Nclex: Maternity Nursing

Front 1

What are the ovarian hormones?

Back 1

Follicle-stimulating hormone (FSH) and luteninizing hormone (LH).
-These hormones are released by the anterior pituitary gland
-They produce changes in the ovaries, causing the menstrual cycle.

Front 2

What pelvis shape is most ideal for a successful labor and birth?

Back 2

Gynecoid. It is considered the normal female pelvis. It is transversely rounded or blunt.

Front 3

What pelvic shape is unfavorable for labor?

Back 3

Android. More often seen in males, it is wedge-shaped or angulated.

Front 4

Where does fertilization occur?

Back 4

Occurs in the upper region of the fallopian tubes.
-It occurs within 12 hours of ovulation and within 2 to 3 days of insemination, the average duration of viability for the ovum and sperm.

Front 5

Define the preembryonic period.

Back 5

First 2 weeks after conception.

Front 6

Define the embryonic period.

Back 6

Beginning of the third through the the eighth week after conception.

Front 7

Define the fetal period.

Back 7

Beginning of the ninth week after conception and ending with birth.

Front 8

What can and cannot pass through the placenta?

Back 8

-Large particles such as bacteria cannot pass through the placenta.
-Nutrients, drugs, antibodies, and viruses can pass through the placenta.

Front 9

How many blood vessels are in a normal umbilical cord?

Back 9

It contains TWO arteries, and ONE vein. The umbilical arteries take blood away from the fetus. The vein brings oxygenated blood back to the fetus.

Front 10

What is the normal fetal heart rate?

Back 10

-First trimester: 160-170 beats/min.
FHR will slow with fetal growth to 120-160 beats/min near or at term.

Front 11

What is the function of the ductus arteriosus and foramen ovale in the fetal heart?

Back 11

They allow for the fetal circulation bypass because of the nonfunctioning lungs
-The ductus arteriosus connects the pulmonary artery to the aorta, bypassing the lungs.
-The foramen ovale is the opening between the right and left atria of the heart, bypassing the lungs.

Front 12

In what form can the status of a women's pregnancy outcomes be described?

Back 12

GTPAL
G=gravidity (number of pregnancies)
T= term births (the number born at term, longer than 37 weeks)
P= preterm births, the number born before 37 weeks gestation.
A=Abortions and/or miscarriages (including gravida before 20 weeks)
L-the number of currently living children

Front 13

What are the presumptive signs of pregnancy?

Back 13

Amenorrhea, N/V, increased size and increased feeling of fullness in breasts, Pronounced nipples, urinary frequency. Fatigue, discoloration of vaginal mucosa.
Quickening (the first perception of fetal movement may occur as early as the sixteenth to twentieth week of gestation).

Front 14

What are the probable signs of pregnancy?

Back 14

-Uterine enlargement
-Hegar's Sign
-Goodell's sign
-Chadwick's sign
-Ballottement
-Braxton Hicks contractions
-Positive pregnancy test for the determination of the presence of human chorionic gonadotropin.

Front 15

What are the positive signs of pregnancy?

Back 15

-Fetal heart rate detected by electronic device (Doppler transducer) at 10 to 12 weeks and by nonelectronic device (fetoscope) at 20 weeks of gestation.
-Active fetal movements palpable by examiner
-Outline of fetus via radiography or ultrasonography.

Front 16

What sexually transmitted diseases can affect the fetus?

Back 16

-Syphilis (can lead to spontaneous abortions, mental subnormality and physical deformites)
-Genital Herpes (fetus is contaminated after membranes rupture or with vaginal delivery).
-Gonorrhea (may result in postapartum infection of the neonate, risk inclue opthalmia, neonatorum, pneumonia, and sepsis)

Front 17

Where should the fundus be during different phases of pregnancy?

Back 17

-2nd and 3rd trimesters (weeks 18-30)= fetus's age in wks plus or minus 2 cm.
-16 weeks=halfway b/w the symphysis pubis and the umbilicus
-20-22 weeks= umbilicus
-36 weeks=xiphoid process

Front 18

At what point during pregnancy can quickening first begin?

Back 18

Quickening occurs as early as 16-20 weeks.

Front 19

What are the main cardiovascular changes that occur when a women gets pregnant?

Back 19

-Blood volume increase, increased RBC volume
-Anemia (plasma increase exceeds RBC production)
-Iron requirements increase
-Heart size increase
-Heart pushed upward and to the left as uterus enlarges
-Pulse may increase 10 bpm
-Slight decrease in BP in 2nd trimester
-Retention of sodium and water

Front 20

What changes occur in the respiratory system during pregnancy?

