MATERNITY (OB) HESI PN BOOK Questions And Answers

MATERNITY (OB) HESI PN BOOK
Questions And Answers

-periduralublocku(epidural,ucaudal)u-uCORRECTuuANSWER--
givenuinufirstuorusecondustageuandublocksunerveuimpulsesufromuT10utouS5,utherebyudeadeni
ngupainuofucontractions.u
-
useduinuconjunctionuwithulocaluorupudenaluforudeliveryuoruaudeliveryudoseuisugivenutoudeaden
uperineumuforudelivery

-mayubeugivenuinusingleudoseucontinuouslyuthroughucatheteruthreadeduintouepiduraluspaceu
-moderatelyuassociateduwithuhypotension,uwhichucanucausesumaternaluandufetaludistress
-
epiduralublockuassociateduwithuprolongedusecondustageubecauseuofudeceasesueffectivene
ssuofupushing.

au22-year-
olduprimigravidauatu12uweeksuhasuanuHgbuofu9.6ug/dLuanduHctuofu31%.uSheuhasugainedu3up
oundsuinutheufirstutrimesteruwhatuisutheuproblem?uwhatushoulduyouutellutheupatient?u-
uCORRECTuuANSWER-auweightugainuofu902utou1814gu(2-

4upounds)uinutheufirstutrimesteruisurecommended.u

thisuclientuisuanemic.

supplementuironuanduaudietuhigheruinuironuisuneeded.

auwomanuisu6uweeksupregnantuwithutheufollowingumaternaluhistory:u

electiveuabortionuatu9uweeks,u8uyearsuago.
miscarriageuatu18uweeks,u4uyearuago
2uyearuoldutwinsu(daughteruanduson)u-uCORRECTuuANSWER-gravidau=u4u

parau=u1u(onlyu1udeliveryuafteru20uweeks)

activeustageuofulaboru-uCORRECTuuANSWER--fromu4utou7cmudilated

**psychological/physicaluresponses**
-increaseduanxiety
-increasedudiscomfortu
-unwillingnessutoubeuleftualoneu
-contracitonsumoderateutousevere,u2-3uminutesuapart,u30-60usecondsuduration.

Activitiesuduringufirstuprenataluvisitu-uCORRECTuuANSWER-1.uobtainuhistoryu

,2.udetermineugravidiyu+uparityu
3.uassistuwithuphysicaluexamu
4.ucalculateugestationaluageu(EDD)uusingunagele'surule
5.uvitalusignsu
6.ufutureuofficeuvisitsu
7.uobtainulabudata
8.utuberculinuskinutestingu(purifieduproteinuderivativeuPPDI)
9.uRhuandubloodutype
10.uurinalysis

Activitiesuduringufirstuprenataluvisit:uANTIBODYuSCREENSu-uCORRECTuuANSWER--HIV
-hepatitisuB
-toxoplasmosis
-rubellau(>1:10u=uimmunity)
-syphilisu(rapiduplasmauregainuRPR,uvenerealudiseaseuresearchulaboratoryutestuVDRL

Activitiesuduringufirstuprenataluvisit:uFUTUREuOFFICEuVISITSu-uCORRECTuuANSWER--
everyu4uweeksuuntilu28uweeks
-everyu2uweeksufromu28uweeksuuntilu36uweeks
-everyuweekufromu36uweeksuuntiludeliveryu

**highuriskupatientsuscheduleuisudetermineubyupatient'suneeds,uvisitsuareuscheduleduasunec
essary

Activitiesuduringufirstuprenataluvisit:uOBTAINuHISTORYu-uCORRECTuuANSWER--
socialuhistoryu(includinguhistoryuofuillicitudrugs,utobaccou+ualcoholuuse.u
-medicaluhistoryu
-historyuandustatusuofucurrentupregnancy
-obstetricuhistory
u**obstetricuhistoryuusingutwoumethods**

twoudigits:uG/Purecordsugravidau+uparauONLYu
fiveudigits:uGTPALu(gravity,utermubirths,upre-
termubirths,uabortionsu+umiscarriages)uprovidesuinfouonuclient'suobstetricubutudoesunotureferu
toupara.

Activitiesuduringufirstuprenataluvisit:uOBTAINuLABuDATAuASuORDEREDu-
uCORRECTuuANSWER--hemoglobinu(Hgb):u>11

-hematocritu(Hct):u>33
-WBCu+udifferentialu
-uHgbuelectrolytesu(sickleucell)
-upapusmearu+ucytologyu(gonorrheau+uchlamydia)

Activitiesuduringufirstuprenataluvisit:uVITALuSIGNSu-uCORRECTuuANSWER--
BPushouldubeunoumoreuthanu30upointsusystolicuandu15upointsudiastolicufromubaselineunorma
l.u
-averageuBPuisu90-140mmuHgusystolicuandu60-90mmuHgudiastolic

