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Maternal Newborn ATI Study Guide
1. Types of barrier methods: condoms, diaphragms
2. A client must be fitted every years for a diaphragm.: 2
3. Reasons clients will have to be refitted for diaphragm:: -Every 2 years
-Gained 15 pounds (7 kg) -had full term pregnancy -had 2nd term abortion
4. What must be used in addition will diaphragms?: spermicide
5. A diaphragm must remain in place for hours after intercourse.: 6
6. True or False: Spermicide must be used with diaphragm for each act of intercourse.: True
7. Side effects of hormonal methods (oral, patch, Nuva Ring) of contraception:-
: chest pain, SOB, leg pain (possible clot), headache, eye problems, HTN
8. Hormonal methods risks: -blood clots, leading to a stroke or PE
-HTN
9. Smokers should not take:: hormonal contraceptives
10. Contraindications of hormonal contraceptives:: hx of blood clots, stroke, cardiac problems,
breast/estrogen related cancers, smoker
11. Depo-provera: injectable progestin
12. Depo-provera can cause:: decreased bone mineral density
13. Education for client receiving Depo injection:: receive adequate intake of calcium and
vitamin D
14. IUDs increase the risk of:: pelvic inflammatory disease, uterine perforation, and ectopic
pregnancy
15. Clients who had IUDs must be on the look out for:: increase in string length, foul smelling
vaginal discharge, pain w/ intercourse, fever, chills
16. Definition of infertility: the inability to conceive after trying for 12 months
17. Workup after determining infertility:: -Sperm analysis on male (done 1st)
- Woman tested if male comes out negative
18. The nurse must ensure that the client receiving a test with dye does not have hx or allergy to
or .: iodine or seafood
19. Presumptive signs of pregnancy: amenorrhea, fatigue, nausea, vomiting, uri- nary frequency,
breast changes, quickening
20. Probable signs of pregnancy: abdominal enlargement, hegar sign (softening of uterus),
chadwick's sign (bluish color of cervix, Goodell's sign (softening of cervical tip), ballottement (rebound of unengaged fetus), braxton hicks contractions, positive pregnancy test, fetal outline felt by examiner
21. Positive signs of pregnancy: hearing fetal heart sounds, see baby with ultra sounds, feeling
of movement in uterus
22. Presumptive signs can:: be explained for problems other than pregnancy
23. Positive signs of pregnancy are:: very distinct
24. Naegele's rule: subtract 3 months, add 7 days, add 1 year
Easier way: Add 9 months, add 1 week
25. GTPAL: G- gravitity (# of times woman has been pregnant, including the current pregnancy)
T- pregnancies of 38 wks or more P- pregnancies of less than 38 wks A- abortions/miscarriages L- living children
26. weight gain range for pregnant woman who is a normal weight: 25-35 pounds
27. weight gain range for woman who is overweight: 15-25 pounds
28. Weight gain range for woman who is underweight: 28-40 pounds
29. During 1st trimester, a woman shouldn't gain more than:: 2-4 lbs (1-2 kg)
30. Once past 1st trimster, weight gain is expected as : 1 pound per week
31. Expected extra calories per day for 2nd trimester: 340 extra cal per day
or nipple stimulation
50. What is monitored during the contraction of a contraction stress test?: -
Fetal HR to see if late deceleration occur
51. If no late decelerations occur during contraction stress test, then the result is:: negative (what
you want)
52. If late decelerations do occur during contraction stress test, the result is:: positive (not a
good thing)
53. Risk of contraction stress test: can potentially send woman into preterm labor
54. When is amniocentesis usually done?: 14 wks
55. What does amniocentesis test for?: genetic abnormalities
56. What is looked at for amniocentesis?: AFP (alpha fetoprotein) LS Ratio
(lecithin sphingomyelin ratio)
57. If levels of afp are high, then it is associated with:: neural tube defects
58. If levels of afp are low, then it is associated with:: chromosomal disorders (Down syndrome)
59. What does LS ratio test for?: fetal lung maturity
60. Risks associated with amniocentesis:: amniotic fluid embolism, hemorrhage, infection, laking
of amniotic fluid, ruptured membranes, or miscarriage
61. When can Chorionic villus sampling be done?: 10-12 wks
62. What does chorionic villus sampling test for?: genetic abnormalities
63. Advantage of chorionic villus sampling as opposed to amniocentesis: can be done early to
