Download N306 Final Exam Study Guide: Practice Questions and Solutions and more Exams Obstetrics in PDF only on Docsity!
1 / 15
N306 Final Study Guide Practice Questions
with Solution
1. What hormone is tested to confirm pregnancy?: HCG (human chorionic gonadotropin)
2. A woman comes into the clinical and is being treated for infertility with Clomiphene Citrate. You are
educating her on adverse reactions. You know ed- ucation was successful when: The woman states the adverse ettects are hot flashes, breast discomfort, headaches, and insomnia Action: stimulates release of FSH and LH
3. Progesterone: Facilitates implantation and decreases uterine contraction
4. Estrogen: enlargement of breasts and uterus
5. hCG - Human Chorionic Gonadotropin Hormone: stims corpus lute to secrete proges- terone/estrogen
6. hPL (human placental lactose): increases insulin resistance in mom and prepares breasts for lactation
7. A woman comes into the emergency department and states that she thinks her water just broke. What test
should be done?: Nitrazine test To determine if if was urine (acidic) or manic fluid (alkaline)
8. When is the fetus most vulnerable to teratogens?: In the first trimester During organogenesis (4-8 weeks)
9. 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?: Do not get pregnant for 6 months, lives in testes for 6 months
10. What are presumptive signs of pregnancy?: Amenorrhea N/V
Breast changes Urination
2 / 15 frequency Quickening (fetal movement)
11. What are probable signs of pregnancy?: Chadwick's sign: blueish-purple vaginal mucosa seen at 6-8 wks
Goodell's sign: softening of the cervix palpates at 8 wks Hegar's sign: softening of the lower uterine segment at 6 wks Melasma: brownish pigmentation on forehead Linea negra: dark line from umbilicus to pubis Ballottement: sharp upward pushing against the uterine wall with a finger inserted into the vagina and will feel impact of the displaced fetus (16 wks) Positive pregnancy test --> hCG in urine
12. McDonald's rule: Between 22-24 weeks fundal height in cm should match the number of weeks 12 weeks: fundus clears symphysis
20 weeks: fundus at umbilicus 36 weeks: fundus at xiphoid
13. If a mother comes in and is group B strep positive. What should the nurse do?: Give the mother antibiotic,
ampicillin 1g Q4h
14. If a mother gives birth and is Hep B positive, what should the nurse do?: Give hepatitis B globulin (HBIG) AND
hepatitis vaccine (2 shots) If the mother is negative only give the vaccine
15. What test is given to the mother if she is Rh negative to see if she is sensitized to her babies blood?: Coombs test -->
if it positive she has been sensitized and needs Rhogam
16. What does the biophysical profile consist of?: FHR reactivity (NST) Fetal movements
4 / 15
- 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
22. Doppler Flow Studies: - Assess placental perfusion
- Used in combo with other diagnostic tests to assess fetal status in IUGR
23. Amniotic Fluid Index: Measure the volume of amniotic fluid
average is 8 cm to 24 cm Oligohydramnios = less than 5 cm Polyhydramnios = above 24 cm
24. Causes of tachycardia in newborn (>160 bpm): Maternal fever/infection Dehydration
Terbutaline Amphetamines Cocaine
25. Decreased variability causes: Fetal sleep cycle Hypoglycemia
Hypoxia Placental perfusion problems Narcotic (Nubain, Stadol, Celestone) Mag sulfate
26. Intrauterine Resuscitation: STOP PITOCIN Reposition
to left lateral Oxygen 10L via face mask Increase IV fluids SubQ terbutaline
5 / 15 Amnioinfusion for variable decels
27. Respiratory Depression in Newborn: #1 cause is C-section S/S:
- Tachypnea
- Cyanosis
- Nasal flaring
- Expiratory grunting
- Retractions of the chest wall
- Hypotonia: decreased muscle tone
28. Hypoglycemia in Newborn: S/S:
- jitteriness
- hypotonia
- irritability
- apnea
- lethargy
- temp instability
29. Halequin sign: normal, immature circulation, the side the baby is lying on will get red, upper side will be pale
30. Barlow and Ortolani: Barlow: dislocatable hips Ortolani:
reputino of the hips
7 / 15
- Diagnosis: nitrizine paper (turns blue), ferning test: fern like vaginal secretions
43. Betamethazone (Celestone): For PROM, 24-34 weeks Steroid
- Side ettects: 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
44. Mag sulfate: For treatment of preeclampsia
Normal side ettects: 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
45. HELLP syndrome: 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
46. Eclampsia: Tonic clonic seizures
Most important thing is maintaining the airway
47. DIC (Disseminated intravascular coagulation): "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:
8 / 15
- 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
