1
Q
Naegele rule
A
Substract 3 months
Add 7 days to the first day of the last menstrual period
Then add 1 year
2
Q
Primigravida means
A
Pregnant for the first time
3
Q
Term baby is a baby born after
A
37 weeks
4
Q
Preterm baby is a baby born before
A
37 weeks
5
Q
Abortion happen before
A
20 weeks
6
Q
Presumptive signs (subjective mom say it )
A
Amenorrhea
Nausea , vomiting
Breast tenderness, tingling , feeling of fullness, increase size and pigmentation, urinary frequency, pigmentation of the areola.
Urinary frequency
Quickening
Fatigue
Linea negra, melasma
7
Q
Probable signs of pregnancy ( could be something else)
A
Uterine enlargement
Hegar signs : compressibility and softening of the lower uterine segment that occurs at about week .
Goodell signs : softening of the cervix that happen at second month.
Chadwick signs : Violet coloration of the mucus membranes of the cervix at 6 weeks
Ballottement : rebounding of the fetus against the examiner
Braxton hicks : Irregular painless contraction
Positive pregnancy test (presence human chorionic gonadotropin)
8
Q
Positive signs of pregnancy ( proven)
A
Fetal heart rate detected (10-12 weeks by doppler)
Nonelectronic device (fetoscope 20 weeks)
Active fetal movement
Outline of fetus vis radiography or ultrasonography
9
Q
Fundal height during second and third trimester (weeks 18 to 30) is equal
A
Approximately equal to fetal age +-2cm
10
Q
Position of the fundus at
A
16 weeks: halfway between the symphisis pubis and the umbilicus.
20-22 weeks: at the location of the umbilicus
36 weeks: at the xiphoid process
11
Q
After 20 weeks when placing client supine monitor for
A
Supine hypotension
12
Q
Intervention for nausea and vomiting during pregnancy
A
Eating dry crackers
Avoid brushing teeth immediately after arising
Eating small frequent , low fat meals during pregnancy
Drink liquid between meals rather than at meals
Avoid fried and spicy foods
Eat protein snack at night
Sucking on hard candy
Ask about acupressure
Ask about use of herbal remedies
Take antiemetics as prescribed
13
Q
Syncope ( fainting ) intervention
A
Sitting with the feet elevated
Risk for falls , change positing slowly
14
Q
Zidovudine indication
A
To decrease the risk of hiv transmission to the fetus
15
Q
ABO type testing rule in pregnancy
A
If the client is RH negative and has a negative antibody screen they need to repeat antibody screen Rhogham at 28 weeks and will also receive rhogham within 72 hours if the infant is RH positive
16
Q
Live vaccine ( do not give during pregnancy) example:
A
Rubella
17
Q
Dark streak down the midline of the abdomen is called
A
Linea negra
18
Q
Chlaosma is a
A
Brownish hyperpigmentation over the forehead cheeks and nose
19
Q
Striae gravidarum is
A
Reddish purple stretch mark on the abdomen , breast , thigh and upper arms
20
Q
Breast tenderness intervention
A
Wearing a supportive bra
Avoid the use of soap on the nipples and areolar area to prevent drying skin
21
Q
Gestational diabetes how to diagnose ?
A
Fasting blood glucose greater than 126
HBA1C greater than 6.5%
Plasma glucose greater than 200 mg
22
Q
Protein 2+ 4+ in urine may indicate
A
Preeclampsia
23
Q
Ultrasonography is used to
A
Confirm gestational age and estimates date of delivery
To determine the presence of premature dilation of the cervix
Outline and identify fetal and birthing parent structures
24
Q
Transvaginal ultrasound is used
A
To determine the length of the cervix in the first trimester
25
Abdominal ultrasound teaching
Client need to drink water to fill bladder to obtain better image.
If i’s a transvaginal ultrasound a lubricated probe is inserted into the vagina
26
Post chorionic villus sampling and amniocentesis teaching
Notify HCP if experiencing chills, temperature greater than 100.4, bleeding , leakage of fluid, decreased fetal movement, uterine contractions
27
Chorionic villus sampling is used to
Detectic genetic abnormalities
28
Amniocentesis is used to
Determine genetic disorder , metabolic defects, and fetal lung maturity
29
Normal fetal kick count teaching
10 movement within 2 hours
Need to sit or lie on the side and count fetal kick
Use a timer and record the number of fetal movement felt
Count fetal movement for 30-60 minutes 3 times a day
30
Nitrazine test is used to
Detect the presence of amniotic fluid in vaginal secretions.
Amniotic fluid will turn the swab blue if present
31
Fern test is used to determine
Presence of amniotic fluid leakage
32
Fibronectin test is used to determine
Preterm labor
33
Reactive Nonstress test reactive means
2 or more FHR accelerations at least 15 beats per minute, lasting at least 15 seconds from the beginning of the acceleration to the end , in acceleration with fetal movement during a 20 minutes period
Normal
34
Non reactive stress test
No acceleration of less than 15 beats per minute, or lasting less than 15 seconds in duration occur during 40 minute observations
Abnormal
35
Amniocentesis intervention
Obtain informed consent
Less than 20 weeks client required full bladder to support the uterus
After 20 weeks requires an empty bladder to minimize chances of puncture
Obtain vital signs and fetal heart rate every 15 minutes
During examination put the client supine , after examination put the client on the left side.
Ultrasonography is performed to locate placenta and avoid puncture
36
In the first trimester thin colorless, or yellow vaginal discharge is a
Normal finding
37
Negative contraction stress test
No late decelaration of fhr
Normal
38
Positive contraction stress test
Represented by late deceleration of the FHR , with 50% or more contractions in the absence of hyperstimulation of the uterus
Abnormal
39
Rubella teaching
Should receive immunization postpartum if titer is less than 1:8.
