OB FINAL EXAM STUDY GUIDE WITH OVER 200 QUESTIONS AND VERIFIED ANSWERS LATEST UPDATE 202, Exams of Nursing

Download OB FINAL EXAM STUDY GUIDE WITH OVER 200 QUESTIONS AND VERIFIED ANSWERS LATEST UPDATE 202 and more Exams Nursing in PDF only on Docsity! OB FINAL EXAM STUDY GUIDE WITH OVER 200 QUESTIONS AND VERIFIED ANSWERS LATEST UPDATE 2024/2025 FREQUENTLY TESTED QUESTIONS ALREADY GRADED A Presumptive Signs of Pregnancy - ANSWER>>changes felt by the woman amenorrhea fatigue breast changes Probable Signs of Pregnancy - ANSWER>>changes observed by an examiner hegar sign ballottment positive pregnancy test Positive Signs of Pregnancy - ANSWER>>signs attributed only to the presence of the fetus fetal heart tones visualizing the fetus (ultrasound) palpating fetal movements Nullipara - ANSWER>>Never pregnant Primipara - ANSWER>>1st pregnancy Multipara - ANSWER>>Multiple pregnancies What is alpha-fetoprotein screening? When is it performed? Why is it performed? What do high and low results indicate? - ANSWER>>Maternal serum levels used as screening tool for neural tube defects (NTDs) in pregnancy Detects 80% to 85% of all open NTDs and open abdominal wall defects early in pregnancy Screening recommended for all pregnant women If trisomy suspected, triple- and quad-screenings Levels detectable between 13-14 weeks What is a normal BMI and what is the expected weight gain? - ANSWER>>18.5-24.9 25-35lbs What is an underweight BMI and what is the expected weight gain? - ANSWER>>less than 18.5 28-40lbs What is an overweight BMI and what is the expected weight gain? - ANSWER>>25-29.9 15-25lbs What is an obese BMI and what is the expected weight gain? - ANSWER>>30 and greater 11-20lbs Which hormone causes a positive pregnancy test? - ANSWER>>Progesterone * Pregnancy hormone * Produced in CL until 14 wks then placenta * Function is to maintain pregnancy by • ensuring endometrium is favorable for implantation of the fertilized ovum Palmar and plantar grasp - ANSWER>>palmar • place finger in baby's palm of hand • infant's fingers curls around examiner's fingers plantar • place finger at base of toes • toes curl downward What is Naegele's rule? - ANSWER>>add one year to the first day of her last menstrual period subtract 3 calendar months and add 7 days What is couvade syndrome? What are some common symptoms? - ANSWER>>man may experience pregnancy-like symptoms such as * nausea, weight gain, and other physical symptoms 2-digit G-P - ANSWER>>First number: gravidity • Number of pregnancies including the current one Second number: parity • Number of pregnancies that has reached 20 weeks of gestation 5-digit G-T-P-A-L - ANSWER>>First number: GRAVIDITY • gravidity Second number: TERM • total number of term births Third number: PRETERM • number of preterm births Fourth number: ABORUTS • number of abortions (includes SABs, TABs, and EABs) Fifth number: LIVING • number of children currently living What is pica? What condition in pregnancy is it associated with? - ANSWER>>* Craving for non-food products • cornstarch • Ice • Clay • Dirt • Cotton balls • Furniture foam Associated with vitamin C deficiency Can lead to gestational diabetes * Should see ferning What is preeclampsia? - ANSWER>>development of HTN and proteinuria in previously normotensive woman after week 20 of gestation or in early postpartum period absence of proteinuria but new-onset hypertension AND either • thrombocytopenia • renal insufficiency • impaired liver function • pulmonary edema • visual symptoms What is eclampsia? - ANSWER>>development of convulsions or coma • not attributable to other causes in a preeclamptic woman What is the purpose of administering betamethasone when a woman is in preterm labor? - ANSWER>>Assist with fetal lung maturity What is hyperemesis gravidarum? - ANSWER>>excessive, prolonged vomiting accompanied by the following: * Weight loss * Electrolyte imbalance * Nutritional deficiencies * Ketonuria How is hyperemesis gravidarum managed? - ANSWER>>Assessment * Assess severity * Weight, V/S, presence of ketonuria * Psychosocial assessment: role of anxiety Initial care * IV therapy *contains MV & vitamin B6 • for correction of fluid/electrolyte imbalances Medications * Ondansetron/promethazine/metoclopramide/corticosteroids * Enteral or parenteral nutrition as a last resort Nursing interventions * monitor vomiting/I & Os * quiet and restful environment *free from odors * increase diet slowly *bland foods Follow-up care * small frequent meals * contact provider if vomiting returns What is oligohydramnios? - ANSWER>>less than normal amniotic fluid less than 300mL What fetal anomalies are associated with oligohydramnios? - ANSWER>>fetal renal issues What is polyhydramnios (hydramnios)? - ANSWER>>more than normal amniotic