NURS 242 FINAL EXAM
Postpartum hemorrhage risk factors - ANSWER -Grand multiparity (five or more)
-Over distention of the uterus (large baby, twins)
-Rapid or prolonged labor
-Retained placenta
-Placenta previa or previous placenta accrete or abruptio placentae
-Drugs (tocolytics, magnesium sulfate, general anesthesia, prolonged use of
oxytocin)
-Operative procedures (cesarean birth, vacuum extraction, forceps)
-Uterine fibroids
-History of PP hemorrhage
-Preeclampsia
-Coagulation defects
Infection risk factors (postpartum) - ANSWER -Operative procedures (cesarean birth,
vacuum extraction, forceps)
-Multiple cervical examinations
-Prolonged labor
-Prolonged rupture of membranes
-Manual extraction of placenta or retained fragments
-Diabetes
-Catheterization
-Bacterial colonization of lower genital tract
Normal finding of fundal assessment - ANSWER -Fundus firmly contracted
-Remains contract after massaging
-Located at level of umbilicus/midline
Abnormal finding of fundal assessment - ANSWER -Soft and boggy (massage until
firm)
-Soft after massaging (call HCP; give oxytocin; apply pressure to express clots)
-Displaced from midline (empty bladder and reassess)
Lochia Rubra - ANSWER -1-3 days
-Bloody; small clots; fleshy earthy odor; red/brown
-Abnormal: large clots; saturated pads; foul odor
Lochia Serosa - ANSWER -4-10 days
-Pink or brown; serosanguineous
-Abnormal: too much; foul smell; continued/recurrent reddish color
Lochia Alba - ANSWER -11-21 days (even until 6 weeks PP)
-White, cream, or light yellow
-Abnormal: persistent lochia serosa; return to lochia rubra; foul odor
Signs of mild fluid volume deficit - ANSWER -Weight loss <5%
-Normal HR and BP
,-Normal skin turgor
-Cap refill: <2 seconds; moist membranes
-Fontanel (normal/flat); normal eyes
Signs of moderate fluid volume deficit - ANSWER -Weight loss 5-10%
-Normal/undetectable BP; increased HR
-Poor, prolonged skin recoil
-Cap refill: 2-3 seconds; dry membranes
-Fontanel (sunken); decreased tears
Signs of severe fluid volume deficit - ANSWER -Weight loss >10%
-Normal/undetectable BP; tachy/thready/brady
-Very poor skin turgor - tenting
-Cap refill: 3-4 seconds; parched membranes
-Fontanel (markedly sunken); no tears
Treatment for minimal fluid volume deficit - ANSWER -ORT not needed
-Age-appropriate diet
-Re-evaluate
Treatment for mild-moderate fluid volume deficit - ANSWER -50-100mL/kg ORS,
plus replace continuing losses over 3-4-hour period
-Breastfeed; resume regular diet after fixing F/E
-Oral dose of ondansetron (Zofran); re-evaluate
Treatment for severe fluid volume deficit - ANSWER -Parenteral (IV) Therapy: IV
fluid bolus (20mL/kg) over period of 20-30 minutes
-Then replacement rate over next 24 hours
-If alert enough for ORS, 100mL/kg over 2-4 hours
S/S of hyponatremia - ANSWER Behavior changes, headache, dizziness, increased
HR, decreased BP, cold/clammy skin, nausea, cramps
S/S of hypernatremia - ANSWER FRIED or SALTIER
--
Fever (low grade), flushed skin
Restless (irritable)
Increased fluid retention and increased BP
Edema (peripheral and pitting)
Decreased urinary output, dry mouth
SALTIER
--
Skin flushed, dry, flaky / Seizures
Agitation / Attention span decreased
Lethargy; Low grade fever
Thirst / twitching
Increased urine specific gravity
Edema (pulmonary)
Reduce cardiac contractility, urine output
, Normal Na+ level - ANSWER 135-145 mEq/L
S/S of hypokalemia - ANSWER Leg cramps
Ileus (bowel obstruction)
Cardiac dysrhythmias (presence of U wave)
S/S of hyperkalemia - ANSWER MURDER
-Muscle weakness, abdominal cramps
-Urine (oliguria, anuria)
-Resp distress
-Decreased cardiac contractility
-ECG changes (T tall, P small, QRS widened)
-Reflexes, hyperreflexia, or areflexia (flaccid)
Normal K+ level - ANSWER 3.5-5.0 mEq/L
S/S of fluid volume excess - ANSWER Weight gain
Edema
Rapid bounding pulses
Increased BP
Dyspnea
Crackles/rales
Treatment for fluid volume excess - ANSWER -Reduce fluid retention by salt and
fluid restriction
-Diuretics to increase fluid excretion
-Treat underlying cause
Food jags - ANSWER When a child will only eat the same food meal after meal
Physiologic anorexia - ANSWER Decreased appetite because of relatively
decreased caloric need - picky, fussy eating
Grazing - ANSWER Unstructured snacking
By ___ age, children eat the same food prepared for the rest of the family -
ANSWER 12 months
Starting at ___ age, children should be eating iron fortified cereals and iron-rich
foods - ANSWER 6 months
Nutrition in the school age child - ANSWER -Increased nutritional needs due to
increased energy needs
-Obesity is major concern
Nutrition in the adolescent - ANSWER More concerned about weight/appearance
than ever before
Caloric increase during pregnancy - ANSWER 1st trimester - none