Must be using burth control during immunization, do not become pregnant 1-3 month after immunization
Avoid contact with anyone who is immunocompromised
Do not administer at the same time as rhogham.
Rubella is administered subcutaneously postpartum
Inquire sensitivity to eggs
40
Risk factors for abortion (before 20 weeks)
-Advanced age
-Previous miscarriage
Previous elective abortion
Uterine abnormalities such as adhesions
Prolonged time to achieve pregnancy
Low serum progesterone
Celiac disease
Polycystic ovarian syndrome
Thyroid dysfunction or Cushing syndrome
Infection, fever, trauma
Low BMI less than 18.5
Smoking, Alcohol, Cocaine high caffeine
41
Screening fir gestational diabetes is performed at
24 to 28 weeks via 1 hour glucose challege test ( abnormal 140 or greater )
If abnormal oral glucose tolerance test is performed to confirm gestational diabetes
42
Ectopic pregnancy
Implantation of the fertilized ovum outside of the uterine cavity
43
Chorioamniotis is an
Infection of the amniotic cavity
44
Hepatitis vaccine administration
At Birth
Second dose at 1 month
3rd dose at 6 momth
45
HIV meds during pregnancy
HAART is given antepartum(12 weeks)
Zidovudine 1 hour before vaginal birth and 3 hours before cesarean birth if the HIV RNA is greater or equal to 400 copies
This may not be required if HIV RNA is less than 400 copies
46
HIV client vaginal birth or cesarean birth ?
Vaginal birth : if viral load is less than 1000 copies
Otherwise : Cesarean birth
47
Hyperemesis gravidarum is
Intractable nausea and vomiting during 1st trimester of pregnancy that causes disturbances in nutrition and fluid and electrolytes imbalance
48
HELLP (medical emergency ) syndrome stands for
Hemolysis
Elevated liver enzymes
Low platelets
49
HELLP ( medical emergency ) syndrome characteristics
Blood clotting impaired
Liver bleed internally
Chest pain
Abdominal pain
50
Eclampsia intervention
Ensure open airway , turn client on the side and administer oxygen 8-10 ml per minute
Monitor fetal heart rate pattern
Administer meds to control seizures
After seizure insert an oral airway and suction the client mouth as needed
Prepare for delivery of the fetus after stabilization
51
TORCH infection stands for
Toxoplasmosis : caused by toxoplasma gondii
Others infections : HIV, Parovirus , Hepatitis B , West nile virus, Group streptococcus
Rubella
Cytomegalovirus
Herpes simplex virus
52
Cymetogalovirus type of precaution
Contact
53
Meds for herpes simplex virus
Acyclovir
Valacyclovir
54
Herpes simplex virus characteristics
Painful vesical lesions
55
Herpes simplex virus teaching
No vaginal exam during active vaginal herpes lesions
Cesarean birth is needed
Contact prescription
56
Placenta previa is
Improperly implanted placenta in the lower uterine segment near or over the cervical os
57
Abruptio placentae is
Premature separation of the placenta from the uterine wall after 20th week of gestation and before the fetus is delivered
58
Placenta previa teaching
No vaginal examination
59
Differences between placenta previa and abruptio placentae
Placenta previa : Painless vaginal bright red vaginal bleeding , uterus soft , relaxed, and nontender, fundal height greater than expected gestational age
Abruptio placentae : dark red vaginal bleeding , uterine pain or tenderness, uterine rigidity
60
Syphyllis is causes by what organisms
Treponema pallidum
61
Trichomoniniasis meds
Metronidazole
62
Vaginal candiasis meds
Fluconazole
63
Tuberculosis meds during pregnancy
Isoniazid
Pyrazinamide
Rifampin
Ethambutamol
64
How do postpartum hiv client shoud feed their baby ?
Bottle feed.
65
Early signs of DIC
Bleeding , petechiae, purpura
66
Severe preeclampsia may trigger
DIC
67
DIC risk factor
Abruptio placentae
Amniotic fluid embolism
Gestational hypertension
HELLP syndrome
Intrauterine fetal death
Liver disease
Sepsis
Severe postpartum hemorrhage
Death fetus syndrome
Severe preeclampsia
68
What amount of blood loss may be considered hemorrhage
More than 500 ml
69
Teaching for cardiac disease in pregnancy
Low sodium diet
Avoid excessive weight gain
Drink adequate fluid , increase high fiber foods
70
Hepatitis B transmission
Direct contact with blood and body fluid
So wash hand and wear gloves
71
Obesity during pregnancy lead to
Venous thromboembolism : so frequent and early ambulation is needed
Cesarean section
72
Abruptio placentae priority
Delivery of the fetus
Control hemorrhage
73
Station means
0 : at the ischial spine
Minus : above ischial spine
Plus Station : below ischial spine
Engagement: when the widest diameter of the presenting part has passed the inlet , corresponds to a 0 station
74
Lightening or dropping
Know as engagement and occur when the fetus descends into the pelvis about 2 weeks before birth.
75
Leopold manoeuver is
Palpation to determine presentation and position of the fetus and aid in location of fetal heart sounds
76
Normal FHR
110-160
77
Tocotransducer or doppler ultrasonic transducer is used
External fetal monitoring
78
Bradycardia
FHR less than 110 per minutes for 10 minutes or longer
79
Tachycardia
FHR over 160 per minutes for 10 minutes or longer
80
Fetal bradycardia or tachycardia intervention
Change position of the client
Administer oxygen
Assess client vitals signs
Notify HCP
81
Bishop score is used to
Determine maternal readiness for labor and evaluate cervical status and fetal position
82
Normal Bishop score
6-8 or greater: chance for successful vaginal delivery
83
Oxytocin should be discontinued if
Uterine contractions frequency is less than 2 minutes, or duration is longer than 90 seconds.
