maternal/newborn

maternal/newborn medication tx for gestational hypertension - CORRECT ANSWER-magnesium sulfate mag sulfate antidote - CORRECT ANSWER-calcium gluconate what the client will feel on mag sulfate - CORRECT ANSWER-hot, flushed, sedated signs of mag toxicity - CORRECT ANSWER-absent DTRs urine output 30ml/hr resp 12/min dec LOC dysrhythmias nursing care for newborns addicted to cocaine - CORRECT ANSWER-avoid eye contact use vertical rocking & pacifier NST purpose is to - CORRECT ANSWER-assess fetal CNS abstinence syndrome s/s - CORRECT ANSWER-hypothermia inc DTR inc muscle tone hypersensitivity to sound and stimuli gestational diabetes baby is jittery and high-pitched cry, intervention - CORRECT ANSWER-offer neonate breast milk/formula therapeutic levels of mag sulfate - CORRECT ANSWER-4-8 a food high in folic acid - CORRECT ANSWER-lentils kegel exercises for urinary incontinence - CORRECT ANSWER-sit on toilet and start to pee and then try to stop flow have designated time and place improvement in 6 weeks tighten for 10, relax for 10 immediately after amniotomy... - CORRECT ANSWER-observe for foul odor document unusual color assess fetal heart for rate and variable devels NST - CORRECT ANSWER-primary method of antenatal fetal assessment measures relationship of FHR to fetal movement can easily be performed outpatient breastfeeding tips - CORRECT ANSWER-avoid a specific length of time burp them between each breast avoid pacifier to prevent nipple confusion prolapsed cord, what to do and in what order - CORRECT ANSWER-notify provider reposition client (trend/knee-to-chest) insert fingers into vagina to reduce pressure on cord admin supp. oxygen prep for c-section hyperemesis gravidarium - CORRECT ANSWER-wt loss lyte imbalance acetonuria ketosis dehydration dec BP, inc pulse from dehydration kernicterus - CORRECT ANSWER-bilirubin encephalopathy from untx hyperbilirubinemia (25) s/s: lethargy hypotonia high-pitched cry tonic motions - arching back of neck & trunk abruptio placenta, what labs will they have (plt, ptt, fibrinogen) - CORRECT ANSWERplt = dec ptt = prolonged fibrinogen = dec cerclage procedure does what - CORRECT ANSWER-reinforces the weakened cervix by use of sutures teaching regarding cerclage is - CORRECT ANSWER-go to the hospital at the first sign of labor because doc has to remove the sutures mom is HIV pos, what to tell her in plan of care - CORRECT ANSWER-discuss importance of her taking her retrovir daily hydatidiform mole, what is it - CORRECT ANSWER-molar pregnancy degenerative, multiple cysts, rapid uterus growth, results in hemorrhage transform into large, fluid-filled vesicles slough off and have dark, brownish vaginal discharge grape-like clusters immediately report this when pregnant - swelling fingers - urinary frequency - white vaginal discharge - N/V - CORRECT ANSWER-swelling of fingers found in pts with preeclampsia 12 weeks pregnant, neg rubella, neg VDRL, type O neg - should receive rhogam today - must be given penicillin immediately - needs to receive a rubella vaccine after delivery - will have future blood work to check for Rh-incompatbility of her blood with the fetus - CORRECT ANSWER-needs a rubella vaccine after delivery rhogam is given at 28weeks and within 72 hrs of delivery what to report immediately for client on mag sulfate with BP 160/110, RR 32, HR 90, DTR +4 - CORRECT ANSWER-urinary output 25ml/hr mag sulfate is excreted thru the kidneys, so adequate output is necessary to prevent toxicity postpartum care for pt with cardiac disease, question which order - strict I&O - high fiber diet - force fluids - monitor VS q2hrs - CORRECT ANSWER-force fluids - at risk for fluid overload - do need more frequent vital signs 2 day old newborn, soft spot on left side of head, bluish discoloration with edema, does not cross suture lines, what to tell mom - will resolve in 2-6 weeks without treatment - will resolve on its own within 2-3 days - ill ask the doc to examine baby's head this morning - don't worry, its normal - CORRECT ANSWER-will resolve in 2-6 weeks without treatment this is a cephalohematoma caput succedaneum resolves in 2-3days had a c-section, reports abdominal distention, what action should nurse implement - suggest pt ambulate in the hallway - request a narcotic analgesic be ordered - position client on right side - encourage carbonated drinks - CORRECT ANSWER-suggest pt ambulate in hallway - walking helps stimulate peristalsis and promotes flatus - lie on LEFT side neonate born at 39 weeks, what characteristic will the nurse find - creases covering entire bottom of both feet - dry, wrinkled skin - vernix well disributed over entire body - lanugo abundant over shoulders - CORRECT ANSWER-creases covering entire bottom of both feet postterm baby will have dry, cracked skin with wrinkled appearance full term baby will have little vernix & lanugo caring for newborn, which finding should be reported to provider - jaundice of the sclera in 4hr old newborn - resp rate of 50/min in 8hr newborn - acrocyanosis in 2hr old newborn - BG of 60 in 1hr old newborn - CORRECT ANSWER-jaundice because jaundice occurring in first 24hrs of birth is related to some type of hemolytic pathology and requires immediate attention normal newborn RR is 40-60 postpartum pt given methylergonovine (methergine) maleate, what to assess before administration - RR - fundal height - apical pulse - BP - CORRECT ANSWER-BP given to stop excessive bleeding , works by causing uterus to contract common SE is elevation of BP what puts a client at risk for postpartal atony - precipitous delivery - distended bladder - vaginal delivery - periurethral tear - macrosomic delivery - CORRECT ANSWER-precipitous delivery = because it happens in less that 2-0.5 hr, uterus is overstressed/overstretched distended bladder macrosomic delivery = baby over 9lbs, uterus overstretched 12hrs old, RR 44/min, resp are shallow and periods of apnea lasting up to 5 sec, what action should the nurse take - request a consult from resp therapy - notify provider immediately - continue routine monitoring - obtain an order for supp oxygen - CORRECT ANSWER-continue routine monitoring short periods of apnea are normal in newborn which reflex is nurse testing by quickly and gently turning neonates head to one side? - startle - moro - tonic neck - babinski - CORRECT ANSWER-tonic neck expected response is that arm and leg will extend outward to the side where the head was turned and the opposite arm and leg will flex moro is when they allow them to fall back and they will extend the arms and for a C with fingers pt has hydatidiform mole removed, appropriate instruction is to not become pregnant for - CORRECT ANSWER-at least 1 year manifestation to expect in neonate for to a drug addicted mother - extended periods of sleep - poor muscle tone - RR 30/min - exaggerated reflexes - CORRECT ANSWER-exaggerated reflexes increased muscle tone rapid RR IUD least likely to be recommended for women who - are hypertensive - have multiple sex partners - are older than 35 and smoke - have hx of thromboembolic dx - CORRECT ANSWER-have multiple sex partners because it doesnt protect against STDs and inc infection rates and scarring with multiple partners betamethasone given at 30weeks gestation to pt who is in preterm labor, what to anticipate in infant - hypothermia - sternal retractions - rapid pulse rate - dec blood glucose - CORRECT ANSWER-dec blood gluc, because it will cause mom to have hyperglycemia 6 hr postpartum, on admission nurse notes slight jaundice of infant's face and trunk, initial nursing action is to - complete assessment and document the findings - obtain an order for a stat bilirubin level - place the isolette in a well-lit area of the nursery - take the neonate to the mother so she can breastfeed - CORRECT ANSWER-obtain an order for a stat bilirubin level and inform provider jaundice in the first 24hrs of life is ALWAYS pathological mag sulfate for preeeclampsia is used as - an antihypertensive - a muscle relaxant - a CNS depressant - an oxytocic - CORRECT ANSWER-a CNS depressant active herpes type 2, best plan for delivery for client with herpes lesions would be - cesarean birth prior to onset of labor - cesarean birth when contractions become regular and inc in intensity - induction close to term so that nursery can be prepared for an infected infant - cesarean birth after ROM - CORRECT ANSWER-cesarean birth prior to onset of labor severe IDA and pregnant, needs injection of iron dextran IM, how to give it - 20 gauge needle, z-track method - 22 gauge, deep in the thigh - 25 gauge, in deltoid - 18 gauge, ventrogluteal muscle - CORRECT ANSWER-20 gauge using z-track method dorsogluteal muscle comlication of an epidural block - N/V - severe headavhes - hypotension - resp depression - CORRECT ANSWER-hypotension oxytocin for induction of labor is contraindicated in - prolonged ROM at 38 weeks - positive contraction stress test at 38 weeks - postterm pregnancy - mild preeclampsia at 38 weeks - CORRECT ANSWER-positive contraction stress test at 38 weeks - fetus have repeated deceleration of HR in response to uterine contractions, prolonged use of oxytocin could compromise fetus' oxygen supply