RNC-OB EXAM WITH COMPLETE SOLUTIONS ALL QUESTIONS AND CORRECT ANSWERS!!, Exams of Advanced Education

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RNC-OB EXAM WITH COMPLETE SOLUTIONS ALL QUESTIONS AND CORRECT ANSWERS!! Threatened Abortion - ANSWER Vaginal bleeding <20 weeks S/S- closed cervix and mild cramping Inevitable Abortion - ANSWER Bleeding with continuous dilation, without expulsion of fetal products. <20 weeks Vaginal bleeding and cramping, watch for hemorrhage May need D&C Incomplete Abortion - ANSWER Partial expulsion of conception products <20 weeks Bleeding and cramping but not all products have passed. Will need D&C Spontaneous/Complete Abortion - ANSWER <20 weeks or <500 gms Spontaneous and complete evacuation of all products of conception. Habitual Abortion - ANSWER spontaneous abortion occurring in three or more consecutive pregnancies When can a cerclage be placed? - ANSWER Second trimester Septic Shock - ANSWER Decreased BP Hypothermia Oliguria Septic - ANSWER Fever Chills Kidney failure DIC ARDS Death Protamine Sulfate - ANSWER Heparin Antagonist Antiphospholipid antibody syndrome - ANSWER Common cause of recurrent miscarriage and early severe pre-E Related to SLE Tx. With Heparin Progesterone - ANSWER Progesterone shots prevent early PTL (McKenna) 16-36 foie cream if <20 weeks or shortened cervix. Pregnancy and > 40 years old - ANSWER Intimacy vs. Isolation Teen Pregnancy - ANSWER Identity vs. Role Confusion Highest indication of a PTD - ANSWER Previous PTD Calorie increase during pregnancy - ANSWER 300 kcal/day 600 with twins Folic acid prevents what? - ANSWER neural tube defects With maternal lead exposure - ANSWER Think neuro and low IQ Type 1 DM - ANSWER Treatment is diet, exercise, and will need insulin injections. Type 2 DM - ANSWER Genetic link Treatment is diet, exercise, oral meds, and insulin may or may not be needed. DKA - ANSWER Metabolic Acidosis BS >250 Kussmauls Respirations Non-Ketosis - ANSWER BS >600 No fruity breath or kaussmauls To. IV fluids, IV insulin GDM A1 - ANSWER Diet controlled GDM A2 - ANSWER Not controlled by diet, needs medications Fetal Macrosomia - ANSWER >4,000 gms or 8lbs 1302 GDM have a higher risk of: - ANSWER UTI Polyhydramnios (baby has polyuria) Abruption PP uterine atony Pre-E- screen at 12 weeks PP Hyperglycemia S/S - ANSWER Polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, syncope Polyhydramnios Recurring infections (UTI) Viral load <1000 copies - ANSWER Vaginal delivery Viral load >1000 copies - ANSWER C/S performed at 38 weeks HIV patients during labor should receive what? - ANSWER Zidovudine + Nevirapine 3 hours prior to delivery/continuous with labor CD4 count less than 200 - ANSWER Diagnostic for AIDS Infant care for HIV positive mom - ANSWER CBC Zidovudine + Nevirapine Viral load checks at birth, 6 weeks, 6 months, 18 months CD4 count Viral load chlAMYdia is treated with - ANSWER zithroMAX 1mg IM or PO x7 days Amy needs Max Must treat partner and retest in 2 weeks- wait 7 days to have sex Chlamydia S/S - ANSWER Often asymptomatic Mucus discharge Salpingitis Inflamed Cervix Burning with urination Risk for PP endometritis If mom is diagnosed with Chlamydia, watch neonate for - ANSWER Conjunctivitis Pneumonia Transmission of Chlamydia to infant - ANSWER Does not cross placenta, transmission during vag delivery after ROM GonoRRhea is treated with what? - ANSWER Rocephine (R) 125mg IM Treat partner- wait 7 days to have sex With Gonorrhea and Chlamydia treat infant with - ANSWER Erythromycin ointment This prevents blindness HPV is the primary cause of what? - ANSWER Cervical Cancer 16 and 18 most common HPV is diagnosed with what? - ANSWER Pap Smear Begin testing at 21 years old, can stop at 65 Every 3 years Trichomoniasis - ANSWER Positive in UA Itching, Vaginal Bleeding Tx. with Flagyl Bacterial Vaginosis - ANSWER PPROM, pre-term delivery Fishy odor Tx. Gardenella Syphillis - ANSWER Crosses the placenta Syphillis treatment - ANSWER Bicillin (PCN G) IM weekly x3 doses If dose is