Or if fetal distress is noted
84
Amniotomy is
Artificial rupture of the membrane to stimulate labor
85
Episiotomy is
An incision made into the perineum to enlarge the vaginal outlet and facilitate birth
86
Second stage of labor indication
Cervical dilation is complete
Ferguson reflex: client feels the urge to push
Second stage end with birth of the baby
87
Amniotomy increase the risk for
Prolapse cord
88
Position to put a client for cearean birth
Supine with a wedge under the right hip
89
Episodic acceleration on electronic fetal monitor tracing is good sign or bad?
Good sign , sign fetal well being , so document
90
Premature rupture membrane put client at risk for
Infection
91
Premature membranes teaching
No vaginal exam , because risk of infection
92
Prolapse umbilical cord (variable deceleration) intervention
Elevate the fetal part that is lying on the cord by applying pressure with a sterile glove hand to relieve pressure.
Place the client in tradelenburg, left lateral, or knee chest position
Call for help , ask to notify HCP because you have to stay with the client.
Administer O2 , 8-10 ml/minute
Wraps the umbilical cord loosely in a sterile towel saturated with warm sterile normal saline
Monitor FHR, assess Fetus for hypoxia
IV fluid , or increase rate of IV solution
Prepare for cesarean birth
Document
93
Precipitous labor is
A labor lasting less than 3 hours
94
Anaphylactic syndrome of pregnancy is
Amniotic fluid infiltrates maternal circulation
95
Fetal distress
FHR less than 110 or greater than 160
96
Fetal distress intervention
Prepare for cesarean birth
97
Intrauterine fetal demise or fetal death in utero is
Death of a fetus after 20th week of gestation and before birth
98
Intrauterine fetal demise put client at risk forc
DIC
99
Risk factor for preterm labor
Multifetal pregnancy
Anemia
Age younger than 18, older than 40
Cardiac disease
Infection ( periodontal disease, UTI)
Tabacco/illicit drug
Cervical surgery
100
Risk factors for labor dystocia
Advanced maternal age
Being overweight
Electrolytes imbalance
Previous difficulty with fertility uterine overstimulation with oxytocin.
Uterine abnormalities
Malpresentation and position of the fetus
Cephalopelvic disproportion
Maternal age
Dehydration
Administration of analgesics early in labor
101
Hypertonic uterine contraction primary intervention
Manage pain
102
Flaccid fundus indicates what? What intervention?
Uterine atony , so massage it until it firm
103
A tender fundus indicates what ?
Infection
104
Lochia amount that indicate bleeding
Saturated menstrual pad in 1 hour = heavy bleeding
Menstrual pad saturated in 15 minutes = excessive bleeding
105
Non-breast feeding intervention
Avoid nipple stimulation
Apply breast/chest binder
Wear a snug-fitting bra
Apply ice pack
Take mild analgesics for engorgement.
106
Engorgement resolve after how long ?
24 to 36 hours
107
Temperature first 24 hrs postpartum what number is normal or not ?
100.4 is normal, this happen because dehydration effects of labor so just administer fluid , do not need to report.
If it’s higher than 100.4 after 24hours report it might be a sign of infection
108
Pulse postpartum what number is normal or anormal ?
May decrease to 50 beats per minute this is normal (normal puerperal bradycardia)
Pulse more than 100 beats may indicate excessive blood loss or infection.
109
Blood pressure postpartum what is normal abnormal
Should be normal
If it decreases suspect hypovolemia
110
Respiration postpartum what is normal and abnormal ?
Rarely change
If respiration increases suspect pulmonary embolism, uterine atony , hemorrhage
111
Orthostatic hypotension postpartum teaching
May happen during the first 8 hours
Teach client to get help before getting out bed
112
Normal bowel sounds or elimination postpartum return after how long
2-3 days postpartum
113
Cytitis is an
Infection of the bladder
114
Teaching to avoid cytitis
Consume adequate fluid
Void frequently to avoid bladder distention
115
Uterine atony intervention
Massage the uterus until it firm
Empty the client bladder or catherize
If it’s not resolve after all that contact HCP
116
What is consider hemorrhage ?
Bleeding greater than 1000 after cesarean
Greater than 500 after vaginal delivery
10% drop in hemoglobin and hematocrit
117
Endometritis is an
Inflammation, infection of the inner lining of the uterus
118
Mastitis intervention
Apply heat to the site
Fluid intake should be 2000-4000 ml per day
Breast pump every 3-4 hours
Wear supportive bra
Administer analgesics and antibiotic(ibuprofen , acetaminophen )
Rest during acute phase
Use ice packs
Warm compresses, massage
Adequate nutrition
119
Subinvolution is the
Failure of the uterus to return to its normal size
120
Thrombophlebitis teaching
Never massage the leg
Avoid crossing legs
Avoid constrictive clothing
Adherance to anticoagulant
121
Do not give aspirin to
Client on anticoagulants
122
What is seesaw respiration
Rise and fall of the chest and abdomen do not occur together
123
APGAR Score
0-3 : Newborn requires full resuscitation
4-7 : Stimulate, rub newborn back, administer oxygen to newborn.
8-10: no intervention
124
After how many months anterior and posterior fontanel closes?
Anterior fontanel : 12-18 months
Posterior fontanel : 2-3 months of age
125
Vitals signs in newborn
Heart rate : 110-160, up 180 when crying
Respiration :30-60 breath per minute
126
Umbilical cord should have :
2 arteries and 1 Vein
AVA
If less notify HCP
127
Tremors in newborn may indicate :
Hypoglycemia
Hypocalcemia
Drug withdrawal
128
How to know if newborn is having adequate fluid ?
6 wet diaper a day
129
Signs of dehydration in newborn
Dry mucus membranes
Sunken eyeballs
Poor skin turgor
Sunken fontanel
130
When should you feed newborn ?
