OB final exam & HESI
The nurse should be concerned after the assessment finding on what during a magnesium
sulfate infusion for preeclampsia?
A. a sleepy, sedated effect
B. a respiratory rate of 10 bpm
C. DTR of 2+
D. absence of ankle clonus - ANSB should alert the nurse for respiratory depression. The other
findings are considered normal.
the most common medical complication of pregnancy - ANShypertension
preeclampsia results in what - ANSdecreased function of organs (placenta, liver, kidneys, brain)
due to vasospasms diminishing the diameter of blood vessels .
a woman being treated with magnesium sulfate should be considered to be treated successfully
if... - ANSno seizures occur
Mag is a CNS depressant, NOT an antihypertensive medication
antidote for magnesium sulfate - ANScalcium gluconate
HELLP syndrome - ANSHemolysis
Elevated Liver enzymes
Low Platelets
A pregnant woman who is at 21 weeks of gestation has an elevated blood pressure of 140/98.
Past medical history reveals that the woman has been treated for hypertension. On the basis of
this information, the nurse would classify this patient as having: - ANSsuperimposed
preeclampsia
positive ankle clonus indicates... - ANShyperactivity and is a cause for concern
which antihypertensive medication would cause a pregnant woman to have a false positive
Coombs test? - ANSmethyldopa (aldomet)
lab values for preeclampsia - ANSelevated hemoglobin
elevated LDH
decreased platelets (below 100,000)
increased BUN
,the most important cause of perinatal loss in diabetic pregnancy is... - ANScongenital
malformations
hypothyroidism in mother could cause - ANSmiscarriage
preeclampsia and hypertension
placental abruption
stillbirth
low birth weight, premature
A patient who is pregnant already has Type 2 diabetes with a hemoglobin A1c value of 7. The
nurse would categorize this patient as having: - ANSpregestational DM
priority assessment for pregnant woman experiencing nausea and vomiting - ANSketonuria
A pregnant woman has maternal phenylketonuria (PKU) and is interested in whether or not she
will be able to breastfeed her baby. Which reaction by the nurse indicates accurate information?
- ANSthe patient should be advised to not breastfeed the infant because her breast milk will
contain large amounts of phenylalanine
what interventions would the nurse anticipate to be ordered by the physician for a patient in a
thyroid storm during delivery? - ANSadminister oxygen
antipyretics
PTU
preeclampsia protein levels - ANSmild: 1+ on dipstick (0.3-2 g/24 hours)
severe: 3+ dipstick (more than 5 g/24 hr)
mag toxicity - ANSflushing
sweating
hypotension
depressed DTR
respiratory depression
creatinine levels of severe preeclampsia - ANSelevated (above 1.2)
platelet levels of severe preeclampsia - ANSdecreased (below 100,000)
incompetent cervix - ANSpremature dilation
tx: surgical placement of cervical cerclage 10-14 weeks gestation to constrict the internal os
provide bed rest, hydration, tocolysis (to inhibit ctx), no sex or standing for a long time
,removed at 37 weeks gestation or prior to c/s
leading cause of life-threatening perinatal infections - ANSGBS
can lead to sepsis, pneumonia, or meningitis causing permanent neuro disability
dx with vag and rectal cultures at 35-37 weeks
tx with antibiotics
opthalmia neonatorum is caused by what organism - ANSgonorrhea (neisseria gonorrhoeae)
mechanisms of labor - ANS1. engagement (lightening, dropping)
2. descent
3. flexion
5. internal rotation
6.. extension (begins after the head crowns)
7. restitution (realignment of the fetal head with the body after the head emerges)
8. external rotation (of the shoulders)
9. explusion
variable decels - ANScord compression
are not as uniform as early and late decels
could be nonperiodic (unrelated to ctx times)
they are significant when FHR repeatedly declines to less than 70 bpm and persists at level for
at least 60 seconds before returning to baseline
