NCLEX Maternity Nursing Study Guide, Exams of Nursing

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NCLEX Maternity Nursing Study Guide

Amniotic Fluid - - Pale straw-colored fluid in which the fetus floats. It serves as a cushion against injury from sudden blows or movements and helps maintain a constant body temperature Ballottement - -Rebounding of the fetus against the examiner's fingers on palpation. When the examiner taps the cervix the fetus floats up in the amniotic fluid and comes down Chadwick's sign - Violet coloration of the mucous membranes of the cervix, vagina and vulva that occurs at about 4 weeks of pregnancy caused by increase vascularity Embryo - Stage of fetal development that last from day 15 until 8 weeks after conception (measures 3 cm from crown to rump) Goddell's sign - - softening of the cervix that occurs at the beginning of the second month of gestation Gravida - A pregnant woman, called gravida I during first pregnancy (primagravida), gravida II in second and so on Hegar's sign - Compressibility and softening of the lower uterus segment that occurs at about 6 weeks of gestation lecithin-to-sphingomyelin (L/S) ratio - Ratio of two component of amniotic fluid is 2: or greater when he fetal lungs are mature Lochia - Discharge from the uterus that consists of blood from the vessels of the placental site and debris from the decidua; last 2-6 week post delivery Na¨gele's rule - Determines the estimated date of birth based on the premise that the woman has a 28-day menstrual cycle. Add 7 days to the first day of the last menstrual period; subtract 3 months and add 1 year. Alternatively, add 7 days to the last menstrual period and count forward 9 months. Parity - Number of pregnancies that have reached viability regardless of whether the fetus was born alive or stillborn Quickening - Maternal perception of fetal movement for the first time, occurring usually in the 16th or 20th week of pregnancy Surfactant - Phospholipid that is necessary to keep the fetal lung alveoli from collapsing; amount is usually sufficient after 32 weeks' gestation.

Pelvis Measurements - True pelvis: lies bellow the pelvic brim False pelvis: shallow portion above the pelvic brim, supports the abdominal viscera Types of Pelvis - - Gynecoid: normal, transversely rounded or blunt

• Antropoid: oval shape
• Android: heart-shaped or angulated, not favorable for labor and birth
• Platypelloid: flat with oval inlet, makes labor and birth difficult Menstrual Cycle Ovarian change - Preovulatory stage - - GnHR is released, FSH stimulates the growth of follicles, most die leaving 1 to mature into a large graafian follicle that releases estrogen which increases the release of luteinizing hormone. The follicle ruptures and releases an ovum into the peritoneal cavity Menstrual Cycle Ovarian change - Luteal Phase - - Begins with ovulation, corpus luteum secretes estrogen and progesterone during the remaining 14 days and degenerates if the ovum is not fertilized. Estrogen and progesterone release decreases and thus new cycle begins Menstrual Cycle Uterine Change - Menstrual Phase - - 4 to 6 days of bleeding as the endometrium breaks down because of the decreased levels of estrogen and progesterone Menstrual Cycle Uterine Change - Proliferative Phase - - last about 9 days, estrogen promotes the growth of the endometrium, ovulation occurs between 12-16 days Menstrual Cycle Uterine Change - Secretory Phase - - last about 12 days after ovulation, graafian is replaced by the corpus luteum, it secretes estrogen and progesterone which prepares the endometrium if egg is fertilized Fertilization - - occurs in the ampulla of the fallopian tube, occurs when the sperm and ovum unite Implementation - Zygote is propelled towards the uterus, and implants 6-8 days after ovulation Fetal Development - Pre-Embryonic period: first 2 weeks after conception Embryonic period: beginning at day 15 through 8 week Fetal period: from the 9th week to conception Fetal Environment - - Amnion: encloses the amniotic cavity, inner membrane that forms a fluid-filled sac that surrounds the embryo then fetus
• Chorion: is the outer membrane, becomes vascularized ans forms the fetal placenta
• Amniotic fluid: 800-1200 mL, surrounds, cushions, and protects the fetus while maintaining body temperature. Fetus moditifies the fluid by urinating, swallowing and breathing

the student understands fetal circulation if the student states that the ductus venosus:

