PN Maternal Newborn Nursing ATI Proctored Exam Questions and Complete Solutions Graded A+

PN Maternal Newborn Nursing ATI Proctored Exam Questions and Complete Solutions Graded A+ Contraceptive use - Answer: a water soluble lubricant should be used with condoms Oral contraceptive danger indications - Answer: Shortness of breath can indicate pulmonary embolism or myocardial infarction IUD (intrauterine device) - Answer: Check for presence of IUD strings following each menstruation to ensure the device is still present. A change in the length of the strings should be reported to the provider Implantable progestins adverse effects - Answer: Irregular vaginal bleeding weight gain breast changes medroxyprogesterone - Answer: clients should take calcium and vitamin D o prevent loss of bone density can cause irregular bleeding Signs of pregnancy: Presumptive - Answer: changes might be subjective or objective: amenorrhea (no periods) fatigue nausea and vomiting urinary frequency breast changes quickening (fluttering movements of a fetus 16 to 20 weeks gestation) abdominal enlargement Signs of Pregnancy: Probable - Answer: changes that make the examiner suspect pregnancy: uterine enlargement Hegar's sign (soft lower uterus) chadwick's sign ( bluish cervix) goodell's sign ( softening cervix tip) ballottement braxton Hickscontractions positive pregnancy test fetal outline felt by examiner Signs of Pregnancy: Positive - Answer: those explained only by pregnancy: fetal heart sounds visualization of fetus by ultrasound fetal movement palpated by experienced examiner hCG blood / urine test - Answer: Human chorionic gonadotropin: can start as early as day of implantation and can be detected about 8 days after conception. peaks about day 60-70, declines til day 100-130 then incline until term raised levels=multifetal, ectopic, hydatidiform mole low level= miscarriage, ectopic Gravidity - Answer: Nulligravida: never been pregnant Primigravida: this is first pregnancy Multigravida: two or more Parity - Answer: Number of pregnancies which fetus reached 20 weeks ( includes stillborn) Nullipara: no pregnancy primipara: one Multipara: two or more Viability - Answer: Point at which a fetus can survive outside the womb. GTPAL - Answer: Gravida, Term - 38 weeks and more Preterm - 37 weeks and under Abortions, Living Physiological changes - Answer: stretch marks hyperpigmentation Supine hypotensive syndrome - Answer: Low blood pressure resulting from compression of the inferior vena cava by the weight of the pregnant uterus when the mother is supine. lie on left side with head elevated on a pillow pulse during pregnancy - Answer: increases 10 to 15/min around 32 weeks until term FHR - Answer: 110-160 beats/min Cardiovasuclar changes - Answer: Output increases blood volume increases heart rate increases uterine changes - Answer: by 36 weeks the top of the uterus and the fundus will reach the xiphoid process, causing shortness of breath as uterus pushes against the diaphragm Skin changes - Answer: chloasma: an increase of pigmentation on face linea nigra: dark line (happy trail) striae gravidarum: stretch marks April 1st was first day of last period. what is her due date - Answer: january 8 G3 T1 P0 A1 L1 what does this mean - Answer: gravida-3 (3 pregnancies including her being pregnant now) term-1 baby delivered at term (38 wks and more) preterm-0 (no preterm deliveries) abortions-1 living-1 which of these are probable signs of pregnancy? select all that apply Enlarged montgomery glands goodell's sign ballottement chadwicks sign quickening - Answer: enlarged montgomery glands- presumptive goodell's sign- probable ballottement- probable chadwicks sign- probable quickening- presumptive explain causes episodes of hypotension? - Answer: this is due to the weight of the uterus on the large blood vessels. Supine hypotensive syndrome, uterus places pressure on the vena cava decreasing venous blood flow to the heart taking a pregnancy test should include - Answer: take urine from first morning void prenatal visits - Answer: monthly until 28 weeks every 2 weeks until 36 weeks every week until born Fetal heart can be heard when - Answer: late in the first trimester listen at the midline, right above the symphysis pubis, by holding the doppler firmly on the abdomen fundal height is the same as age of gestation in weeks... - Answer: 18-30 begin checking for fetal movement between weeks.... - Answer: 16-20 Rh negative clients receive Rho(D) immune globulin IM around... - Answer: 28 weeks Cbc with differential (types of wbc's