Nevada State College_NCLEX Practice Questions Review | LATEST UPDATES | 100% coreect answers

eopold maneuvers 1st maneuver- determines fetal part lying in fundus and fetal presentation 2nd- which direction fetus back facing Third maneuver determines part of fetus at inlet and mobility 4 th- fetal attitude and degree of flexion of head Meconium aspiration Intubation and immediate suction needed-no longer than 5 sec If HR low, PPV given and suction performed later Don’t suction with bulb syringe when head pass-no longer recommended RR 20-40breaths/min HR 90-130 bpm BP 90/56 Calories An increase of 340 calories/day is recommended during the second trimester. An increase of 462 calories/day is recommended during the third trimester. Add 330 when breastfeeding Protein Folic acid- prevent neural tube defects Leafy green veggies, dry beans/peas, Orange juice Iron Increase rbc mass Take 1 hour before meals Take empty stomach Give with vit C Don’t give with milk/caffeine Can cause constipation- give fiber Increase absorption of iron Avoid calcium containing foods-milk and yogurt Maternal PKU Genetic disease Increase levels phenylalanine Resume diet 3 months before pregnancy and throughout pregnancy Avoid high protein foods in phenylalanine Mental retardation/behavior problems Pap Smear Class 1 through Class V Class 3- indicate abnormal but doesn’t confirm cancer diagnosis Reveal abnormal cervical cell growth Supine Hypotension Vena cava syndrome Dizziness common sign Epidural anesthesia Maternal blood pressure decrease(hypotension)-give fluids CNS depressant Most effective in active labor Cause bradycardia in fetus-bolus mom with 500 mL of IV fluid before inserting epidural catheter Given before active phase of labor- prolongs the labor-take longer for cervix to dilate and efface Spinal anesthesia headaches Fundus Displaced when bladder full Post-delivery- found firm at midline Magnesium sulfate Calcium gluconate antidote-reverse CNS depression Given to women to prevent preterm labor/stop contractions Can cause resp depression in mom Treat PIH- decrease BP Prevent seizures in pre-eclamptic women Cause CNS depression in neonate-monitor for respiration depression Smooth muscle relaxant Report decreased U/O Reduce RR Depressed or absent reflexes Hypotension Decreased cardiac function AE Decreased bp Depressed dtr Lethargy Nalbuphine Opioid pain relief Pre-eclampsia/PIH Cause HTN and proteinuria-monitor closely Edema of hands and face common finding Indicate hepatic involvement Report epigastric pain Report pitting edema of ankles Expect 3+ deep tendon reflex Oliguria Proteinuria greater than 0.3 q 24 hrs Expect blurred vision and photophobia Symptoms- sudden weight gain, swelling, edema, severe headache, reports of seeing spots, blood in urine, dizziness, nausea, vomiting When worsened- baby may need to be delivered or mag sulfate given IV to prevent seizures Call 911 to be evaluated Can last for many weeks after delivery Rest sidelying-increase tissue perfusion Daily fetal kick count Drug Addiction Increased muscle tone Respirations greater than 60 Hyperactivity –CNS irritability Don’t stimulate infant-need calm environment with minimal stimulation to promote rest and reduce stress Active Labor Check cervix before giving pain meds Given too close to delivery can cause resp depression in neonate Contraction Stress Test Fetus repeated decels of FHR response to contractions Don’t give oxytocin for positive CST at 38 weeks- compromise fetal oxygen supply Positive-abnormal-late decels Neg- normal-no late decels Nipple stiumation Ectopic Preg Fertilized egg implant outside uterus Scarring from tubal infection/surgery- PID Betamethasone(Celestone) Glucocorticoid Prevent resp distress syndrome in premature infants No effect on neonatal VS No effect on baby temp Given at 30 weeks gestation Given to stimulate fetal lung maturity-prevent resp distress Cause hyperglycemia in mom Can cause baby to have hypoglycemia 1st few hours after delivery PIH Develop edema, elevated BP, proteinuria Reflex normally plus 2 Nonstress Test(20 min) Measure FHR accelerations with normal movement Fetal acc. Positive sign Increase 15/min and last 15 sec Nonreactive- no acc. Reactive- norm baseline/moderate variability Sit in reclining chair or on left