Back 20

-Increased O2 consumption (15-20%)
-Elevated diaphragm (due to uterus enlargement)
-SOB may be experienced

Front 21

What changes occur in the GI system during pregnancy?

Back 21

-N/V may occur (due to the secretion of human chorionic gonadotropid, should subside by THIRD month)
-Decreased motility, may lead to poor appetite
-Changes in taste and smell
-Constipation (result of progesterone production)
-Flatulence and heartburn
-Hemorrhoids (due to increased venous presure)
-Swollen gum tissue

Front 22

What changes occur in the renal system during pregnancy?

Back 22

-Frequency in urination (uterus enlargement)
-Decreased bladder tone
-Renal threshold for glucose may be reduced

Front 23

What are the changes that occur in the Endocrine system during pregnancy?

Back 23

-Basal metabolic rate rises
-Thyroid activity increase
-Aldosterone levels gradually increase
-Anterior lobe of the pituitary gland, parathyroid and throid enlarges slightly

Front 24

How does the cervix change during pregnancy?

Back 24

-It becomes shorter, more elastic and larger in diameter.
-Endocervical gland secrete a thick mucous plug (it is expelled from the canal when dilation begins)
-Increased vascularization and estrogen causes softening and a blue-purple discoloration (Chadwick's Sign-at about 6 weeks)

Front 25

What function do the ovaries play during pregnancy?

Back 25

-Secretes progesterone for teh first 6 to 7 weeks

Front 26

What occurs the the vagina during pregnancy?

Back 26

-Hypertrophy of the muscle
-increase in vaginal secretions, they are usually thick, white and acidic.

Front 27

What happens to the breast during pregnancy?

Back 27

<>Changes occur b/c of the increasing effects of estrogen and progesterone
-Increase size
-Nipples become more pronounced
-Areola becomes darker
-Superficial veins become prominent
-Colostrum may leak

Front 28

What is linea nigra?

Back 28

A dark streak down the midline of the abdomen that may occur during pregnancy.

Front 29

What is chloasma?

Back 29

aka Mask of Pregnancy
-a blotchy brownish hyperpigmentation, over the forehead, cheeks, and nose.

Front 30

What are striae?

Back 30

Reddish-purple stretch marks on teh abdomen, breast, thighs and upper arms.

Front 31

When is N/V a problem during pregnancy?

Back 31

Occurs in first trimester

Front 32

What interventions are used for a women who are experiencing N/V during pregnancy?

Back 32

-Eat dry crackers before arising
-Avoid brushing teeth immediately after arising
-Small frequent, low fat meals
-Drink liquids inbetween meals rather than at meals
-Avoid fired and spicy foods
-Acupressure

Front 33

What blood tests are done on a pregnant woman?

Back 33

-ABO typing: determines the woman's blood time in the ABO antigen system
-RH typing: done to determine blood type in the rhesus antigen system. If the client is Rh negative she should receive Rh immune globulin at 28 weeks' gestation.

Front 34

How do hemoglobin and hematocrit levels change during pregnancy?

Back 34

-Levels will drop during gestation due to an increase in plasma level.
-A decrease in hemoglobin level to lower than 1-g/dL or hematocrit level lower than 30% indicates anemia.

Front 35

What is the Alpha-fetoprotein screening done to determine.

Back 35

-Elevated levles of protein are associated with open neural tube and abdominal wall defects
-Can detect spina bifida and Down syndrome.

Front 36

When is an alpha-fetoprotien screening performed?

Back 36

Maternal blood sample can be drawn at 15 to 18 weeks' gestation.

Front 37

What is Chorionic villus sampling done for?

Back 37

-The physician aspirates a small sample of chorionic villus tissue at 8-12 weeks
-it is used to detect genetic abnormalities.

Front 38

What is the use of a Kick count test?

Back 38

-Mother sits/lies quietly and counts fetal kicks for a period of time
-Should notify the physician if there are fewer than 10 kicks in a 12-hour period.

Front 39

What is the use of an amniocentesis.

Back 39

-Aspiration of amniotic fluid, may be done after 13 to 14 weeks of pregnancy
-It is performed to determine genetic disorders, metabolic defects and fetal lung maturity.

Front 40

What are the risks of amniocentesis?

Back 40

Maternal hemorrhage, infection, Rh isoimmunization, abruptio placentae, amniotic fluid emboli, premature rupture of the membrames

Front 41

What is the fern test?

Back 41

Microscopic slide test to determine the presence of amniotic fluid leakage.
-A specimen is obtained from the external os of the cervix and vaginal pool and is examined on a slide under a microscope
-A fern-like pattern produced by the effects of salts of the amniotic fluid indicates the presence of amniotic fluid.

