Maternal Newborn Nursing, Exams of Nursing

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Uworld maternity

Maternal Newborn

Nursing

Postpartum

1. Prior to hospital discharge, the nurse discusses sexuality after childbirth with a client who had an uncomplicated vaginal birth with no perineal laceration. Which client statement requires further teaching? “I will begin using condoms to prevent pregnancy once menses returns”. Rationale: - many postpartum clients resume sexual activity before their postpartum checkups (4- 6 weeks after birth). Encouraging the use of barrier contraceptive (e.g. Condoms) to prevent pregnancy is important because ovulation may occur as daily as 4 weeks after birth and before resumption of menses.
2. the graduate nurse (GN) receives report on a postpartum client with a Rh-negative blood type. Which statement by the GN regarding the Rh immune globulin injection requires the preceptor to provide further teaching? “if the maternal antibody screen is negative, I will hold Rh immune globulin and contact the health care provider”. Rationale: - Rh alloimmunization occurs when a pregnant client with an Rh-negative blood type is exposed to Rh-positive fetal RBcs. Postpartum, the nurse should verify that the client is not Rh sensitized by checking for a negative screen and then proceeding with administration of Rh immune globulin if the newborn is Rh positive.
3. A nurse is caring for postpartum client who is breastfeeding and has been diagnosed with mastitis of the right breast. Which of the following instructions should the nurse include in client teaching? SATA Apply warm compresses to breast; increase oral fluid intake; take ibuprofen as needed for pain. Rationale: - treatment of lactational mastitis includes antibiotic therapy, continued breastfeeding, breastfeeding support(e.g. Proper latch technique), warm compresses, massage, adequate nutrition and hydration, and appropriate analgesics(e.g. Ibuprofen, acetaminophen).
4. A nurse is caring for a client who had a vaginal birth 2 hours ago. The client has saturated a perineal pad in 20 minutes. During assessment, the nurse notices that the client has a boggy fundus that is deviated to the right and slightly above the umbilicus. Which intervention should the nurse performs first? Assist client to use the bedpan to void. Rationale:- excessive postpartum bleeding is most commonly caused by uterine atony.The nursing priority for uterine atony associated with bladder distension id to assist the client with voiding and then perform fundal massage and other intervention as needed to control excessive bleeding.
5. the pediatric nurse is performing an assessment on a 4 week old client in the clinic. During the assessment, the newborn’s mother starts to cry and states, “ I am the worst mother in the world’. What should the nurse do next? “Have you felt depressed or hopeless over the last 2 weeks?’

Rationale: PPD is a perinatal mood disorder characterized by crying, irritability, sleep disturbances, anxiety, or feeling of guilt. Nurses should assess for PPD by asking specific questions about the feeling of depression and hopelessness as well as thoughts about self- harm.

6. the nurse provides a follow-up phone call to a client who gave birth at a birthing center 5 days ago. Which statement by the client should the nurse be most concerned about? “my bleeding is like a really heavy period with some blood clots.” Rationale: - secondary or delayed PPH occurs > 24 hrs but < 6 weeks postpartum. Reports of increased vaginal bleeding, soaking a pad in < 1-2 hrs, reverting from lochia serosa back to lochia rubra, or passing several/large clots are concerning findings associated with secondary PPH.
7. The nurse receives report on several postpartum clients who gave birth a term gestation. Which client should the nurse assess first? Client G5P5, who is 12 hrs postvaginal birth and saturating perineal pads every hr for 2 hrs with lochia rubra. Rationale:_ The nurse should prioritize assessment of clients with signs of immediately life threatening postpartum, complications( eg. Hemorrhage, pulmonary embolism). A perineal pad that is saturated in  1 hr indicates excessive bleeding and requires immediate assessment to prevent hemodynamic compromise.
8. The nurse is caring for a postpartum client 36 hrs after a cesarean birth who was just diagnosed with postpartum endometritis. Which prescription is priority for the nurse to administer? Clindamycin IV every 8 hrs. Rationale:- postpartum endometritis is an infection of the uterine lining and is characterized by fever, chills, tachycardia, uterine tenderness, and foul-smelling or purulent lochia. The nurse priority intervention is initiation of broad spectrum antibiotics ( clindamycin, gentamycin). Subsequent intervention includes antipyretics, IV fluids, and possibly uterotonics for uterine subinvolution.
9. The postpartum nurse is assessing a client who gave birth by cesarean section 5 hrs ago and is requesting pain medication. The client appears restless, has a heart rate of 110/min, and admits to recent onset of anxiety. What priority action should the nurse take? Obtain oxygen saturation reading by pulse oximeter Rationale:- pregnancy is a hypercoagulable state that increases risk for deep vein thrombosis and pulmonary embolism(PE). Sx of PE include anxiety/restlessness, pleuritic chest pain/tightness, shortness of breath, tachycardia, hypoxemia, and hemoptysis. Priorities are rapid symptom identification, assessment of oxygenation, and notify HCP.
10. A nurse is caring for a client following delivery of a stillborn infant. Which actions should the nurse take? SATA Ask the parents if they would like to help bathe the infant Encourage the parents and family members to hold the infant