1. Connects the pulmonary artery to the aorta
2. Is an opening between the right and left atria
3. Connects the umbilical vein to the inferior vena cava
4. Connects the umbilical artery to the inferior vena cava - 3. Connects the umbilical vein to the inferior vena cava The ductus venosus connects the umbilical vein to the inferior vena cava. Options 1, 2, and 4 are incorrect. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery.
5. A pregnant client tells the clinic nurse that she wants to know the sex of her baby as soon as it can be determined. The nurse understands that the client should be able to find out at 12 weeks' gestation because by the end of the twelfth week:
6. The sex of the fetus can be determined by the appearance of the external genitalia.
7. The sex of the fetus can be determined because the external genitalia begins to differentiate.
8. The sex of the fetus can be determined because the testes are descended into the scrotal sac.
9. The sex of the fetus can be determined because the internal differences in males and females become apparent. - 1. The sex of the fetus can be determined by the appearance of the external genitalia. By the end of the twelfth week, the external genitalia of the fetus have developed to such a degree that the sex of the fetus can be determined visually. Option 2 (differentiation of the external genitalia) occurs at the end of the ninth week. Option 3 occurs at the end of the thirty-eighth week (testes descend into the scrotal sac). Option 4 occurs at the end of the seventh week (internal differences in the male and female).
10. A nurse is performing an assessment on a client who is at 38 weeks' gestation and notes that the fetal heart rate is 174 beats/min. On the basis of this finding, the appropriate nursing action is to:
11. Notify the physician.
12. Document the finding.
13. Check the mother's heart rate.

4. Tell the client that the fetal heart rate is normal. - 1. Notify the physician. The fetal heart rate (FHR) depends on gestational age and ranges from 160 to 170 beats/min in the first trimester, but slows with fetal growth to 120 to 160 beats/min near or at term. At or near term, if FHR is less than 120 beats/min or more than 160 beats/min with the uterus at rest, the fetus may be in distress. Because the FHR is increased from the reference range, the nurse should notify the physician. Options 3 and 4 are inappropriate actions based on the information in the question. Although the nurse documents the findings, based on the information in the question, the physician needs to be notified.
5. A nurse is conducting a prenatal class on the female reproductive system. When a client in the class asks why the fertilized ovum stays in the fallopian tube for 3 days, the nurse responds that the reason for this is that it:
6. Promotes the fertilized ovum's chances of survival
7. Promotes the fertilized ovum's exposure to estrogen and progesterone
8. Promotes the fertilized ovum's normal implantation in the top portion of the uterus
9. Promotes the fertilized ovum's exposure to luteinizing hormone and follicle-stimulating hormone - 3. Promotes the fertilized ovum's normal implantation in the top portion of the uterus The tubal isthmus remains contracted until 3 days after conception to allow the fertilized ovum to develop within the tube. This initial growth of the fertilized ovum promotes its normal implantation in the fundal portion of the uterine corpus. Estrogen is a hormone produced by the ovarian follicles, corpus luteum, adrenal cortex, and placenta during pregnancy. Progesterone is a hormone secreted by the corpus luteum of the ovary, adrenal glands, and placenta during pregnancy. Luteinizing hormone and follicle-stimulating hormone are excreted by the anterior pituitary gland. The survival of the fertilized ovum does not depend on it staying in the fallopian tube for 3 days.
10. A nursing instructor is reviewing the menstrual cycle with a nursing student who will be conducting a prenatal teaching session. The instructor asks the student to describe the folliclestimulating hormone (FSH) and the luteinizing hormone (LH). The student accurately responds by stating that:
11. FSH and LH are secreted by the adrenal

the most favorable for successful labor and birth. An android pelvis (resembling a male pelvis) would be unfavorable for labor because of the narrow pelvic planes. An anthropoid pelvis has an outlet that is adequate, with a normal or moderately narrow pubic arch. A platypelloid pelvis (flat pelvis) has a wide transverse diameter, but the anteroposterior diameter is short, making the outlet inadequate.

209. A nurse explains some of the purposes of the placenta to a client during a prenatal visit. The nurse determines that the client understands some of these purposes when the client states that the placenta:
210. Cushions and protects the baby.
211. Maintains the temperature of the baby.
212. Is the way the baby gets food and oxygen.
213. Prevents all antibodies and viruses from passing to the baby. - 3. Is the way the baby gets food and oxygen. The placenta provides an exchange of oxygen, nutrients, and waste products between the mother and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus and maintains the body temperature of the fetus. Nutrients, drugs, antibodies, and viruses can pass through the placenta.