detect the genetic abnormalities
64. Ectopic pregnancy: ovum is planted outside the uterus (often in fallopian tube)
65. Main symptom of an ectopic pregnancy:: unilateral stabbing pain and abdom- inal tenderness
in LLQ
66. Molar pregnancy: proliferation and degeneration of trophoblastic villi in the placenta
67. Main symptom of molar pregnancy: bleeding that resembles prune juice (dark brown)
68. Placenta previa: placenta abnormally implants in the lower segment of the uterus by the
cervix as opposed to near the fundus
69. Complete placenta previa: cervix is completely covered by the placental at- tachment
70. incomplete/partial placenta previa: cervix is partially covered
71. Main symptom of placenta previa:: painless, bright red bleeding during 2nd or 3rd trimester
72. Placenta previa vs abruptio placenta: placenta previa is painless whereas abruptio
placenta is painful
73. abruptio placenta: premature separation of placenta from uterus
74. abruptio placenta has high rate of fetal and maternal:: mortality and morbid- ity
75. main symptom of abruptio placenta is:: sudden onset of intense localized uterine pain with
dark red vaginal bleeding
76. What infection is common for pregnant women?: yeast infection
77. s/s of yeast infection: cottage cheese looking discharge, vulvar redness, white patches on
the vaginal wall
78. Incompetent cervix: recurrent premature dilation of the cervix
79. If woman has incompetent cervix, then what will she get?: cervical cerclage (keep cervix
closed)
80. When is cervical cerclage removed?: 37 wks gestation or when spontaneous labor occurs
81. Hyperemesis gravidarum: excessive n/v past the first 12 wks of pregnancy
82. Interventions for hyperemesis gravidarum: -IV fluids
-administration of B -antiemetic medications (Reglan, Zofran)
83. What should a client take with iron supplements?: food that is rich in vitamin C
84. Foods high in vitamin C: orange juice
85. What is woman at higher risk for if she has gestational diabetes?: diabetes after pregnancy
86. Tests that will be done if mother is diagnosed with gestational diabetes: -
non stress test, biophyiscal profile
87. What will be used to control sugar levels during gestational diabetes: in- sulin (oral
antihypertensives (methyldopa, nifedipine, hydralazine, labetalol
103. What meds are given for eclampsia: anticonvulsant (magnsium sulfate)
antihypertensives (methyldopa, nifedipine, hydralazine, lebetalol)
104. Important point for magnesium sulfate: monitor patient for magnesium tox- icity
105. s/s of mag toxicity: no reflexes, low urine output, low respirations, decreased LOC,
dysrhythmias
106. Antidote for magnesium sulfate toxicity: calcium gluconate
107. Tests to determine if mother is in preterm labor: -swab of vaginal secretions
108. What does swab of vaginal secretions determine?: if there is fetal fi- bronectin
109. Meds for preterm contractions: -nifedipine (calcium channel blocker)
-Magnesium (relaxes smooth muscle of uterus) -indomethacin (NSAID) -betamethasone
110. What is betamethasone used for?: promotion of fetal lung maturity
111. Premature rupture of
membranes is a major cause of : infection
112. If premature rupture of membranes has occured, what is done:: -nitrazine paper test
-positive ferning test
113. Nitrazine paper test should turn which color if there is ruptured mem- branes: blue
114. What is client given during premature rupture of membranes?: -antibiotics
-betamethasone
115. Physiological changes prior to labor: back ache, weight loss (1-3 lbs), lightening
(fetal head descends into true pelvis), true contractions, bloody show, energy burst, nausea, vomiting, indigestion, rupture of membranes
116. true contractions vs braxton hicks: true contractions are regular and in- crease in
strength braxton hicks contractions are irregular
117. When is GBS usually done?: 36-37 weeks gestation
118. 1st stage of labor time frame: the onset of labor until complete dilation of the cervix
(10 cm)
119. 2nd stage of labor time frame: full dilation of cervix to birth of baby
120. 3rd stage of labor time frame: birth of the baby to delivery of placenta
121. 4th stage of labor time frame: delivery of placenta until mother's vital signs are WNL
122. Phases of labor within the 1st stage of labor: latent phase, active phase, and
transition phase
123. Latent phase of labor: - 0-3 cm dilation
- mother is talkative and eager.