Offer to obtain handprints, footprints, and photographs of the infants. Rationale: - Intrauterine fetal demise(i.e stillbirth) is the birth of an infant who is not alive. The nurse should encourage family members to hold and name the infant. Mementos (eg. Hand/footprints, photographs) should be made for family to keep. However, none of these actions should be forced if the parents declined.

11. A nurse is providing care to a group of postpartum clients. Which client comment should prompt further investigation? My aunt has come over every day to care for the bay b/c the baby cries bother me. Rationale:- perinatal mood disorders may occur at any time during pregnancy but are more common in the immediate postpartum period. Client with postpartum depression may feel intense and persistent anxiety, anger, guilt, and sadness. A client showing irritability and disinterest in caring for the newborn should be assessed for postpartum depression and offered a referral for follow up.
12. A client who gave birth vaginally with epidural anesthesia still has limited movement and strength of the right leg, and reports no urge to urinate at 2 hrs postpartum. The nurse palpates the clients fundus 2 cm above the umbilicus and to the right. What should the nurse do next? Perform in-and- out catheterization Rationale:- Signs of bladder distension in a postpartum client includes a displaced and /or boggy uterus, or a palpable bladder. Performing an in - and - out catheterization can help prevent postpartum hemorrhage r/t to uterine atony and in juries r/t falls if sensory/motor function of the lower extremities is decreased.
13. A nurse is caring for a postpartum client who has chosen to exclusively formula feed her newborn for medical reasons and is experiencing breast engorgement. What should the nurse teach regarding relief of breast engorgement? Use chilled, fresh cabbage leaves on breast throughout the day. Rationale:- comfort measures for breast engorgement include application of ice packs and chilled , fresh, cabbage leaves; analgesics; and firm breast support.
14. preeclampsia can develop in the postpartum period several days after birth. Clients in the postpartum period with signs and symptoms of preeclampsia[ edema, persistent headache, vision changes, elevated blood pressure] should be evaluated and treated immediately.
15. postpartum hemorrhage is defined as maternal blood loss > 500 ml after vaginal birth or > 1000 ml after cesarean birth. Uterine atony(boggy uterus) is most common cause of early PPH. Risk factors include uterine distension [ macroscopic infant >4000 gm ], uterine fatigue, high parity, and certain medications.
16. proper breastfeeding and latch technique are Breastfeed every 2 - 3 hrs on average. Breastfeed “on demand” whenever the newborn exhibits hunger cues(sucking, rooting reflex) Position the newborn “tummy to tummy” with mouth infront of nipple and head in alignment with body Ensure a proper latch(i.e grasps both nipple and part of areola)

Insert a clean finger beside the newborn’s gums to break suction before unlatching. Alternate which breast is offered first at each feeding.