Every 2-3 hours for breastfeeding
Every 3-4 hours for formula feeding
131
Newborn pass Meconuim when ??abd what’s the color?
First 24 hours after birth , greenish black with thick, sticky , tarlike consistency
132
Intervention when newborn experiencing tremors
Swaddle the newborn
Check for hypothermia or hyperthermia
Check for hypoglycemia , hypocalcemia, other labs values
Check for possible drug withdrawal
Notify HCP
133
What is the moro reflex ?
When you hold the newborn in a semisitting position and allow head and trunk to fall backward, then the newborn assumes sharp extension and abduction of the arms with the thumbs and forefinger in a C position
134
After how long moro reflex disappear
6 months
135
Precautions to prevent abduction (illegal removal or unauthorized)
All personal must wear identification
Teach parent to allow only staff with proper identification to take their infant from them
Question anyone with a newborn near an exit or unusual part of the facility
Position the crib away from the door
Always transport a newborn in the crib , but never carry do not carry, never allow to carry
136
Syphilis precautions in newborn
Wear gloves for the first 24 hours until antibiotics has been administered
137
Highest priority for a newborn with a low apgar score is
Airway ( respiration resuscitation equipment, oxygen)
138
Respiratory distress syndrome is what ?
Serious lung disorder caused by immaturity and inability to produce surfactant, resulting in hypoxia and acidosis
139
Respiratory distress syndrome signs and symptoms
Tachypnea
Nasal flaring
Expiratory grunting
Retraction
Seesaw respiration
Pallor and cyanosis
Hypothermia
Poor muscle tone
140
Addicted newborn signs and symptoms
Irritability
Tremors
Hyperactivity And hypertonicity
Sleep disturbances
Respiratory distress, Tachypnea
Vomiting , open projectile
High pitched cry
Sneezing, nasal stuffiness
Fever, temperature instability
Diarrhea
Excessive sweating
Poor feeding
Extreme sucking of fists
Seizures
141
Why administering Erythromycin to newborn ?
To prevent ophthalmia neonatorum from occurring after birth in a newborn to a parent with an untreated gonococcal infection
142
Why vitamin K (phytadione) is given to newborn
Because they are deficient and this prevent newborn from bleeding
143
Tocolytics indications
To halt uterine contractions and prevent preterm birth
144
Tocolytics contraindications
Severe preeclampsia, eclampsia
Active vaginal bleeding
Intrauterine infections
Cardiac disease
Placental abruption
Poorly controlled diabetes
Gestational age greater than 37 weeks
Cervical dilation 4 cm
Fetal demise
Chorioamniotis
Acute fetal distress
Chronic intrauterine growth restriction
145
Magnesium sulfate antidote
Calcium gluconate
146
Magnesium sulfate indication
Stop preterm labor
Prevent and controlling seizure in preeclamptic and eclamptic client
147
Magnesium sulfate adverse effects
May cause respiratory depression, depressed reflexes, flushing , hypotension, decreased urine output, pulmonary edema, elevated serum magnesium level , somnolence
148
Magnesium sulfate contraindicated in client with
Heart block
Myocardial damage
Kidney failure
149
Tocolytics meds example
Indomethacin
Magnesium sulfate
Nifepidine
150
Indomethacin adverse effects
Vaginal bleeding
151
Indomethacin teaching
Should not be used more than 2 to 3 days at a time
Avoid in client who are more than 32 weeks because of ductus arteriosus
Avoid in client with ulcer, bleeding disorder or kidney, liver disease
152
Nifepidine adverse effects
Tachycardia, hypotension, dizziness, headache, nervousness, facial flushing, fatigue , nausea
153
Magnesium sulfate teaching
Monitor client for respiratory depression, so call HCP if respiration are 12 breath per minute or less
154
Bethamethasone and dexamethasone indication
They are corticosteroids that increase production of surfactant to accelerate fetal lung maturity or reduce the incidence of respiratory distress syndrome
155
Opioids antidote
Naloxone
156
Oxytocin administration complications intervention
Stop the infusion
Turn client on the side , stays with the client , ask another nurse to contact HCP
Administer oxygen by snug face mask
Assess vitals signs, fetal heart rate pattern, frequency, duration, and force of contraction
Document
157
Postpartum hemorrage meds
Methylergonovine
Oxytocin
Prostaglandin (Carboprost tromethamine)
158
Methylernogovine administration teaching
check blood pressure first because it can cause severe hypotension, and it is contraindicated in client with hypertension
159
Hepatitis B injection adverse effects
Rash , fever, erythema, pain at injection site
160
Oxytocin adverse effects (stop oxytocin)
Late deceleration
Uterine hyperstimulation
161
Expected finding in preeclampsia
3+ proteinuria
162
Methylernogovine is contraindicated in client with
Cardiovascular disease
Peripheral vascular
Hypertension
Preeclampsia
Eclampsia
163
Iron teaching
Take on empty stomach
Take with orange, tomato juice to increase absorption
164
Rubelle infection during first trimester may cause
Hearing loss and congenital abnormalities in first trimester.
After 12 weeks the risk decreased
165
Vitamins and minerals for healthy gums
Fresh fruit and vegetables
166
Low or oddly placed ear intervention
Report to HCP , this is associated with congenital defects
167
Chlaosma characteristics
Blotchy brown macules accross the cheeks
168
Fetal circulation teaching
The ductus arterious allow blood to bypass the fetal lungs
One Vein carry oxygenated blood from placenta to fetus
Two arteries carry deoxygenated blood and waste product away from the fetus to the placenta
169
Ductus venous connect what ?
Umbilical vein to the inferior vena cava
170
Why fertilized ovum stays in fallopian tube for 3 days
To promote fertilized ovun normal implantation in the top portion of the uterus
171
Amniotic fluid function
Allow fetal movement
Surround, cushions, protect the uterus
Maintain the body temperature of the fetus
Can be used to measure fetal kidney function
172
What type of pelvis is the most favorable for labor and birth?
