N306 Final Study Guide Practice Questions with complete solution, Exams of Nursing

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N306 Final Study Guide Practice EXAM NEWEST, 2024/ 2025, ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY GRADED A What hormone is tested to confirm pregnancy? ...... answer.....HCG (human chorionic gonadotropin) A woman comes into the clinical and is being treated for infertility with Clomiphene Citrate. You are educating her on adverse reactions. You know education was successful when ...... answer.....The woman states the adverse effects are hot flashes, breast discomfort, headaches, and insomnia Action: stimulates release of FSH and LH Progesterone ......: answer.....Facilitates implantation and decreases uterine contraction Estrogen ...... answer.....enlargement of breasts and uterus hCG - Human Chorionic Gonadotropin Hormone ...... answer.....stims corpus lute to secrete progesterone/estrogen hPL (human placental lactose) ...... answer.....increases insulin resistance in mom and prepares breasts for lactation A woman comes into the emergency department and states that she thinks her water just broke. What test should be done? ...... answer.....Nitrazine test To determine if if was urine (acidic) or manic fluid (alkaline) When is the fetus most vulnerable to teratogens? ......answer.....In the first trimester During organogenesis (4-8 weeks) A woman states that she and her husband have been out of the country and they are trying to get pregnant. The father tests positive for Zika. What would you educate them? ...... answer.....Do not get pregnant for 6 months, lives in testes for 6 months What are presumptive signs of pregnancy? ......answer.....Amenorrhea N/V Breast changes Urination frequency Quickening (fetal movement) What test is given to the mother if she is Rh negative to see if she is sensitized to her babies blood? ...... answer.....Coombs test --> if it positive she has been sensitized and needs Rhogam What does the biophysical profile consist of? ...... answer.....FHR reactivity (NST) Fetal movements Tone Breathing Amniotic fluid volume *a score of 2/10 or less prompts immediate delivery* Chorionic villus sampling ...... answer.....Used for chromosomal analysis between 10-12 weeks to detect feral abnormalities Tests for metabolic disorders --> cystic fibrosis Fetal heart rate is auscultated twice in 30 mins Instruct the woman to report: abdominal cramping, leaking of fluid, bleeding, fever, or chills Administer Rhogam to Rh- mothers Amniocentesis ...... answer.....Genetic testing, fetal lung maturity, assessment of hemolytic disease, or intrauterine infection, and therapy for polyhydramnios Done between 15-20 weeks Elevated bilirubin levels indicate fetal hemolytic disease *Instruct the woman not to lift anything for 2 days* Fetal Blood Sampling/Percutaneous Umbilical Blood Sampling (PUBS) econ answer.....Performed at 18 wks Used to test metabolic and hematologic disorders, fetal infection *Nursing Action: have terbutaline ready in case the mother starts having contractions* Alfa-fetoprotein. ...... answer.....Screening tool for certain developmental defects, *such as neural tube defects* *Decreased levels are associated with trisomy 21* (down syndrome) Multiple Marker Screening ...... answer.....Triple marker screening: AFP, hCG, estrous levels Quad screen test: AFP, estriol, and *inhibin-A (adds this to increase detection of trisomy 21- downs syndrome)* - Low levels of AFP and unconjugated estrous levels suggest abnormality -*hCG and inhibin-A levels are TWICE AS HIGH IN PREGNANCIES WITH TRISOMY 21* - “decreased estriol levels are an indicator of neural tube defects* Nuchal translucency: to check how much fluid is in the back of the babies neck (done at 10-13 wks) --> if increased higher likelihood of baby having trisomy 21 Intrauterine Resuscitation ...... answer....."STOP PITOCIN* Reposition to left lateral Oxygen 10L via face mask Increase IV fluids SubQ terbutaline Amnioinfusion for variable decels Respiratory Depression in Newborn ...... answer.....