17. thrombus formation is associated with venous stasis which may occur during or after surgery due to immobility. intervention to prevent thrombus formation includes: Promoting early and frequent ambulation by ensuring adequate pain control(administer analgesics 30 min before activity) Instructing the client to perform leg exercises hourly. Maintaining prescribed compression devices during sedentary activities.
18. A foul odor of lochia suggests endometrial infection. This client has an increased risk of infection due to her prolonged labor, which involved multiple cervical examination. A foul smell warrants further evaluation. LABOR AND DELIVERY
19. pregnant client esp. with placental abruption and intrauterine fetal demise are at risk for disseminated intravascular coagulation(DIC). Signs of DIC include frank external bleeding ( venipuncture site bleeding), signs of internal bleeding (petechia, ecchymosis), and organ damage from blood clotting(respiratory distress, renal failure). Baseline laboratory test( coagulation studies, platelets, fibrinogen) and physical assessment for signs of DIC are priority.
20. Anencephaly is severe neural tube defect resulting in little to no brain tissue or skull formation in utero. Nurses should facilitate a therapeutic environment for grieving parents and provide newborn comfort care such as warmth and oxygen.
21. A sinusoidal fetal heart rate pattern is usually an ominous finding associated with severe fetal anemia that requires intrauterine resuscitation and, potentially, an expedited birth.
22. vaginal examination of the laboring client with ruptured membrane should be performed using sterile glove to decrease the risk of infection to the client and fetus.
23. uterine tachysystole occurs when contraction are too frequent(> 5 in 10 minutes), which may cause inadequate fetal oxygenation , placental abruption, or uterine rupture.
24. uterine tachysystole with late deceleration requires discontinuation of oxytocin, repositioning to side-lying, administration of oxygen by facemask at 8 - 10 L/min, and an iv fluid bolus.

25. opioid agonist-antagonist medications used in labor include butorphanol tartrate(stadol) and nalbuphine hydrochloride(Nubain). Maternal adverse effects include sedation, dizziness, and nausea. Butophanol tartrate crosses the placental barrier, peaking 30-60 minutes; its duration of action is 2-4 hrs. if given near the time of birth, there is a risk for newborn respiratory depression.
26. late deceleration occurs after the onset of uterine contraction and continue beyond its end. Late decel occurs when fetal oxygenation is compromised. Immediate steps to correct late decel include: Stopping oxytocin if it is being administered. Repositioning client to the left/right side Administering oxygen by face mask Administering IV bolus of isotonic fluid as needed.
27. preterm labor is progressive cervical dilation and /or effacement resulting from uterine contraction before term gestation. The nurse should anticipate following intervention for clients in preterm labor before 34 weeks gestation Administration of antenatal glucocorticoids ( betamethasone, dexamethasone) Administration of antibiotics (penicillin) Initiating inv magnesium sulfate Giving tocolytic medication(nifedipine, indomethacin)
28. uterotonics drugs (oxytocin) promotes uterine contractions. If uterine tachysystole (> 5 contraction in 10 min) continues, the client is at risk for decreased placental blood flow and fetal heart rate decelerations. The nurse should request to decrease or discontinue the oxytocin infusion rate.
29. after placental delivery, the fundus should be firm, midline, and at or slightly below the umbilicus. The initial nursing action to correct uterine atony with a midline, boggy uteus is fundal massage.
30. in an operative vaginal birth, forceps or a vacuum extractor is used to shorten the second stages of labor. The nurse ensures that the clients bladder is empty, monitor for contractions, and documents the time that forceps or a vacuum extractor was applied. Fundal pressure should never be applied during this procedure or labor/birth.
31. The period of active labor from 8-10 cm dilation (i.e transition” can be emotionally challenging for laboring clients. Signs of near complete dilation include bloody show and urge to push. Clients should be coached in breathing technique and should avoid pushing until fully dilated tonprevent cervical trauma.

