Midwifery I Final Exam QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025, Exams of Nursing

Download Midwifery I Final Exam QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025 and more Exams Nursing in PDF only on Docsity! Midwifery I Final Exam QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025 How is chronic hypertension diagnosed? HTN prior to conception or prior to 20 weeks Mild chronic HTN Severe chronic HTN >140/90 >160/110 Persists for at least 12 weeks postpartum Baseline labs for chronic HTN Medications? CBC, LFTS, creatinine, protein/creatinine ratio Antihypertensives not recommended unless they were on something before, labetolol is commonly used Management of chronic HTN--when to see pt and tests to perform? Patient education? What should they watch out for? Visits every 3 weeks NST, BPP, growth US Manage diet, salt intake, exercise Visual changes, decreased fetal movement, manage BP at home and report >140/90, new-onset headache that won't go away with tylenol, heart burn that won't go away with tums, edema above elbows/knees or face Complications of chronic HTN---what are they are at high risk for? High risk for: preterm labor, placental abruption, cesarean, IUGR, oligohydramnios When is a pt considered to have gestational htn? Can she have proteinuria? Does it resolve postpartum? Has two separate readings >140 systolic OR 90 diastolic (for the first time) at least 6 hours apart AFTER 20 weeks gestation No proteinuria Resolves within 12 weeks postpartum What labs to monitor for gestational HTN? Management? what tests to run? urine protein, platelets, LFTs Serial growth U/S, BP readings at home 2x No medications are necessary Watch for s/s of preeclampsia 1. Pathophysiology of preeclamspia 2. Mild preeclamspia defined as? 3. Severe preeclampsia defined as? 4. When does preeclampsia usually occur? 1. Abnormal trophoblastic invasion of the uterus at the placental site Causes narrowing of spiral arteries 2. 2 separate readings at least 6 hrs apart >140 OR >90 after 20 weeks OR Protein--> +300mg in 24 hr urine OR PCR 0.3 OR +1 urine dip on two samples at least 6 hrs apart 3. 2 separate readings at least 6 hrs apart >160 OR >110 after 20 weeks Protein-->+500mg in 24 hr urine OR +3 urine dip on two samples 6hrs apart 4. Usually occurs late onset, >36 weeks Diagnostic evaluation for preeclampsia Severe features defined as? HTN after 20 weeks greater than 140/90 AND ONE of the following: Proteinuria Greater than 300 in 24 hour urine PCR >0.3 Greater than 1+ dipstick Visual or cerebral symptoms Platelets <100,000 Serum creatinine >1.1 Elevated liver enzymes Pulmonary edema 5. S/S How can this be managed? 1. Closed 2. retained products of conception 3. small or appropriate for gestational age 4. Rising or beginning to fall 5. amenorrheic Can be managed expectantly or refer out for medical management Incomplete/Threatened/Inevitable abortion 1. Cervix 2. U/S 3. Uterus size 4. bHCG 5. S/S 6. How is it managed (medication?) when can it be administered? Dosage? How often can it be repeated? How long will it take to evacuate the uterus? Patient education on s/s? 1. Open or closed 2. retained products of conception 3. enlarged 4. continued elevation of bHCG 5. cramping intense, heavy bleeding 6. Misoprostol--<12 weeks, 400-600ug PO Can repeat q3 hrs up to 3 doses, 4-16 hours N/V, chills, fever, heavy bleeding w/ clots. cramping 3-4 days, spotting for a +week Ectopic pregnancy When does the bleeding or lower quadrant pain commonly occur? BHCG trends? Medical management Ectopic rupture S/S 6-8 weeks Trends upward more slowly Methotrexate IM Hemorrhage--dark prune juice Abdominal pain shoulder pain shock, dizziness, fainting Hyaditiform mole--what is it? 2 nonmalignant 3 malignant Most common symptom is? How long should women avoid pregnancy? Benign neoplastic disease where a normal fertilized ovum implants into the uterus but the chorionic villi do not develop properly 2 nonmalignant--complete and partial 3 malignant--choriocarcinoma, placenta site trophoblastic tumor, invasive mole (invades myometrium) vaginal bleeding Avoid for 6 months--should not get pregnant until their bHCG levels drop 5 important questions to ask when managing a pt with early bleeding 1. Are they stable? 2. Do they have a fever? 3. Location of the bleeding? (intrauterine, cervical, trauma?) 