analyzed) Hgb and Hct - Answer: detect infection and anemia Hgb electophoresis - Answer: identifies hemoglobinopathies (sickle cell and thalassemia) rubella titer - Answer: determines immunity to rubella hep B screen - Answer: identifies carriers of hep b group B streptococcus - Answer: obtain a vaginal/anal culture at 35-37 weeks to check for group b strep infection urinalysis with exam of pH, specific gravity, color, sediment, protein, glucose, albumin, RBC's, WBC's, casts, acetone, and hCG - Answer: identify pregnancy, diabetes, gestational hypertension, renal disease, preeclampsia, one hour glucose tolerance - Answer: Identifies hyperglycemia; done at initial visit for at-risk clients, and at 24 to 28 weeks of gestation for all pregnant women ( greater than 140 mg/dL requires follow up). Papanicolaou (Pap) test - Answer: Screening tool for cervical cancer, herpes simplex type 2, and/or human papillomavirus. PPD test - Answer: tuberculosis test at 20 weeks gestation gestational hypertension signs - Answer: severe persistent headaches blurred vision edema of face and hands epigastric pain relieve backache during pregnancy - Answer: perform the pelvic rock exercise every day (bend back forward then backwards) use proper body mechanics which is a complication that should be promptly reported? a. vaginal bleeding b. swelling ankles c. heartburn after eating d. lightheadedness when lying on her back - Answer: vaginal bleeding- could indicate placental problems what do you do for nausea and vomiting in the morning - Answer: eat crackers or plain toast 30-60 minutes before rising from bed 6 weeks pregnant: signs/symptoms - Answer: breast tenderness urinary frequency epistaxis ( nose bleed) 8 weeks and says she isnt too happy about being pregnant. your response: - Answer: feelings of ambivalence about pregnancy are normal during the first trimester Nurtrition - Answer: calories: 340 extra during 2nd trimester 452 extra during 3rd trimester 450-500 extra for breastfeeding mothers increasing protein intake folic acid: 400-600 mcg a day iron: given with OJ, extra fluids decrease constipation from iron calcium: 1000g/day limit caffeine 200mg/day good sources of calcium other than milk - Answer: dark green leafy vegetables weight gain during pregnancy - Answer: 3-4 lbs in first trimester 1 lb per week in second (total 12 lb just in 2nd) 25-30 lbs By 3rd trimester what can these lead to: iron deficiency anemia calcium deficiency maternal obesity folic acid deficiency - Answer: iron deficiency poor bone and teeth macrosomic fetus neural tube defects What aids iron absorption? - Answer: Vitamin C ( Orange Juice) a postpartum woman who is breastfeeding and doesnt like milk needs.... - Answer: calcium supplements Biophysical Profile (BPP) - Answer: Assessment of five variables in the fetus with a score of 2 for each normal finding and 0 for each abnormal finding FHR- reactive 2, nonreactive 0 FETAL BREATHING MOVEMENTS- at least on episode of greater than 30 seconds duration in 30 min =2 GROSS BODY MOVEMENTS- at least three body or limb extensions with return to flexion in 30 min=2 FETAL TONE- at least one episode of extension with return to flexion = 2 QUALITIVE AMNIOTIC FLUID VOLUME- at least one pocket of fluid that measures at least 2 cm in two perpendicular planes =2 Biophysical profile scoring - Answer: 8-10: Normal 4-6: Suspect chronic asphyxia 0-4: Strongly suspect asphyxia Nonstress test (NST) - Answer: antepartum evaluation of fetal well being performed during third trimester. monitors response of FHR to fetal movement accelerates 15/min for at least 15 seconds amniocentesis - Answer: aspiration of amniotic fluid for analysis by insertion of a needle transabdominally into a client's uterus and amniotic sac under direct ultrasound guidance a nurse is reviewing findings of a client's biophysical profile with the charge nurse. Which of the following variables should the nurse expect the test to include? (select all that apply) a. fetal weight b. fetal breathing movements c. fetal tone d. fetal position e. amniotic fluid volume - Answer: B. Fetal breathing movements C. Fetal Tone E. Amniotic Fluid Volume what test is part of an amniocentesis to determine fetal lung maturity? - Answer: Lecithin/sphingomyelin (L/S) ratio before having an amniocentesis, instruct client to..... - Answer: empty bladder causes of bleeding during pregnancy - Answer: first trimester: spontaneous abortion: before 20 wks ectopic pregnancy: outside of uterus second trimester: gestational trophoblastic disease: trophoblast cells third