TX: change position, administer oxygen, d/c pit, assess mother's vitals, assist with
amnioinfusion to decompress cord as prescribed
Four Stages of Labor - ANSSTAGE 1
a) Latent
1-4 cm dilation w/ UC 15-30 minutes apart and 15-30 seconds duration
b) Active
4-7 cm dilation w/ UC 3-5 minutes apart for 30-60 seconds
c) Transition
8-10 cm w/ UC 2-3 min apart for 45-90 seconds
STAGE 2
exit of fetus
assess every 5 minutes
, STAGE 3
placental exit
<30 minutes after fetus
fundus remains firm 2 fingerbreadths below umbilicus
STAGE 4
about up to 4 hours after delivery
assess Q15 for first hour, Q30 for second hour, and hourly for 3rd and 4th hour
what score of the bishop scale indicates readiness for labor induction - ANS6
bishop scoring - ANS0-3
dilation (0-- 1 to 2-- 3 to 4-- more than 5)
effacement (0 to 30-- 40 to 50-- 60 to 70-- 80)
consistency of cervix (firm--med--soft)
position of cervix (posterior--mid--anterior)
station (-3.. -2.. -1... +1)
when is an amniotomy performed - ANSif the fetus is 0 or plus station and membranes haven't
ruptured
increases the risk of a prolapsed cord and infection
placenta previa - ANSimproperly implanted placenta (total, partial, marginal in relation to the
internal os)
sudden, PAINLESS, BRIGHT red vaginal discharge
SOFT, RELAXED, NONTENDER uterus
fundal height is higher than expected
abruptio placenta - ANSpremature separation of placenta (after 20th week but before birth)
DARK red bleeding (or none if too high), PAINFUL, TENDER uterus w/ RIGIDITY
fetal distress with maternal shock
in which placental condition would vaginal exams be contraindicated - ANSplacenta previa
anticipate what intervention for abruptio placentae - ANSdelivery
preterm labor - ANSbefore 37 weeks
risks: multifetal pregnancy, overdistended uterus, anemia, age extremities, substance abuse, hx
of obsteric or other issues (cardiac issues)
The nurse should be concerned after the assessment finding on what during a magnesium
sulfate infusion for preeclampsia?
A. a sleepy, sedated effect
B. a respiratory rate of 10 bpm
C. DTR of 2+
D. absence of ankle clonus - ANSB should alert the nurse for respiratory depression. The other
findings are considered normal.
the most common medical complication of pregnancy - ANShypertension
preeclampsia results in what - ANSdecreased function of organs (placenta, liver, kidneys, brain)
due to vasospasms diminishing the diameter of blood vessels .
a woman being treated with magnesium sulfate should be considered to be treated successfully
if... - ANSno seizures occur
Mag is a CNS depressant, NOT an antihypertensive medication
antidote for magnesium sulfate - ANScalcium gluconate
HELLP syndrome - ANSHemolysis
Elevated Liver enzymes
Low Platelets
A pregnant woman who is at 21 weeks of gestation has an elevated blood pressure of 140/98.
Past medical history reveals that the woman has been treated for hypertension. On the basis of
this information, the nurse would classify this patient as having: - ANSsuperimposed
preeclampsia
positive ankle clonus indicates... - ANShyperactivity and is a cause for concern
which antihypertensive medication would cause a pregnant woman to have a false positive
Coombs test? - ANSmethyldopa (aldomet)
lab values for preeclampsia - ANSelevated hemoglobin
elevated LDH
decreased platelets (below 100,000)
increased BUN
,the most important cause of perinatal loss in diabetic pregnancy is... - ANScongenital
malformations
hypothyroidism in mother could cause - ANSmiscarriage
preeclampsia and hypertension
placental abruption
stillbirth
low birth weight, premature
A patient who is pregnant already has Type 2 diabetes with a hemoglobin A1c value of 7. The
nurse would categorize this patient as having: - ANSpregestational DM
priority assessment for pregnant woman experiencing nausea and vomiting - ANSketonuria
A pregnant woman has maternal phenylketonuria (PKU) and is interested in whether or not she
will be able to breastfeed her baby. Which reaction by the nurse indicates accurate information?
