Maternity Final

Front 1

If fetal death occurs at 18-16 weeks and is retained > 6 weeks, the patient is at risk for what condition?

Back 1

Disseminated Intravascular Coagulation

Front 2

Name some post-abortion follow-up actions.

Back 2

If mother is Rh negative, give RhoGam.
If near 20 weeks, consider the Keinhauer Betke test to measure fetal cells within mother to assess how much Rhogam to give.
If mother is Rubella non-immune, offer rubella immunizations.

Front 3

Name some risk factors for having an ectopic pregnancy.

Back 3

-PID, endometriosis
-Infertility, former ectopic pregnancy
-Use of hormonal birth control methods
-In vitro fertilization, therapeutic abortions
-Past abdominal surgery or DES exposure
-Incidence found greater in non-white women and AMA

Front 4

Name at least 2 signs and symptoms of ectopic pregnancy.

Back 4

Abdominal tenderness
Dark brown vaginal spotting
Decreased pregnancy symptoms
Referred shoulder pain d/t hemorrhage and irritation of diaphragm
NOTE: suspect ectopic pregnancy in a pregnant woman who comes to the clinic with abdominal pain.

Front 5

Name some differences between the different types of abortions.

Back 5

Front 6

List the criteria for cerclage for incompetent cervix.

Back 6

Membranes intact.
Cervical dilation < 3 cm
<50% effaced

Front 7

Name at least 2 signs and symptoms associated with H-mole or GTD.

Back 7

Chronic/acute bleeding
Hyperemesis r/t high levels of hCG
Expulsion of grape-like vesicles
Rapid enlargement of uterus
No FHT or activity
Extremely high levels of hCG

Front 8

List 2 complications and risks associated with H-mole.

Back 8

HTN, PIH, ARDS, hyperthyroidism, increased risk of developing cancer.

Front 9

Describe the treatment for invasive
H-mole.

Back 9

Evacuation of uterus (D&C)
After termination:
-CXR, CT scan to r/o metastasis
-Chemotherapy
-Serial hCG weekly for 3 weeks then monthly for 6 weeks.

Front 10

List differences in signs and symptoms of abruptio placenta and placenta previa.

Back 10

Front 11

Name the 3 classic signs of preeclampsia.

Back 11

hypertension: >140/90 or an increase of 30mmHg or greater in systolic BP, and 15mmHg or greater in diastolic BP.
Edema: manifests as sudden weight gain, sudden onset edema that does not go away.
Proteinuria: >2+ protein (urine dipstick)

Front 12

Describe normal BP changes during pregnancy.

Back 12

Early part of pregnancy: at baseline
Middle: slightly low BP
Later part of pregnancy: back at baseline.

Front 13

Name at least 3 risk factors for PIH.

Back 13

-Primigravida
A: age (teens, AMA)
B: babies more than 1 (multiple gestation)
C: chronic illness
D: diabetes
E: ethnicity (African American)
F: family history, fat (obesity)
G: gestational trophoblastic disease

Front 14

Name PIH-induced changes in the renal system.

Back 14

Decreased renal blood flow and GFRincreased uric acid, BUN, and creatininedamage to glomerular membranesproteinuria… as it worsens, oliguria and hematuria develop.

Front 15

Name at least 2 nursing assessments and interventions for severe PIH.

Back 15

-continuous monitoring in a low stimulus environment
-medications: Magnesium Sulfate, antihypertensives, BMZ,
-DTRs, clonus, urine dipstick
-bedrest
-Assess for vision changes, epigastric pain, UO (may be monitored through FC)

Front 16

What are signs and symptoms of magnesium toxicity?

Back 16

Decreased to absent reflexes, decreased respirations, decreased LOC

Front 17

What is the antidote for Magnesium Sulfate?

Back 17

Calcium Gluconate

Front 18

What is the therapeutic blood level of Magnesium?

Back 18

4-7 mEq

Front 19

List nursing actions for a client with eclampsia.

Back 19

Keep client safe.
Do not force anything by mouth.

Front 20

Describe signs and symptoms of HELLP syndrome.

