CNUR 303 EXAM MASTER PACK – SOLVED QUESTIONS WITH CORRECT ANSWERS AND DETAILED SOLUTIONS

1. When is oxytocin given in 3rd stage of labour - ANSWER after delivery is ant. Shoulder 2. What is monitored immediately after birth of placenta - ANSWER BP, HR, fundus and flow q15min x 4 3. Indication of placental delivery - ANSWER increased bloody show Lengthening of cord Change in uterine tone/ shape 4. Intermittent auscultation indicaions - ANSWER Intrapartum healthy mother 37-41+3wks gestation in spontaneous labour 5. How often is uterine activity monitored in active 1st and 2nd stage of labour - ANSWER Every 15 mins looking for frequency, duration, strength and resting tone 6. Normal amount of contractions - ANSWER 5 or less in a 10 minute period averaged over 30 mins 7. Term for abnormal uterine acivity - ANSWER Tachysystole 8. Normal duration of contraction - ANSWER <90 sec 9. normal restine tone - ANSWER about 30 seconds + 10. tachysystole requirements - ANSWER resting tone <30 sec duration >90 sec >5 contractions in 10 mins 11. when is EFM indicated? - ANSWER pregnancies at risk for adverse perinatal outcomes 12. Definition of EFM accelerations - ANSWER Abrupt increase in FHR (onset to peak under 30 seconds) 15 more more bpm above baseline for 15 seconds or more Doesn't last longer than two minutes Over 10 mins is a change in baseline 13. What does FHR accelerations indicate? - ANSWER sympathetic response Cam be reaction to stimuli Periodic or episodic 14. Gradual decel - ANSWER 30 sec or more from baseline to nadir 15. Abrupt decel - ANSWER under 30 sec from baseline to nadir 16. What do decels means - ANSWER Domination of parasympathetic Stim of vague nerve decreases AV firing lowering babes heart rate 17. Early decel meaning - ANSWER Gradual onset (30 sec or more) Mirror contractions Fetal head compression =vagal response NORMAL finding 18. Late decel meaning - ANSWER Gradual (30 sec or more) Nadir at end of contraction Decreased uteroplacental blood flow and possible hypoxia 19. Variable decel meaning - ANSWER Abrupt onset (under 30 sec) 15 bpm or more below baseline for 15 seconds or more Altered umbilical blood flow/ cord compression Can be complicated or noncomplicated u shaped 20. Variability meaning - ANSWER Fluctuation in baseline Parasymp slows down, sump speed up (FHR) Mature CNS, babe is oxygenated, intact medulla 21. How to assess variability - ANSWER 1min section with no acels, decels or contractions. Take highest FHR and lowest and find the difference = range of variability Mod: 6-25bpm (under is mild, above is marked and none is absent) 22. BPP testing includes... - ANSWER score out of 10 after completing An NST Breathing movement Body movement Muscle tone and Amniotic fluid volume 8-10= healthy 5-7= retest in 12-24h 0-4= fetus at risk 23. Intrauterine resus goals - ANSWER Improve uteroplacental blood flow, umbilical circulation, and maternal oxygenation 24. How to intrauterine resus - ANSWER Confirm FHR/MHR Position change Stop induction of labour Modify pause pushing Improve maternal hydration Vag exam Consider tocolysis Support O2 by mask 25. Reasons to induce - ANSWER post date 41+3days + PROM Maternal morbidity Fetal distress Fetal size (IGUR, LGA) IUFD 26. Reasons NOT to induce - ANSWER vag delivery contraindicated HIV high viral load Active genital herpes previous uterine surgery Not consented Social issuses 27. risks of induction - ANSWER failure of vaginal delivery Fetal distress 28. Why is oxytocin dependent on estrogen - ANSWER because you need estrogen to create oxytocin receptors 29. Nursing role of oxytocin in pp period - ANSWER Monitor for PPH because of uterine fatigue Continue oxy in pp 30. hCG (human chorionic gonadotropin) - ANSWER This stimulates the corpus luteum to produce estrogen & progesterone until placenta is ready to do so (14wks) first preg hormone 31. Estrogen role in preg - ANSWER Uterine and breast enlargement 32. Progesterone role in preg - ANSWER