NCLEX UWORLD MATERNAL NEWBORN EXAM QUESTIONS AND ANSWERS

NCLEX UWORLD MATERNAL
NEWBORN EXAM QUESTIONS AND
ANSWERS
Uterine Atony - ANSWERS--"boggy" uterus
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-may lead to excessive blood loss and clots
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-FIRM fundal massage gv gv


-
if fundal massage causes uterus to become firm nurse should check every 15 min
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utes for first hour after birth
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-if fundal massage does not work oxytocin may be necessary
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Lochia - ANSWERS-1. birth to 3-
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4 days after birth: lochia rubra, dark or bright red blood with some small clots
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2. 4-14 days after birth: lochia serosa, pink brownish decreasing in amount
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3. 11 days up to 6 weeks after birth: lochia alba, white color/
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creamy in light quantity gv gv gv




Fetal Strip - ANSWERS--moderate variability expected and indicates movement
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-accelerations expected gv


-early decelerations are expected
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-late decelerations are cause for concern
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Late Decelerations - ANSWERS-
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CAUSED BY UTEROPLACENTAL INSUFFICIENCY
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-oxygen
-reposition on left side gv gv gv


-IV fluid bolus
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-notify HCP and prepare to stop oxytocin
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Presentations
1. cephalic
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2. breech
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3. prolapsed cord - ANSWERS-1. head down, diamond shape palpated
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2. legs down, fetal legs/buttocks/feet palpated
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3. soft/rubbery/pulsating structure, requires emergent c-
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section and mother to be on hands and knees & use sterile/
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gloved hand to relieve pressure on cord
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Spontaneous Rupture of Membranes - ANSWERS--sterile gloves
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-nitrazine pH test strip: positive for amniotic fluid if blue color present on strip
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Stages of Labor - ANSWERS-1. latent (1-5 cm dilation) or active (6-
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10 cm dilation), < 100% effaced
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2. 10 cm (complete) dilation to birth, 100% effaced
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,3. birth of baby and expulsion of placenta
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4. 1-4 hours after birth, mother's physiologic readjustment
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Systemic Analgesia for Labor Pain - ANSWERS--
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given in stage 1 active labor ONLY
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-do not give to opioid dependent women
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-more than 3 doses not recommended d/t ceiling effect
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-ex. Stadol & Nubain
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*give at peak of contraction for best absorption
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Stable Labor - ANSWERS--stable maternal vital signs
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-fetus HR 110-160gv gv


-well established labor contractions
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-satisfactory contraction/fetal strip gv gv




Oxytocin - ANSWERS-STIMULATES UTERINE CONTRACTIONS
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RISKS
-late decelerations, bradycardia
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-emergency C-section gv


-postpartum hemorrhage gv


-water intoxication gv


-uterine tachysystole (>5 contractions in 10 minutes)
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-monitor every 15 minutes in first hour
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-contractions should be 2-3 minutes apart gv gv gv gv gv


-electronic IV pump gv gv


-continuous monitoring gv


-monitor mother's fluid intake gv gv gv


-secondary IV line gv gv


-titrated based on rate and intensity of contractions
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Placenta Accreta - ANSWERS- gv gv gv


PLACENTA IMPLANTS IN MYOMETRIUM AND NOT ENDOMETRIUM
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-detected through US gv gv


-prepare for potential hemorrhage
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Precipitous Birth - ANSWERS-lasts 3 hours from onset to birth
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Labor
1. true
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2. false - ANSWERS-
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1. regular intervals with increasing intensity, begins in lower back and radiates to a
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bdomen, pain increases despite comfort measures, increase in cervical dilation & e
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ffacement, brown/mucoid discharge gv gv


2. irregular intervals, no increase in intensity, starts in lower back and radiates to g
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roin, contractions may lessen with comfort measures, no cervical changes
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, Group B Strep - ANSWERS--tested at 35-37 weeks gestation
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-treated prophylactically with abx
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Choriamniotitis - ANSWERS-infection of amniotic fluid gv gv gv gv gv




Primigravida - ANSWERS-woman's first child gv gv gv gv




Fetal Positions gv


1. occiput
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2. anterior
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3. posterior - ANSWERS-1. head is in middle of pelvic bone
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2. face pointed towards mom's back
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2. face pointed towards mom's stomach
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*right or left gv gv


*occiput anterior is ideal gv gv gv




Pudendal Nerve Block - ANSWERS- gv gv gv gv


PAIN RELIEF METHOD GIVEN IN LATER STAGES OF LABOR
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-local anesthesia injected
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-does not relieve contraction pain but relieves pressure pain
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Preeclampsia - ANSWERS-HIGH MATERNAL BP gv gv gv gv




-seizure precautions (if seizure occurs place on left side)
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-
magnesium sulfate used to treat during labor (check deep tendon reflexes every h
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our, calcium gluconate is reversal agent)
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-limit environmental stimuli
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-
placental hemorrhage is major risk (watch for abdominal cramps and vaginal bleedi
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HELLP Syndrome (severe case)
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-hemolysis
-elevated liver enzymes gv gv


-low platelet count
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-sx: RUQ pain, nausea, vomiting, malaise
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MAGNESIUM SULFATE TOXICITY gv gv


-nausea, headache, hyporeflexia, cardiac arrest
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-tx: stop magnesium sulfate therapy & use IV calcium gluconate to reverse
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Adoption - ANSWERS--encourage mother to create memories with the newborn
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-give chance to say goodbye
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-notify other health care workers who may interact with client
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-reinforce adoption as a loving decision
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