NUR 2633 MC Exam 1 Study Guide Questions With
Complete Solutions
"I am in labor." What should the nurse do? Correct Answers
Fetal monitor (FIRST)
Vaginal exam
Labs: CBC, hgb, hct, glucose, UA, GBS, blood type, & RH
Determine presentation/positioning of baby
Ask Questions:
Due date?
Membranes rupture?
Describe contractions
Allergies?
What helps with discomfort>
Is fetus active?
Who is with you?
Abstinence Correct Answers The only thing that protects
against both STIs and pregnancy
Accelerations Correct Answers Always happy to see!
Indicative of a healthy and strong baby with good perfusion
Advanded Maternal Age (AMA) Correct Answers 35 yrs of
age or older
Alpha-fetoprotein (AFP) Correct Answers Lvl is measured in
mother's blood to help determine birth defects of baby
,Amniocentesis Correct Answers Check the AFP level in the
amniotic fluid surrounding the baby
Detects/rules out birth defects
Amniotic Fluid Correct Answers Allows for movement
Cushions cord
Controls temperature
Allows for symmetrical fetal growth
Prevents adherence of the amnion to the fetus
Oligohydramnios: Too little fluid
Renal issues; fundal height less
Polyhydramnios: Too much fluid; diabetes, fluid follows sugar;
fundal height increased
Amniotic Fluid Emboli Correct Answers Can be ANY mom!
How to identify?
SOB
Chest pain
Management?
Give oxygen
STAT C-section to save baby! Most often, mother does not
survive!
,Anemia Correct Answers Nutritional intake will need to be
adjusted
May need iron supplement
Take iron supplement w/o calcium (OJ, grapefruit, tomato juice)
Iron supplement may increase risk for constipation so increase
fiber & fluids!
APGAR Correct Answers
APGAR Correct Answers We do at 1 minute & 5 minutes
after birth!
Range: 0-10
Normal: 7-10
Intermediate: 4-6
Bad: < 4
Appearance/Color
Pulse/HR
Reflex Irritability/Grimace
Activity/Muscle tone
Respiratory effort
What causes most babies to lose a point or two?
Acrocyanosis: hands & feet
APGAR score is 3: CPR & call doctor!
, APGAR score of 6 at 1 minute: Stimulate
Blow by oxygen (R: 30-600
Baby is flaccid or pale
Poor reflexes
Appropriate Activity Correct Answers HR should not exceed
140
Walking
Swimming
Yoga: Requires supervision! Avoid laying pregnant woman in
supine position; can lead to supine hypotension; occludes
superior vena cava
Augmenting Labor Correct Answers Start Pitocin (Oxytocin)
Keep PT on fetal monitor the whole time
Make sure infusing pump is working correctly!
Titrate UNTIL contractions are 2-3 minutes apart (We do not
want to increase frequency of contractions: Hypoxia may result
and uterus muscle may get fatigued)
Make sure PT is emptying her bladder!
Amniotomy: Rupture her membranes
Only physician can perform this procedure
First responsibility is to check fetal monitor before and after
rupturing membranes
Complete Solutions
"I am in labor." What should the nurse do? Correct Answers
Fetal monitor (FIRST)
Vaginal exam
Labs: CBC, hgb, hct, glucose, UA, GBS, blood type, & RH
Determine presentation/positioning of baby
Ask Questions:
Due date?
Membranes rupture?
Describe contractions
Allergies?
What helps with discomfort>
Is fetus active?
Who is with you?
Abstinence Correct Answers The only thing that protects
against both STIs and pregnancy
Accelerations Correct Answers Always happy to see!
Indicative of a healthy and strong baby with good perfusion
Advanded Maternal Age (AMA) Correct Answers 35 yrs of
age or older
Alpha-fetoprotein (AFP) Correct Answers Lvl is measured in
mother's blood to help determine birth defects of baby
,Amniocentesis Correct Answers Check the AFP level in the
amniotic fluid surrounding the baby
Detects/rules out birth defects
Amniotic Fluid Correct Answers Allows for movement
Cushions cord
Controls temperature
Allows for symmetrical fetal growth
Prevents adherence of the amnion to the fetus
Oligohydramnios: Too little fluid
Renal issues; fundal height less
Polyhydramnios: Too much fluid; diabetes, fluid follows sugar;
fundal height increased
Amniotic Fluid Emboli Correct Answers Can be ANY mom!
How to identify?
SOB
Chest pain
Management?
Give oxygen
STAT C-section to save baby! Most often, mother does not
survive!
,Anemia Correct Answers Nutritional intake will need to be
adjusted
May need iron supplement
Take iron supplement w/o calcium (OJ, grapefruit, tomato juice)
Iron supplement may increase risk for constipation so increase
fiber & fluids!
APGAR Correct Answers
APGAR Correct Answers We do at 1 minute & 5 minutes
after birth!
Range: 0-10
Normal: 7-10
Intermediate: 4-6
Bad: < 4
Appearance/Color
Pulse/HR
Reflex Irritability/Grimace
Activity/Muscle tone
Respiratory effort
What causes most babies to lose a point or two?
Acrocyanosis: hands & feet
APGAR score is 3: CPR & call doctor!
, APGAR score of 6 at 1 minute: Stimulate
Blow by oxygen (R: 30-600
Baby is flaccid or pale
Poor reflexes
Appropriate Activity Correct Answers HR should not exceed
140
Walking
Swimming
Yoga: Requires supervision! Avoid laying pregnant woman in
supine position; can lead to supine hypotension; occludes
superior vena cava
Augmenting Labor Correct Answers Start Pitocin (Oxytocin)
Keep PT on fetal monitor the whole time
Make sure infusing pump is working correctly!
Titrate UNTIL contractions are 2-3 minutes apart (We do not
want to increase frequency of contractions: Hypoxia may result
and uterus muscle may get fatigued)
Make sure PT is emptying her bladder!
Amniotomy: Rupture her membranes
Only physician can perform this procedure
First responsibility is to check fetal monitor before and after
rupturing membranes