Inhibits contractions to maintain endometrium 33. Relaxin - ANSWER Softens/ relaxes joints and cervix and inhibits contractions 34. hCL human placental lactogen - ANSWER Insulin antagonist 35. Goodelle's sign - ANSWER wk5-6 softening of the cervix 36. Chadwick's sign - ANSWER wk 6-8 Bluish purple discoloration of the cervix, vagina, and labia as hypervasculation 37. Heger's sign - ANSWER wk 8-12 softening of isthmus (lower uterine segment) 38. Presumptive signs of pregnancy - ANSWER subjective: amenorrhea, morning sickness, excess fatigue, urinary freq, changes in breasts 39. Probable signs of pregnancy - ANSWER objective: goodell, chadwick and hegars sign, positive pregnancy test, progressive uterine enlargement, palpation of fundus 40. positive signs of pregnancy - ANSWER objective, canot be anything else, FHR, fetal movement, ultrasound 41. what three things must happen for successful neonatal transition - ANSWER resps begin and continue effectively fluid is cleared from the airways systemic vascular resistance increases and FO and DA shunts close 42. Newborn Priorities - ANSWER initiation and maintenance of resps establishing extrauterine circulation maintenance of body temp adequate nutrition establishment of waste elim prevention of infec establishing infant-parent relationship 43. nursing action immidiatly following birth - ANSWER warmth (skin plus blanket on top) position to keep airways open clear secretions prn dry baby stimulate (skin to skin) 44. why vit K in newborn - ANSWER to help form blood clots and stop bleeding as necessary since babies lack bacterial flora needed to create vit K 45. why erythromycin in newborn - ANSWER prevention of ophthalmia neonatorum prevent bacterial eye infection from birth that can cause blindness 46. caput - ANSWER edema from pressure on cervix or vaccum. spongy fluid on palpation 47. Cephalohematoma - ANSWER Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines. 48. subgalealhemmorrhage - ANSWER bleed in subgaleal space that does not heal on its own putting babe at risk for hypovolemic shock 49. baby hypoglycemia symptoms - ANSWER jitteriness, hypothermia, temp instability, lethargic 50. baby infection symptoms - ANSWER resp distress temp instab feed intolerance 51. Hyperbilirubinemia signs - ANSWER Yellow skin and sclera Minimal or no poops Poor feeding Lethargic 52. Why is more frequent feeding a treatment for hyperbilirubinemia - ANSWER because more in= more out. Helps with physiological jaundice 53. Reason for phototherapy in hyperbilirubinemia - ANSWER helps break down bilirubin, making it easier to excrete 54. Possible reasons for neonatal resus - ANSWER abnormal FHR Mec stained fluid Prolonged/ difficult delivery Asphyxia Weak cry Sternal reactions Poor breathing 55. Indicators intrapartum asphyxia - ANSWER cord oh under7 Base excess -12/+12 APGAR 0-3 Seizures, hypotonia, coma Multiorgan dysfunction 56. Risk for neonatal resp distress - ANSWER mec stained fluid Hypothermia Hypoglycemia TTN RDS 57. Indicators of resp distress - ANSWER Tachypnea Apnea Cyanosis Grunting Nasal flaring Reactions (xiphoid) Poor feeding 58. Transient tachypnea of newborn TTN - ANSWER wet lung syndrome. Happens when there is access fluid in the lungs or delayed reaborption. 4-6h post birth 59. TTN s/s - ANSWER Tachypnea, tachycardia, grunting, nasal flaring, cyanosis, use of accessory muscles, crackles or diminished lung sounds. 