#1 cause is C-section S/S: - Tachypnea - Cyanosis - Nasal flaring - Expiratory grunting - Retractions of the chest wall - Hypotonia: decreased muscle tone Hypoglycemia in Newborn ....... answer.....S/S: -jitteriness - hypotonia - irritability - apnea - lethargy - temp instability Halequin sign. ...... answer.....normal, immature circulation, the side the baby is lying on will get red, upper side will be pale Barlow and Ortolani ...... answer.....Barlow: dislocatable hips Ortolani: reputino of the hips Allis sign ...... answer.....demonstration of unequal knee height Moro (startle) reflex ...... answer.....loud noises or sudden movements cause newborns back to arch, throw out hands and legs, and cry Tonic neck reflex ...... answer....."fencing neck" when the face is turned to the side, the arm and neck on the side it was turned to extends and the arm and leg on the opposite side flex Grasp reflex ...... answer.....good hand grasping Crawling reflex ...... answer.....baby is placed on stomach and they will pull legs under the body and kick them out in crawling motion Cullen's sign. ......: answer.....In ectopic pregnancy --> blueish discoloration around the umbilicus - Diagnosis: *nitrizine paper (turns blue)*, *ferning test: fern like vaginal secretions* Betamethazone (Celestone) ...... answer.....For PROM, 24-34 weeks Steroid - Side effects: *maternal hyperglycemia, therefore making the baby hypoglycemic when they come out* *We do not give tocolytics b/c stopping labor can increase the risk of infection once membranes have ruptured* Mag sulfate ...... answer.....For treatment of preeclampsia Normal side effects: warmth over body/flushing, burning at IV site, mild SOB, mild chest pain, congestion, headache, dizziness *S/S of toxicity: (BURP) BP decreases, Urine output decreases, Respiratory rate decreases, Patellar reflexes are absent* HELLP syndrome ......: answer.....*Hemolysis, Elevated liver enzymes, Low platelet* - Complication of preeclampsia - *S/S: nausea, epigastric pain, general malaise, RUQ tenderness, visual changes --> blurred vision* - Treatment: platelet transfusion, delivery of baby, monitor for hemorrhage and DIC, steroids to increase renal function Eclampsia ....... answer.....Tonic clonic seizures *Most important thing is maintaining the airway* DIC (Disseminated intravascular coagulation) ...... answer....."Clotting cascade" resulting in depletion of clotting factors in the blood - *S/S: excessive bleeding from orifices, petechiae, purpura, hypotension, multi- organ failure* Nursing care: - Identify the underlying cause - Monitor for signs of hemorrhage, bleeding petechiae, cutaneous oozing, dyspnea, lethargy, pallor, increased HR, decreased BP, headache, dizziness, muscle weakness, restlessness, and internal bleeding - Do not disturb clots, use pressure and ice to control bleeding - Admin blood factors products The 5 P's Affecting Labor ...... answer.....Powers (contractions) Passage (the pelvis and birth canal) Passenger (the fetus) Position (maternal postures and physical positions to facilitate labor) Psyche (the response of the woman) Hemabate (Carbopros) ...... answer.....Side effect: stinky diarrhea This is for a uterus that is boggy Uterine Atony ....... answer.....Source of hemorrhage Risk factors: - Big uterus, macrosomia - Precipitous labor - Retained placental fragments - Mag sulfate (will cause the uterus to relax) Intervention: *Massage the fundus* Laceration ...... answer.....Source of hemorrhage Priority: call the dr Hematoma ......: answer.....Source of hemorrhage S/S: - Severe pain, bruising, swelling, tightness, skin will be taught and shiny, pressure Priority: Call the dr Drugs for Postpartum Hemorrhage ...... answer.....First line: Oxytocin Second line: Methergine *(Cannot give to patient who is preeclamptic --> will give hemabate to the woman with hypertension or Cytotec)* - Normal bleeding is 300-500 mL, over 1000 mL is hemorrhage - Risk factors for hemorrhage: shoulder dystocia, macrosomia, long labor, obese Endoretritis ...... answer.....PP Infection S/S: tenderness, foul smelling loch, fever, WBC increased Risk Factors: Prolonged ROM, a lot of vaginal exams, difficult delivery, manipulation at birth, manual labor of placenta, vacuum delivery - Call the dr --> will order antibiotics --> Reassure the mother that the antibiotics will not hurt the baby Teaching: goof hygiene, good pericarp, change pads frequently, driving lots of fluids, may put her on methergine, get up and walk Wound Infection ...... answer.....Teaching: - Make sure the woman looks at the laceration, episiotomy, and C-section incision - Teach signs of infection (REEDA) UTI ...... answer.....