NUR 211 EXAM #2 - HIGH RISK OB QESTION AND CORRECT ANSWER 2024/2025 100% CORRECT A+

NUR 211 EXAM #2 - HIGH RISK OB QESTION AND CORRECT ANSWER 2024/2025 100% CORRECT A+ what is a normal FHR baseline? - CORRECT ANSWER-110-160 bpm for 10 minutes or more there should be at least _______ fetal accelerations in 20 minutes - CORRECT ANSWER-2 define gravida - CORRECT ANSWER-the total number of pregnancies including the current define para - CORRECT ANSWER-Number of pregnancies past 20 weeks what are the early signs of hemorrhagic shock in the pregnant woman? - CORRECT ANSWER-- change in LOC - irritability/confusion - restlessness - decreased renal output what are the late signs of hemorrhagic shock in a pregnant woman? - CORRECT ANSWER-- pallor - VS change - fetal distress - oliguria (30mL/hr) what is a normal weight gain during weeks 20-36? - CORRECT ANSWER-1 lb. weight gain every 2-4 weeks what is a normal weight gain after 36 weeks? - CORRECT ANSWER-1 lb. per week right after delivery, where should the fundus be? - CORRECT ANSWER-between the umbilicus and symphysis pubis 10-12 hours after birth, where should the fundus be? - CORRECT ANSWER-at the umbilicus and then decrease by 1 fingerbreadth per day currently, an NST is recommended twice weekly (after 28 weeks) for clients with? - CORRECT ANSWER-diabetes, IUGR, preeclampsia, and other high risk condition nonstress test: - CORRECT ANSWER-- requires no initiation of contractions - quick to perform - no known side effects what does the client do before a nonstress test to stimulate fetal activity? - CORRECT ANSWER-eats a meal. after, she is placed in the left lateral recumbent position to avoid supine hypotension syndrome. an external fetal monitoring device is applied, one belt detects FHR and the other records uterine activity. the mother is instructed to push the button on the remote each time she feels a fetal movement it lasts about 20-30 minutes. nursing management for a NST: - CORRECT ANSWER-- have the client void before - semi-fowler position - interpret the NST as reactive or nonreactive a reactive NST includes? - CORRECT ANSWER-two FHR accelerations from the baseline of at least 15 bpm for at least 15 seconds during a 20 minute period. if the test does not meet these criteria after 40 minutes, it is considered non-reactive. a non-reactive NST is characterized by? - CORRECT ANSWER-the absence of two FHR accelerations using the 15x15 criterion in a 20 minute time frame. a non-reactive test has been correlated with higher incidence of fetal distress and mortality during labor. what are the early hemorrhagic conditions? - CORRECT ANSWER-the different types of abortions (loss of an early pregnancy, usually before 20 weeks of gestation) a ______________ abortion has no cervical dilation or change as well as a closed cervical os - CORRECT ANSWER-threatened. an __________________ abortion has intense abdominal cramping, heavy vaginal bleeding, and passage of some of the products of conception - CORRECT ANSWERincomplete. high risk for infection and hemorrhage. fetus will be evacuated via D&C or prostaglandin analog the placenta implants over the cervical os - CORRECT ANSWER-placenta previa. a bleeding condition that occurs in the last two trimesters, has a high risk of hemorrhage, abruption, or emergency c-section. list and define the 4 types of placenta previa. - CORRECT ANSWER-1. total: internal cervical os is completely covered 2. partial: 50% of internal cervical os is covered 3. marginal: placenta at the margin or edge of cervical os 4. low-lying: placenta implanted in the lower uterine segment, but does not reach the cervical os what s/s might indicate placenta previa? - CORRECT ANSWER-painless, bright red vaginal bleeding with a soft or nontender uterus nursing management and considerations for placenta previa: - CORRECT ANSWER-- client may have a planned c section - a stable client will have a "wait and see" approach as well as bedrest - if contractions occur, patient may receive betamethasone or tocolytics - avoid cervical, vaginal, and rectal exams - educate on recording fetal movement - tell patient to notify HCP if bleeding or back aches occurs - monitor vaginal bleeding (the initial bleeding is not perfuse, will cease, and then reoccur again) what is the cause of placenta previa? - CORRECT ANSWER-the cause is unknown. risk factors include previous c-sections, multiparity, smoking, and short intervals between pregnancy true/false - with placenta previa, fetal distress is usually absent but may occur if cord problems arise - CORRECT ANSWER-true abruptio placentae is a _____________ emergency - CORRECT ANSWER-medical. it is not preventable, but risk factors include HTN, smoking, drug abuse, and advanced maternal age. What is abruptio placentae? - CORRECT ANSWER-premature separation of a normally implanted placenta. high risk for *hemorrhage,* *DIC,* emergency