When a patient with GDM is feeling nauseated or ill, it is most important to assess
Adherence to insulin regimen
Patients with diabetes must still take insulin when sick because insulin needs increase during times of stress and illness
Kaplan OB Final Exam
What is the primary purpose of using a foley catheter after a hysterectomy?
Keeping the bladder decompressed
An expanded bladder may interfere with wound healing by pressing on the wound area
Total vaginal hysterectomy
Removal of uterus and cervix through vagina
Total abdomen hysterectomy and bilateral salpingo-oopherectomy definition
Removal of uterus, ovaries, and fallopian tubes through incision of the abdomen
Total abdomen hysterectomy and bilateral salpingo-oopherectomy nursing care
- Potential food/fluid restrictions for 1-2 days
- Assessing bowel sounds and peristalsis
- Admin analgesics for comfort and to promote ambulation
- Removal of foley when pt begins to ambulate
Hysterectomy complications
- venous thromboembolism
- Hemorrhage
- Bladder dysfunction
Infertility: Medical Definition
Unable to conceive after 1 year of unprotected intercourse
After a biopsy, the most important nursing action is to
Observe for bleeding!
Greatest risk= ligation of artery or vein
Also observe for:
- pallor, cool/clammy skin
- increased pulse & decreased BP
Nursing action when patient feels like bearing down, but not yet fully dilated
Encourage panting through pursed lips (prevents pushing)
Norestrogel (progestin) contraceptive: report S/S of
- Fluid retention
- Mental depression
- Liver dysfunction
- Embolism
Most fertile time of woman’s cycle
10-14 days after onset of the menstrual period
Most important nursing action for newborn safety during phototherapy
Cover neonate’s eyes with protective patches
Diet during lactation (vs. pregnancy)
More kcal, but same amount of protein, calcium, and fluids
Placenta Previa
Placenta is abnormally placed near or over opening of cervix (aka lower uterine segment)
Major indicator of placenta previa
Painless, frank bright red vaginal bleeding
- also soft uterus in 3rd trimester
Placenta Previa Nursing Care
♣ Bed rest
♣ Ultrasound to locate placenta
♣ No vaginal/rectal exams
♣ Amniocentesis for lung maturity
♣ Daily D&H
♣ 2 units cross-matched blood available
Palpate contractions using your…
Fingertips; press gently
Brachytherapy definition
Use of internal radiation at treatment site, usually a malignancy
Purpose of inserting foley and administrating an enema prior to brachytherapy
Prevents displacement of the internal implant
Moment of peace and increase in bloody show occurs at what stage of labor?
Beginning of second, right before birth of baby
Most common characteristics of preterm infant
- Red, wrinkled skin
- Hypotonic muscles
- Lanugo
Pre-eclampsia Dx Criteria:
+
and/or __
HTN (>140/90)
+
proteinuria and/or edema
In patients with preeclampsia, ensure adequate intake of
Protein (to restore osmotic pressure)
Pre-X patients:
1) Position?
2) Daily _ & Monitor _
3) Precautions?
1) Left lateral
2) Weight; I/Os
3) Seizure precautions
After C-section, priority to monitor for: _ &
Hemorrhage & shock
To help decrease pain during first stage of labor, first __
Coach in relaxation and breathing techniques
In 2nd and 3rd trimesters, increase kcal by +__
+300
Good sources of iron:
- Chicken/pork livers; in veggies, substitute tofu
- Cooked artichoke
- Some cereals
3 positive signs of pregnancy
1) Presence of fetal heartbeat
2) Palpation of fetal movement
3) Fetal skeleton on x-ray or sonogram
GDM Diet:
1) Moderate intake of carbs & 2) Low intake of carbs &
3) High intake of
1) Moderate complex carbs & protein
2) Low simple carbs and fat
3) High fiber
Purpose of fetal monitor
Determine if fetus is getting adequate O2
Warning signs that pregnancy is in danger:
o Leaking amniotic fluid, vaginal bleeding
o Severe headaches
o abdominal pain
o Persistent vomiting
o Fever/chills
o Swelling of face/fingers
Fibrocystic disease of breast (involves benign cysts): cyst characteristics
- Soft/tender
- Movable
- Enlarge during menstruation
Avoid aspirin during
3rd trimester of pregnancy
Breast soreness during pregnancy
- Cold compresses
- Supportive bra
- Wash with warm water and keep dry
Discomforts of Pregnancy
o Urinary freq
o Nausea and vomiting, Indigestion
o Constipation, increase bulk foods, fiber, and fluid intake; encourage regular exercise
o Hemorrhoids
o Edema of feet/legs
o Breast tenderness
o Leg cramps, increase calcium intake, flex feet, and local heat
Cold stress S/S:
1) Skin?
2)_ RR? 3) Respiratory and metabolic
1) Mottling of skin
2) Increased respiration rate
3) Acidosis
Gonorrhea Treatment
Ceftatrioxone IM + doxycycline PO 7 days/month
Newborn narcotic withdrawal generally occurs
24-72 hours post-birth
Untreated gonorrhea can lead to maternal
Infertility
Gonorrhea complications in L&D process:
1) Preterm / & Premature _ 2) Postpartum
3) Neonatal & __
1) Premature labor/birth & premature ROM
2) Endometriosis
3) Sepsis & conjunctivitis
Weight gain during pregnancy
1) 1st trimester
2) 2nd trimester
3) 3rd trimester
1) 2-4 lbs.