124. Active phase of labor: - over 3 cm to 7 cm dilation
- mother is anxious, restless, and is feeling helpless
125. Transition phase of labor: - over 7 cm to 10 cm dilation
- mother has feelings of not being able to go on; "I can't continue" -has urge to push -has increased rectal pressure; may feel like she needs to have bowel movement
126. Nonpharmacological pain management methods: Effleurage, sacral counter
pressure, music, distraction, aromatherapy, imagery
127. Effleurage: light gentle circular stroking on client's abdomen
128. Sacral counter pressure: using heel of hand or fist to push against client's sacral
area to offer counter pressure against pain in low back
129. I
f client receives a sedative or opioid analgesic, then there is a risk of in the baby.: respiratory depression
130. Important factors to consider when giving opioid analgesics to mother: -
sedation, hypotension, and decreased variability in fetal heart rate
-increase IV fluids -discontinue oxytocin -administer O -notify provider
148. variable decelerations: umbilical cord compression
149. interventions for variable decelerations: - reposition client from side to side OR knee to
chest position -discontinue oxytocin
- administer O -notify provider
150. prolapsed umbilical cord: part of the cord is protruding through cervix and is being
crushed by fetus's head
151. Interventions for prolapsed umbilical cord: -notify provider
-using sterile gloved hand, insert 2 fingers into vagina and on either side of the cord lift the babies head off the cord.
- reposition client to knee chest OR trendelenburg position
- Use warm sterile saline soaked towel on cord so it doesn't dry up
152. Rhogam should be administered within of giving birth for women who
are Rh and their baby is Rh .: 72 hours, negative, positive
153. Immediately after delivery, what should fundus look/feel like: firm, midline with
umbilicus, approx. at level of umbilicus
154. 12 hours after delivery, what should fundus look/feel like?: 1 cm above umbilicus
155. every 24 hours after the 12 hour mark post partum, the fundus should:: -
descends 1-2 cm per day
156. By 6th postpartum day, where should fundus be?: half way between um- bilicus and
symphasis pubis
157. True or false: by 10th day postpartum, the fundus should not be able to be palpated.:
true
158. 3 types of lochia: lochia rubra, lochia serosa, lochia alba
159. lochia rubra: bright red bleeding that occurs during day 1-3 after woman gives birth
-has fleshy odor, may see blood clots (but not excessive clots)
160. lochia serosa: -from day 4-
-serosanguinous (pinkish brown)
161. lochia alba: -from day 11 to 6 weeks postpartum
-yellowish-white creamy color -fleshy odor
162. During lochia rubra time period, it is important that bleeding should not be excessive.
What is considered excessive bleeding?: saturating a pad within 15 minutes
compresses -tight bra -mild analgesics
177. Postpartum complications: DVT, pulmonary embolism, hemorrhage
178. s/s of DVT: unilateral area of swelling, warmth, and redness in one leg, calf
tenderness
179. s/s of pulmonary embolism: chest pain, difficulty breathing
180. s/s of maternal hemorrhage: tachycardia, hypotension, soaking a lot of pads in small
amount of time
181. Meds used for hemorrhaging or uterine atony: pitocin (oxytocin), methyler- gonovine
(methergine), misoprostol (Cytotec)
182. s/s of mastitis: painful/tender localized hard mass, reddened area usually on one
breast, fever, chills, fatigue
183. Education on breast hygiene in preventing mastitis: -washing hands prior to breast
feeding -keeping breasts clean -allow nipples to air dry -when breast feeding, ensure the newborn is taking in both the nipple and areola in their mouth -attempt to empty both breasts when feeding
184. postpartum blues: -last up to 10 days
-very common -if last more than 10 days or s/s become worse, it is important to test for postpartum depression
185. postpartum blues s/s: tearfulness, insomnia, lack of appetite, feeling of let down
186. postpartum depression: -occurs within 6 months of delivery
187. s/s of postpartum depression: persistent feelings of sadness, intense mood swings
188. postpartum psychosis: -common with mothers who has hx of bipolar disorder
189. s/s of postpartum psychosis: disorientation, hallucinations, obsessive be- haviors,
paranoia
190. Normal range APGAR score: 7-
191. 4-6 APGAR score indicates:: moderate distress
192. under 4 APGAR score indicates:: severe distress
193. 5 areas tested for APGAR: heart rate, respiration rate, muscle tone, reflex
irritability, color
194. Heart rate APGAR: score of 2: HR greater than 100 score
of 1: HR in between 0- Score of 0: no HR
195. Respiration rate APGAR: score of 2: good cry