Gynecoid pelvis
173
Kick count teaching notify provider if client feels fewer than 10 kicks over two consecutive 2-hour intervals
Notify provider if client feels fewer than 10 kicks over two consecutive 2-hour intervals
174
Classic signs of preeclampsia
Proteinuria
Hypertension
175
Insulin teaching during pregnancy
Insulin needs decrease in first trimester.
Insulin needs to be increased 2nd and 3rd trimester
Hypoglycemic event will happen in first 3 month
Insulin will return to pre-pregnancy level within 7-10 days after birth if bottle feed
176
Obese client what do when caring for them?
They are at risk for Venous thromboembolism , increased risk for cesarean section and infection
So, frequently ambulate them, administer heparin , overbed lift bed
177
Why ovulation ceases during pregnancy
Estrogen and progesterone level are high , this promote the release of follicle stimulating and luteinizing hormones
178
Abruptio placentae risk factor
Hypertension
Smoking
Alcohol
Cocaine use
179
Sources of iron
Lean meats
Liver
Shellfish
Dark green
Leafy vegetables
Legumes
Whole grains
Enrich grain
Cereal
Whole grain cereal
180
Sources of vitamin C
Potatoes
Cantaloupe
181
Sources of calcium
Milk (calcium and phosphorus )
Dark green leafy vegetables
Brocolli
Legumes
Nuts
Dried fruits
Cheese
182
Food rich in folic acid
Leafty green vegetables
Whole grains
Fruits
Liver
Beans such kidney beans
Legumes
Glandular meats
Yeast
Dried beans
Beans
Rice
Fortified cereals
183
Do you need an informed consent for nonstress test
No
184
How nonstress test is performed
A tocotransducer detects uterine activity and fetal movement also i secured to the maternal abdomen.
Fetal activity and movements are recorded
185
To prevent constipation in pregnancy instruct client to
Drink 8-10 OZ glasses of fluid per day
Increase intake of fiber (whole grains , fruits , vegetables)
Exercises
186
What does a biophysical profile assess
Fetal activity
Fetal breathing movement
Gross fetal movement
Fetal tone
Amniotic fluid volume
187
Signs of spontaneous abortion (miscarriage)
Cramps, moderate vaginal bleeding , dilated cervix > client will lose the baby this can’t be reversed
188
Ectopic pregnancy is
Grow outside other than inside the uterus
189
Risk factor for ectopic pregnancy
Fertility medications
Sexually transmitted infections
Intrauterine device
Pelvic inflammatory disease
190
Hydatiform mole (gestational trophoblastic disease) signs and symptoms
Vaginal bleeding
Excessive nausea and vomiting
Larger than normal uterus for gestational age
Elevated level of HCG
Failure to detect fetal heart rate
Early development of gestational hypertension
191
Source of thiamine
Pork
192
Triple screen test is used to
Determine increase risk for neural tube defects or chromosomes trisomies
Determine if at risk for spinal bifida
Will need other testing if test is abnormal
193
What substances that cross the placental barrier and affect the fetus
Viruses
Bacteria
Nutrients
Antibodies
Medication
Recreational drugs
Metabolic waste of the fetus
194
Preeclampsia teaching
Reduce external stimuli to prevent seizure
Keep on bed rest
Monitor for magnesium toxicity
Implement seizures precautions
195
Platypelloid pelvis teaching
May impede fetal descent
Make vaginal delivery more difficult
Cesarean birth may be required
Place at risk for shoulder dystocia
196
Biophysical profile is done at
32 to 36 weeks
197
Gestational diabetes intervention
Plan for weekly nonstress test at 32 weeks
Obtain nutritional counseling with s dietitian
198
Candida albicans signs and symptoms
Pain, itching , thick white vaginal discharge
White patches on the oral mucosa , palate and tongue and difficulty sucking or feeding
199
Characteristic of fetus at different weeks periods
At weeks 5 = fetal heart begins to beat
At weeks 8 = eyelids begin to fuse
At weeks 16 = fetal skin is transparent
At weeks 28: fetus weights 1200 g
At 36 weeks =fetus weight 2200-2900 g and is 42-48 cm long , skin is pink and body is rounded
200
Fetal heart rate of 180 indicate what
Infection
Fetal distress
201
Preeclampsia what to monitor
Blood pressure
Proteinuria
Deep tendon reflexes
Keep track of daily weight
202
Why breast changes in size and appearance during pregnancy
Secretion of progesterone and estrogen
Blood vessels beneath the skin appear as blue , interrwining especially in primigravida
203
Effleurage is what
Massage abdomen during contraction using both hands in a curcular motion
204
Healthy gujms vitamins during pregnancy
Fresh fruits
Vegetables
205
A contraction stress test assess what
Placental oxygenation
Fetal ability to tolerate labor
Determine fetal well being
206
How contraction stress test is performed
External fetal monitor is attached to view fetal heart rate response to an established contraction pattern
Uterus is stimulated to contact by the administration of small amount of oxytocin or by nipple stimulation
207
Signs and symptoms of preterm labor
Lower abdominal cramping
Diarrhea
Dull and intermittent low back pain
Painful menstrual like cramps
Suprapubic pain or pressure
Pelvic pressure or heaviness
Urinary frequency
Change in character in amount of vaginal discharge
Rupture of amniotic membrane
208
1 hour glucose test teaching
It is performed at 24-28 weeks
If the results are greater than 140 the recommendation is further assessment via the 3-hour OGTT
209
Normal biophysical profile score? And what should you do next ?