fluid greater than 2L What fetal anomalies are associated with polyhydramnios? - ANSWER>>GI and other fetal malformations What is a tocolytic? - ANSWER>>Medication that inhibits uterine contractions What nursing assessments are essential when giving magnesium sulfate? - ANSWER>>Vital signs FHR What is administered in the case of magnesium toxicity? - ANSWER>>Calcium gluconate What is the therapeutic magnesium level in a client with preterm labor? - ANSWER>><9 What is the average expected heart rate and respiratory rate of the full-term newborn? - ANSWER>>Newborn increase to 160-180 bpm Gradually decrease to 100-120 bpm after 30 minutes Respirations irregular at 60-80 breaths / min Fine crackles may be present Grunting, nasal flaring, chest retractions may be seen * Should subside 1st hour after birth What are the four ways that heat is lost by the newborn? - ANSWER>>Convection Radiation Evaporation Conduction What are examples of Convection heat loss? - ANSWER>>heat goes from the body to the cooler air What are examples of radiation heat loss? - ANSWER>>heat goes from body to cooler surface not in direct contact What are examples of evaporation heat loss? - ANSWER>>loss of heat when liquid is converted to vapor What are examples of conduction heat loss? - ANSWER>>heat goes from body to cooler surface in direct contact How do you prevent convection heat loss in a newborn? - ANSWER>>wrap infant apply cap to head How do you prevent radiation heat loss in a newborn? - ANSWER>>Place crib away from windows and air drafts How do you prevent evaporation heat loss in a newborn? - ANSWER>>quickly, thoroughly dry newborn after birth and baths How do you prevent conduction heat loss in a newborn? - ANSWER>>place protective cover on scale before weighing infant Lanugo - ANSWER>>Very thin, soft downy hair on the body of newborn Nevus Flammeus - ANSWER>>port-wine stain red to purple not elevated do not blanch most common on face and neck Erythema Toxicum Neonatorum - ANSWER>>flea bite dermatitis newborn rash found during first 3 weeks of life three stages • erythematous macules • papules • small vesicles appear suddenly anywhere on body inflammatory response Eosinophils found in vesicles help decrease inflammation Telangiectatic Nevi - ANSWER>>stork bites pink/easily blanched upper eyelids/nose/upper lip/lower occipital/nape of neck no clinical significance fade by 2nd year of life Rooting - ANSWER>>Turns head toward mom or stimulus Sucking - ANSWER>>Opens mouth, takes hand, sucks on hand Touch infant lips/cheek/corner of mouth with nipple Tonic neck (fencing) - ANSWER>>turn infant head quickly to one side while falling asleep if infant facing left the same side arm / leg extend opposite side are and leg flex Moro - ANSWER>>Hold infant in semi-sitting position Allow head/trunk to fall 30 degrees Place infant on flat surface/strike surface to startle infant Perform sharp hand clap Symmetric abduction/extension arms Fingers fan and form C with thumb/forefinger Slight tremor noted Babinski - ANSWER>>Beginning at heel stroke upward along lateral aspect of foot Move finger across ball of foot Toes hyperextend Big toe dorsiflexion Recorded as positive sign What are the components of the Apgar score? - ANSWER>>Heart rate Respiratory effort avoid eye contact or talking during feedings organize care to minimize handling * cluster care! Ok to breastfeed if on Methadone, but not other drugs Infants exposed to methadone are at greater risk for feeding problems What assessment findings would the nurse see in an infant with developmental dysplasia of the hip (DDH)? - ANSWER>>Hip easily dislocates on exam More often in females in breech position and family history Asymmetrical gluteal/thigh skinfolds Uneven knee levels What are the tests that assess for DDH? - ANSWER>>Barlow Maneuver * Place middle finger over greater trochanter/thumb along midthigh * Hip flexed 90 degrees and abducted * Femoral head gently pushed down * If dislocated, femoral head moves out of acetabulum "clunk" Orlani Test * determines if femoral head can be returned to acetabulum * hip abducted/upward leverage applied * dislocated hip should return to acetabulum with "clunk" What are the signs of respiratory distress in an infant? - ANSWER>>Nasal flaring/grunting/retractions/seesaw breathing Apnea * 20 seconds or greater without breathing * less with bradycardia/cyanosis/hypotonia Periodic breathing * 10-15 seconds of rest * pause followed by 10 -15 seconds of rapid compensatory breathing What is shoulder dystocia? - ANSWER>>Head is born, but anterior shoulder cannot pass under pubic arch What are the fetal complications associated with shoulder dystocia? - ANSWER>>Neurological damage r/t asphyxia Brachial plexus and phrenic nerve