- Moms will complain of burning on urination but it may not be UTI - If it is burning from birth, use the peribottle while peeing - May have to strait cath if they cannot get a clean catch Necrotizing Entercolitis ...... answer.....- The baby has been exposed to bacteria which causes infection in the intestines - Early feeding may cause this --> feeding before the baby can handle it - S/S: bulging and increase abdominal girth, residual feeding (will feed baby through NG tube and wait an hour, if there is the same amount of residual in the baby it is not absorbing any of the food) - This also may be due to hemorrhage in the mom 00> the blood will only go to vital organs if it is lost - *Make the child NPO* - Will do X-rays to see if part of the intestines are necrotic Intraventricular Hemorrhage ...... answer.....Bleeding occurring in the ventricles of the brain and is related to severe hypovolemia and hypoxia - Grade 1-2: no damage - Grade 3: bleeding within the ventricles but they get too big and distorted and disrupts the flow of CSF - Grade 4: extends into the brain Diagnosis: Cat scan, MRI Risk factors: severe preterm baby, severe distress, hypoxia, hypovolemic episode - Serial ultrasounds on these kids Hyperbilirubinemia ...... answer.....Risk factors: -birth injuries -bruising -cephalohematoma (hematoma at the dural level, does not cross the midline b/c it is deeper) --> could be due to vacuum delivery or long labor -ABO incompatibility (Coombs test positive will have interaction between mom and babies blood, the mom is O and baby is A or B) - Rh factors (will also do coombs, Rh can be lethal --> erythroblastosis fatales, *give prophylactic Rhogam at 28 weeks* *Normal physiological jaundice is after 24 hours* *Pathological is before 24 hours* Rhoganm ...... answer.....- Give prophylactically at 28 weeks - Give after amniocentesis - If there has been an abruption, *can do the KB test to see if the mother has been sensitized*, give Rhogam - Also get Rhogam if there has been aboriton, ectopic pregnancy, or anytime she delivers if she is Rh- Abstinence ...... answer.....- If a mother comes in acting bizarre, ask the dr fora tox screen - 1st: the social worker is notified - After birth the baby has urine tox screen S/S: LGA ...... answer.....A LGA baby has a weight above the 90th percentile for his or her gestational age Neonate infections ...... answer.....- GBS - TORCH T: toxoplasmosis (can be from cate feces) O: Other (syphilis, varicella-zoster, parvovirus B19) R: Rubella C: cytomegalovirus --> causes hearing loss in neonates, vision loss H: herpes Stroke warning signs ....... answer.....B: balance E: eyes F: facial droop A: arms S: speech T: time Calenda rhythm method of fertility ...... answer.....Ex: A woman has a 28 day cycle, subtract 14 from the cycle (28-14=14) then subtract 5 from 14 (14-5 = 9) then add 3 to 14 (14+3 = 17) *the woman will ovulate on day 9 through the 17* Hormonal Contraceptives ...... answer.....Contraindications: history of thrombophlebitis, liver disease, heavy smoking, gallbladder disease, hypertension, DM, migraines Depo-Povera (Progestin Only) ...... answer.....- Nursing mothers can use this - *May take 9 months for fertility to return if taking this* Ex: A woman comes into the clinic with DM and her mother has breast cancer, she also has heavy cramping periods. What would be her best fit for birth control? ...... answer.....The diaphragm *Not an IUD b/c heavy cramping periods, and not the full b/c her mother has breast cancer* Chronic pelvic pain ...... answer.....Pain in pelvic region that lasts 6 months or longer, unresponsive to pain management Polycystic Ovary Syndrome (PCOS) ...... answer.....Elevated levels of estrogen, testosterone, and LH, and a decrease in secretions of FSH S/S: infertility, menstrual disorders (irregular, infrequent, and/or absent menstrual periods), hirsutism, ovarian cysts, obesity, oily skin and acne, pelvic pain, male- pattern baldness, *and irregular or no menstrual periods, heavy periods, excess