60. Resp distress syndrome RDS - ANSWER Born before lungs are fully matured (lack surfactant) and ready for extrauterine life (common in preterm). Without surfactant infant may not inflate lungs 61. When in bethametazone indicated in oreterm - ANSWER If birth is anticipated between 24-33+6 wks it may be given to mom to encourage lung maturity 62. RDS s/s - ANSWER Tachypnea, grunting, nasal flaring, cyanosis, sternal reactions, accessory muscles, resp or mixed acidosis 63. neonatal abstinence syndrome NAS - ANSWER withdrawing from substance exposed in utero 64. NAS puts babes at risk for... - ANSWER resp distress jaundice IUGR behavior abnormalities seizure congenital abnormalities 65. how long can neonatal withdrawal last to opiates and some common symptoms - ANSWER can last up to 6 months tremors and irritability 66. how do amphetamines effect neonates - ANSWER not well known but can cause cleft lip/ palate, preterm birth/ SGA, and intracranial hemmorhage 67. hoe does marijana effect neonates - ANSWER can cause post dates, SGA, and less prolactin can effect breast feeding 68. how smoking in preg effects baby - ANSWER SGA, SIDS, behavioral problems, resp comprimise 69. preterm infant characteristics - ANSWER large fontanelles, permeable, shinny skin with less creases, no breast tissue, large external labia, undescended testes 70. persistent patent ductus arteriosus s/s - ANSWER tachypnea, tachycardia, crackles, systolic murmur, bounding peripheral pulses, hepatomegaly 71. Necrotizing Enterocolitis (NEC) - ANSWER acute inflammation of the bowel that leads to ischemia or tissue necrosis. breast milk can help prevent 72. preterm intracranial hemorrhage - ANSWER results from trauma, asphyxia, and resp distress <32 wks have screening increased risk in preterm because of fragility of head 73. Late preterm newborn - ANSWER 34-36+6wks 74. late preterm looks like a term baby but is at higher risk of what? - ANSWER hypothermia bc less BAT ad subq aft hypoglycemia resp distress hyperbilirubinemia immature suck/swallow feeding difficulties 75. Chorioamnionitis - ANSWER infection of the amniotic fluid that affects a person during pregnancy 76. Cord prolapse - ANSWER When an unborn babies cord slips through the cervix into the vagina after the moms water breaks and before the baby descends into the birth canal 77. Cord prolapse risks - ANSWER causes poor perfusion to the fetus due to compression between the presenting fetal part and birth canal 78. TOLAC - ANSWER planned or attempted vaginal birth after csection. only VBACK if once TOLAC results in vaginal delivery 79. Labor dystocia - ANSWER >4h active labor w less than 0.5cm dilation/h or 1h of pushing without decent or presenting part aka slow progress of labor caused by one of the 5 p's of labor. 80. labor dystocia protraction disorder - ANSWER delayed cervical dilation/ slow decent of head 81. labor dystocia arrest disorder - ANSWER can happen during active phase, secondary arrest of cervical dilation, arrest/failure decent of fetal head 82. late preterm - ANSWER 34-37wks 83. labor dystocia risk factors - ANSWER AMA, obesity, short stature, infertility difficulties, prior EVC, uterine abnormalities, malpresentation, CDP, uterine overstim w oxy, maternal fatigue, inappropriate timing of analgesic 84. ECV - ANSWER External cephalic version is a procedure used to get baby from breach to head down 85. CPD - ANSWER cephalopelvic disproportion where size mismatch between moms pelvis and babies head size 86. hypertonic uterine contractions - ANSWER midsection contracts with more force than the fundus or contraction is not synchronized 87. hypertonic uterine contractions nursing care - ANSWER therapeutic rest by having a warm bath and analgesic such as morphine to inhibit uterine contractions, reduce pain and encourage sleep. 88. hypotonic uterine contractions - ANSWER weak and inefficient contractions. no basal tone, insufficient intensity, fails to dilate 89. common causes of hypotonic contractions - ANSWER CDP and malposition 90. primary powers - ANSWER uterine contractions that dilate cervix 91. secondary powers - ANSWER decent of baby 92. protracted labour - ANSWER prolonged labor 93. Labour arrest - ANSWER stopping of labor 94. causes of abnormal labor patterns - ANSWER ineffective uterine contractions, pelvic contractures, CPD, abnormal presentation, early use of analgesics, nerve block analgesia or anesthesia, anxiety and stress. 