injuries Fracture of the humerus or clavicle Maneuvers for shoulder dystocia - ANSWER>>McRoberts Maneuver Gaskin maneuver What is the McRoberts maneuver? - ANSWER>>Preferred method if woman has epidural often used to help deliver fetus with shoulder dystocia woman's legs flexed apart with knees on abdomen causes sacrum to straighten and symphysis public to rotate toward mother's head • This decreases angle of inclination which frees posterior shoulder pressure is applied to anterior shoulder to get it under symphysis pubis What is the Gaskin maneuver? - ANSWER>>If woman is mobile and has unimpaired motor function have her assume hands and knees position may help to deliver the fetus with shoulder dystocia. Squatting & lateral recumbent positions may also be used What is necrotizing enterocolitis (NEC)? - ANSWER>>acute inflammatory disease of the GI mucosa, complicated by bowel necrosis and perforation What are the risk factors of NEC? - ANSWER>>Intestinal ischemia Bacterial colonization Enteral feeding What are the signs of NEC? - ANSWER>>Distention Bile-stained residual gastric aspirates Bloody stools Abdominal tenderness Erythema of abdominal wall What is phototherapy and why is it used? - ANSWER>>Light treatment for newborns with hyperbilirubinemia How is a newborn assessed for jaundice in the hospital? - ANSWER>>Apply pressure with finger over bony area (nose/forehead/sternum) Blanched area will appear yellow before capillary refill Dark skin infants have conjunctival sacs and buccal mucosa assessed Natural light recommended What are the dangers of hyperbilirubinemia? - ANSWER>>Jaundice Kernicterus What is the most appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy? - ANSWER>>Close infant's eyes before applying eye mask to prevent corneal abrasions What teaching should the nurse provide a mother who has a newborn with a cleft lip and palate? - ANSWER>>congenital midline fissure resulting from failure of primary palate closure caused by genetic environmental causes * smoking/alcohol/steroids/lithium/radiation lip repaired at 12 weeks/palate at 1 year unable to create a seal or suction when eating milk comes through the nares What is ABO incompatibility? - ANSWER>>most common cause of hemolytic disease in the newborn * although usually mild Fetal blood type is A/B/AB and maternal type is O Can occur with first pregnancy * mothers with type O blood already have anti A and anti B antibodies Naturally occurring anti-A and anti-B antibodies transfer across placenta to fetus More common than Rh incompatibility, but less severe * Occurs in about 15% of pregnancies What causes an ABO incompatibility in a newborn? - ANSWER>>hemolytic anemia * result of incompatibility between mother's blood type/newborn's blood type What are the signs of cold stress in the newborn? - ANSWER>>occurs when baby's body needs an increase in heat production leads to hypoglycemia Bradycardia central cyanosis hypoglycemic metabolic acidosis hypotonia hypoxia shivering peripheral vasoconstriction What are the priority assessments of a neonate born to a mother with gestational diabetes? - ANSWER>>Fetal blood sugar Lie - ANSWER>>Relaxation of long axis (spine) of the fetus to the long axis (spine) of mom Longitudinal - 90% of deliveries Vertical - 1% of deliveries (vaginal birth cannot occur) Oblique - at an angle. Converts to longitudinal or vertical during labor Presentation - ANSWER>>Part of fetus that enters pelvic inlet first and leads thru birth canal in labor Cephalic - 96% of births (occiput) Breech - 3% of births (buttocks/feet) Shoulder - 1% of births (scapula) Attitude - ANSWER>>How baby is looking Relation of the fetal body parts to one another General flexion • Normal/desirable • Chin flexed to chest • Extremities flexed into torso Critical measurements of fetal head Biparietal diameter • Largest transverse diameter (BPD) Suboccipitobregmatic diameter • Smallest Station - ANSWER>>Relationship of presenting fetal part to imaginary line between maternal ischial spines Measured in cm above/below ischial spines Birth about to occur at +4/+5 Position - ANSWER>>4th P Affects woman's ability to adapt to labor stimulates uterine contractions aids in milk ejection reflex Synthetic Pitocin What are the indications for use of oxytocin? - ANSWER>>induce labor promote labor that is progressing slowly d/t inadequate uterine contractions What is misoprostol? - ANSWER>>Cytotec prostaglandin E1 Tablet form inserted intravaginally into the posterior vaginal fornix w/out lubricant What are the indications for misoprostol use? - ANSWER>>ripens cervix * softening results in effacement and dilation What is dinoprostone? - ANSWER>>Cervidil Prepidil Gel Prostaglandin E2 What are the indications of dinoprostone? - ANSWER>>only