missed treatment must be started all over again. Zithromax if allergy 10-90 day incubation Syphillis Diagnostic Test - ANSWER RPR- 1:8 (diluting 8 times, still positive) VDRL FTA False positive RPR can be caused by - ANSWER **Underlying lupus** Malignancy Hepatitis Mono Primary Chancre - ANSWER Lesion that is painless and ulcerative Secondary Chancre - ANSWER Fever Marie's Flu-like symptoms Generalized lymphadenopathy *“red palms and soles of feet** Dangers of Syphillis to fetus - ANSWER IUGR Stillborn Neuro- skin peels after delivery Treat prior to__ weeks to protect fetus - ANSWER 16 IgM antibodies indicate - ANSWER Immediate infection TORCH - ANSWER -Toxoplasmosis -Other (hep b, syphillis, varicella, Epstein Barr, parvovirus 5th disease (slapped cheeks) *does cross the placenta* With CMV the first half of pregnancy is - ANSWER More dangerous- causes severe neuro impairment IGG - ANSWER Previous exposure, not active IGM - ANSWER Immediate active exposure CMV affects to baby - ANSWER Hearing loss LBW IUGR Mental Retardation Microcephaly Liver- jaundice and hepatosenomegaly CMV maternal affects - ANSWER Feels "ill" Fever Fatigue Resembles mono Flu like URI Varicella- Chicken Pox - ANSWER Most moms have immunity Think NEURO If mom is exposed to Varicella - ANSWER Get VZIG within 10 days of exposure to prevent and reduce maternal infection and symptoms. If mom has chicken pox at delivery - ANSWER Worry about neonatal Varicella and give VZIG Warning for Varicella exposure: - ANSWER 8-20 weeks fetal skin scarring, impaired brain development and underdeveloped limbs Rubella is also known as - ANSWER German Measles Viral-distinct red rash Rubella - ANSWER Value for immunity >1.8 If equivocal= non-immune (injection at dc home) Incubation 2-3 weeks With Rubella worry about - ANSWER Congenital abnormalities (Brain and heart) especially 1st trimester Post Partum Rubella moms need - ANSWER MMR vaccine Do not get pregnant for 1-3 months HSV - ANSWER Both 1 and 2 can cause genetically hsv but 2 is usually causative During an outbreak, the infected person should not - ANSWER Have sex Primary Herpes - ANSWER Symptomatic 3-5 days, incubation dew days-3 weeks Mucosal blisters Lymphadenopathy Malaise Fever HA Urinary retention 1st outbreak is very painful Secondary Herpes - ANSWER "Subsequent Outbreak” Usually unilateral in the same area Subclinical Herpes - ANSWER No prior history Asymptomatic with shedding (might say they've never had a outbreak) Occurs several years after acquiring If first outbreak is at delivery there is a what? - ANSWER Increased chance for neonatal transmission that if it was a recurrent outbreak. If visible lesions are present - ANSWER C/S If no active lesions for 2 weeks - ANSWER Vaginal delivery Suppression treatment begins at 35 weeks Valtrex Acyclovir Herpes Neonate risk - ANSWER Primary outbreak 50% Secondary outbreak 1-2% If neonate is exposed to Herpes outbreak: - ANSWER Watch skin and eyes for blistering Give acyclovir no more than 6 hours after ROM Can cross placenta and infect fetus in utero - ANSWER Syphillis CMV Ice x1 minute prior to avoid bruising Report bleeding gums, nose, or excessive bruising Heparin antagonist - ANSWER Protamine Sulfate During pregnancy maternal blood is: - ANSWER Hypercoagulable (reason for DVT/PE) If mom has a prosthetic valve/endocarditis what is needed with labor? - ANSWER Amp and Gent Anemia causes - ANSWER Iron deficiency- (not enough iron to make HGB) B12- (pernicious anemia) gastrectomy/bypass and vegetarians Folate Deficiency- lack citrus fruits and grains Instruct patients to take Iron with - ANSWER Vitamin C- increases absorption 325 mg up to 3x a day Avoid tea, coffee, Ca, and magnesium Folate - ANSWER Whole grains Nuts Citrus Fruits Folic Acid - ANSWER 0.4-0.8mg or 400-800mcg If pernicious anemia give - ANSWER IM B12 Iron - ANSWER Liver Spinach Lentils B12 - ANSWER Lean meats Poultry Fish Eggs Dairy Fruits Veggies With PICA look for - ANSWER Iron deficiency anemia Twice as high risk of PTD before 35 weeks