48. The 5 P's Affecting Labor: 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)
49. What can be given to a newborn with Persistent pulmonary hypertension (PPHN)?: Nitric oxide
- This is a vasodilator
- PPHN is a baby that is not spontaneously breathing
50. Bronchopulmonary Dysplasia (BPD): A chronic lung problem that attects neonates who have been treated with mechanical ventilation and
oxygen for problems such as RDS, this is COPD for babies
- Neonates who are dependent on oxygen beyond 28 days of life and/or have been on mechanical ventilation are at risk for BPD Complications of BPD:
- Pneumonia, upper respiratory infection
- Ear infection
10 / 15
- Severe pain, bruising, swelling, tightness, skin will be taught and shiny, pressure Priority: Call the dr
56. Drugs for Postpartum Hemorrhage: 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
57. Endometritis: PP Infection
S/S: tenderness, foul smelling loch, fever, WBC increased Risk Factors: Prolonged ROM, a lot of vaginal exams, diflcult 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
58. Wound Infection: Teaching:
- Make sure the woman looks at the laceration, episiotomy, and C-section incision
- Teach signs of infection (REEDA)
59. UTI: - 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
60. Teaching for a woman who has constipation and hemorrhage: Increase fiber, increase water and fluids, increase
exercise, get up and walk
11 / 15
61. RDS (Newborn): S/S: nasal flaring, grunting, retractions, cyanosis, tachypnea
- The baby will need oxygen support
- For the baby that is hypoxic at birth, the mother may have had narcotics
Will not have a vigorous cry when born, the lungs will not open up (This is persistent pulmonary hypertension)
62. Retinopathy of prematurity: - The baby cannot literate the high level of oxygen Goal: keep the oxygen at the
lowest level possible to prevent retinopathy
- Want low pressure high frequency
- Advantages of nasal prongs: will not erode the trachea like the ventilator (watch for erosion of the nares)
63. Bronchopulmonary dysplasia (BPD): Caused by mechanical ventilation in neonates who have been dependent on oxygen past the 28
days of life
64. Necrotizing Entercolitis: - 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
65. Intraventricular Hemorrhage: Bleeding occurring in the ventricles of the brain and is related to severe hypovolemia and hypoxia
13 / 15
- After birth the baby has urine tox screen S/S:
- The baby will have shrill cry, hyerstomulation, exaggerated moro
- We need quiet environment, and constant swaddling
- There will be an alteration in bonding and safety (infant safety)
69. Postmaturity Syndrome: The placenta gets old, decreased perfusion, and increased rates of meconium stained fluid and there can be a possibility of
meconium aspiration, macrosomia, dry peels skin, overgrown nails, abundant hai, minimal fat deposits, and skin is greenish from meconium staining Complications: meconium aspiration pneumonia
70. SGA: Infant in that weighs less than the 10th percentile for his or her gestational age
71. Symmetric IUGR: Generalized proportional reduction in the size of all structured and organs except for the heart and brain
Conditions as a result: exposure to teratogenic substances, congenital infections, and genetic problems
72. Assymetric IUGR: A disproportional reduction i the size of structures and organs, results from maternal or placental conditions that occur later in
pregnancy and impede placental blood flow Conditions that result in this: preeclampsia, placental infarcts, severe maternal malnutrition
73. LGA: A LGA baby has a weight above the 90th percentile for his or her gestational age
74. Neonate infections: - 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
14 / 15
75. Stroke warning signs: B: balance E: eyes
F: facial droop A: arms S: speech T: time
76. Calenda rhythm method of fertility: 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
77. Hormonal Contraceptives: Contraindications: history of thrombophlebitis, liver disease, heavy smok- ing, gallbladder disease, hypertension, DM,
migraines
78. Depo-Povera (Progestin Only): - Nursing mothers can use this
- May take 9 months for fertility to return if taking this
79. 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?: The diaphragm Not an IUD b/c heavy cramping periods, and not the full b/c her mother has breast cancer
80. Chronic pelvic pain: Pain in pelvic region that lasts 6 months or longer, unresponsive to pain management
81. Polycystic Ovary Syndrome (PCOS): 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 body and facial hair, acne, diflculty getting pregnant, patches of thick dark velvety skin Education:
- Primary treatment is lifestyle changes