Back 20

HEMOLYSIS: resulting in increase in bilirubin
ELEVATED LIVER ENZYMES: epigastric pain, UOQ tenderness, increase in AST, ALT
LOW PLATELETS: <100,000

Front 21

TRUE OR FALSE
There is no increase in risk of congenital fetal abnormalities in pregnant women with Gestational Diabetes Mellitus (GDM).

Back 21

TRUE
Because GDM develops at 20 weeks gestation, organogenesis is complete.

Front 22

List at least 2 prenatal risks caused by GDM.

Back 22

PIH, IUGR, increased risk for infections, yeast infections, UTIs, pyelonephritis, polyhydramnios, SAB, shoulder dystocia, PTL, C/S birth, fetal macrosomia, fetal birth defects

Front 23

TRUE OR FALSE
Pregnant women with DM are prohibited from using insulin. They are encouraged to take oral antihyperglyemics.

Back 23

FALSE
Many oral hypoglycemic agents are teratogenic. Insulin use is safe during pregnancy as it does not cross the placenta.
Note: Glucose crosses the placenta.

Front 24

TRUE OR FALSE
Risk for hypoglycemia is greater during the 3rd trimester.

Back 24

FALSE
Hypoglycemia: 1st trimester
Hyperglycemia: 2nd and 3rd trimester

Front 25

Glucose levels should be maintained at what levels during pregnancy?

Back 25

-May not require insulin for 24-48 hours, usually stabilized within 3 days of delivery
-Breastfeeding is encouraged
-BCM: barriers, progestins

Front 26

TRUE OR FALSE
DKA occurs in a state of untreated hypoglycemia and ketosis.

Back 26

FALSE
DKA occurs in a state of untreated HYPERGLYCEMIA. It is thus more likely to occur during the 2nd and 3rd trimesters.

Front 27

List nursing actions for a woman with GDM.

Back 27

Teach about tight glucose control by diet, exercise, and/or insulin; blood glucose parameters (FBS <90mg/dl, 2hr PPrandial <120mg/dl, Before meals <105 mg/dl)
-Nutritionist referral
-Educate of sxs of complications and tight glucose control.

Front 28

List at least 2 PP complications associated with GDM.

Back 28

PP hemorrhage, PIH/eclampsia, infection

Front 29

TRUE OR FALSE
Neonatal Hyperglycemia is a common in babies born to diabetic mothers.

Back 29

FALSE
Neonatal HYPOglycemia:
Maternal hyperglycemia fetal hyperglycemiaoverstimulation of fetal pancreas hyperinsulinemia(after birth) hypoglycemia.

Front 30

TRUE OR FALSE
All women who have a blood glucose level >140 after a 1 hour glucose tolerance test are diagnosed with GDM.

Back 30

FALSE
1 hour OGTT (usually done in week 24-28 in low risk women) is a screening test. Levels above 140mg/dl indicate need for the diagnostic test (3 hour OGTT)

Front 31

Fill out the following table about Prolonged Labor Patterns.

Back 31

Front 32

List nursing actions for tetanic contractions for a client who is receiving pitocin for augmentation of labor.

Back 32

Turn off pitocin, turn client to a sidelying position, and administer O2 by facemask.
Note: Also assess UO because oxytocin has an antidiuretic effect which may cause water intoxication.

Front 33

List at least 3 contraindications of using pitocin to augment labor.

Back 33

Known CephaloPelvic Disproportion
Fetal stress
Placenta Previa
Prior classical incision into uterus
Active genital herpes infection
Floating fetus
Unripe cervix

Front 34

Name 3 assessments that should be monitored continuously if a client is on Oxytocin.

Back 34

FHR
Uterine Resting Tone
Contraction frequency, duration, strength
NOTE: Duration should be no longer than 90 seconds.

Front 35

At what stage does hypertonic dystocia usually occur as opposed to hypotonic dystocia?

Back 35

HYPERTONIC: USUALLY IN THE LATENT PHASE
HYPOTONIC: USUALLY IN THE ACTIVE PHASE

Front 36

List some possible causes of Hypotonic Dystocia.

Back 36

Overdistended uterus, excessive use of narcotic analgesic, anesthetic or sedative.

Front 37

List common complications of C-sections.

Back 37

Infection and increase in bleeding.
Bladder or ureter damage.
Pain
Bowel Dysfunction
Complications associated with anesthesia

Front 38

Name at least 4 indications for C-sections.