FDA approved medication for cervical ripening/labor induction used when Bishop score is 4 or less • to ripen cervix before administration of oxytocin Spinal anesthesia - ANSWER>>Injected between 3rd and 5th lumbar vertebral space • Into the subarachnoid space. Medication solution mixes with CSF Works with gravity The level of the block is complete and fixed within 5-10 minutes • may creep upward for 20 minutes or longer. A block from T8 to S1 is desired. Anesthetic effect depends on the type of agent used. Epidural anesthesia - ANSWER>>Currently the most effective pharmacologic pain relief method for labor A block from T10 to S5 is needed to relieve discomfort from labor & vaginal birth Injection made between 4th and 5th lumbar space. combination of opioid & local anesthetic agent is used. Test dose given to ensure catheter tip is in correct location Obese patients-placement can be challenging May prolong 2nd stage of labor by 15-30 minutes How is a prolapsed cord managed? - ANSWER>>keeping sterile gloved hand in vagina and holding presenting part off of the umbilical cord What lab findings would the nurse expect to see in a client with HELLP syndrome? - ANSWER>>Hemolysis Elevated Liver enzymes Low Platelets What is the nurse's first intervention for a prolapsed cord? - ANSWER>>calling for help and keeping pressure off of the umbilical cord What is an amnioinfusion? - ANSWER>>Infusion of room-temperature isotonic fluid (LR or NS) into the uterine cavity Bolus given over 20-30 minutes by gravity flow or infusion pump, then a maintenance drip given Fluid can be warmed for the pre-term infant Volume of fluid returned should be approximately the same as what was infused When is an amnioinfusion used? - ANSWER>>When amniotic fluid volume is low Why is an amnioinfusion used? - ANSWER>>it helps to relieve compression on the umbilical cord Early decelerations - ANSWER>> V C E H A O L P - ANSWER>>Variable Decels - Cord Compression Early Decels - Head Compression Accelerations - Okay! Late Decels - Placental Insufficiency Late Decelerations - ANSWER>> Variable decelerations - ANSWER>> What nursing interventions are needed during variable decelerations? - ANSWER>>Change maternal position (side to side or knee-chest) D/C oxytocin Give O2 via NRB at 8-10 LPM Notify provider Assist with exam to check for cord prolapse Be prepared for birth, including C section What nursing interventions are needed during accelerations or early decelerations? - ANSWER>>no nursing interventions needed What nursing interventions are needed during late decelerations? - ANSWER>>Change maternal position to lateral Elevate legs if maternal hypotension is present Increase rate of maintenance IVFs Assess for tachysystole by palpating the uterus Discontinue oxytocin if infusing Administer O2 via NRB mask at 8-10 liters Notify provider Consider internal monitoring Prepare for birth, including C section What should be administered if the woman is Rh negative and the baby is Rh positive and why? - ANSWER>>Rhogam * Rh+ blood cells leak into mother's system * Mother's body produces antibodies * Antibodies can cross placenta and destroy baby's RBC What What is placenta previa? - ANSWER>>placenta implanted in lower uterine segment * either partially covering the cervix * close enough to cause bleeding when cervix dilates / lower uterine segment effaces What are the risk factors of placenta previa? - ANSWER>>previous c-sections advanced maternal age (>35-40) multiparity history of prior suction curettage smoking living @ high altitudes women carrying male fetuses What are the clinical manifestations associated with placenta previa? - ANSWER>>painless bright red vaginal bleeding during the second or third trimester most cases diagnosed by ultrasound before bleeding occurs What is the major maternal complication associated with placenta previa? - ANSWER>>Hemorrhage What is placental abruption? - ANSWER>>Premature separation of placenta What are the risk factors of placental abruption? - ANSWER>>maternal HTN cocaine blunt external abdominal trauma cigarette smoking history of abruption in previous pregnancies PROM What are the symptoms of placental abruption? - ANSWER>>abdominal pain vaginal bleeding uterine tenderness contractions What are the maternal complications of placental abruption? - ANSWER>>Hemorrhage hypovolemic shock hypofibrinogenemia thrombocytopenia What are the fetal complications of placental abruption? - ANSWER>>IUGR preterm birth neurologic defects cerebral palsy SIDS calf tenderness & swelling may be red and warm but many have no symptoms What are the clinical manifestations of pulmonary embolism? - ANSWER>>tachypnea dyspnea tachycardia apprehension pleuritic chest pain cough hemoptysis elevated