side/don’t walk Give mom OJ and crackers to stimulate fetus movement Press button when feel fetal movement FHR V C- variable decels cord compression E H-early decels- head compression A O-accelerations ok L P-late decels placenta insufficiency Oxytocin Stimulate contractions Can cause decreased FHR and hypoxia due to increased uterine pressure AE- subarachnoid hemorrhage, seizure, coma, HTN, abruption placenta Don’t bolus Give through IV pump Always monitor FHR Discontinue when contractions q 1-2 min lasting 90-100 sec Weight Gain 25-30 lbs entire preg 4 lb- 1st tri 12 lb- 2/3 tri normal- 1-3kg/month 2nd/3rd trimester ITP Autoimmune response with decreased platelet count Increased megakaryocytes 6 weeks gestation + 24 weeks GBS done at 35-37 weeks Rubella titer done at initial prenatal visit to determine rubella immunity Glucose tolerance test 3 hour gtt done in women with elevated glucose levels after 1 hour test is done at 28 weeks LGA(macrosomnic infant) heel stick glucose 50 normal respirations 50 notmal acrocynaosis normal jittery is sign of hypoglycemia Breastfeeding and engorgement apply cold cabbage to relieve pain breast binders suppress lactation breast shells for patients with inverted nipples or flat or pts with sore nipples Prolapsed umbilical cord call for help apply internal upward pressure to presenting part Abruptio placenta cocaine use increase risk for vasoconstriction and abrupted placenta Infant safety set hot water heater no higher than 49 C 120 F crib slats no more than 6.3 cm 2 3/8 in apart no comforter in crib hyperemesis gravidarum eat to taste to avoid nausea eat healthy snack at bedtime alternate liquids and solids every 2 hour eat protein following sweet snack Vaginal hematoma pressure in vagina persistent vaginal pain terbutaline protect from light relax smooth muscle primary action- bronchodilation subqqa 4 hrs no longer than 24 hr AE- headache, dizzy, arrhythmias, nausea, paradoxical bronchospasms, tachycardia, hyperglycemia, hypoklemia Hydatidiform mole Placental abnormal Chorionic villi of placenta develop into grape like mass-clear vesicles With or w/o fetus present Avoid preg for 1 year As cells slough- discharge dark brown vaginal Jaundice Pathological- 1st 24 hrs, inform HCP- stat bilirubin test Physiological- breastfed after 24 hours Late decels Placental insufficiency Pressure on IVC-decrease O2 to placenta and fetus Turn on left side, give O2, then give fluids Naloxone Reverse respiratory depression, hypotension of opiods AE- seizures, pulmonary edema, tachycardia, HTN, V FIB Diaphragm Remove after 24 hrs-clean with mild soap water Replace q 2 years Insert on empty bladder Weight gain greater/less 10-15 lbs refitted Keep in place 6 hours after sex Chadwick sign Blue discoloration in cervix, vagina Low Back pain Posterior-face mom back Rub lower back-help relax muscles in low back and relieve pressure of fetus head Cerclage Reinforce weak cervix Use sutures that go around cervix, hold it close Go to hospital first sign of labor Can have sex Polyhydramnios Excessive fluid surrounding fetus Increased fundal height Increased weight gain Increased urination GI fetal malformations and neuro disorders-anticipate Oligohydraminos Volume amniotic fluid less than 300 Fetal renal dysfunction Obstructive uropathy Confirmed by US IUGR Mineral oil Treat constipation Take at bedtime on empty stomach Abruption placentae Premature separation of placenta from uterine wall Platelet count decreased Prolonged partial thromboplastin Decreased fibrinogen Normal clotting time Abdominal pain-sharp painful bleeding Placenta previa Placenta attach low in uterus Painless vaginal bleeding Life threatening-need continued hospitalization and close monitoring Near or covering cervix opening- partially or totally Don’t perform vaginal exams Monitor fetal heart tones- continuous EFM Take vs q 15 min Most common in 3rd trimester Abdominal US Need full bladder Ask when last voided Rubella When mom titer neg, give another after delivery Avoid preg at least one month after vaccine Mild rash and joint ache 7-10 days after Get each preg May have low grade fever Erythromycin ophthalmic Give within 1st hour Gonorrhea/chlamydia Hep B vaccine Given several hours after birth Parent consent Vitamin K Used for synthesis