OB/Maternity HESI Exam 2023 -2024 Ovulation occurs how many days before the next menstrual period? (AKA between ovulation & beginning of next menstrual cycle, there a re how many days?) - ANS-14 To prevent pregnancy, a couple must avoid unprotected sex for ______days before anticipated ovulation & for ___ days after ovulation to prevent pregnancy - ANS-Several days before antcipated ovulation & 3 days after ovulation ---sperm live approx 3 days ---eggs live about 24 hrs Because some women experience _____ or _____, they do not know they are pregnant - ANS-implantation bleeding OR spotting Signs of maternal -fetal bonding in utero? - ANS-talking to fetus in utero massa ging abdomen nicknaming fetus For women, battering (emotional/physcial abuse) begins during preg. How should women be assessed for abuse? - ANS-In private, away from male partner, by nurse who is familiar w/ local resources & knows how to determine safety of the client A women who is 6 wks preg has the following maternal history: -healthy 2 yo daughter -miscarriage at 10 wks -elective abortion at 6 weeks -5 years earlier (what is her GTPAL?) - ANS-4-1-0-2-1 gravida 4, para 1 (only 1 delivery after 20 wks gestation) What is EBD using Nagele's rule? --Woman's last menstrual period Oct. 17 - ANS-Count back 3 months +7 days --July 24 When does plasma volume increase during preg? - ANS-At approx 28 to 32 weeks, plasma volume increase 25 -40%, resulting in hemodilution of Hct values 32 -42% --High Hct values may look good, BUT in reality they represent a gestational HTN disorder & depleted vascular space Foods high in iron - ANS--fish & red meats -cereals & yellow vegetables -green leafy vegetables & citrus fruits -egg yolks and dried fruits What position increases perfusion to uterus, placenta, and fetus? - ANS-L side -lying Changes in _ _____ are the 1st & most important indicators of compromised blood flow to fetus, & these changes require action! - ANS-changes in FHR --fetal well -being determined by fundal height, fetal heart tones & rate, and uterine activity (contractions) Possible i ndications of preeclampsia & eclampsia are? - ANS--*visual disturbances* -*swelling of face, fingers, or sacrum* -*severe, continuous headache* -*persistant vomiting* -*epigastric pain* -infection signs (*chills, temp >100.4, dysuria, pain in abd*) -*fluid discharge* or *bleeding from vagina* (anything besides norm leukorrhea) -*change in fetal movement* or *increased FHR* Nurse's responsibility regarding prenatal vitamins? - ANS-Teach about proper diet & about taking prescribed vitamins as they have been prescribed by HCP ---only HCP can prescribe prenatal vitamins (aka ensure client receives adequate intake of vitamins) What should preg women eat to ensure daily calcium needs are met to help alleviate leg cramps? - ANS-equivalent of 3 cups of milk or yogurt per day Name major discomforts of 1st trimester & suggestions to help relieve each - ANS--N/V: crackers before risi ng -fatigue: rest periods & naps & 7 -8 hrs sleep at night At 20 weeks gestation, the fundal height would be___; the fetus would weight approx ____ and would look like ____ - ANS-at umbilicus; 300 -400g; a baby (w/ hair, lanugo, & vernix, BUT w/o any subq f at) Norm psychological responses to preg in 2nd trimester - ANS--ambivalence wanes & acceptance of pregnancy occurs -preg becomes "real" -signs of maternal -fetal bonding occur Hemodilution of preg peaks at ____ weeks & result in an ____ in a women's Hct? - ANS-28-32 weeks; decrease 3 principles relative to pattern of weight gain in preg - ANS--average 25 -35 pounds -gain should be consistent throughout preg -an avg of 1lb/week in 2nd & 3rd trimesters During preg woman should add ____ cals & drink ____ cu ps of milk per day? - ANS-