32. fetal occiput posterior position may cause intense back pain during labor. Client comfort can be increased by applying counterpressure to the sacrum during contractions.
33. caring for a client who plans to relinquish a newborn to an adoptive family involves giving the client an opportunity to express emotions, be involved in decision making, interact with newborn, make memories, and feel reassured that the decision is one of love and not abandonment.
34. an acceleration is a reassuring finding most often indicating fetal movement. Moderate variability is considered “good” and normal and fluctuates off baseline from 6 - 25/min.
35. the end of the first stage of labor(8-10 cm dilation) is transient phase of labor. It is characterized by perineal/rectal pressure due to fetal descent, which the client may perceive as an urge to have bowel movement. The maternal ischial spines are designated as 0 station landmark. During this period, descent of fetal station below maternal ischial spines( +1 or greater) results in nausea, vomiting, trembling, or shivering.
36. the nurse is most likely palpating the diamond shaped anterior fontanelle of the fetal head, which is cephalic.
37. umbilical cord prolapse causes cord compression, fetal heart rate deceleration, and disruption of fetal oxygen supply. The priority with fetal bradycardia after suspected rupture of membranes is to assess for a prolapsed cord. The nurse should then manually elevate the presenting fetal part off the cord, leave the hand in place, and call for help.
38. magnesium sulfate is commonly prescribed to client with severe preeclampsia to prevent seizures. Side rails should be padded and the bed kept in the lowest position to prevent trauma during seizures. Functioning suction equipment and supplemental oxygen should be available at the bedside. During seizure, the nurse should turn the client to the left side to prevent aspiration and promote uteroplacental blood flow. After the seizure subsides, the nurse should suction any oral secretion and apply 8-10L/min by facemask. Deep tendon reflexes should be assessed hourly during administration. Calcium gluconate should be immediately available.
39. an amnioinfusion is a transvaginal infusion of isotonic fluids through an intrauterine pressure catheter to compensate for low amniotic fluid and relieve recurrent variable decelerations. The nurse should monitor for an elevated uterine resting tone baseline and minimal to absent fluid return, which may indicated uterine overdistension.
40. Oxytocin (Pitocin) stimulates contraction of the uterine smooth muscle and is used to induce or augment labor and to prevent postpartum hemorrhage (PPH). Oxytocin administration increases the risk of abnormal fetal heart rate patterns, emergency cesarean birth, uterine

tachysystole, placental abruption, and uterine rupture. Prolonged administration increases the risk of water intoxication and PPH.

41. A client with a prolapsed umbilical cord should be placed in the knee-chest or Trendelenburg position to relieve pressure on the cord until emergency birth is possible.
42. Shoulder dystocia occurs when the fetal head emerges but the anterior shoulder remains wedged behind the maternal symphysis pubis. The nurse should be prepared to perform McRoberts maneuver and apply suprapubic pressure.
43. Epidural blocks can inhibit the sympathetic nervous system, causing peripheral vasodilation leading to hypotension. Hypotensive symptoms include lightheadedness and nausea. The nurse should first assess blood pressure and then intervene (eg, IV fluids, left lateral positioning, oxygen) as appropriate.
44. Vaginal hematomas are formed following trauma to the tissues of the perineum during vaginal delivery (eg, vacuum- or forceps-assisted delivery, episiotomy). The client reports severe pain or a persistent feeling of fullness in the region. Assessment shows a firm, midline uterine fundus with minimal or unchanged vaginal bleeding.
45. True labor is defined as contractions that cause progressive cervical change over time. Probable signs of labor are identified by assessing the timing and intensity of contractions , the success of comfort measures in relieving the pain, and the location of the pain. Consistent, intense contractions that get stronger and closer together ( more frequent over time) and are associated with lower back discomfort that radiates to the abdomen are indicative of true labor.
46. The Bishop score is a system for the assessment and rating of cervical favorability and readiness for induction of labor. A score ≥6-8 in nulliparous women is associated with successful induction and subsequent vaginal birth.
47. Uterine inversion is a rare, obstetrical emergency that occurs after birth when the uterine fundus collapses (partially or completely) into the uterine cavity, causing sudden hemorrhage , severe pelvic pain, and hypovolemic shock. Successful manual replacement of the inverted uterus through the vaginal canal by the health care provider (HCP) is the first step in resolving the inversion and requires a soft, uncontracted uterus. Tocolytics (eg, terbutaline) or inhaled anesthetics may be needed to assist with uterine relaxation. Uterotonic medications (eg, oxytocin, carboprost) must be delayed or discontinued until after the HCP has corrected the inversion (ie, manual uterine replacement) (Option 1). After uterine replacement, uterotonics are administered to reinforce its location in the pelvis and control further bleeding.
48. Group B Streptococcus (GBS) infection can be transmitted to the newborn during labor and birth and cause serious complications. Indications for prophylactic antibiotics during labor