Back 38

Labor dystocia
Repeat C/S, previous uterine surgery, uterine abnormalities
Placenta Previa, Placenta Abruptio, prolapsed cord
Active herpes, Severe PIH, multiple gestation
Fetal distress, malpresentation, congenital abnormality

Front 39

Name at least 2 complications of shoulder dystocia to the newborn.

Back 39

Fractured clavicle
Brachial plexus injury
cephalhematoma
death

Front 40

What station should the fetus be at in order for Vaccuum Extraction to be considered?

Back 40

2+ or greater

Front 41

Define Preterm Labor.

Back 41

Preterm Labor:
True labor that occurs between 20-37 wks

Front 42

What do we instruct clients to do when sign and symptoms occur?

Back 42

Empty Bladder
Lay Down on Left Side
Drink 2-3 glasses of fluids
If greater than 1hour, call MD.

Front 43

List at lest 4 tests to be done when a pregnant woman comes in with suspected PTL.

Back 43

Fetal Fibronectin
Salivary estriol test
Transvaginal sonogram
Tests for ROM (fern test, nitrazine swab)
Cervical cultures, wet mount, CBC, C&S
Amniocentesis to determine fetal lung maturity

Front 44

List the criteria for PTL suppression

Back 44

<3 cm dilated, <50% effaced

Front 45

List at least 2 side effects of Terbutaline Sulfate.

Back 45

MATERNAL:
Tachycardia, CP, Pulmonary Edema, Hyperglycemia,
FETAL:
Tachcardia, Hypoglycemia, hyper insulinemia.

Front 46

Name the medication that can be used to suppress labor aside from Terbutaline, Magnesium Sulfate, and Nifedipine.

Back 46

Indomethacin
(prostaglandin Inhibitor)
-side effect: premature closure of the ductus arteriosus.

Front 47

List some strategies to PREVENT PTB for women with no PTL signs and symptoms

Back 47

Assess prior reproductive history, lifestyle, etc
Encourage changes in risk behavior
Teach signs and symptoms to identify early PTL
Modify work situation
Maintain adequate hydration and empty bladder frequently
Restrict number of embryos in IVF

Front 48

Describe the characteristics of an infant who has the best chance of survival in PTB.

Back 48

Neonates over 2000 g (4.5lbs) or 32 weeks gestation have best chance of survival

Front 49

List some predisposing factors to PTL.

Back 49

DM, cardiac disease, preeclampsia, placenta previa
Infection, especially UTI
Overdistention of the uterus due to multiple gestation, hydramnios, LGA baby
Psychosocial stresses

Front 50

What signs and symptoms should alert the nurse to hold the next dose of Magnesium Sulfate?

Back 50

RR< 12/min
UO < 100cc/4 hrs
Absent DTRs
Magnesium Sulfate Level >8mg

Front 51

True or false,
Podofilox is safe to use during pregnancy

Back 51

FALSE

Front 52

What important instruction should you provide a woman on Flagyl?

Back 52

“Do not take alcohol with this medication”

Front 53

MYSTERY VAGINAL DISCHARGE:
Discharge has a fishy odor, yellow, creamy, gray

Back 53

DISCHARGE 101
Bacterial Vaginosis- fishy odor, creamy yellow, white or gray
VVC: odorless, cottage cheese like
Trichomonas: greenish, yellowish mucopurulent, odorous

Front 54

Which STD’s can cause opthalmia neonatorium?

Back 54

Gonorrhea and Chlamydia

Front 55

True or False
A pregnant woman who is non-immune to Rubella should receive a vaccine.

Back 55

FALSE

Front 56

True or False
Painful genital lesions are associated with syphillis

Back 56

FALSE

Chancre: syphilis: painless lesions
HSV: painful lesions
HSV I: facial lesions
HSV 2: genital lesions
+ shedding and recurrence on nerves

Front 57

How is toxoplasmosis transmitted and prevented?

Back 57

Toxoplasmosis is a protozoal infection transmitted by handling or eating anything contaminated with infected cat feces or eating or handling raw meat.
Prevention includes avoiding the handling of cat litter, soil, or raw meat.

Front 58

Match the correct treatment to the correct vaginosis

Back 58

Front 59

Match the following dz to the tx

Back 59