Thrombocytopenia - ANSWER <100K platelets Caused by decreased PLT production or early destruction of PLT. Immune response from lupus, lymphoma, infectious diseases, drug induced (asa and heparin) Treatment for Thrombocytopenia - ANSWER Dexamethasone/Predinsone orally or IM Can increase up to 50k in one week Thrombocytopenia is associated with - ANSWER Pre-E, Eclampsia, ITP, SLE With Thrombocytopenia watch with - ANSWER Epidurals/Spinals Pressure on spine can cause someone to be paralyzed Can cause hematoma (spinal bleeding) Dic - ANSWER Widespread bleeding both internal and external Massive transfusion protocol- shock risk Labs for DIC - ANSWER PLT <100k Fibrinogen <100 mg/dl Fibrin split product >40mg/dl Prothrombin Time >14 seconds D-Dimer elevated( always elevated during pregnancy) Normal Bleeding Labs - ANSWER PT 11-13 sec PTT 30-40 sec INR 0.8-1.1 H&H 12-16/37-47 Fibrinogen 150-400 mg/dl Blood needed for DIC - ANSWER Must contain clotting factors ( FFP, Cryoprecipitate, PLT) Whole blood does not contain clotting factors Thalassemia - ANSWER Less hemoglobin is produced, results in mild or severe anemia *Treatment is folic acid* Beta Minor Thassemia - ANSWER Chronic anemia with normal or increased RBC Anemia does not respond to iron Beta Major Thalassemia - ANSWER Life threatening and needs regular transfusions Anemia with stunted growth Jaundice, chronic bone marrow hyperplasia, splenomegaly, hepatomegaly PTD risk is high Decreased TSH Increased free T4 Hypothyroidism - ANSWER Not enough energy Cold Fatigue Weight gain Dry skin Edema Joint pain Depression Hair Loss Bradycardia Goiter Constipation Increased risk for miscarriage and pre-e TSH elevates T4 normal to low - essential for fetal mental capacity T3 normal Synthroid “fetal brain and spinal development* auto immune thyroiditis - ANSWER Hashimoto's Two common surgeries with pregnancy - ANSWER Appendectomy Cholecystectomy Appendectomy - ANSWER Laparoscopic 1st-2nd trimester Laparotomy 3rd trimester RT flank pain, fever, rebound tenderness, N/V, contractions Guarding- McBurney's Point Labs- UA to r/o UTI CBC- elevated WBC Due to constipation, progesterone in addition to enlarged uterus decreases peristalsis Choleyscytectomy - ANSWER Laparoscopic 1st-2nd timester RUQ pain, RT flank, RT shoulder pain, rebound tenderness, N/V, food intolerance, flatulance Murphy's Sign- inflamed gallbladder “breathe with RT costal pressure" Labs- UA to r/o UTI Electrolytes, amylase, lipase, AST, ALT, bilirubin, alkaline phosphatase Intrahepatic Cholestasis of Pregnancy: ICP - ANSWER Happens during pregnancy, mostly 3rd trimester due to flow of bile slowing and causing build up of bile salts. *INTENSE ITCHING* but no rash (skin may be red from itching) ICP treatment - ANSWER IVF Cold bath Vitamin K Liver function testing Watch weight, appetite, nausea, jaundice Antihistamines Steroid treatment Fetal growth scans UTI diagnosis - ANSWER 100,000 or more colonies of a single organism with 2 consecutive clean bath specimens Most common neuro condition is pregnancy - ANSWER Headache Seizures during pregnancy can cause: - ANSWER Fetal HR decell Fetal hypoxia Abruption PTL/PTD If pregnant with epilepsy, what should be increased? - ANSWER Folic Acid- drugs interfere with maternal absorption of Folic Acid 4 major functions of the Liver - ANSWER Clotting Detoxify Create Albumin Break down drugs Acute Fatty Liver Disease risk factors - ANSWER ‘1st pregnancy Pre-E Multiple gestation Male fetus SGA and poor perfusion >140/90 sustained 6 hours apart Proteinuria <300mg (doesn't meet requirements) P/C ratio - ANSWER Random urine sample If PCR <0.3 then under 300 mg in 24 hour collection HELLP Syndrome - ANSWER Hemolysis Elevated Liver Low PLTS -RBC destruction yields low 02 carry capacity -Ischemia in Liver leads to enlargement and RUQ pain -Low PLTS due to endothelium damage increasing PLT consumption -DIC bleeding from all sites When is the highest risk for seizure? - ANSWER ‘st 24 hours after delivery Caring for the Eclamptic Patient - ANSWER Prevent aspiration Mag Sulfate (4-6gm loading dose- first line) ABG's Valium, Ativan, Versed, Dilantin Seizures - ANSWER Can abrupt, dilate rapidly after seizure Most are self-limiting <1 minute Think MAG, labetalol, and hydralazine Fetal assessment for maternal HTN - ANSWER AFI weekly/BPPS (looking for oligo) Weekly NST's start at 30-32 weeks Serial US growth scans q 4 weeks/start at 28 weeks Induce by 39 weeks Goal is 37 weeks if pre-e without severe features Fetotoxic blood pressure medications include - ANSWER ACE inhibitors and ARBS 1st line CHTN medications - ANSWER Methyldopa (aldomet) Nifedipine (procardia) 1st line HTN medications post partum - ANSWER PO procardia Labetolol trandate Severe Pre-E medications - ANSWER Labetolol Hydralazine PO procardia if no IV Nursing care for HTN moms - ANSWER Restrict activity- rest on side (enhances blood flow) BP assessments, DTR, Clonus Ask if having HA, visual disturbances, RUQ pain Quiet environment What is the purpose of Mag Sulfate? - ANSWER Prevent seizures Keep sedated Muscles relaxed *not to decrease BP* Mag dosage - ANSWER Loading dose 4-6 gm/hr Maintenance dose 2-4 gm/hr Nursing Care with Mag - ANSWER VS q 5-15 minutes during loading dose 1&0 Maternal assessment q hour Antidote for Mag Sulfate - ANSWER Calcium Gluconate 1GM in DSW In 10cc push over 3 minutes Normal Magnesium Level - ANSWER 1.5-2 mEq/L Therapeutic 4-8 mEq/L Classic S/S of Mag Toxicity - ANSWER Absent DTR RR <12 Chest Pain UOP <30 mi/hr BP decreased Fetal Distress Coma Who can NOT receive Mag Sulfate? - ANSWER Myasthenia Gravis Beta Blockers - ANSWER Use caution when given to diabetics (masks s/s of hypoglycemia) Do not give to asthmatics Do not give Beta Blockers if there's already what? - ANSWER Bradycardia ora heart block present Don't give Nubian and Stadol to who? - ANSWER Addicts or those recovering. Creates immediate withdrawal. Methadone - ANSWER Reduces withdrawal symptoms and is part of detox for narcotics Alternative to Methadone - ANSWER Subutex- DOC during pregnancy Soboxone- subutex+naloxone (narcan) Soboxone - ANSWER Sublingual- don't chew Not approved during pregnancy Prevents withdrawal symptoms Breastfeeding and withdrawal meds - ANSWER Can breastfeed on methadone/subutex but infants do better with subutex Sudden withdrawal during pregnancy - ANSWER PTD Fetal distress Miscarriage Is alcohol passed in breast milk? - ANSWER Yes- wait 2-3 hours after a beer or glass of wine Fetal Alcohol Syndrome - ANSWER Flat nose Thin upper lip Microcephaly/impaired CNS development IUGR Micro ophthalmia (short eye measurement across) Mental retardation, neuro and developmental delays ACOG recommends waiting how long after bariatric surgery before conception? - ANSWER 12-24 months Nurses should know what with bariatric surgery patients? - ANSWER Will have malabsorption issues Usually had fertility issues before now they may need birth control counseling. Seafood to avoid during pregnancy includes what? - ANSWER No raw fish, shark, sword fish, king mackerel No “big fish" RADAR - ANSWER Routinely screen females Ask direct questions Document your findings Assess patient safety Review options and referrals With history of domestic violence there is an increased risk for what? - ANSWER Fetal death If patient reports domestic violence what should be known? - ANSWER RH status due to possible mixing of blood Fetal monitoring and domestic violence - ANSWER 4 hours of monitoring Need <6 ctx in a hour If >6 24 hours of monitoring required Quickening - ANSWER Movement felt around 18-22 weeks Trimesters - ANSWER ‘st- 1-13 weeks 2nd- 14-27 weeks 3rd- 28-42 weeks When can you hear baby's hear beat? - ANSWER US 6-7 weeks Doppler 9-10 weeks Fetoscope- 20 weeks (most reliable to hear arrhythmia) Molar Pregnancy - ANSWER Thromboplastic disease (grapelike clusters of cells) Cancer risk Tx. With methotrexate Do not become pregnant for 1 year or longer Naegele's Rule - ANSWER Add 7 days Subtract 3 months Add 1 year Pytalism - ANSWER Spitters Avoid starch