,-averageupulseu=u60utou90bpm
-averageurespirationu=u16utou24bpm
-averageutempu=u36.1Cutou37.7Cu(97F-100F)

activitiesuduringusubsequentuvisits:u-uCORRECTuuANSWER-1.ucheckuurine
2.ugraphuweightugainu
3.ucheckufundusuheighu
4.ucheckufetaluhearturate
5.uimportanceuofucontinuinguprenatalucare
6.ureinforceuteachinguplansuthatuincludeuanticipatoryuguidanceu-ufirstutrimester
7.ureinforceuteachinguplansuthatuincludesuanticipatoryuguidanceu-usecondutrimester
8.ureinforceuteachinguplansuthatuincludesuanticipatoryuguidanceu-uthirdutrimester

activitiesuduringusubsequentuvisits:uCHECKuFETALuHEARTuRATEu-
uCORRECTuuANSWER--10utou12uweeksuuseudoppler

-15utou20uweeksuuseufetoscope

activitiesuduringusubsequentuvisits:uCHECKuFUNDUSu-uCORRECTuuANSWER--
12utou13uweeks:ufundusurisesuaboveusymphysis
-20uweeks:ufundusuatuumbilicusu
-
24uweeks:ufundusuheighuisumeasureduinuCMuwithutheunumberuofuCMuaboveutheusymphysisu
equalutoutheunumberuofuweeksupregnantuuntilu36uweeks.

activitiesuduringusubsequentuvisits:uCHECKuURINEuFOR....u-uCORRECTuuANSWER--
albuminu(protein):unoumoreuthanuautraceuforunormalufindingsurelatedutoupreeclampsia
-glucose:unoumoreuthanu1+uforunormalufindingurelatedutoougestationaludiabetes

activitiesuduringusubsequentuvisits:uGRAPHuWEIGHTuGAINu-uCORRECTuuANSWER--
2utou4upoundsuinutheufirstutrimesteru=unormalu
-
0.9upounduperuweekuafterufirstutrimesteru(moreuthanu902g,u2lbs/weekurelatedutoupreeclamp
siauedema)
-totaluweightugainushouldubeu11.3kguandu15.8kgu(25-35lbs)

activitiesuduringusubsequentuvisits:ureinforceuteachingupanuthatuincludeuanticipatoryuguidan
ceu-ufirstutrimesteru-uCORRECTuuANSWER--
discomfortsu(nausea,ufatigue,uurinaryufrequencyusubsidesuafteru13uweeks)
-sleepsuneedsuincreaseutou8uhoursuauday
-
mayuexerciseuasulonguasuwomanuisuableutouconverseueasilyuwhileuexercising.uifunotuwomanu
shoulduslowuitudown.
-umayuworkuifunouhazardousuchemical/toxinsuexposure
-mayubatheuuntilumembranesuruptureu(usuallyuwithinuhoursuofudelivery)
-mayutravelubyucaru(frequentubreaksu+useatubelt)

, -
airutravel,uvariesubyuairline.uremainuwelluhydrated,umoveufrequentlyutouminimizeuriskuofuthro
mbophlebitisu
-dontuingesumedicationsuorualcohol,unousmoking.

activitiesuduringusubsequentuvisits:ureinforceuteachingupanuthatuincludeuanticipatoryuguidan
ceu-usecondutrimesteru-uCORRECTuuANSWER--
sexualuneeds/desireumayuchange.uencourageucommunicationuw/upartneruregardinguadjust
mentsu
-haveuregularucheckups/dentaluhygieneu(gumuhypertrophyucommon)
-delayuxraysu+umajorudentaluworkuifupossible

activitiesuduringusubsequentuvisits:ureinforceuteachingupanuthatuincludeuanticipatoryuguidan
ceu-uthirdutrimesteru-uCORRECTuuANSWER--scheduleuchildbirthuclasses
-noteuurinaryufrequencyu+udyspneaumayuoccuru
-reviewuinterventionsuforulegucramps,unasalustuffiness,uvaricoseuveinsu+uconstipationu
-reinforceuteachinguaboutusafetyurelatedutwoubalanceu
-positionuwithupillowsuforucomfort.u
-rounduligamentupainuwilluoccuru
-
instructuclientutoucomeutouhospitaluwhenucontractionsuareuregularlyu5uminutesuapartuforu1uho
ur.
-ureinforceunutritionaluneedsubecauseu3rdutrimesteruisurapidufetalugrowth.u
-reinforceurisks/symptomsuofupretermulabor

Advantagesuofubreastfeedingu-uCORRECTuuANSWER--lowucost
-distinctuimmunologicuadvantagesuforunewborn

Amniocentesisu-uCORRECTuuANSWER-
theuremovaluofuanuamnioticufluidusampleufromutheuuterusuasuearlyuasu14-16uweeks.

Amniocentesis:uCOMPLICATIONSu-uCORRECTuuANSWER-
spontaneousuabortionu(1%),ufetaluinjury,uanduinfection

Amniocentesis:uFINDINGSu-uCORRECTuuANSWER--geneticudisorders
-fetalumaturityu
-fetaluwellubeing

Amniocentesis:uFINDINGSu(GENETICuDISORDERS)u-uCORRECTuuANSWER-
**karyotype**
-determinesuDownusyndromeu(trisomyu21),uotherutrisomies,uandusexuchromatinu(sex-
linkedudisorders)

**alpha-fetoproteinu(AFP)**