include maternal GBS-positive status or unknown GBS status with fever ≥100.4 F (38 C), preterm gestation, and/or prolonged rupture of membranes.

49. IV narcotics administered to laboring women can cause fetal sedation and subsequent respiratory depression at birth. Administering IV narcotics at the peak of contractions reduces the amount of narcotic that crosses the placental barrier and affects the fetus.
50. A pudendal nerve block can provide pain relief for clients Newborn
    1. Oral candidiasis is a candida albicans infection. Manifestation include white patches on the oral mucosa, palate, and tongue, and difficulty sucking or feeding. The patches are nonremovable and tend to bleed when touched.
    2. During the first 3 - 4 days of life, a weight loss of approximately 5%- 6% of birth weight is expected due to fluid excretion through urine, stool, and respirations. Weight loss greater than 7% may indicate need for breastfeeding support and formula supplementation and require evaluation.
    3. Hirschsprung disease is characterized by a lack of specialized nerve cells in portions of the distal large intestine resulting in lack of peristalsis and inability of the interior anal sphincter to relax. Manifestation includes distended abdomen; no passage of meconium within 48 hrs; difficulty tolerating feedings, and bilious emesis.
    4. Trisomy 18 (Edwards syndrome) is a life-threatening chromosomal abnormality. Many of those affected will die in the first week of life and most do not make it the first birthday. The nurse should request a collaborative meeting between the health care provider and the palliative care team to help the parents understand their infants condition and make decisions.
    5. There are 3 distinct phases of p[ostpartum adjustment to motherhood, as outlined by Rubin. Rubin phase Timeline Client focus Nursing focus Taking in Birth to 24 - 48 hr Self Anticipating the client's needs Taking hold 2 - 10 days Learning to care for the Providing learning

infant opportunities & positive reinforcement Letting go >10 days Adapting to new parenting role Following up with a phone call

6. Poorly controlled diabetes negatively affects fetal oxygenation throughout pregnancy. In utero, erythropoiesis accelerates to meet additional fetal oxygen needs. Due to overproduction of red blood cells, infants of diabetic mothers commonly experience polycythemia(hematocrit > 65%)
7. Hypoglycemia occurs commonly in newborns of mothers with diabetes due to elevated insulin levels and consumption of stored glucose. Common signs include poor feeding, jitterness, and irritability. Asymptomatic newborn with low blood glucose ( < 40- 45mg/dl) should be fed breast milk or formula immediately.
8. Sudden infant death syndrome(SIDS) is leading cause of death among infants age 1 month to 1 year. Nurses should inform caregivers about childcare practices that reduce the risk of SIDS; place infant on the back to sleep on a firm surface every time; infant shouldnot share bed with anyone; nothing in the bed with the infants is safest; avoid bumper pads for the crib; maintain smoke free environment; avoid overheating; breast feed and ensure immunizations are updated.
9. Bile made by the liver is green and is released into the duodenum on eating to aid digestion. When there is an obstruction in the intestine and stool cannot pass, it may come back up as green vomit. A bowel obstruction is an emergency that can lead to bowel rupture, peritonitis, and sepsis.
10. A gestational age assessment assists the nurse in providing developmentally care for preterm newborns. The newborn at 28 week gestation has abundant lanugo; flat areolae without palpable breast buds; and smooth, pink skin with visible veins.
11. Newborns whose mothers have diabetes mellitus are increased risk for hypoglycemia, especially in the first several hours after birth. A common symptom of newborn hypoglycemia is jitteriness. Newborn hypoglycemia required immediate intervention to prevent neurologic damage.
12. The Moro(startle) reflex is elicited in newborns by stimulating a falling sensation; the infants extends and raises the arms and then curls into the fetal position. An absent Moro reflex may indicate brain or spinal cord underdevelopment or damage.
13. Some abnormal findings in a newborn include decreased muscle tone, sacral dimple, and a single artery in the umbilical cord. Bluish discoloration of the hands, feet, and lips and heart rate 110 - 160/min are normal physiologic variations in newborns.
14. Breastmilk is the optimal form of nutrition for infants from to a least 6 months old. The precepting nurse should intervene if a graduate nurse offers supplemental formula to a mother with a healthy newborn who desires breastfeeding because it can hinder successful breastfeeding. Supplemental formula is recommended if the newborn