95. pelvic dystocia - ANSWER Contractures of pelvic diameters that reduce the capacity of the bony pelvis, inlet, midpelvis, or outlet 96. soft tissue dystocia - ANSWER obstruction of birth passage caused by an anatomical abnormality not involving the bony pelvis. 97. soft tissue dystocia causes - ANSWER placenta previa, tumor, full bladder or rectum, leiomyomas (uterine fibroids) may prevent fetus from entering the birth canal 98. anomalies causing dystocia - ANSWER gross ascites, large tumours, and open neural tube defects such as myelomeningocele and hydrocephalus 99. why anomalies cause dystocia - ANSWER effect relationship with fetal anatomy to pelvic capacity because fetus is unable to drop into birth canal 100. most common fetal malposition - ANSWER ROP right occiput posterior or LOP 101. how is breech presentation diagnosed - ANSWER leos maneuver, vag exam and ultrasound 102. potential causes of breech - ANSWER neuromuscular because limited movement 103. abnormal amniotic fluid (inc and dec) because it affects fetal mobility 104. risks during breech - ANSWER cord prolapse, mec stained fluid, 105. where is FHR best heard in breech - ANSWER above maternal umbilicus 106. vaginal birth risks when babe is breech - ANSWER cord prolapse (especially if single or double footling) , trapping of after-coming of fetal head (especially preterm) 107. criteria of vaginal birth when babe is breech - ANSWER frank or complete breech position (pike & crosslegged) 108. estimated fetal weight between 2000 and 3800g 109. normal (gynecoid) pelvis 110. flexed fetal head 111. upright position during labor - ANSWER sit and squat facilitate fetal decent during pushing and shorten second stage of labor 112. hands and knees position during labor - ANSWER facilitate rotation from posterior occiput position 113. dystocia intervention - ANSWER ECV, cervical ripening, induction/ augmentation of labor and operative procedures (vacuum/ forescepts or csection) 114. precipitous labor - ANSWER Labor that lasts 3 hours or less from onset of contractions to time of delivery 115. precipitous labor complication - ANSWER location (risk for infec), laceration, hemorrhage, infant bruising 116. why is an ECV done after 36wks - ANSWER because before 36 weeks baby still has time to turn on its own 117. what is important to be done before breech delivery - ANSWER NST and ultrasound 118. occiput posterior maternal risks - ANSWER back pain, prolonged 2nd stage, 3rd and 4th degree tears or episiotomy 119. ultrasound before an ECV to look for what - ANSWER fetal position 120. cord 121. previa? 122. adequacy of maternal pelvis 123. amount of amnotic fluid, gestational age and presence of anomalies 124. induction of labor - ANSWER chemical/mechanical initiation of uterine contractions before their spontaneous onset for the purpose of pushing out babe 125. amniotomy - ANSWER artificial rupture of membranes (AROM) used to induce labor when cervix is ripe or augment if labor is slow 126. how soon does labor usually start after the rupturing of membranes - ANSWER 12h 127. amniotomy risks - ANSWER cord prolapse, infection, and decreased amniotic fluid 128. how often is temp taken after amniotomy - ANSWER q2h 129. shoulder dystocia risk factors - ANSWER macrosomia 130. previous SD 131. arrest descent 132. prolonged labor 133. post term 134. maternal obesity or poorly controlled diabetes 135. short maternal stature 136. operative vaginal delivery 137. ALARMER acronym for shoulder dystocia - ANSWER A- ask for help 138. L- legs hyper flexed A- apply suprapubic pressure/ ant shoulder disimpaction 139. R- rotate posterior shoulder 140. M- manual removal of posterior arm 141. E- episiotomy 142. R- roll on all 4's 143. indication for forceps assisted birth - ANSWER prolonged second stage of labor, the need to shorten the second stage for maternal reasons, abnormal FHR, abnormal presentation (arrest of rotation) 144. conditions for forceps' delivery - ANSWER cervix fully dilated 145. mom bladder empty 146. babe engaged 147. membranes ruptures 148. adequate maternal pelvis size 149. conditions for vacuum birth - ANSWER cervix fully dilated 150. vertex presentation 151. head engaged 152. ruptured membranes 153. adequate maternal pelvis (no sus CPD) 154. caput after vacuum delivery subsides in how many days - ANSWER 3-5 days 155. vacuum delivery documentation - ANSWER number of applications, pop offs, number of pulls and max amount of suction used 156. nursing care in vacuum delivery - ANSWER support, educate, FHR 157. after birth: signs of trauma (poor sucking ad listlessness) 158. csection complications - ANSWER hemorrhage 159. aspiration 160. atelectasis 161. endometriosis 162. infection 163. injury to bladder and bowel 164. feta injuries 165. fetal asphyxia 166. When does the mom begin to feel babe move in her belly - ANSWER 26-32wks 167. Normal kick count - ANSWER 6 or more in 2h 168. what tests are done if less than 6 kicks in 2h - ANSWER nst 169. If less than normal kick count, and normal nst with risk factors or sus of IUGR what tests should be done - ANSWER BPP or AFV w/in 24h 170. If abnormal nst after not meeting normal kick count, what tests would the nurse expect to be done - ANSWER BPP or CST asap 171. If mom is rh-, when is she getting her first dose of anti-D IgG IM/ WinRho? - ANSWER 28wks 172. DAT testing / Indirect combs test - ANSWER test to see if mom or baby has been sensitized to Rh positive blood 173. What does a negative DAT test indicate? - ANSWER that mom has not developed Rh positive antibodies 174. Kleinhaur-Betke test evaluates ________? - ANSWER Kleinhaur Betke test is used to detect the presence of fetal blood in maternal circulation 175. WinRho indications - ANSWER Rh neg mom at 28 wks preg 176. Rh neg mom that's never been sensitized (neg KB and given birth w/in 72h to an Rh pos newborn who's not sensitized evidenced by a DAT) 177. Isoimmunized women who are at higher risk preg 178. When is a GBS swab taken? - ANSWER 35-37wks 179. Potential fetal health outcomes in GBS pos mom - ANSWER meningitis, pneumonia, sepsis 180. Risk factors for GBS neonatal outcomes - ANSWER Positive prenatal culture 181. Preterm birth 182. PROM 183. Intrapartum maternal fever 184. When is Tdap recommended during pregnancy? - ANSWER trap is recommended in every pregnancy at 21-32 wks gestation and to father/ close caregivers 185. Signs of Approaching Labor - ANSWER Lightning pain 186. Braxton hicks contraction 187. Backpain 188. Bloody show 189. Spontaneous rupture of membranes srom 190. What is labour - ANSWER Progesterone withdrawl 191. Oxytocin and prostaglandin proudction 192. Estrogen stimulation 193. 5 Ps of labour - ANSWER Passenger 194. Passage 195. Powers 196. Position of mother 197. Psychological response 198. Primary powers - ANSWER uterine contractions 199. Secondary powers - ANSWER Use of muscles to push 200. 1st stage of labour - ANSWER 3 phases (early/ latent, active and transition) 201. 2nd stage of labour - ANSWER fully dilated to birth 202. 3rd stage of labour - ANSWER Birth to placenta 203. 4th stage of labor - ANSWER Placenta to 1-4h PP 204. Early phase dilation and effecement - ANSWER 0-3cm/ 0-40 percent 205. How often MHR done in early phase - ANSWER q4h if membranes intact q2h if ruptured 206. How often is FHR done in early phase - ANSWER q4h if in hospital 207. Active phase dilation and effecement - ANSWER 4-7cm /40-80 percent effecement 208. How often is FHR done in active pase - ANSWER Q15-30min 209. How often is MHR done in active phasd - ANSWER q4h if intact q2h if ruptured 210. Transition phase dilation and effacement - ANSWER 8-10cm/ 80 100 percent effaced 211. What might be some signs mom is in transition phase - ANSWER Urge to push 212. Rectal pressure 213. N/v 214. Shakiness 215. Increased bloody show 216. Stronger contractions 217. FHR in transition phase - ANSWER q15-30 218. FHR 2nd stage active - ANSWER Done q contraction or at least q5min 219. MHR in 2nd stage active - ANSWER q15-30 min