2) 12-14 lbs.
3) 8-12 lbs.
Total: 22-30 lbs.
FIRST nursing action after normal vaginal delivery
Observe the flow of lochia!
premenstrual syndrome recommendations to alleviate S/S
- Moderate exercise
- OTC analgesics
- Limit caffeine
Pre-op breast biopsy teaching:
1) NPO by _ 2) Removal of
3) Tests that should have been completed
4) & prep
1) Midnight night before
2) Dentures, jewelry, and nail polish
3) All lab tests, CXR, and EKG
4) Skin & bowel prep
Spermicides:
1) Insertion time?
2) To increase effectiveness, use with __
1) must be inserted 30 min prior to sex
2) may be used with barrier methods to increase effectiveness
Male condoms: when applying, leave ___; when removing, hold onto __
leave space at end for ejaculate to collect; when removing, hold onto rim
Natural family planning failure rate
20-25%
Cervical mucus ovulation detection method (billings method): pre-ovulation & ovulation characteristics
Amount of d/c increases just before ovulation
♣ Pre-ovulation: cloudy, yellow or white, sticky
♣ Ovulation: clear, wet, slippery
Formation of spinnkarkeit
A stretchable thread of cervical mucus influenced by estrogen, indicates ovulation and the fertile time of a woman’s cycle
Contraception: estrogen-progestin combos MoA: inhibit __
Combos inhibit dominant follicle formation. does not have LH surge resulting in anovulatory menstrual cycles
Hormonal contraception (combo type) common adverse effects
♣ N&V
♣ Increased susceptibility to vaginal infections
♣ VTE(venous thromboembolism)
Hormonal contraception contraindications
♣ HTN
♣ Thromboembolic disease
♣ History of circulatory disease
♣ Varicosities
When using hormonal contraception, report if any of the following occur:
- Severe, persistent chest pain
- Cough, SOB
- Severe abdominal OR leg pain
- Dizziness
- Weakness, numbness
Progestin (Norestrogel) MoA:
1) Causes cervical mucus to _ 2) Causes endometrial lining to be
3) Slows
4) Interferes with _
1) mucus thickens
2) endometrial lining unreceptive
3) Slows peristalsis in fallopian tubes
4) Interferes with LH surge
Progestin Adverse Effects
- Irregular spotting
- Menstrual irregularities
- CV and carcinogenic risks
Pregnancy Physical Changes: Respiratory
o Breathing changes from abdominal to thoracic
o May have hyperventilation or SOB
Pregnancy Physical Changes: Cardivasular
o Blood volume increases 45%
o Increased CO, pulse, and leukocyte production
o Vena cava syndrome may occur
Pregnancy Physical Changes: GI
o N/V during first trimester
o Delayed gastric emptying and peristalsis
o Heartburn and constipation
Cystoscopy – correct answer✔✔ Used to examine bladder
Culdoscopy
Sedation?
Position for procedure and after?
Any side effects? – correct answer✔✔ Directly examines ovaries, fallopian tubes, uterus, and small
intestines
Local anesthetic and/or light sedation
Knee-chest position
Severe shoulder pain
Positioned on her abdomen with a pillow underneath to expel air
Colposcopy – correct answer✔✔ Magnifies tissue
Observe tissue for color, shape, vasculature, and lesions
Laproscopy
Sedation? – correct answer✔✔ View pelvic cavity
General anesthesia
Maintain bladder depression with foley
Distend abdomen with CO2
How often are vital signs in the newborn? – correct answer✔✔ Initially q30min for 2 hours
Then q4hrs if stable
Then q8hrs if stable
How will a newborn present with an infection? – correct answer✔✔ Respiratory distress, lethargy,
instability of temperature, and poor feeding. Not a temperature
How to infants loose heat? What are nursing interventions for each? – correct answer✔✔ Convection:
when cooler air flows over the infant and heat leaves the baby to the surrounding air. Eliminate drafts
Conduction: when a transfer of heat from one item to another through direct contact. Cover the surface
with a warm blanket or towel. Stethoscope warmed
Evaporation: when liquid is converted to vapor. Drying the baby after delivery or bath. Hat on head.
Radiation: heat is lost to an object that is cool without direct contact. Move away from cold windows or
outside walls.
When should a newborn void by? – correct answer✔✔ Within 48 hours after delivery, if not notify
practitioner if not by 24 hours
How often are formula fed babies fed? – correct answer✔✔ q 3-4 hours
When are heel stick screenings done in the newborn to screen for common diseases? Why is it done at
this time? – correct answer✔✔ 24 hours of age
This allows the baby to feed and digest their feeding
What type of liquid is given to a formula fed newborn for the first feeding? Why? – correct answer✔✔
Sterile water, so if the infant aspirates, the liquid is sterile. Breast fed babies go straight to the breast
because colostrum is sterile since it is coming straight from the mother
How much should the mom drink while the baby is breastfeeding? – correct answer✔✔ 8 oz of water
every time the baby drinks
What are the normal vital signs of the newborn? – correct answer✔✔ Temperature: typically axillary,
97.7-99.1 (if higher check environment)
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