experiences medical complications ( hypoglycemia) or if breastfeeding is repeatedly unsuccessful.

15. Imperforate anus is a congential malformation of the anorectal opening that prevents normal stool passage. If no stool (meconium) is noted within 24 hrs of birth, the nurse should request immediate evaluation of the newborn to facilitate diagnosis and correction of the suspected defect.
16. Hepatitis B virus infection is a bloodborne disease that poses a significant infection risk to the newborn. It is not a contraindication to breastfeeding. However, the hepatitis B immune globulin and vaccine should be administered to the newborn within 12 hrs birth.
17. The newborn should be fully exposed , except for a diaper, when placed under phototherapy lights. Lotions and ointments should not be applied as they can absorb heat and cause burns. Newborns should wear eye shields and be monitored for adequate hydration and urine output.
18. Acrocyanosis results from poor perfusion to the periphery of the body, an initial mechanism to reduce heat loss and stabilize temperature. Initial nursing management includes promoting thermoregulations by placing the newborn skin-skin with the mother or under radiant warner and assessing axillary temperature.
19. Newborn safety teaching should include use of a newborn sleep sack, which keeps newborn warm while preventing the head from becoming covered; supine sleep position; no loose bedding; and proper car safety seat use( snuggly fitted harness, rear facing, back seat)
20. The normal respiratory rate and pattern for newborns is 30 - 60/min with periodic pauses lasting < 20 seconds. Sustained tachypnea, nasal flaring, retractions, and grunting are signs of newborn respiratory distress. Respiratory distress may be related to retained amniotic fluid in the lungs, meconium aspiration, or infection.
21. Manifestation of neonatal abstinence syndrome are irritability, restlessness, a high pitched cry, nasal congestion, frequent yawning/sneezing, poor feeding, and diarrhea.
22. Signs of cold stress are decreased temperature, altered mental status, bradycardia, hypoxia, hypotonia, and a weak cry and /or suck.
23. Manifestation of spina bifida are tuft of hair, hemangioma, nevus, or dimple along the base of the spine. And nurse should notify these ton HCP.
24. Omphalocene and gastroschisis are congenital defects of the abdominal wall that place the newborn at risk for temperature instability, infection, and fluid loss. Immediately after birth, the nurse should cover the herniated bowel with non adherent dressing and initiate IV access.
25. Necrotizing enterocolitis is a life threatening complication in premature infants due to underdeveloped intestine and gut immunity. Frequent abdominal girth measurements are essential to assess for worsening distension. Clients are placed supine and undiapered. Rectal temperatures should be avoided due to risk of perforations.
26. Nurses should educate parents about newborn safety and security procedures throughout the hospital admission and remain diligent and aware of any suspicious persons on the unit. The nurse must prioritize responding to any perceived or reported threat to newborn security quickly to prevent infant abduction.