trimester: placenta previa: placenta lies low in uterus abruptio placentae: placenta seperates vasa previa: fetal vessels are implanted into membrane rather than the placenta kleihaauer-betke test - Answer: used to detect fetal blood in maternal circulation ectopic pregnancy signs - Answer: unilateral lower quadrant pain with or without bleeding abruptio placentae risk factors - Answer: blunt abdominal trauma cocaine cigarette use 32 weeks and has placenta previa. actively bleeding. what medication is prescribed? - Answer: Betamethasone is given to promote lung maturit if delivery is anticipated indomethacin nifedipine - Answer: for the client in preterm labor methylergonovine - Answer: for the client experiencing postpartum hemorrhage Hydatiform Mole (Molar Pregnancy) - Answer: Abnormal development of the trophoblast, a placenta develops, but no fetus exhibits increased fundal height that is inconsistent with the week of gestation and excessive nausea and vomiting HIV infection is a contraindication to... - Answer: episiotomy forceps, internal fetal monitoring *blood exposure TORCH symptoms - Answer: joint pain, malaise, rash, tender lymph nodes cervical insufficiency - Answer: cervix opens too early and expulsion of the products of conception occurs. blood glucose level during pregnancy - Answer: 70-110 mg/dL risk factors of hyperemesis gravidarum - Answer: obesity multifetal pregnancies lab results for a suspected hyperemesis gravidarum. ketones in urine - Answer: the presence of ketones in the urine is associated with the breakdown of protein and fats signs of magnesium sulfate toxicity - Answer: BURP Blood pressure decrease Urine output decrease Respiratory rate decrease Patella reflex absent (deep tendon reflexes) -and flushing/sweating magnesium sulfate antidote - Answer: calcium gluconate heparin antidote - Answer: protamine sulfate iron antidote - Answer: Deferoxamine (Desferal) pyridoxine - Answer: Vitamin B6 preterm labor lab tests - Answer: fetal fibronectin (FFN) cervical cultures CBC Urinalysis management of a client who is in preterm labor - Answer: activity restriction ensuring hydration identifying and treating an infection chorioamnionitis monitor FHR and contraction pattern fetal tachycardia Nifedipine - Answer: Calcium channel blocker to Suppress contractions monitor for headache, flushing, dizziness, and nausea Don't administer with Magnesium Sulfate Magnesium Sulfate - Answer: Tocolytic to Suppress uterine contractions monitor for edema, toxicity, antidote Calcium Gluconate Indomethacin - Answer: NSAID suppresses preterm labor by blocking production of prostaglandins Suppress contractions Dont exceed 48 hrs Only for weeks LESS THAN 32 Betamethasone - Answer: enhance fetal lung maturity and surfactant production in fetuses between 24 and 36 weeks ampicillin - Answer: antibiotic for infection (chorioamnionitis) Risk factors for Preterm Labor - Answer: urinary tract infection, multifetal, diabetes, uterine abnormalitie, hydramnios (excessive amniotic fluid) what medication hastens fetal lung maturity - Answer: betamethasone Nifedipine for preterm labor, monitor for... a. blood sputum b. dizziness c. pallor d. somnolence - Answer: b. dizziness and lightheadedness contraindications for magnesium sulfate - Answer: Acute fetal distress Vaginal bleeding Cervical dilation greater than 6 cm Severe pregnancy-induced hypertension 26 weeks, PROM, what should the nurse instruct at discharge - Answer: keep a daily record of fetal kick counts physiologic changes preceding labor - Answer: Backache, low, dull Weight loss 1-3 lbs Lightening, head descends into true pelvis 14 days before labor Contractions increased vaginal discharge/blood show energy burst called nesting GI changes Cervical ripening- becomes soft, effaced Rupture of membranes- labor usually occurs within 24 hours Amniotic fluid is alkaline Urine is slightly acidic Five P's - Answer: Passenger (fetus and placenta) Passageway (birth canal) Powers (contractions) Position of mother Psychologic response Position of Fetus - Answer: Right (R) or Left (L)- first letter Occiput (O), Sacrum (S), Mentum (M), Scapula (Sc)- 2nd letter Anterior (A), Posterior (P), Transverse (T)- 3rd letter preferrably Occiput Station - Answer: measurement of fetal descent in centimeters Station 0 at level of ischial spines Station negative (-1, -2) superior to ischial spines Station + inferior to ischial spines Inducing labor - Answer: Cervical ripening Oxytocin- monitor vitals 30-60 min, FHR every 15 min. STOP if hyperstimulation occurs Nonreassuring