8 , place fetal heart rate monitor on the client in order to do a nonstress test assess
210
Fetal strip study
211
Taking phenytoin during pregnancy put you at risk for
Cleft lift palate development
212
Characteristics of placenta previa
Painless bright red vaginal bleeding
Location in the lower uterine segment
213
Nulliparous feels fetal movement at
14 to 16 weeks
214
Signs and symptoms for abruptio placentae
Vaginal bleeding
Abdominal pain
Uterine tenderness and contraction
Firm uterus by palpation
Mild to severe hypertonicity
Increase uterine resting tone on fetal monitoring
215
What’s a transvaginal ultrasonography
When a lubricated probe is inserted in the vagina for evaluation of pelvic anatomy
216
Transvaginal ultrasound teaching
Need a full bladder to perform the test
Client placed in lithotomy position and Transvaginal probe or pelvis elevated by towels, cushion, or folded blanket
The probe inserted into the vagina will be covered with a disposable cover and coated with a gel that provides lubrication and conductivity
This procedure takes 10-15 minutes
217
You may know the sex of a baby at how many weeks
End of 12 weeks
218
Can a hepatis B client breastfeed?
Yes , after baby is vaccinated and immune globulin is administered
219
Rubella teaching
If titer is less than 1:8 client is not immune
A retesting will be prescribed and immunization will be provided postpartum
220
Kegel exercise help with
Strengthening the pelvic floor as well as the muscle that supports the bladder and urethra
221
Pelvic tilt reduce what
Backaches
222
Anemic pregnant client characteristics
Headaches and fatigue
223
Between insulin and glucose which crosses the placenta ?
Glucose crosses
224
What to wear to prevent varicose vein
Wear support or panty hose , but never knee high hose
225
How to stop legs cramps during pregnancy
Dorsiflexion of the foot while extending the knee stretches the affected muscle and prevents the muscle from contracting
226
How to reduce breast tenderness
Wash the breast/Chest with warm water and keep the skin dry.
Avoid soap on the nipple
Wear a supportive bra
Wear soft textured clothing
227
Pulse in pregnant client at 14-20 weeks
Pulse increases 10-15 beats per minutes
228
Systolic and diastolic BP decreased by how much and when during pregnancy?
Decreased by 5-10 mm Hg until 24 to 32 weeks
229
Fetal movement may be noted when :
18-20 weeks
230
Signs client is in Second stage of labor
Start with the cervix dilated completely and end with birth of the neonate
Strong urge to push from perineal pressure
Ferguson reflex is initiated from perineal pressure
231
What are the outcomes of amniotomy? Action to take?
Increase efficiency of contractions
Monitor fetal heart rate monitoring to detect the presence of a prolapse cord
232
Do not perform manual pelvic examination if
Client got placenta previa
233
Do not do vaginal examination to
Client with Premature rupture membranes due to risk of infection
234
Placenta previa signs and symptoms
Painless bright red vaginal bleeding in second trimester
Soft , relax , nontender uterus
Fundal height larger than expected for gestational edge
235
DIC signs and symptoms
Petechiae
Hematuria
Oozing from injection sites
Prolonged clotting time
236
During precipitous labor when the infant head crowns what should you do
Instruct the client to breath rapidly
237
How to use the doppler device
Palpate simultaneously the maternal radial or carotid pulse and auscultate the FHR to differentiate between the two.
238
Concealed abdominal bleeding signs and symptoms
Increase fundal height
Hard board like abdomen
Persistent abdominal pain
Late deceleration in FHR
Decreased baseline variability
239
Amniotic fluid normal appearance
Pale straw in color and may contain flecks of vernix caseosa
240
Severe preeclampsia intervention
Best rest on lateral position
Keep room semi dark
Initiate seizures precautions
Padding side rails
Avoid environmental stimulation
241
Regional anesthesia major side effect
Hyppotension
So BP are taken every 5 minutes during the first 15 minutes, then at 30 minutes and 1 hour
242
What meds is contraindicated if client got history of opioid dependency?
Butorphanol tartrate, because this meds precipitate withdrawal
243
Signs of uterine inversion
Depression in fundal area
Visualization of the interior of the uterus through the cervix or vagina
Severe abdominal pain
Hemorrhage
Shock
244
Ruptured uterus symptoms
Chest pain
Rigid abdomen
245
Before giving birth client with group B streptococcus will need
Intravenous antibiotics prophylaxis
246
Minimal variability is
Fluctuations that are fewer than 6 beats / minute
247
Minimal variability signs and symptoms
Tachycardia
Fetal hypoxia
Metabolic acidemia
Congenital anomalies
248
Early deceleration is
A visually apparent gradual decrease of the FHR with gradual return to the FHR baseline.
249
Variable deceleration is
Rapid onset of less than 30 seconds with a rapid return to FHR baseline
250
Intervention for hypotension causing by epidural anesthesia
Turn on left side
Administer O2 via face mask
Increase the rate of iv transfusion
251
Intravenous meds during labor should be administered how
In small doses starting at the beginning of a contraction and carrying over for 3 to 5 contraction
252
Intervention after epidural block
Palpate the bladder at at frequent intervals because full full bladder will impede the progression of labor
253
Normal amniotic fluid volume
500 - 1000
254
Cord compression position
Tradelenburg
255
Respiratory distress syndrome signs and symptoms
Cyanosis
Tachypnea or apnea
Nasal flaring
Chest wall retraction
Audible grunts
256
Newborn who use to drugs signs and symptoms
Irritability
Consttant crying
Difficulty to comfort
257
Fetal alcohol syndrome signs and symptoms
Craniofacial abnormalities
Intrauterine growth restriction
Cardiac abnormalities
Abnormal palm creases
Respiratory distress
Irritability
Poor feeding
Tremors
258
Erythromycin is used for
Prophylactic treatment for ophthalmia neonatorum which is caused by the bacterium Neisseria gonorrhoeae
259
HIV type of precautions
Standard precautions
260
Cord care teaching
The cord needs to be kept clean and dry to prevent infection
Card fall off between 7 and 14 days
Clean 2-3 times a day with soap and water
261
How to perform moro reflex
Place newborn on a flat surface and strike the surface or making a loud , abrupt noise to startle the newborn
262
Normal respiration for newborn
30 - 60 breath per minute
263
Congenital neonatal syphilis signs and symptoms
Poor feeding
Hyperthermia
Snuffles
264
End of first week signs and symptoms for congenital neonatal syphilis
Maculopapular dermal rash observed on the palms of the hands on soles of the feet , in diaper , around mouth and anus
Copper colored rash
Mucopurulent nasal drainage
265
How long after birth apgar score is performed
1 minute after birth , and again 5 minutes after birth
266
How to calculate APGAR score
267
Anterior fontanel shape
Diamond shaped located at the top of the head
Soft and flat may range in size 4 to 5 cm
268
Posterior fontanel shape
Triangular shape
1 cm to 2 cm in size
269
Posterior fontanel close after how long
Posterior fontanel closed 2 month of age or at birth
270
Cephalohematoma indicate what ?