- ANSthe patient should be advised to not breastfeed the infant because her breast milk will
contain large amounts of phenylalanine
what interventions would the nurse anticipate to be ordered by the physician for a patient in a
thyroid storm during delivery? - ANSadminister oxygen
antipyretics
PTU
preeclampsia protein levels - ANSmild: 1+ on dipstick (0.3-2 g/24 hours)
severe: 3+ dipstick (more than 5 g/24 hr)
mag toxicity - ANSflushing
sweating
hypotension
depressed DTR
respiratory depression
creatinine levels of severe preeclampsia - ANSelevated (above 1.2)
platelet levels of severe preeclampsia - ANSdecreased (below 100,000)
incompetent cervix - ANSpremature dilation
tx: surgical placement of cervical cerclage 10-14 weeks gestation to constrict the internal os
provide bed rest, hydration, tocolysis (to inhibit ctx), no sex or standing for a long time
,removed at 37 weeks gestation or prior to c/s
leading cause of life-threatening perinatal infections - ANSGBS
can lead to sepsis, pneumonia, or meningitis causing permanent neuro disability
dx with vag and rectal cultures at 35-37 weeks
tx with antibiotics
opthalmia neonatorum is caused by what organism - ANSgonorrhea (neisseria gonorrhoeae)
mechanisms of labor - ANS1. engagement (lightening, dropping)
2. descent
3. flexion
5. internal rotation
6.. extension (begins after the head crowns)
7. restitution (realignment of the fetal head with the body after the head emerges)
8. external rotation (of the shoulders)
9. explusion
variable decels - ANScord compression
are not as uniform as early and late decels
could be nonperiodic (unrelated to ctx times)
they are significant when FHR repeatedly declines to less than 70 bpm and persists at level for
at least 60 seconds before returning to baseline
TX: change position, administer oxygen, d/c pit, assess mother's vitals, assist with
amnioinfusion to decompress cord as prescribed
Four Stages of Labor - ANSSTAGE 1
a) Latent
1-4 cm dilation w/ UC 15-30 minutes apart and 15-30 seconds duration
b) Active
4-7 cm dilation w/ UC 3-5 minutes apart for 30-60 seconds
c) Transition
8-10 cm w/ UC 2-3 min apart for 45-90 seconds
STAGE 2
exit of fetus
assess every 5 minutes
, STAGE 3
placental exit
<30 minutes after fetus
fundus remains firm 2 fingerbreadths below umbilicus
STAGE 4
about up to 4 hours after delivery
assess Q15 for first hour, Q30 for second hour, and hourly for 3rd and 4th hour
what score of the bishop scale indicates readiness for labor induction - ANS6
bishop scoring - ANS0-3
dilation (0-- 1 to 2-- 3 to 4-- more than 5)
effacement (0 to 30-- 40 to 50-- 60 to 70-- 80)
consistency of cervix (firm--med--soft)
position of cervix (posterior--mid--anterior)
station (-3.. -2.. -1... +1)
when is an amniotomy performed - ANSif the fetus is 0 or plus station and membranes haven't
ruptured
increases the risk of a prolapsed cord and infection
placenta previa - ANSimproperly implanted placenta (total, partial, marginal in relation to the
internal os)
sudden, PAINLESS, BRIGHT red vaginal discharge
SOFT, RELAXED, NONTENDER uterus
fundal height is higher than expected
abruptio placenta - ANSpremature separation of placenta (after 20th week but before birth)
DARK red bleeding (or none if too high), PAINFUL, TENDER uterus w/ RIGIDITY
fetal distress with maternal shock
in which placental condition would vaginal exams be contraindicated - ANSplacenta previa
anticipate what intervention for abruptio placentae - ANSdelivery
preterm labor - ANSbefore 37 weeks
risks: multifetal pregnancy, overdistended uterus, anemia, age extremities, substance abuse, hx
of obsteric or other issues (cardiac issues)