FHR - Answer: 1. Notify provider 2. Turn pt on their side 3. Keep IV open and increase fluids 200ml/hr 4. administer O2 face mask 5. administer Tocolytic terbutaline 6. monitor, document, prepare for cesarean Prolapsed umbilical cord - Answer: umbilical cord is displaced, preceding the presenting part of fetus, protruding through cervix, results in cord compression and compromised fetal circulation 1. call for assistance immediately 2. notify prescriber 3. the RN or provider will use a sterile gloved hand to lift fetus off of cord 4. pt in a knee chest , trendelenburg stages of labor - Answer: STAGE 1 - onset of uterine contractions till dilation of cervix is complete (6-24 hours). STAGE 2 - maximal cervical dilation until baby passes thru the vagina (few minutes - one hour). STAGE 3 - expulsion of the placena (15 mins). Stage 1 labor - Answer: Latent phase dilates 0-3 cm Active phase dilates 4-7 cm transition phase dilates 8-10 cm a pt experiences a large gush of fluid from her vagina while walking in hallway, what should the nurse do first - Answer: monitor FHR for distress 40 weeks, contractions every 3-5 min, dilated 3 cm, 80% effaced, -1 station. client asks for pain meds, what should nurse do - Answer: encourage use of patterned breathing techniques administer opioid analgesic medication suggest application of cold before performing an amniotomy, what should the nurse ensure during a vaginal exam - Answer: fetal engagement at a 0 station to prevent umbilical cord prolapse if a pt's water breaks and the nurse sees the umbilical cord coming out, what should the nurse do first - Answer: call for assistance Monitoring FHR - Answer: - count for 30-60 seconds for a baseline -auscultate immediately following rupture of membranes -count FHR between contractions for a baseline -auscultate FHR: latent phase 30-60 mins active phase 15-30 mins 2nd Stage 5-15 mins Benefits of Internal Fetal Monitoring - Answer: can detect abnormal fetal heart tones early allows for accurate readings despite maternal movement can measure uterine contraction intensity Fetal tachycardia can be caused by - Answer: maternal fever, infection, chorioamnionitis late decelerations in FHR, what should the nurse do IN ORDER - Answer: 1. assist client to left lateral position 2. apply oxygen face mask 3. increase rate of maintenance IV 4. prepare for vaginal exam An external monitor cannot measure what - Answer: uterine contraction intensity Fundus Postpartum - Answer: Involution- uterus returns to its prepregnant state -Immediately after delivery ,the fundus should be firm midline with umbilicus -should descend 1-2cm every 24hrs, halfway between symphis pubis and umbilicus by day 6 -after 2 wks the uterus should lie within the true pelvis and should not be palpable Lochia rubra - Answer: dark red to brown discharge 1-3 days after delivery Lochia serosa - Answer: Pinkish/brown, serosanguineous. Lasts day 4-10 postpartum Lochia Alba - Answer: Yellowish-white creamy discharge on Day 11-8 weeks postpartum Cardio changes in postpartum - Answer: decrease in blood volume related to : blood loss during birth (300-500mL) diaphoresis and diuresis of the excess fluid ( loss occurs within 2-3 days postdelivery) pulmonary embolus - Answer: when fragments or an entire cot dislodges and moves into circulation is a complication of DVT that occurs if the embolus moves into the pulmonary artery or one of its branches and lodges in a lung, occluding the vessel and obstructing blood flow to the lungs thrombolytic therapy Oxytocin - Answer: Uterine Stimulant -to promote uterine contractions Postpartum hemorrhage - Answer: occurs if client loses more than 500 mL of blood after a vaginal birth or more than 1,000 mL of blood after a cesarean birth Uterine Atony - Answer: inability of uterine muscle to contract adequately after birth, can lead to postpartum hemorrhage give oxytocin, methylergonovine, misoprostol, or Carboprost tromethamine Methylergonovine, Misoprostol, Carboprost tromethamine - Answer: uterine stimulant -to control postpartum hemorrhage Subinvolution of the uterus - Answer: uterus remains enlarged with continued lochia discharge and can result in postpartum hemorrhage give oxytocin or methylergonovine Inversion of the uterus - Answer: uterus is turning inside out can be partial or complete results in hemorrhage; emergent situation give tocolytic Terbutaline - Answer: Tocolytic -relax uterus prior to the provider's attempt at replacement of the uterus into the uterine cavity and uterus repositioning Retained placenta - Answer: Placenta or fragments of the placenta remain in the uterus preventing the uterus from contracting which leads to uterine atony or subinvolution Med given: oxytocin....if unsuccessful then tocolytic for d&c Lacerations - Answer: occur during labor and birth consist of the tearing of soft tissues in the birth canal and adjacent structures including the cervical, vaginal, vulvar, perineal, and rectal areas -episiotomy can extend and become a third- or fourth- degree laceration Hematoma - Answer: collection of 250-500 mL of clotted blood within tissues that can appear as a bulging bluish mass. Can occur in pelvic region or higher in vagina or broad ligament ice packs to treat small hematomas pain meds sitz baths and frequent perineal hygiene Endometritis - Answer: uterine infection usually 2nd to 5th day postdelivery meds: clindamycin, cephalosporins, penicilins, gentamicin (all antibiotics) mastitis - Answer: breast infection involving connective tissue -most common in breastfeeding mothers for thrombophlebitis, what intervention should the nurse recommend? - Answer: measure leg circumferences to monitor changes teaching on a breastfeeding mother with mastitis, what to include? - Answer: completely empty each breast at each feeding or use a pump which of the following risk factors should the nurse include for UTI's ? - Answer: epidural anesthesia urinary bladder catheter frequent pelvic exams history of UTI's cesarean births postpartum client who is exhibiting tearfulness, insomnia, lack of appetite,and a feeling of sadness what do these symptoms indicate - Answer: postpartum blues postpartum psychosis; what is the nurses priority - Answer: ask the client if she has thoughts of harming herself or her infant expected reference range for newborns - Answer: 2,500 g - 4,000 g / 5.51 lb-8.81 lb 45 cm - 55 cm / 17.7 in - 21.6 in head circum: 32 cm - 36.8 cm/ 12.6 in - 14.5 in chest circum: 30 cm - 33 cm/ 11.8 in - 12.9 in vital signs reference - Answer: RR 30-60/min with short apnea (less than 15 secs) HR 110-160 BP 60-80 systolic/ 40-50 diastolic T 97.7-99.5 F/ 36.5 - 37.5 C milia - Answer: small raised white spots on face mongolian spots - Answer: bluish purple spots of pigmentation telangiectatic nevi - Answer: Flat, pink or red marks that easily blanch and are found on the back of the neck, nose, upper eyelids, and middle of forehead nevus flammeus - Answer: a port wine stain on face or neck that is permanent birthmark of newborn erythema toxicum - Answer: pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks. small white nodules on the roof of the newborn's mouth - Answer: epstein perals In checking for the Moro reflex in a newborn, the nurse should perform which of the following to assess it? - Answer: hold newborn in a semi sitting position, then allow the newborn's head and trunk to fall backward bluish marking across newborn's lower back - Answer: this is frequently seen in newborns of african american, asian, or native american origin a nurse is preparing to administer prophylactic eye ointment to a newborn to prevent ophthalmia neonatorum. Which medication will the nurse administer - Answer: Erythromycin a nurse is returning a newborn to his mother following circumcision. Which of the following actions should the nurse take to ensure safety of the newborn - Answer: match the mothers identification band with the newborns identification band teaching about breastfeeding - Answer: when latched on, the infants nose, cheek, and chin are touching the mother's breast teaching about proper techniques for bottle feeding with a new mother - Answer: keep the nipple full of formula when feeding to prevent infant from sucking air readiness to feed sign - Answer: attempts to place his hand in his mouth circumcision contraindications - Answer: hypospadias (foreskin used to repair defect) family history of hemophilia episadias (defect in urethral opening) 42 weeks in labor, what should she expect because her baby is postmature - Answer: leathery, cracked, and wrinkled skin high bilirubin level and is receiving phototherapy what is a priority finding - Answer: Sunken fontanels (injury from dehydration) 32 week newborn weighing 1,100 g, findings expected include - Answer: Lanugo weak grasp reflex translucent skin, thin, smooth, shiny postterm newborn - Answer: thin, loose skin, wasted appearance meconium staining of umbilical cord long finger nails Neonatal Abstinence Syndrome - Answer: a continuous high pitched cry father appears nervous when the mother asks him to help care for the newborn, - Correct Ans: