NURS 330 Exam #2 Study Guide UPDATED ACTUAL
Questions and CORRECT Answers
Labs before epidural -CBC to look at H&H, platelets, WBC
-Infection and coagulopathy are contraindications
Concerns after insertion of an epidural -Marked hypotension:
-Can slow the progress of labor
-Ineffective breathing pattern
-Inability to effectively push
-Headache (fixed with autologous blood patch)
-Safety/Falls as patient unable to get up and walk
If your patient has marked hypotension after an epidural -Monitor for impaired placental perfusion on FHM
is placed, what should you do? -Place side pillow
-IV fluid
-Supplemental O2
-Ephedrine
What is the most common endocrine disorder in -Diabetes Mellitus
pregnancy? -Due to the hormones of pregnancy, any form of DM is hard to control even if pt
is compliant with multidisciplinary care plan
When and how are patients screened for Gestational -GDM is screened for between 24-28 weeks
Diabetes Mellitus? -Glucose Tolerance Test (GTT)
-If blood glucose more than 140, 3 hour GTT is ordered.
-If two out of 3 values are elevated, pt is considered gestational diabetic.
How is DM (GDM, Type I, and Type II) managed during -GDM can often be managed with ADA diet
pregnancy? -Regular and NPH insulin (not long acting as thats hard to titrate)
-Oral DM medications not usually used
Is sugar a teratogen? Yes
Fetal risks with maternal diabetes -Macrosomia (big baby)
-Hydramnios (too much amniotic fluid)
-Ketoacidosis
-Hyperglycemia
-Hypoglycemia
-Dystocia
-Sudden and unexplained stillbirth
-Congenital malformations in CVS (atrial or ventral septal defect more common),
CNS, and Skeletal system
How are fetuses monitoring in GDMs as they at risk for -NST (fetal monitoring) twice a week starting at 32 weeks
sudden, unexplained death? -Kick counts (come in for decreased fetal movement)
What is an ectopic pregnancy? -Fertilized ovum outside of the uterus that proliferates
, What is the priority nursing diagnosis for ectopic -If the fallopian tube were to rupture, there is a risk for hemorrhage. NANDA
pregnancy? would be about shock not pain.
What medications are given for ectopic pregnancy? -Methotrexate stops the fetal cells from proliferating if unruptured
-Salpingostomy vs salpingectomy is surgical treatment.
How is the progress off labor measured? Dilation, effacement, and station
What is dilation? Cervix become wider.
-Latent phase is 0-3 cm
-Active phase is 4-7 cm
-Transition phase is 8-10 cm
-10 cm is full dilated
What is effacement? Cervix thins out
-Measured from 0-100%
-Needs to be 100% for delivery
What is station? Where the baby's head is in relation to the mother's ischial spines
-Estimated and subjective
-High negative number= head less engaged
-High positive number= head more engaged
Types of breech position -Frank Breech
-Single Footling Breech
-Complete Breech
*A strong indicator that C-Section is needed
Risks for breech position Prolapsed cord as the head is not engaged with the cervix
-A prolapsed cord compromises fetal circulation leading to variable or prolonged
deceleration and decreased fetal movement
-Apply manual pressure with fingers on fetal presenting part to decreased cord
compression
Risks for ROM and PROM -Infection (chorioamnionitis) and prolapse of umbilical cord are the biggest risks
-Ideal to deliver within 24 hours of ROM for infection
-Need to check to ensure umbilical cord has not come through the cervix
-Premature Rupture of Membranes (PROM): the spontaneous rupture of the
amniotic membranes 1 hr or more prior to the onset of true labor. For most
women, PROM signifies the onset of true labor if gestational duration is at term
-Preterm Premature Rupture of Membranes (PPROM): the premature spontaneous
rupture of membranes after 20 weeks of gestation and prior to 37 weeks of
gestation
Questions and CORRECT Answers
Labs before epidural -CBC to look at H&H, platelets, WBC
-Infection and coagulopathy are contraindications
Concerns after insertion of an epidural -Marked hypotension:
-Can slow the progress of labor
-Ineffective breathing pattern
-Inability to effectively push
-Headache (fixed with autologous blood patch)
-Safety/Falls as patient unable to get up and walk
If your patient has marked hypotension after an epidural -Monitor for impaired placental perfusion on FHM
is placed, what should you do? -Place side pillow
-IV fluid
-Supplemental O2
-Ephedrine
What is the most common endocrine disorder in -Diabetes Mellitus
pregnancy? -Due to the hormones of pregnancy, any form of DM is hard to control even if pt
is compliant with multidisciplinary care plan
When and how are patients screened for Gestational -GDM is screened for between 24-28 weeks
Diabetes Mellitus? -Glucose Tolerance Test (GTT)
-If blood glucose more than 140, 3 hour GTT is ordered.
-If two out of 3 values are elevated, pt is considered gestational diabetic.
How is DM (GDM, Type I, and Type II) managed during -GDM can often be managed with ADA diet
pregnancy? -Regular and NPH insulin (not long acting as thats hard to titrate)
-Oral DM medications not usually used
Is sugar a teratogen? Yes
Fetal risks with maternal diabetes -Macrosomia (big baby)
-Hydramnios (too much amniotic fluid)
-Ketoacidosis
-Hyperglycemia
-Hypoglycemia
-Dystocia
-Sudden and unexplained stillbirth
-Congenital malformations in CVS (atrial or ventral septal defect more common),
CNS, and Skeletal system
How are fetuses monitoring in GDMs as they at risk for -NST (fetal monitoring) twice a week starting at 32 weeks
sudden, unexplained death? -Kick counts (come in for decreased fetal movement)
What is an ectopic pregnancy? -Fertilized ovum outside of the uterus that proliferates
, What is the priority nursing diagnosis for ectopic -If the fallopian tube were to rupture, there is a risk for hemorrhage. NANDA
pregnancy? would be about shock not pain.
What medications are given for ectopic pregnancy? -Methotrexate stops the fetal cells from proliferating if unruptured
-Salpingostomy vs salpingectomy is surgical treatment.
How is the progress off labor measured? Dilation, effacement, and station
What is dilation? Cervix become wider.
-Latent phase is 0-3 cm
-Active phase is 4-7 cm
-Transition phase is 8-10 cm
-10 cm is full dilated
What is effacement? Cervix thins out
-Measured from 0-100%
-Needs to be 100% for delivery
What is station? Where the baby's head is in relation to the mother's ischial spines
-Estimated and subjective
-High negative number= head less engaged
-High positive number= head more engaged
Types of breech position -Frank Breech
-Single Footling Breech
-Complete Breech
*A strong indicator that C-Section is needed
Risks for breech position Prolapsed cord as the head is not engaged with the cervix
-A prolapsed cord compromises fetal circulation leading to variable or prolonged
deceleration and decreased fetal movement
-Apply manual pressure with fingers on fetal presenting part to decreased cord
compression
Risks for ROM and PROM -Infection (chorioamnionitis) and prolapse of umbilical cord are the biggest risks
-Ideal to deliver within 24 hours of ROM for infection
-Need to check to ensure umbilical cord has not come through the cervix
-Premature Rupture of Membranes (PROM): the spontaneous rupture of the
amniotic membranes 1 hr or more prior to the onset of true labor. For most
women, PROM signifies the onset of true labor if gestational duration is at term
-Preterm Premature Rupture of Membranes (PPROM): the premature spontaneous
rupture of membranes after 20 weeks of gestation and prior to 37 weeks of
gestation