Edema resulting from bleeding below the periosteum of the cranium
271
Stomach capacity in newborn
10-20ml =for newborn infant
30-60ml=1 week old
75-100ml=3 week old
90-150ml=1 month old
272
Gastroesophagel reflux for newborn signs and symptoms
Irritability
Failure to thrive
Choking
Weight loss
Spitting up
Regurgitation
Hiccups
273
Hiatal hernia clinical manifestation
Failure to thrive
Vomiting
Coughing
Wheezing
Short period of apnea
274
Esophageal atresia and trans esophageal atresia clinical manifestation
Excessive oral secretion
275
Congenital diaphragmatic hernia manifestation
Bowel sound heard over chest
276
When is hepatitis B vaccine given
12 hours after birth
277
Presence of cephalohematoma may indicate
Jaundice
278
Negative direct combs test means what
No maternal antibodies are present on fetal erythrocytes
279
How to measure head circumference in newborn
Place the tape measure under the infant head, wrap the tape around the occipicut and measure just above the eyesbrow so that the largest area of the occipicut is included
280
Most common complications for small gestational age
Hypoglycemia
281
Most common complications for small gestational age baby are
Hypoglycemia
282
Gastronomy tube teaching postoperative
Elevated the gastronomy tube
283
Bluish discoloration of the hand and feet in newborn is what and is it normal ?
Acrocyanosis , Yes
284
Large gestational age for baby is at risk for
Hypoglycemia
Fracture clavicle
Congenital heart defect
285
Rooting reflex is performed by
Stimulating the perioral area with finger
286
Temperature of 100.4 of newborn is a sign of dehydration effects
287
Do not use soap and water when
Cleaning the breast
288
Clots larger than 1 cm are :
Abnormal
289
A precipitous labor is a
Labor that last 3 hours or less
290
Cystitis is what ?
Inflammation of the bladder
291
Cystitis teaching
Consume 3000 ml fluid per day
292
Anemic pregnant client is at risk for
Postpartum infection
Poor wound healing
293
Intervention for superficial venous thrombosis
Elevation of the affected extremity
294
Uterine involution how to perform
Palpate the fundal height
295
Where is fundus 12 hours postpartum
Above the umbilicus
296
How often the nurse should take newborns vital signs per hour
Every 15 minutes in the first hour of birth
Every 30 minutes the next 2 hours
Every hour for the next 2 to 6 hours
297
Thrombophlebitis signs and symptoms
Pain in the calf area
298
Most common cause of bleeding after childbirth
Uterine atony , so massage the fundus
299
Technique to feed baby with soreness on breast
Feed from the breast that is not sore and pump the one that is sore
300
Primary risk for client with endometritis
Cesarean birth
301
When breastfeeding client needs to increase what ? And by how much ?
500 calories
May substitute with peanut butter and jelly sandwich and glass of 2% milk
302
Afterpain is noticeable after what ?
Breast/chest feeding
303
What to do to relief engorgement
Wear a supportive bra between feeding
Apply ice pack
Fresh cabbage leave
Apply mois heat to both breast/chest area for about 20 minutes before a feeding
Feed infant every 2 hours for 15-20 minutes on each side
Massage the breast/chest area gently during a feeding from outer area to the nipples
304
Client affected with covid 19 may broke precautions with newborn
10 days since the covid-19 test
305
Signs of hyperglycemia
Nausea
Vomiting
Excessive thirst
Dry mouth
Weakness
Abdominal pain
Fruity breath odor
306
Difference between the 1-hour glucose test and the 3 hour glucose test
1 hour =60 minutes do not require fasting before testc
3 hours => required fasting
307
Varicose vein intervention
Elevate hips with a pillow while lying in bed
Compression underwear needs to be worn to improve circulation
Alternate between putting heat and ice packs on the affected areas
308
Hormone that increase joint laxicity
Progesterone
Relaxin
309
Recommended weight gain for obese pregnant client
11 to 20 lb
310
How many calories pregnant client need per day based on trimester
1st trimester => 1800
2nd trimester => 2200
3rd trimester => 2400
311
Ductus arterious do what ?
