
Within the first two days after birth, progesterone levels fall causing what acid base change
Increased PaCO2 and low ph
What acid base change is normal in pregnancy?
Slight alkalosis, elevated ph due to decrease PaCO2
Compared to the value seen in the 3rd trimester, the catabolic process of involution causes an increase in which of the following values postpartum?
BUN
The cause of sudden late onset postpartum hemorrhage secondary to retained placental fragments is due to
Necrotic tissue separation from the uterus
The insulin requirement for most breastfeeding women is
Decreased
You are caring for a new mother in the recovery room who delivered by c/s at 35weeks. She has a personal history of Tetraology of Fallot. Your nursing care
Vital signs including lung sounds and assessment of pedal edema
What % of women with gestation Htn will develop proteinuria
25%
In the absence of proteinuria, preeclampsia can be diagnosed with new onset of any of the following:
Plt < 100,00, serum creatinine > 1.1 or doubling of serum creating conc. In absence of other renal disease, elevated liver enzymes to 2x normal
Severe pre-e = any ONE of the following > 20 weeks
BP 160 or 110 at least 4 hrs apart while on bed rest, plt < 100,000, 2x normal liver functions or severe ft upper quad or epigastric pain unresponsive to meds and not accountable to alt diagnoses or both, creatinine greater than 1.1 or double normal, pulmonary edema, new onset cerebral or visual disturbances
Superimposed pre-e
Must have prior diagnoses of CHTN or before 20 weeks
Superimposed pre-e diagnosed when
New onset proteinuria after 20wks, sudden change in proteinuria, sudden change in BP requiring dose inc, change in symptoms, inc ALT, AST, plt <100,000, rt upper quad pain, severe ha, pulmonary congestion or edema, renal insuff (creatinine 1.1 or double)
Eclampsia
New onset grand mal sx in pt with pre-e
HELLP
Hemolysis – abnormal peripheral smear (shistocytes, burr cells), LDH > 600, total bilirubin >= 1.2, elevated liver enzymes, serum asparate amniotransferase>70, low pots< 150,000
Secondary causes of hypertension
Cortisol, pituitary tumor, glucocorticoid meds, sleep apnea, meth/cocaine, renal artery stenosis
Path physiology of Htn
Starts early in placental development with incomplete trophoblastic invasion into maternal spiral arteries that perfume the placenta. Results in tortuous vessels, high resistance, I paired p,acetal functioning and decreased placental perfusion
Pathophysiology of tachysystole
Constriction of spiral arterioles and decreased blood flow in the intervillous space, risk for fetal hypoxemia and metabolic acidemia
Acidosis
Increase in hydrogen ions in tissue
Metabolic acidosis
Low bicarb (base excess) in the presence of normal (PCO2)
Respiratory acidosis
High pco2 with normal bicarb
Asphyxia
Hypoxia with metabolic acidosis
Cord ph – arteries
From fetus – deoxygenated
Cord ph – vein
To fetus oxygenated
FHR tones of baby in ROP position best assessed over
Right lower quad
Crettas
Think alphabet in order of badness
Doppler flow – rising s/d ratios
Reflect blood flow resistance to placenta, demonstrates dismissed vessel flow volume
What is autotransfusion?
Increased cardiac output due to 300-500 ml blood back into circulation with each contraction
What causes heartburn during pregnancy?
Relaxation of the lower esophageal sphincter
what is a normal wbc after labor?
20-22
when is the glucose screen done?
26-28 weeks
Onset of GHTN is most commonly seen in which trimester?
3rd
On admission to L& D a pt inquires if her history of Herpes Simplex VIrus will prevent a vaginal delivery. THe nurse knows that even without any apparent lesions, the recommendation is to?
Take oral acyclovir for weeks prior to delivery
Most rapid peak effect parenteral analgesic?
fentanyl
Guidance for ethical nursing care is provided by the
ANA code of ethics for nurses
Disruptive clinician behavior is often linked to
clinical practice issues
professional nursing liability is most commonly increased by the absence of
adequate record documentation
culturally American Indians are at high risk for
increased alcoholism, heart disease, cirrhosis of the liver, DM
Korean culture
Mother in law cares for the mother and newborn post partum
What are some strategies to increase cultural competence?
-enhance communication skills
-determine the family decision makers
-non-verbal commuication
-culturally appropriate teaching
The areas of clinical practice that are most commonly involved in perinatal pt harm are
-fetal assessment
-labor induction
-second stage labor management
essential criteria for safe care include:
effective leadership, shared philosophy, professional behavior, excellence in key clinical practices
An African American/black woman who believes she should not swallow her saliva and carries a spit cup with her during pregnancy is most likely from
Haiti
during labor maternal cardiac output
increases progressively
during labor/delivery when is cardiac output greatest
immediately after birth
By term, blood flow to the uterus is approximately
500 ml/min
The hormone released from the anterior pituitary that is responsible for initiating lactation is
prolactin
The hormones responsible for maintaining progesterone and estrogen production by the ovaries until the placenta is established is
HCG
what hormone produces relaxation of smooth muscle and vasodilaton?
progesterone
The pregnant woman is at increased risk for venous thrombosis formation due to
coagulation changes and venous stasis
Potent vasodilators that affect smooth muscle contractility and play an important role in labor onset
prostaglandins
After the initial screening for gc/chlamydia when should this test be repeated
at 36 weeks
5 parts of a BPP
-AFI
-NST
-fetal tone
-fetal breathing
-fetal reflex movement
maternal morbidity from hypertension in pregancy results from
-abruptio placentae
-DIC
-hepatic failure
-acute renal failure
the risk of uterine inversion is increased with
traction applied to the cord
vesa previa is a result of the
velamentous insertion of the cord
active management of the third stage of labor includes
-administering pit with delivery of the anterior shoulder
-clamping/cutting the umbilical cord by 2-3 minutes of birth
-controlling traction of the umblical cord with the provider’s hand supporting the uterus
-performing vigorous fundal massage for at least 15 seconds
5 diabetogeic hormones of pregnancy
-prolactin
-estrogen
-progesterone
-human placental lactogen
-cortisol
Maternal outcomes in pregnancies of women with Marfan syndrome are related to
degree of aortic root dilation
symptoms indicative of heart disease in pregnancy are
-severe dyspnea
-disatolic murmurms
-sycope with exertion
-chest pain with exertion
mitral and aortic stenosis are examples of cardiac diseases caused by
rhuematic fever
the most common bacterial pathogen in pneumonia during pregnancy is
streptococcus pneumoniae
maternal complications of pneumonia during pregnancy are
preterm labor, pericardial tamponade, bacteremia, pneumothorax, atrial fib, respiratory failure
the lambdia sign, a triangle-shaped ultraound marker seen at the junction of the chorions and amnions indicates
trizygotic gestation
the term for similarity in FHR accels, basline oscilations, and periodic changes with contractions in healthy twins is
fetal synchrony
fetal programming refers to
the process in which an in utero stimulus establishes a permanent fetal response that can lead to increased susceptibility to disease throughout life.
women who are overweight or obese are how many times more likely to develop gestational diabetes than a normal weight woman?
six
the epidural catheter for labor pain management is generally placed between the:
4th and 5th lumbar vertebrae
One of the contraindications to neuraxial anasthesia is that the woman received her last dose of low-molecular-weight heparin within
12 hours