of clotting factors in liver Given to prevent bleeding Newborns risk of bleeding-lack of intestinal flora needed to make vit K Cephalhematoma 2-6 weeks for edema and discoloration to disappear no treatment needed caput succedaneum resolve 2-3 days Ergotamine treat migraine one tab at onset of migraine max 3 in 24 hr period Methylergonovine(methergine) treat PP hemorrhage monitor VS and vag bleeding AE- seizures, stroke, headache, nausea, chest pain, palpitations, increased BP CI- high BP Bethanechol Cholinergic stimulate muscarinic receptors Phenytoin Don’t take with mil or calcium Less than 10mcg subtherapeutic-cause seizures Levels more than 20 toxic effects Cause gingival hyperplasia- tell dentist Report nystagmus Anticholinergic drugs Worsen urinary retention Atropine Scopolamine Benztropine Constipation Tachycardia Glucose in infants Normal ranges 40-95 mg/dL Fasting glucose 60-90 for pregnant Bilirubin Report greater than 8 Hct Normal 48-69% LGA Weight above 90th percent Increase risk for hypoglycemia Congenital hip dysplasia Limited abduction indicate head femur slipped out of acetabulum Limited abduction of hip Asymmetrical gluteal folds Stepping reflex Should be gone by 4 weeks Moro reflex aka startle reflex 8 weeks Babinski reflex 1 years Stroke bottom of foot Extrusion Infant spit out food tonic neck 3-4 months Jet hydrotherapy Doppler device, fetoscope, wireless external monitor safe Don’t use internal electrode Newborn assessment Posterior fontanel should be larger than anterior Assess apical pulse for 1 full minute-when baby quiet Overlapping suture line Lanugo over shoulders normal Breast nodules up to 10mm T 36.5-37.2C Weight 2.5-4 kg Length 45-55cm Chest circumference in term 2 cm less than head circumference-measured at nipples Head circumference greater than 37cm or less than 33cm investigate for neurologic involvement Neonatal sepsis Temp instability Tachypnea Hypotonia Lethargy Nasal flaring Irritability Vaginal hematoma Pressure in vagina Persistent vaginal pain Infant safety Hot water heater no higher than 49 C 120 F Crib slats no more than 2 3/8 inch No loose bedding in crib Amniocentesis Rhogam given following procedure Potential of fetal RBC entering maternal circulation Given at 28 wks Circumcision Sterile gauze for bleed Petroleum jelly each change Don’t wipe off yellow exudate- normal Document voids after- secondary Change diaper at least q 4 hours Avoid soap and water Rim usually fall off in 1 wk 1st priority is to monitor for bleeding q 15 min for 1st hour after procedure DON’T APPLY petroleum jelly after circumcision when plastibell used Complications-hemorrhage, infection, urethral fistula formation Mastitis Unilateral breast pain with tenderness Reposition, increase fluids, give oxygen 8L Itp Decreased platelet Increased megakaryocytes GBS 35-37 wks 3 hr glucose 28 wks Heparin don’t take aspirin bedrest don’t massage apply warm compress not cold hperbilirubinemia yellow mucous membranes, bron or gold urine, maculopapular rask normal irritable complication Uterine Inversion Don’t remove placenta if still attached- can cause larger SA for bleeding Large amt blood suddenly gush from vagina Fundus not palpable in abdomen Don’t give oxytocics- compounds the inversion Assess VS and establish IV access and fluids Discontinue uterotonic drugs-allow uterine relaxation for replacement Pharmacology NCLEX practice questions Acetazolamide Diuretic For chronic open angle glaucoma, epilepsy, edema AE Paresthesia-tingling fingers Hyperglycemia Oxybutynin For urinary incontinence Anticholinergic effects-dry mouth, photophobia, constipation, blurred vision, tachycardia Dopamine Increase BP in cardiogenic shock Cardiac stimulation No effect on RR Increase renal circulation- incr UO Doxycycline Tetracycline antibiotic CI Pregnancy Effects on developing bone and teeth Regular insulin Manage gestational diabetes Baclofen Decrease seizure threshold in pt with epilepsy Decr freq and severity of muscle spasms No effect on cognition Inhibits reflexes at spinal level Tamoxifen Treat breast cancer AE Menstrual irregular Hot flashes-anti estrogen Bruising Inhibitor overdose Antidote- atropine sulfate Neuromuscular blocker overdose Neostigmine- cause nausea, increased salivation, bradycardia Show Less