OB HESI Study Questions (taken from HESI NCLEX-RN book) 2022

OB HESI Study Questions (taken from HESI NCLEX-RN book) 2022 Objective signs that signify ovulation - ANS- Abundant, thin, clear cervical mucus (egg-white stretchiness), open cervical os, slight drop in basal body temp & then 0.5 to 1°F rise, ferning Ovulation occurs how many days before the next menstrual period? - ANS- 14 days 3 ways to identify gestation of pregnancy - ANS- 10 lunar months, 9 calendar months, 3 trimesters of 3 months each, 40 wk, 280 days What maternal position provides optimum fetal and placental perfusion during pregnancy? - ANS- Knee-chest but side-lying is most comfortable and removes pressure from abdominal vessels Major discomforts of first trimester and suggestions for relief for each - ANS- N/V: crackers before rising. Fatigue: 7-8hr sleep at night Naegele's Rule - ANS- First day of LMP: Oct 24 Subtract 3 months: July 24 Add 7 days: July 31=Estimated Date of Delivery (Adjust year accordingly) Fundal height at 20 wk gestation - ANS- At the umbilicus Approximate wt of fetus @ 20 wk gestation - ANS- 300-400g Characteristics of fetus @ 20 wk gestation - ANS- Looks like baby with hair, lanugo, vernix. No subcutaneous fat. Normal psychosocial responses to pregnancy in 2nd trimester - ANS- Acceptance of pregnancy (ambivalence wanes) Signs of maternal-fetal bonding Peak of hemodilution in pregnancy - ANS- 28-32 wk (decreases Hct) 3 principles relative to wt gain in pregnancy - ANS- Total gain average 24-30 lb Gain should be consistent throughout pregnancy Average of 0.9 lb/wk in 2nd & 3rd trimesters How many calories should be added daily to the pregnant woman's diet? - ANS- 300 calories How much milk should a pregnant woman consume daily during pregnancy? - ANS1 quart At how many wks can fetal heart tones be auscultated by Doppler? - ANS- 10-12 wks Schedule of prenatal visits for low-risk pregnant woman - ANS- Once a month until 28 wks Every 2 wks from 28-36 wks Once a wk until delivery Five maternal variables associated with diagnosis of high-risk pregnancy - ANS- 1. Age (17, 34) 2. Parity (5) 3. Dx of preeclampsia 4. Dx of Diabetes Mellitus 5. Dx of cardiac disease Is one ultrasound exam useful in determining presence of IUGR? - ANS- No, serial measurements are needed What does the biophysical profile determine (BPP)? - ANS- Fetal well-being List 3 nursing actions prior to ultrasound exam for woman in 1st trimester of pregnancy - ANS- 1. Have client fill bladder 2. Don't allow client to void 3. Position client supine w/uterine wedge Advantage of CVS over amniocentesis - ANS- -Can be done during 8-12 wks gestation -Results returned in 1 wk -Allows for decision about termination in 1st trimester Why are serum or amniotic AFP levels done prenatally? - ANS- Elevated AFP levels may indicate presence of neural tube defects. Low AFP levels may indicate trisomy 21 Most important determinant of fetal maturity for extrauterine survival - ANS- L:S ratio (lung maturity, lung surfactant development) 3 most common complications of amniocentesis - ANS- 1. Spontaneous abortion 2. Fetal injury 3. Infection 4 changes of FHR - ANS- 1. Accelerations 2. Early decelerations 3. Variable decelerations 4. Late decelerations Cause of FHR accelerations and nursing treatment - ANS- -Caused by burst of sympathetic activity -Reassuring and require no treatment Cause of FHR early decelerations and nursing treatment - ANS- -Caused by head compression -Benign and alert nurse to monitor for labor progress and fetal descent Cause of FHR variable decelerations and nursing treatment - ANS- -Caused by cord compression -Change of position should be tried first Cause of FHR late decelerations and nursing treatment - ANS- -Caused by uteroplacental insufficiency (UPI) -Place client on side and administer O2 VEAL CHOP (acronym for FHR interpretation) - ANS- Variables=Cord compression Early decel=Head compression Accelerations=OK Late decel=Placental insufficiency Most important indicator of fetal autonomic nervous system integrity and health - ANS- FHR variability 4 causes of decreased FHR variability - ANS- 1. Hypoxia 2. Acidosis 3. Drugs 4. Fetal sleep Most important action when cord prolapse is determined - ANS- Position mother to relieve pressure on cord or push presenting part off cord with fingers until emergency delivery is accomplished Reactive non-stress test - ANS- FHR acceleration of 15 bpm for 15 sec in response to fetal movement Dangers of nipple-stimulation stress test - ANS- -Inability to control oxytocin "dosage" -Tetany/hyperstimulation Normal fetal scalp pH in labor - ANS- 7.25-7.35 Fetal scalp pH in labor of 7.2 indicates what? - ANS- True acidosis 6 prodromal signs of labor - ANS- Lightening, Braxton Hicks contractions, increased bloody show, loss of mucous plug, burst of energy, & nesting behaviors True labor vs. False labor - ANS- True: regular, rhythmic contractions that intensify with ambulation, pain in abdomen sweeping around from back, cervical changes. False: Irregular rhythm, abdominal pain (not in back) that decreases with ambulation 2 ways to determine whether membranes have truly ruptured - ANS- Nitrazine testing paper turns dark blue or black, & Demonstration of fluid ferning under microscope Are psychoprophylactic breathing techniques prescribed for use according to the stage and phase of labor? - ANS- No. Clients should use these techniques according to their discomfort level and should change techniques when one is no longer working for relaxation. 2 reasons to withhold anesthesia and analgesia until the midactive phase of stage I labor - ANS- If given too early it can retard labor, if given too late it can cause fetal distress. CONTINUES...