temperature syncope What are the primary causes of VTE? - ANSWER>>venous stasis hypercoagulation What are some interventions for preventing deep vein thrombosis? - ANSWER>>Early ambulation Frequent turning Why is the postpartum woman at risk for DVT? - ANSWER>>Fibrinogen (clotting factor) increased during pregnancy Remain elevated postpartum C-section increases risk What are some interventions to help a breastfeeding mother with sore nipples? - ANSWER>>Air dry nipples No soap (can dry out nipples) Use correct method to remove baby from breast Identify cause of sore nipple and treat it What complications are caused by over distension of the bladder and urinary retention during the postpartum period? - ANSWER>>Uterine atony Hemorrhage What are the fetal risks and complications associated with poorly-controlled gestational diabetes during pregnancy? - ANSWER>>Increased fetal size shoulder dystocia Hypoglycemia What are the neonatal risks and complications associated with poorly-controlled gestational diabetes during pregnancy? - ANSWER>>IUFD (stillbirth) • related to poor glycemic control Congenital malformations Main cause of diabetic associated birth defects hyperglycemia during first trimester/organ & organ system formation cardiovascular and CNS most affected Macrosomia • fetal pancreas begins to secrete insulin at 10-14 weeks • produces excess stores of glycogen/protein/adipose tissue What is a hysterosalpingogram? - ANSWER>>radiographic image of uterus and fallopian tubes scheduled 5 days after menstruation to prevent inadvertent flushing of fertilized ovum into peritoneal cavity dye injected through cervix, then image taken When is a hysterosalpingogram indicated? - ANSWER>>To rule out scarring or adhesions in the uterus or fallopian tubes. Which are the most common techniques or interventions used for the termination of a pregnancy in the first trimester? - ANSWER>>Aspiration * vacuum or suction curettage Medical abortion * Methotrexate * Mifepristone What is the most common technique for the termination of a pregnancy in the second trimester? - ANSWER>>Dilation & Evacuation (D&E) What is nonoxynol-9 (N-9)? - ANSWER>>Spermicide Use * Come in suppositories, cream, foam, tablets, film, and gel * Inserted high into vagina contacting the cervix. * Must be reapplied before each episode of sexual intercourse - Failure rate - 28% How does N-9 prevent pregnancy? - ANSWER>>Chemical barriers against semen; prevent sperm from fertilizing ovum * N -9 destroys the cell membrane What is the risk with frequent use of N-9? - ANSWER>>N9 may increase the risk of HIV when used frequently (>2 times/day) * No prescription needed What birth control methods are contraindicated if a woman has had a history of toxic shock syndrome (TSS)? - ANSWER>>Cervical cap Diaphragm Cervical sponge Which clients are not candidates for hormonal contraception? - ANSWER>>history of thromboembolic disorders CVA or CAD breast cancer gallbladder disease estrogen-dependent tumors pregnancy cirrhosis lactation <6 weeks postpartum smoking & older than 35 severe headaches HTN DM more than 20 years with vascular disease What are the fertility awareness based methods of birth control? - ANSWER>>Calendar rhythm method Standard days method Symptoms-based methods * Two-day method * Cervical mucus ovulation detection method * Basal body temperature (BBT) *Symptothermal method What time of day should a woman check her temperature to determine when she is ovulating? - ANSWER>>Immediately after waking & getting out of bed What should the nurse tell a client who forgot a dose of her oral contraceptive? - ANSWER>>Use alternative birth control method Abstain from intercourse Take next scheduled dose What are inborn errors of metabolism? - ANSWER>>More than 350 Rare individually Collectively common Gene mutation reduces the efficiency of encoded enzymes until normal metabolism cannot occur Are most inborn errors of metabolism inherited in an autosomal dominant or autosomal recessive pattern? - ANSWER>>Autosomal recessive inheritance What are some examples of inborn errors of metabolism? - ANSWER>>Phenylketonuria (PKU) Cystic Fibrosis Tay-Sachs Disease Sickle Cell Anemia What is a genotype? - ANSWER>>An individual's entire genetic makeup What is a phenotype? - ANSWER>>The observable expression of an individual's genotype What is a genome? - ANSWER>>entire set of genetic instructions found in a cell What is a karyotype? - ANSWER>>A pictorial analysis Most common cells used for karyotype - ANSWER>>WBC and fetal cells in amniotic fluid What is a trisomy disorder? - ANSWER>>Union between a normal gamete and one that has an extra chromosome What are some examples of trisomy disorders? - ANSWER>>Down Syndrome Edward Syndrome Patau Syndrome