4. Location of the pregnancy (intrauterine, ectopic) 5. Pregnancy viable? Common causes of early pregnancy bleeding What 2 exams should be performed and what are you looking for? What labs should you draw? Benign causes--Implantation bleeding, cervical polyps, post coital bleeding Molar pregnancy ectopic pregnancy Subchorionic hemorrhage Leiomyomas/fibroids Speculum exam--signs of infection, dilation of cervix, polyps, bleeding or tissue from os, trauma, cervical friability Bimanual exam: adnexal tenderness, cervical motion tenderness, size of the uterus Serial bhcg--usually should double every 48 hrs CBC with differential Blood type and screen BHCG--when should you see... 1. gestational sac? 2. yolk sac? 3. cardiac activity? What is the trend? 1000 7000 100,000 peaks 8-10 weeks, then declines 10-12 weeks Placenta Previa--what is it? 3 Types? Do not perform what exam? What distance must the placenta be to have a vaginal delivery? When the placenta implants close or over the cervical os Complete, partial, low lying/marginal do not perform a vaginal exam! >2cm of placenta from cervical os Vasa Previa Blood source? Easily diagnosed via? Management? Abnormal cord insertion from the cord to the placenta, splaying of the vessels, may present in the amniotic sac, goes across the cervical os Fetal blood ultrasound emergency cesarean Major risk factor of abnormal placentation? 3 types uterine scarring Accreta Increta Percreta Diagnostics for GDM for preexisting diabetes: Random sugar Fasting sugar HbA1c >200 >126 >6.5 AFV: less than or equal to 200-500 mL DVP: less than or equal to 2 cm AFI: less than or equal to 5 cm Causes of oligohydramnios Fetal: Renal agenisis Urinary obstruction PPROM Fetal growth restriction Abnormal placentation elevated alpha fetoprotein Pregnancy past 42 weeks Maternal uteroplacental insufficiency HTN disorders Dehydration Antiphospholipid syndrome POTTER Sequence for oligo Pulmonary hypoplasia Oligohydramnios Twisted faces Twisted skin Extremity deformities Renal agensis--missing one or both kidneys Polyhydramnios defined as-- AFV? DVP? AFI? AFV: >2100 mL DVP: >8cm AFI: greater than or equal to 25cm Causes of Polyhydramnios Idiopathic Fetal Swallowing mechanism congenital, genetic anomalies Hydrops Multiple gestation Maternal uncontrolled GDM hemorrhage Complications of polyhydramnios Preterm birth Macrosomia Malpresentation Placental abruption postpartum hemorrhage cord prolapse Non-engagement Meconium stained fluid--risk for aspiration Fetal intolerance to labor NICU admission cesarean Fundal height--what is normal? What does the growth US measure? +/- 2cm from gestational age is normal Measures: head circumference, femur length, abdominal circumference-->estimate fetal weight IUGR defined as? symmetric vs. asymmetric When should you suspect IUGR? How do you diagnose? <10th percentile for weight All body parts are small vs. head circumference and femur are normal but abdominal circumference is small When fundal measurement is 3cm or more less than gestational age. Serial growth u/s at least 2 weeks apart Complications of IUGR babies Hypoglycemia Hypothermia Meconium aspiration RDS Asphyxia Decreased body fat increased skin folds thin umbilical cord Preterm labor defined as? Diagnostic criteria? Labor occurring 20-37 weeks Labor between 20-37 weeks Contractions occurring 4/20 mins or 6/60 mins with or without ruptured membranes Cervical dilation >2cm or effacement of 80% or more What is the biggest risk factor for preterm birth? What is another strong predictor? Previous preterm labor Low prepregnancy BMI What medication and dosage is given to treat GBS? When is GBS usually tested? PCN 5 million units now and 2.5-4 million units q 4 hrs 36 weeks What is the main reason tocolytics are used? When is it given? When should it be stopped? "Anticontraction" meds Gives corticosteroids a chance to work, helps delay preterm labor Give this 24-48 hrs after steroids are given (do not given any longer) Stop if contractions have ceased or are less than 4/hour without cervical change When can magnesium sulfate and Indomethacin be given? Only if <32 weeks Fetal Fibronectin test What does a negative result mean? When is it performed? Do not perform this if__________ How is it performed? What causes false positives? Negative result means the women is unlikely to be in labor in the next 2 weeks Perfomed 22-34 weeks Do not perform this if she is thought to be ruptured Swab posterior fornix for 10 seconds (can do it blind) do it prior to any other speculum or cervical exam Sex within 24 hrs prior, lubricant, bleeding