Allow blood to bypass the fetal lung
Connect umbilical vein to the inferior vena cava
312
Placenta funtion is to
Provide exchange of oxygen, nutrients, waste of product between birthing parents and the fetus
313
Prolapse cord position
Knee chest position
Tradelenburg position
314
Shoulder Dystocia intervention
McRoberts maneuver => sharp flexion of maternal thighs toward the abdomen to widen space between pubic bone and sacrum
Suprapubic pressure ( press down on the symphysis pubis ) : Downward pressure applied to the maternal pubic bone and sacrum
Document timing of events like time of birth of the fetal head , verbalize passing time
Minimize time it takes to deliver the fetal body as more than 5 minutes causes hypoxia, nerve injury , death
315
Macrosomia number
Fetal weight > 8lb 13 OZ
>4000g
316
Signs of hypoglycemia in newborn
Jitteriness
Irritability
Hypotonia
Apnea
Lethargy
Temperature instability
317
Newborn vitals signs
Heart rate : 110-160 but can go to 180 during crying or drop to 100 when sleeping
Respiratory rate : 30-60 min
318
First intervention for a pregnant client after trauma
Tilt the client to the lateral position to promote blood circulation to the fetus and address supine hypotension
319
Postpartum endometriotitis treatment
Clindamycin
Gentamicin
320
Abruptio placentae intervention
Delivery of the fetus (immediate birth)
Obtain specimens for type and cross match for blood transfusions
Insert peripheral venous access device
321
Why do pregnant client need folic acid
To decrease chances of neural tube defects
322
How much folic acid a pregnant women needs per day
Minimum of 400 mcg per day
323
Expected finding for a neonates 1 hour after birth
Respiration 30-60
Glucose 40-60
Milia : white papules on bridges of the nose
324
Ventricular septal defect is ? When does it dissapear ?
A holosystolic murmur at the left lower sternal border
It disappear within first 6 month of life
325
Down syndrome signs
Single transverse crease extending across the palm of the hand
326
Normal findings in a newbon
Plantar creases on the soles of the feet
Babinski reflex : Toes fan out as the lateral surface of the sole is stroked
Epstein pearl : white pearl-like cysts on the gum
327
Bishop Score table
328
Bishop score table
329
Amniotomy intervention
Monitor temperature after 2 hours
Assess fetal rate
Note amniotic fluid color and odor
Assist client in a side lying position or an upright position
330
MMR vaccine teaching
It is a live attenuated vaccine
It is contraindicated during pregnancy and should be administered postpartum
Pregnancy should be avoided for 4 weeks after immunizations
331
Cleft palate intervention
Use special bottle or nipple
Burp the newborn
Feed newborn in upright position
Initiate feeding asap
332
Normal weight gain during pregnancy
25-35 lb
333
Recommended vaccine during pregnancy
TDAP
Influenza
Rho immoglobulin
334
Vaccine contraindicated during pregnancy
HPV
MMR
Live attenuated vaccine
Varicella
335
Breastfeeding technique
Breastfeed every 2-3 hours on average (8-12 times/day)
Position newborn tummy to tummy
Feed at least 15-20 minutes
Insert finger beside the gums to break suction
336
GTPAL meaning
337
What is oligohydramnios? What it put client at risk for :
Conditions characterized by low amniotic fluid volume, and put client at risk for cord compression
338
Preterm labor intervention
Administer glucocorticoids ( betamethasone, dexamethasone)
Administer antibiotic (penicillin)
Administer magnesium sulfate
Give tocolytic : Nifepidine , Indomethacin)
339
Late deceleration intervention
IV fluid
Reposition client laterally
Discontinue IV oxytocin
340
Client with placenta previa are at risk for what
Hemorrhage
341
Placenta previa intervention
Prepare for cesarean birth
Electronic fetal monitoring
Monitor pad count
Initiate large bore IV
Collect blood specimen type and screen
342
Signs of hypertensive disorder in pregnancy
Headache
Facial edema
343
Newborn safety
Use sleep sack
Maintain supine position
Snuggly fitted harness
Rear-facing back seat
344
Pica is often accompanied by what ? And should do what ?
Iron deficiency anemia, so monitor hemoglobin and hematocrit
345
Labs associated with hyperemesis gravidarum
Ketonuria
Elevated hematocrit
Hypokalemia
Increased urine specific gravity
346
Acrocyanosis (bluish discoloration) intervention
Put the client skin to skin with parent
347
Transition phase( dilated 8-10cm) of labor intervention
Encourage breathing techniques
348
Contractions duration
Should not exceed 90 seconds or occur less than 2 minutes apart
349
Gastroesophageal reflux intervention
Offer small frequent feeds
Burp the baby
Hold infant upright after feeding
350
True & False Labor
351
Hirschprung disease manifestations
Feeding intolerance
Bilious emesis
Distended abdomen
No passage of meconium within 48 hrs
352
Yellow exudate on the glans penis after circumcison is normal or abnormal
Normal
353
Circumcision teaching
Only use warm water to clean
354
Ectopic pregnancy manifestations
Hypotension
Tachycardia
Shoulder pain
355
Indirect coombs test for what
Rh sensitization in client who are RH-Negative
356
Bowel obstruction signs
Green vomiting
357
Neonatal abstinence syndrome manifestations
Irritability
Restlessness
High pitched cry
Nasal congestion
Frequent yawning, sneezing
Poor feeding and diarrhea
358
What meds are contraindicated in all stages of pregnancy
Angiotensin-converting enzymes inhibitor (PRIL) : enalapril, lisinopril
Angiotensin II receptor blockers (sartan) : losartan , valsartan )
359
When do you administer IV narcotics to client in labor
Administer it at the peak of contraction reduces the amount of narcotics that crosses the placental barrier and affect the fetus
360
5 rights of delegation
361
Posterm newborn findings
Deep plantar creases
Dry , cracked , peeling skin
Long fingernails and scalp hair
Minimal or absent vernix
362
Pregnant client with poor controlled diabetes is at risk for
Polycythemia, so monitor hematocrit
363
Hydrocephalus value
Head circumference >14.6 inches
364
Postpartum psychosis manifestations
Depression
Increased energy level
Severe insomnia
Agitation
Disorganized behavior
Psychotic symptoms
365
Omophocele intervention
Cover with nonadherent dressing, sterile, saline soaked gauze
Initiate IV access
366
Pelvic inflammatory disease manifestations
Low abdominal pain
Purulent cervical discharge
Cervical motion tenderness
Nclex prep
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