300 cals; 3 cups FHR can be auscultated by Doppler at ____ wks gestation - ANS-10 to 12 weeks Describe schedule of prenatal visits for low -risk preg woman - ANS--Once every 4 wks until 28 wks -Every 2 wks from 28 to 36 wks -Once per wk until delivery In some states, screening for neural tube defects by testing either _____ or _____ is mandated by state law. This screening test is highly associated w/ both false positives & false negatives - ANS-maternal serum alphafetoprotein (A FP) or amniotic fluid AFP levels When amniocentesis is done early in preg, bladder must be ____ vs done late bladder must be _____ - ANS-*Early in preg:* bladder must be full to help support the uterus & help push uterus up into abd for easy access *Late in preg:* bladder must be empty to avoid puncture Early decels, caused by _____ & ______, usually occur _____& ______ - ANS-Caused by head compression & fetal descent Usually occur btw 4 and 7 cm & in 2nd stage of labor ---check for labor progress i f early decels are noted If cord prolapse is detected, what should examiner do? - ANS-Position mother knee -to-
chest (or l lateral) to relieve pressure on cord OR Push the presenting part off the cord until immediate c/s can be accomplished Late decels in dicate ___ & are associated w/ what conditions? - ANS-*indicate UPI* -associated w/ conditions such as: *post maturity, preeclampsia, diabetes mellitus, cardiac disease, & abruptio placentae* When decels patterns (late or variable) are associated w/ decre ased or absent variability & tachycardia, the situation is _____ & requires what? - ANS-Situation is ominous (potentially disastrous) & requires immediate intervention & fetal assessment A decrease in uteroplacental perfusion results from ____. Cord compr ession results from _____. Nursing interventions include? - ANS--*⬇ uteroplacental perfusion = late decels* (uniform shape, return to baseline after contraction, depth doesn't indicate severity, rarely falls below 100 bpm) -*cord compression = variable dec els* (severe variable = below 70 bpm lasting longer than 30 -60 sec & slow return to baseline) ---*interventions: change positon, discontinue Pitocin, administer O2, notify HCP* Most important determinant of fetal maturity for extrauterine survival? - ANS-L/S ratio (lung maturity, lung surfactant development) 5 maternal variables associated w/ high -risk preg - ANS--age (<17 or >34)
300 cals; 3 cups FHR can be auscultated by Doppler at ____ wks gestation - ANS-10 to 12 weeks Describe schedule of prenatal visits for low -risk preg woman - ANS--Once every 4 wks until 28 wks -Every 2 wks from 28 to 36 wks -Once per wk until delivery In some states, screening for neural tube defects by testing either _____ or _____ is mandated by state law. This screening test is highly associated w/ both false positives & false negatives - ANS-maternal serum alphafetoprotein (A FP) or amniotic fluid AFP levels When amniocentesis is done early in preg, bladder must be ____ vs done late bladder must be _____ - ANS-*Early in preg:* bladder must be full to help support the uterus & help push uterus up into abd for easy access *Late in preg:* bladder must be empty to avoid puncture Early decels, caused by _____ & ______, usually occur _____& ______ - ANS-Caused by head compression & fetal descent Usually occur btw 4 and 7 cm & in 2nd stage of labor ---check for labor progress i f early decels are noted If cord prolapse is detected, what should examiner do? - ANS-Position mother knee -to-
chest (or l lateral) to relieve pressure on cord OR Push the presenting part off the cord until immediate c/s can be accomplished Late decels in dicate ___ & are associated w/ what conditions? - ANS-*indicate UPI* -associated w/ conditions such as: *post maturity, preeclampsia, diabetes mellitus, cardiac disease, & abruptio placentae* When decels patterns (late or variable) are associated w/ decre ased or absent variability & tachycardia, the situation is _____ & requires what? - ANS-Situation is ominous (potentially disastrous) & requires immediate intervention & fetal assessment A decrease in uteroplacental perfusion results from ____. Cord compr ession results from _____. Nursing interventions include? - ANS--*⬇ uteroplacental perfusion = late decels* (uniform shape, return to baseline after contraction, depth doesn't indicate severity, rarely falls below 100 bpm) -*cord compression = variable dec els* (severe variable = below 70 bpm lasting longer than 30 -60 sec & slow return to baseline) ---*interventions: change positon, discontinue Pitocin, administer O2, notify HCP* Most important determinant of fetal maturity for extrauterine survival? - ANS-L/S ratio (lung maturity, lung surfactant development) 5 maternal variables associated w/ high -risk preg - ANS--age (<17 or >34)
