Hesi Maternity Exam - Antepartum

Front 1

1st Trimester Psychosocial Responses

Back 1

Ambivalence; financial worries; career concern

Front 2

2nd Trimester Psychosocial Responses

Back 2

Quickening; pregnancy becomes real; pregnant woman accepts pregnancy; ambivalence wanes

Front 3

3rd Trimester Psychosocial Responses

Back 3

Introverted and self absorbed; begins to ignore partner

Front 4

Throughout Pregnancy Psychosocial Responses

Back 4

Mood swings; ultrasensitive; strained relationship

Front 5

Gravida and Parity

Back 5

Gravida - # of times a woman has been pregnant
Para - # of births past 20 weeks

Front 6

TPAL

Back 6

Term, Preterm, Abortion, Living

Front 7

HESI Hint

Back 7

Look for signs of maternal-fetal bonding during pregnancy (talking to baby, nicknames, massaging)

Front 8

HESI Hint

Back 8

Abuse begins during pregnancy; assess for abuse in private, away from partner

Front 9

Nagele Rule

Back 9

Count back 3 months from LMP and add 7 days

Front 10

V/S During Pregnancy

Back 10

BP - average 90-140/60-90
HR - 60-90
RR - 16-24
T - 97-100

Front 11

Office Visits During Pregnancy

Back 11

Every month until 28 weeks; every 2 weeks 28-36 weeks; every week after 36 weeks
(for low risk clients)

Front 12

Labs to check in prenatal visit

Back 12

HIV, Hep B, CMV, Toxoplasmosis, Rubella, Syphillis, TB, Rh and blood type, Urinalysis

Front 13

Rubella

Back 13

>1:10 = immunity

Front 14

Foods Rich in Iron

Back 14

fish, red meat, green leafy vegetables, cereals, yellow vegetables, citrus fruits, egg yolks, dried fruits

Front 15

Weight Gain During Pregnancy

Back 15

3.5-5lb during 1st tri; 0.9lb thereafter; total should be 25-35 lbs

Front 16

Urine - Albumin & Glucose

Back 16

Albumin - no more than trace amount (r/t preeclampsia)
Glucose - no more than +1 (r/t gestational diabetes)

Front 17

Fundal Height

Back 17

12-13 wks - fundus rises out of symphysis; 20 wks - at umbilicus; 24 wks - fundal height is measured in cm with the number of cm = to # wks gestation

Front 18

Fetal Heart Rate

Back 18

10-12 weeks detectable using doppler; 15-20 weeks detectable using fetoscope; 110-160 bpm is normal range

Front 19

HESI Hint

Back 19

Fetal well being is detected by fetal tone, FHR, UCs, fundal height, fetal movement; changes in FHR are first and more important indicator of compromised blood flow

Front 20

HESI Hint

Back 20

Teach clients to report immediately: visual changes, swelling of face, fingers, sacrum, severe HA, persistent vomiting, infection, fluid discharge, change in fetal movement

Front 21

Nutrition Interventions

Back 21

Iron 30+mg/day; folic acid 800-1000mcg/day; increase vit A, C, and calcium

Front 22

HESI Hint

Back 22

Only healthcare provider can prescribe prenatal vitamins but it is the RN's responsibility to teach about proper diet and taking vitamins

Front 23

HESI Hint

Back 23

It is recommended that pregnant women consume 1 qt/day of milk or yogurt to ensure adequate calcium (dec. leg cramps)

Front 24

Position recommended for optimal perfusion to uterus, placenta, fetus

Back 24

Knee-Chest Position

Front 25

Maternal Risk Factors

Back 25

Age <17 or >34; high parity; HTN; anemia; multiple gestation; Rh incompatibility; Hx of dystocia Malnutrition; Infection; Medical disease during pregnancy; abuse

Front 26

HESI Hint

Back 26

In some states, screening for neural tube defects by AFP or amniotic fluid AFP levels is mandated by state law; this test is highly associated with false positives and false negatives

Front 27

Ultrasound

Back 27

High frequency sound waves are beamed into the abdomen; echoes are returned to a machine that records the fetus' location and size; bladder must be full

Front 28

Ultrasound in 1st trimester

Back 28

Used for # of fetuses, presence of cardiac movement and rhythm, uterine abnormalities, gestational age

Front 29

Ultrasound in 2nd/3rd Trimester

Back 29

fetal viability, gestational age, amniotic fluid vol, placental location and maturity, uterine abnormalities, results of amniocentesis

Front 30

BPP

Back 30

5 variables assessed: FHR, Fetal tone, fetal breathing movements, body movements, amniotic fluid volume; score can go up to 10 = good

Front 31

HESI Hint

Back 31

Gestational age is best determined by an early sonogram rather than a later one

Front 32

Chorionic Villi Sampling

Back 32

Removes small piece of villi between 8-12 wks to test for genetic dx; informed consent

Front 33

Amniocentesis

Back 33

Removal of amniotic fluid sample from uterus between 14-16 weeks; used for genetic dx, fetal maturity, fetal well-being; meconium in fluid may indicate stress

Front 34

L/S Ration

Back 34

Should be 2:1, indicates fetal lung maturity which is best predictor of extrauterine survival

Front 35

Nursing Care during amniocentesis

Back 35

Obtain Mom V/S and FHR, supine position, scrub with Betadine, emotional support, assist to void after

Front 36

HESI Hint

Back 36

When an amniocentesis is done in early pregnancy, bladder must be full. In late pregnancy bladder must be empty

Front 37

Contractions

Back 37

Duration, Frequency, Intensity (30mmHg is weak, 70mmHg is strong)

Front 38

What is the most important indicator of health of the fetal CNS?

Back 38

FHR

Front 39

Accelerations of FHR

Back 39

caused by sympathetic response, occur in response to movement, indicative of a reactive/healthy fetus

Front 40

Early Decels

Back 40

Due to head compression, HR decels at beginning of contraction and returns to baseline at end

Front 41

Variability

Back 41

Absent or minimal; Short term is absent, long term is minimal; Causes - hypoxia, acidosis, maternal drug ingestion, fetal sleep

Front 42

Bradycardia

Back 42

Baseline is below 110 bpm for 10 min; causes - LATE manifestation of hypoxia, maternal hypotension, med induced, fetal heart block, cord compression

Front 43

Tachycardia

Back 43

baseline is about 160 bpm; causes: early sign of hypoxia, fetal anemia, dehydration, maternal infection, maternal hyperthyroid disease, med induced

Front 44

Variable Decels

Back 44

Caused by cord compression

Front 45

Variable Decels Nursing Interventions

Back 45

Change mom position, stimulate fetus, d/c Oxytocin, Administer O2, perform vaginal exam, report to MD

Front 46

Late Decels

Back 46

Indicative of uteroplacental insufficiency