Postpartum hemorrhage risk factors - ANSWER -Grand multiparity (five or more)
-Over distention of the uterus (large baby, twins)
-Rapid or prolonged labor
-Retained placenta
-Placenta previa or previous placenta accrete or abruptio placentae
-Drugs (tocolytics, magnesium sulfate, general anesthesia, prolonged use of
oxytocin)
-Operative procedures (cesarean birth, vacuum extraction, forceps)
-Uterine fibroids
-History of PP hemorrhage
-Preeclampsia
-Coagulation defects
Infection risk factors (postpartum) - ANSWER -Operative procedures (cesarean birth,
vacuum extraction, forceps)
-Multiple cervical examinations
-Prolonged labor
-Prolonged rupture of membranes
-Manual extraction of placenta or retained fragments
-Diabetes
-Catheterization
-Bacterial colonization of lower genital tract
Normal finding of fundal assessment - ANSWER -Fundus firmly contracted
-Remains contract after massaging
-Located at level of umbilicus/midline
Abnormal finding of fundal assessment - ANSWER -Soft and boggy (massage until
firm)
-Soft after massaging (call HCP; give oxytocin; apply pressure to express clots)
-Displaced from midline (empty bladder and reassess)
Lochia Rubra - ANSWER -1-3 days
-Bloody; small clots; fleshy earthy odor; red/brown
-Abnormal: large clots; saturated pads; foul odor
Lochia Serosa - ANSWER -4-10 days
-Pink or brown; serosanguineous
-Abnormal: too much; foul smell; continued/recurrent reddish color
Lochia Alba - ANSWER -11-21 days (even until 6 weeks PP)
-White, cream, or light yellow
-Abnormal: persistent lochia serosa; return to lochia rubra; foul odor
Signs of mild fluid volume deficit - ANSWER -Weight loss <5%
-Normal HR and BP
,-Normal skin turgor
-Cap refill: <2 seconds; moist membranes
-Fontanel (normal/flat); normal eyes
Signs of moderate fluid volume deficit - ANSWER -Weight loss 5-10%
-Normal/undetectable BP; increased HR
-Poor, prolonged skin recoil
-Cap refill: 2-3 seconds; dry membranes
-Fontanel (sunken); decreased tears
Signs of severe fluid volume deficit - ANSWER -Weight loss >10%
-Normal/undetectable BP; tachy/thready/brady
-Very poor skin turgor - tenting
-Cap refill: 3-4 seconds; parched membranes
-Fontanel (markedly sunken); no tears
Treatment for minimal fluid volume deficit - ANSWER -ORT not needed
-Age-appropriate diet
-Re-evaluate
Treatment for mild-moderate fluid volume deficit - ANSWER -50-100mL/kg ORS,
plus replace continuing losses over 3-4-hour period
-Breastfeed; resume regular diet after fixing F/E
-Oral dose of ondansetron (Zofran); re-evaluate
Treatment for severe fluid volume deficit - ANSWER -Parenteral (IV) Therapy: IV
fluid bolus (20mL/kg) over period of 20-30 minutes
-Then replacement rate over next 24 hours
-If alert enough for ORS, 100mL/kg over 2-4 hours
S/S of hyponatremia - ANSWER Behavior changes, headache, dizziness, increased
HR, decreased BP, cold/clammy skin, nausea, cramps
S/S of hypernatremia - ANSWER FRIED or SALTIER
--
Fever (low grade), flushed skin
Restless (irritable)
Increased fluid retention and increased BP
Edema (peripheral and pitting)
Decreased urinary output, dry mouth
SALTIER
--
Skin flushed, dry, flaky / Seizures
Agitation / Attention span decreased
Lethargy; Low grade fever
Thirst / twitching
Increased urine specific gravity
Edema (pulmonary)
Reduce cardiac contractility, urine output
, Normal Na+ level - ANSWER 135-145 mEq/L
S/S of hypokalemia - ANSWER Leg cramps
Ileus (bowel obstruction)
Cardiac dysrhythmias (presence of U wave)
S/S of hyperkalemia - ANSWER MURDER
-Muscle weakness, abdominal cramps
-Urine (oliguria, anuria)
-Resp distress
-Decreased cardiac contractility
-ECG changes (T tall, P small, QRS widened)
-Reflexes, hyperreflexia, or areflexia (flaccid)
Normal K+ level - ANSWER 3.5-5.0 mEq/L
S/S of fluid volume excess - ANSWER Weight gain
Edema
Rapid bounding pulses
Increased BP
Dyspnea
Crackles/rales
Treatment for fluid volume excess - ANSWER -Reduce fluid retention by salt and
fluid restriction
-Diuretics to increase fluid excretion
-Treat underlying cause
Food jags - ANSWER When a child will only eat the same food meal after meal
Physiologic anorexia - ANSWER Decreased appetite because of relatively
decreased caloric need - picky, fussy eating
Grazing - ANSWER Unstructured snacking
By ___ age, children eat the same food prepared for the rest of the family -
ANSWER 12 months
Starting at ___ age, children should be eating iron fortified cereals and iron-rich
foods - ANSWER 6 months
Nutrition in the school age child - ANSWER -Increased nutritional needs due to
increased energy needs
-Obesity is major concern
Nutrition in the adolescent - ANSWER More concerned about weight/appearance
than ever before
Caloric increase during pregnancy - ANSWER 1st trimester - none