score of 1: slow, weak cry score of 0: no cry at all
196. Muscle tone APGAR: score of 2: well flexed
score of 1: some flexing score of 0: flaccid
197. Reflex irritability APGAR: score of 2: crying
score of 1: grimacing score of 0: silent
198. Color APGAR: score of 2: completely pink
score of 1: pink body and cyanotic hands and feet (acrocyanosis) score of 0: overall blue and pale
199. What does new ballard scale measure?: neuromuscular maturity and phys- ical
maturity
200. according to new ballard scale ,if baby is full term they will be:: well flexed in arms and
legs
201. new ballard neuromuscular maturity assessment contents: square win- dow, arm
recoil, scarf sign, popliteal angle, heel to ear test
202. Characteristics of preterm infant: -thinner, transparent, sticky skin
-lanugo present
215. Sucking and rooting reflex: birth to 4 months
216. Palmar grasp: birth to 6 months
217. Plantar grasp: birth to 8 months
218. Moro reflexes (startle reflex): birth to 4 months
219. Tonic neck reflex (extend arm and leg which they are turned to and flex opposite arm
and leg): birth to 3-4 months
220. Babinski reflex: birth to 1 year
221. Stepping reflex: birth to 4 weeks
222. Ways babies can lose heat: -conduction (lose heat because in direct contact with
cooler surface ex. cold stethoscope, scale without padding) -Convection (lose heat from cooler environmental air ex. fan) -evaporation (lose surface liquid as vapor ex. giving bath, after birth) -radiation (lose heat from body surfce to cooler surface nearby ex. window, AC)
223. Meconium should be passed
within the first after birth: 24 hours
224. Interventions done on baby after birth: -prophylactic eye care (erithromycin ointment)
to prevent infection from gonorrhea or chlamydia -vitamin K supplement until they start producing their own vitamin K
225. What is baby's first vaccine?: Hep B (1st one at birth, second one at 1 month, third one
at 6 months)
226. s/s of hypoglycemia in baby: jitteriness, twitching, weak high pitched cry, irregular
respirations, cyanosis , lethargy, eye rolling, seizure, blood glucose level under 40.
227. If baby has hypoglycemia, it is important for baby to:: feed (breastfeeding or
supplement with formula until milk comes in)
228. How much weight does a baby lose right after birth? When should they regain that
weight?: 5-10% of body weight; 10-14 days after birth
229. Reasons to breast feed:: reducing risk of infection, brain growth, inexpensive,
convenient, reduces incidence of SIDS
230. For first 6 months of life, babies do not need:: food, other than breast/for- mula
feeding.
231. At 6 months, what is the first food introduced?: iron fortified rice cereal
232. True or false: Breastfeeding causes uterine cramping: true; breastfeeding releases
oxytocin; is normal and will reduce incidence of uterine atony
233. How long should mother breast feed on each breast during a feeding?: -
15-20 minutes per breast
234. Best indicator that baby is getting enough food from mother: diaper output
235. How often should newborn void per day?: 6-8 diapers
236. Storage of breast milk:: -room temp under clean for up to 8 hours
-refrigerated in sterile bottles and used within 8 days -frozen for up to 6 months in regular freezer; can stay in deep freezer for up to 12 months -used portions of breastmilk must be discarded
237. Thawing of breast milk: thaw in fridge for 24 hours DO
NOT MICROWAVE, DO NOT REFREEZE
238. Storage of formula:: -refrigerated for up to 48 hours
-discard unused portions
239. When putting baby to sleep what position should they be in?: on their back; reduced risk
of SIDS
240. How much do newborns sleep?: 17 out of 24 hours for 1st month
241. Cord care: -keep dry and above diaper
-give sponge baths only until cord falls off -monitor cord to ensure it's not moist, red, purulent drainage, or has foul odor
242. When does cord fall off?: 10-14 days after birth
243. Circumcision care for clamp procedure: -apply petroleum jelly with each diaper
change for first 24 hour after procedure to prevent diaper from sticking to the penis
244. True or false: Tub baths should not be given until circumcision is healed-
: true
264. When is phototherapy prescribed?: -bilirubin level greater than 15 mg/dl prior to 48
hours of age OR -greater than 18 mg/dl prior to 72 hours of age OR -greater than 20 at any time
265. Interventions for baby on phototherapy: -eye mask over baby
-keep undressed except for diaper -avoid applying lotions -remove newborn from phototherapy every 4 hours -reposition baby every 2 hours
266. Effects of phototherapy: bronze discoloration, rash, dehydration
rash and bronze discoloration are not a big deal but dehydration is really what you want to monitor for