Front 42

What is the Nitrazine test used for?

Back 42

-It is a test strip used to detect the presence of amniotic fluid in vaginal secretions.
-It uses pH. Vag secretions have pH of 4.5-5.5, amniotic fliuid has a pH of 7.0-7.5 and turns nitrazine string or swab blue.

Front 43

What is the nonstress test?

Back 43

-The test is preformed to assess placental function and oxygenation
-Determines fetal well-being
-The test evaluates fetal heart rate response to fetal movements

Front 44

What is a reactive nonstress test?

Back 44

-Normal, negative
-This indicates a healthy fetus.
<>This occurs when two or more FHR accelerations of at least 15 bpm, lasting at least 15 secods from the beginning of the acceleration to the end., in association with fetal movement, during a 20 minutes period

Front 45

What is a nonreactive nonstress test?

Back 45

-No accelerations of accelerations of less than 15 bpm or lasting less than 15 seconds in duration occur during a 40 minute observation.

Front 46

What weight gain is expected during pregnancy?

Back 46

25-35 lbs

Front 47

How many calories a day should a pregnant woman consume over the normal consumption?

Back 47

300 calorie increase

Front 48

What is the extra calorie intake needed during lactation?

Back 48

500 cal/day extra

Front 49

Why is an increase in folic acid important in pregnant women?

Back 49

It is necessary for all women of childbearing age to prevent neural tube defects in the fetus during the first trimester of pregnancy.

Front 50

What is the definition of an abortion?

Back 50

-A pregnancy that ends before 20 weeks gestation, spontaneously or electively.

Front 51

What medication is administered to a pregnant woman who is HIV positive?

Back 51

Zidovudine (ZDV) is recommended for the prevention of the maternal-fetal HIV transmission and is administered orally beginning after 14 weeks' gestation, IV during labor an din the form of syrup to the neonate for 6 weeks after birth.

Front 52

What complication may a women experience if she is anemic during pregnancy?

Back 52

-Predisposes the client to postpartum infection.

Front 53

Why are patients with various cardiac disease issues considered a high risk pregnancy population?

Back 53

-They may be unalbe to physiologically cope with the added plasma volume and increased cardiac output that occur during pregnancy. Blood volume is at a maximum during the last weeks of the second trimester.

Front 54

What is chorioamnionitis?

Back 54

a bacterial infection of the amniotic cavity; can result from premature rupture of the membrane, vaginitis, amniocentesis, or intrauterine procedures.

Front 55

How does diabetes mellitus complicate pregnancy?

Back 55

-Causes insulin requirements to change (first trimester, decrease. 2nd and 3rd increase dose needed)
-After placental delivery, placental hormone levels drop abruptly and insulin requirements decrease.

Front 56

How is the fetus affected or how does it affects the mother with diabetes?

Back 56

-Maternal glucose crosses the placenta but insulin does not
-The fetus produces its own insulin and pulls glocose from the mother, which predisposes the other to hypoglycemic reactions.

Front 57

What are the risks of a newborn infant of a mother with diabetes?

Back 57

At risk for hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, and congenital anomalies.

Front 58

What is gestational diabetes mellitus?

Back 58

-Diabetes that occurs only in pregnancy (during 2nd or 3rd trimester). The pancreas cannot respond to the demand for more insulin.
-Pregnant women should be screened between 24 and 28 weeks of pregnancy.

Front 59

What WBC value should be expected postpartum?

Back 59

For 10-12 days postpartum the WBC will be elevated.

Front 60

What may occur to a woman's hematocrit postpartum?

Back 60

The Hct level may be high due to fluid losses that occur as part of the normal postpartum process (high Hct indicating a greater amount of volume in proportion to loss of RBCs). The client should be encouraged to increase fluid intake if this occurs.

Front 61

What are the conditions for a reactive nonstress test?

Back 61

Reactive if two or more FHR accelerations of 15 bpm that last 15 sec or longer are noted and are associated with fetal movement in a 20 minute period.

Front 62

How is fetal lung development determined?

Back 62

Fetal lung maturity can be determined in one of two ways. First, the amniotic fluid from the vaginal pool can be tested for phosphatidylglycerol (PG); if PG is PRESENT, fetal lung maturity is probable. Second, fetal lung maturity can be determined by collecting amniotic fluid through amniocentesis and evaluating for lecithin/sphingomyelin (L/S) ratio. An L/S ratio of 1:8 to 2:1 indicates probable lung maturity.

Front 63

What is the most common complication following a circumcision?

Back 63

Bleeding. The site should be monitored hourly to observe for bleeding in the first 12 hours following the procedure.

Front 64

When a patient's labor is not progressing due to shoulder dystonia, what action should the nurse take?

Back 64

Suptrapubic pressure can be used to attempt to push the shoulder to go under the symphysis pubis and thus pass through the birth canal.

Front 65

What does a new mother focus on during the taking-hold phase?

Back 65

The mother is focusing on care of the newborn and acquiring parenting skills. This is a good time for teaching the mother about new skills for caring for the newborn.

Front 66

What are normal bilirubin levels for a newborn?

Back 66

LOOK UP ANSWER

Front 67

How should counterpressure be used as a non-pharmaceutical method for pain relief during pregnancy?

Back 67

Pressure should be applied to the lower back continuously for back pain.

Front 68

If a nurse observes decelerations beginning and ending with contractions, what action should the nurse take?

Back 68

The nurse should just continue fetal heart monitoring, these are early decelerations, which are a normal finding during the transition phase of labor progression.

Front 69

What are some possible reasons for jitteriness in a newborn?

Back 69

It may be an indication of infection, hypoglycemia or hypoxia.

Front 70

What is a possible risk for a pregnant mother that has a high maternal serum alpha-fetoprotein level?

Back 70

Anencephaly
Spina bifida

Front 71

What is a possible risk for a pregnant mother that has a low maternal serum alpha-fetoprotein level?

Back 71

Down Syndrome

Front 72

How should a newborn be suctioned using a bulb syringe?

Back 72

-Suction the mouth before the nose (otherwise the newborn may gasp and inhale pharyngeal secreations)
-Suction until gurgling subsides
-Insert the bulb syringe on the sides of the mouth
-Compress the bulb syringe before insertion

Front 73

What should the nurse do to avoid hypotension in the pregnant client who is receiving an epidural?

Back 73

-Give IV lactated Ringer's bolus before hand. This will help maintain adequate fluid volume to prevent hypotension resulting from epidural-related vasodiation.

Front 74

How many weight a week should a pregnant woman gain in the second and third trimesters?

Back 74

0.4 kg (.88 lb) per week.

Front 75

What is the cause of variable decelerations?

Back 75

Umbilical cord compression, which can be caused by short cord, prolapsed cord, and cord wrapped around fetal body part.

Front 76

How soon after conception can Human chorionic gonadotropin (hCG) be detected in the blood.

Back 76

6 to 11 days after conception.

Front 77

Why is assessing lochia a priority assessment for a woman who is post-cesarean section?

Back 77

During the immediate postpartum period, the greatest risk to the client is bleeding. The amount of lochia can assist the nurse in determining if excessive bleeding is occuring. pooledblood under the buttocks or a perineal pad that is saturated in 15 min or less is a sign that require immediate attention.

Front 78

What is the priority assessment for a client undergoing an amniotomy?

Back 78

Checking temperature because the greatest risk for the client is infection.

Front 79

What is the pattern of lochia changes after delivery?

Back 79

-Lochia rubra=Bright Red lasts 3-4 days
-Lochia serosa=pale pink or brown, lasts 22 to 27 days
-Loachia alba= white, may persist longer than 6 weeks.

Front 80

What are the main assessment findings that indicate fetal distress?

Back 80

-Fetal Heart rate less than 120 or greater than 160 bpm
-Meconium stained amniotic fluid
-Fetal hyperactivity
-Progressive decrease in baseline variability
-Severe variable decelerations
-Late decelerations

Front 81

When is a pregnant/delivering mother given Methylergonovine (Methergine)?

Back 81

Causes the uterus to contract, can be used when the uterus is hypotonic, postpartum.

Front 82

When is ibuprofen used in a delivering mother?

Back 82

Used for postpartum pain.

Front 83

When is magnesium sulfate used in a delivering mother?

Back 83

It is used to prevent postpartum seizures.

Front 84

When is Terbutaline (Brethine) used in a delivering mother?

Back 84

Used to suppress uterine activity in preterm labor.

Front 85

When performing a heel stick for a blood glucose check of a newborn, what should the nurse do?

Back 85

-The nurse can apply a warm cloth to the heel to dilate blood vessels
-The area should be cleansed with alcohol
-The nurse should use a spring-loaded puncture device
-The puncture shoulbe be made at the lateral aspect of the heel. This decreases the risk of puncturing the bone and causing trauma to the heel.

Front 86

When should the car seat change from rear facing to front facing (age/weight)?

Back 86

20lbs and one year of age.

Front 87

What is the cause of late decelerations? Of variable decelerations.

Back 87

Late: Uteroplacental insuffiency
Variable: Cord compression

Front 88

What is a consequence to a newborn whose mother is exposed to rubella during pregnancy?

Back 88

The infant may experience hearing loss.