hysterectomy, need for a blood transfusion, and renal failure. while the cause of abruptio placentae is unknown, what is the issue that causes the placenta to detach? - CORRECT ANSWER-bleeding from vessels causes a clot to form between the placenta and uterine wall. Increased bleeding will lead to increase pressure between the placenta and the uterine wall, then leading to separation = compromised blood supply to the fetus. with moderate abruption (1,000-1500 mL), the patient will experience mod. bleeding, abdominal pain, mild shock, a normal BP, and a __________ HR - CORRECT ANSWER-fast with severe abruption (1500 mL) the patient will experience profound shock with dark vaginal bleeding and agonizing abdominal pain. She will have hypotension with tachycardia. What issue will also arise? - CORRECT ANSWER-DIC. In disseminated intravascular coagulation, abnormal clots form inside blood vessels. These abnormal clots use up the blood's clotting factors, which can lead to massive bleeding in other places. - loss of balance between clot-forming thrombin and clot-lysing plasmin. what will labs look like for a patient with DIC? - CORRECT ANSWER-- low fibrinogen and platelets - prolonged PT and aPTT - positive D-dimer what assessment findings might indicate DIC? - CORRECT ANSWER-bleeding gums, tachycardia, oozing from the IV site, and petechiae. how is DIC treated? - CORRECT ANSWER-determine the underlying cause, administer FFP and cryo as well as anticoagulant therapy (lmwh), PRBC, albumin, and other volume expanders (pg. 701) an abnormal increase in fundal height may indicate ______________ - CORRECT ANSWER-bleeding emergency management of placental abruption includes? - CORRECT ANSWER-- establishing two large bore IVs with NS or LR (combats hypovolemia). - obtain blood specimen to determine type and cross - c-section done immediately if fetal distress present. also: if time allows, assess for pain or contractions and ask about fetal movement. Assess FHR as well. nursing considerations for placental abruption: - CORRECT ANSWER-- place on strict bed rest (left lateral position) - O2 via NC - VS every 15 minutes - insert foley to monitor UOP - assess vaginal bleeding every 15-30 min. - assess fundal height what is placenta accreta? - CORRECT ANSWER-placenta attaches too deeply into the uterine wall, but does not penetrate the uterine muscle. risk factors include multiparity or Hx of c-sections or abnormal placentation. Tx includes c-section and possible hysterectomy. *high hemorrhage risk* what are the hypertensive disorders of pregnancy? - CORRECT ANSWER-1. chronic HTN 2. gestation HTN 3. preeclampsia 4. eclampsia this is the most commonly encountered medical condition in women - CORRECT ANSWER-hypertensive disorders exists prior to pregnancy or develops before 20 weeks - CORRECT ANSWER-chronic HTN BP of 140/90 after 20 weeks without proteinuria. BP will return to normal limits at about 12 weeks pp. - CORRECT ANSWER-gestational HTN develops with proteinuria after 20 weeks. It is a multisystem disease process classified as mild or severe depending on related factors - CORRECT ANSWER-preeclampsia onset of seizure activity in a woman with preeclampsia - CORRECT ANSWEReclampsia for a diagnosis of ___________ HTN, the BP must be 140/90 on at least 2 occasions at least 4-6 hours apart after 20 weeks of gestation - CORRECT ANSWER-gestational. a recent study shows that progesterone supplementation during the first trimester reduces the incidence of gestational HTN what is always the "cure" for preeclampsia? - CORRECT ANSWER-delivery of the placenta preeclampsia is a ___________ disorder that can lead to hypoperfusion - CORRECT ANSWER-vasopressive. if the body becomes under-perfused due to the vasopressive factor, damage can occur to the brain, liver, kidneys, placenta, and lungs if damage to the organs occur with preeclampsia, what issues may arise? - CORRECT ANSWER-- pulmonary edema - oliguria - seizures - thrombocytopenia - abnormal liver enzymes *all r/t hypoperfusion* who might put at person at risk to develop preeclampsia? - CORRECT ANSWER-- african american race - age 20 years and 35 years - primigravida - obesity - chronic stress - Hx of DM or renal disease determine whether the following patient has mild/severe preeclampsia or eclampsia: - BP: 140/90 - proteinuria 300 mg/24 hours - no seizure activity or hyperreflexia - mild facial edema - CORRECT ANSWER-mild preeclampsia what are some nursing considerations for mild preeclampsia? - CORRECT ANSWER-- patient will be placed on bed rest @ home. - the lateral recumbent position is best. - the pt. must monitor BP daily q4-6 hours. - perform a dipstick twice daily - weigh daily - daily fetal movement counts taken - *no sodium restriction* - *drink 6-8, 8oz glasses of water daily* - eat foods high in protein and fiber - will use watchful waiting til term unless condition progresses poorly what s/s