27. Expected findings for a neonate at 1 - 3 hrs postpartum include respirations 30 - 60bpm, milia, glucose levels <70- 100 but more equal than40mg/dl.
28. Clients with tetralogy of Fallot are at risk for polycythemia(increased RBC) due to prolonged tissue hypoxia. Hemoglobin > 22g/dl or hematocrit > 65% are priority b/c increased circulatory viscosity increases the risk for thrombus formation and stroke.
29. Expected findings for a term newborn include plantar creases up the sole of the foot, presence of Babinski reflex, and Epstein’s pearl( white pearl like cyst on gum margins).
30. Preterm newborns are at increased risk for cold stress and heat loss. The nurse can help prevent cold stress by covering cool surfaces with warm blankets, completely drying the newborn after birth, providing care in the radiant warmer, transferring the newborn in a prewarmed incubator, and encouraging skin-to-skin contact.
31. Yellow exudate on the glans indicate normal healing. Unusual swelling, increased redness, odor, abnormal discharge, excessive bleeding, or absent/decreased urine output should be reported.
32. The newborn of a mother who is opioid-dependent is at high risk for neonatal abstinence syndrome. Swaddling and gentle, rhythmic rocking can soothe the newborn, minimize stimulation, and prevent skin excoriation from excessive movement caused by hyperactivity and restlessness. Antepartum
    1. Pregnant client should avoid deli meats and hot dogs(unless steaming hot), liver, unpasteurized milk products, unwashed fruits and vegetables, raw fish, and fish high in mercury.
    2. Indirect coombs testing screens for Rh sensitizations in Rh negative mother.
    3. Abruptio placenta intervention :- emergent cesarean birth, continuous external fetal monitoring, blood draw for type and crossmatch.
    4. When education about travel safety to pregnant client :- carrying prenatal record; increasing fluid intake; wearing compression stockings and loose clothing; avoid long periods of sitting; and wear the lap belt underneath the gravid abdomen and across the hips.
    5. Syphilis is sexually transmitted infection that crosses the placenta and may have teratogenic effects on fetal development. If a pregnant client has a penicillin allergy, penicillin desensitization is recommended to receive appropriate treatment and prevent or treat congenital syphilis.
    6. Zika infection in a pregnant woman can cause birth defects and developmental dysfunction. Current guidelines recommend that pregnant women avoid travel to zika affected areas.
    7. Pyrosis (heartburn ) is common during pregnancy due to increase of progesterone hormones, which causes the esophageal sphincters to relax. Lifestyle changes to reduce symptoms: - eating smaller meals, avoiding fried/fatty food, maintaining upright position after meals, and drinking fluids mostly between meals.
    8. HELLP syndrome is a form of preeclampsia that requires priority intervention to prevent severe maternal/fetal harm. Symptoms may be non-specific, such as right upper quadrant pain and nausea.

9. NSAIDs should be avoided in the third trimester due to risk of premature closure of the fetal ductus arteriosus.
10. Pica is the constant craving for and consumption of nonfood and/or non nutritive food substances that may occur during pregnancy. It is accompanied by iron deficiency anemia. Hemoglobin and hematocrit levels are useful in these clients to screen for anemia.
11. MMR vaccine is a live attenuated vaccine and is contraindicated in pregnancy due to risk of teratogenic effects to the fetus. Clients who are nonimmune to rubella should receive the vaccine in the postpartum period. Pregnancy should be avoided for at least 1 - 3 months after immunization.
12. Anemia during pregnancy occurs when hemoglobin is < 11g/dl in the first or third trimester or <10.5 g/dl in the second trimester.
13. Client with placenta previa are at high risk for hemorrhage. The nurse should initiate electronic fetal monitoring and pad counts, draw a type and screen, initiate large bore IV access. Digital vaginal examination are contraindicated.
14. 12 weeks of gestation – fundal height just above the symphysis pubis.
15. Magnesium toxicity signs:- magnesium > 7mEq/L; absent/decreased DTR; repiratory depression;cardiac arrest.
16. A nitrazine PH test strip can differentiate between alkaline amniotic fluid and vaginal secretions or urine, which are acidic. Recent sexual intercourse should nalert the nurse to notify the HCP that nitrazine results may be falsely positive due to presence of semen(alkaline) in the vagina.
17. Alternate sources of folic acid:- beans, rice, peanut butter, fortified cereals.