should someone with mild preeclampsia report to the provider? - CORRECT ANSWER-HA or hyperreflexia. IV magnesium sulfate may be given prophylactically for the high risk of seizures with a blood pressure 160/110, proteinuria of 500/24 hours, no seizure activity, and hyperreflexia present, a patient could present with what additional s/s? - CORRECT ANSWER-this is indicative of severe preeclampsia. the patient could present with HA, oliguria, blurred vision, scotoma, pulmonary edema, thrombocytopenia, cerebral disturbance, epigastric or RUQ pain. this patient is also at risk for HELLP severe preeclampsia indicates a need for immediate ____________. - CORRECT ANSWER-hospitalization. upon arrival, fetal age is assessed for viability in worst case scenario. oxytocin and magnesium sulfate may/can be given simultaneously via infusion pump nursing considerations for severe preeclampsia: - CORRECT ANSWER-- vaginal delivery preferrable - steroids may be given - place on seizure precautions - I/O q hour - PGE2 gel may be given to ripen the cervix if delivery will occur with a BP of 160/110, marked proteinuria, and seizures/hyperreflexia, a patient is experiencing? - CORRECT ANSWER-eclampsia. treated by administering IV mag sulfate and antihypertensive meds. continuous FHM indicated. what is the antidote for mag sulfate toxicity? - CORRECT ANSWER-calcium gluconate with eclampsia, convulsive activity begins with a ______________ twitch - CORRECT ANSWER-facial. will then progressive to generalized muscle rigidity what do you assess to determine hyperreflexia? - CORRECT ANSWER-DTR of one of the following: biceps, triceps, patella, achilles, or plantar. graded 0-4+ with 2+ or 3+ being normal. clonus is the presence of rhythmic involuntary contractions, most often at the foot or ankle. what is HELLP? - CORRECT ANSWER-hemolysis, elevated liver enzymes, low platelet count HELLP is a _________ specific diagnosis - CORRECT ANSWER-lab. diagnosed by: - decreased hematocrit and platelets - elevated LDH, AST, ALT, BUN, Cr, Bilirubin, and Uric Acid how is HELLP treated? - CORRECT ANSWER-- FFP, PRBC, and PLT's transfused - antihypertensives - mag sulfate if seizures occur - birth may be delayed up to 96 hours *nursing management is the same as for a woman with severe preeclampsia* assessment findings on a patient with HELLP syndrome may include? - CORRECT ANSWER-- nausea - malaise - epigastric/RUQ pain - edema - microangiopathic anemia What does VEAL CHOP stand for? - CORRECT ANSWER-*V*ariables (*C*ord) *E*arlies (*H*ead) *A*ccerlations (*O*k) *L*ates (*P*lacental insufficiency) Helps you remember the causes how would you treat late decels r/t placental insufficiency? - CORRECT ANSWER-- lateral position - increase fluid rate - oxygen 8-10L via face mask - oxytocin to induce IV magnesium sulfate is used in the treatment of? - CORRECT ANSWER-seizures (active and prophylactically) in the preeclamptic and eclamptic woman mag sulfate dosage: - CORRECT ANSWER-loading dose of 4-6 g in 100 mL of fluids over 15-30 minutes, then maintained by infusion at 1-4 g/hr side effects of mag sulfate include? - CORRECT ANSWER-maternal flushing, N/V, dry mouth, hypotension S/S of Magnesium Sulfate Toxicity: - CORRECT ANSWER-*C* - Cardiac dysrhythmias *O* - Output less than 30mL/hour *R* - Respirations less than 12/min *A* - Absent deep tendon reflexes *L* - LOC is decreased *S* - Slurred speech assessment of a patient receiving magnesium sulfate would include? - CORRECT ANSWER-- VS (especially RR) hourly - hourly I&O - DTR hourly - assess for s/s of toxicity - perform continuous electronic FHR monitoring (report any decreased variability) Normal magnesium levels are? - CORRECT ANSWER-1.5-2.1 what is the normal L:S ratio? - CORRECT ANSWER-2:1 or higher indicates lung maturity an amniocentesis is performed after ______ weeks - CORRECT ANSWER-14 _________ should be assessed before and immediately after an amniotomy - CORRECT ANSWER-FHR one intervention for late decels includes a change in _______ - CORRECT ANSWERposition nifedipine and terbutaline are ________________ medications - CORRECT ANSWERtocolytic true/false - the client should empty her bladder before an amniocentesis - CORRECT ANSWER-true what is included in a biophysical profile? - CORRECT ANSWER-fetal breathing, motion, and amniotic fluid volume __________ is the stimulation of uterine contractions by medical/surgical means before the onset of spontaneous labor - CORRECT ANSWER-induction _______________: stimulating the uterus to increase the frequency, duration, and intensity of contractions after the onset of spontaneous labor - CORRECT ANSWERaugmentation what is the purpose of betamethasone? - CORRECT ANSWER-betamethasone is a corticosteroid to promote fetal lung maturity by increasing surfactant production and preventing respiratory distress syndrome/intravascular hemorrhage in the preterm infant (34 weeks)