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OB HESI Study Questions (taken from HESI NCLEX-RN book) 2022

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OB HESI Study Questions (taken from HESI NCLEX-RN book) 2022 Objective signs that signify ovulation - ANS- Abundant, thin, clear cervical mucus (egg-white stretchiness), open cervical os, slight ... drop in basal body temp & then 0.5 to 1°F rise, ferning Ovulation occurs how many days before the next menstrual period? - ANS- 14 days 3 ways to identify gestation of pregnancy - ANS- 10 lunar months, 9 calendar months, 3 trimesters of 3 months each, 40 wk, 280 days What maternal position provides optimum fetal and placental perfusion during pregnancy? - ANS- Knee-chest but side-lying is most comfortable and removes pressure from abdominal vessels Major discomforts of first trimester and suggestions for relief for each - ANS- N/V: crackers before rising. Fatigue: 7-8hr sleep at night Naegele's Rule - ANS- First day of LMP: Oct 24 Subtract 3 months: July 24 Add 7 days: July 31=Estimated Date of Delivery (Adjust year accordingly) Fundal height at 20 wk gestation - ANS- At the umbilicus Approximate wt of fetus @ 20 wk gestation - ANS- 300-400g Characteristics of fetus @ 20 wk gestation - ANS- Looks like baby with hair, lanugo, vernix. No subcutaneous fat. Normal psychosocial responses to pregnancy in 2nd trimester - ANS- Acceptance of pregnancy (ambivalence wanes) Signs of maternal-fetal bonding Peak of hemodilution in pregnancy - ANS- 28-32 wk (decreases Hct) 3 principles relative to wt gain in pregnancy - ANS- Total gain average 24-30 lb Gain should be consistent throughout pregnancy Average of 0.9 lb/wk in 2nd & 3rd trimesters How many calories should be added daily to the pregnant woman's diet? - ANS- 300 calories How much milk should a pregnant woman consume daily during pregnancy? - ANS1 quart At how many wks can fetal heart tones be auscultated by Doppler? - ANS- 10-12 wks Schedule of prenatal visits for low-risk pregnant woman - ANS- Once a month until 28 wks Every 2 wks from 28-36 wks Once a wk until delivery Five maternal variables associated with diagnosis of high-risk pregnancy - ANS- 1. Age (<17, >34) 2. Parity (>5) 3. Dx of preeclampsia 4. Dx of Diabetes Mellitus 5. Dx of cardiac disease Is one ultrasound exam useful in determining presence of IUGR? - ANS- No, serial measurements are needed What does the biophysical profile determine (BPP)? - ANS- Fetal well-being List 3 nursing actions prior to ultrasound exam for woman in 1st trimester of pregnancy - ANS- 1. Have client fill bladder 2. Don't allow client to void 3. Position client supine w/uterine wedge Advantage of CVS over amniocentesis - ANS- -Can be done during 8-12 wks gestation -Results returned in 1 wk -Allows for decision about termination in 1st trimester Why are serum or amniotic AFP levels done prenatally? - ANS- Elevated AFP levels may indicate presence of neural tube defects. Low AFP levels may indicate trisomy 21 Most important determinant of fetal maturity for extrauterine survival - ANS- L:S ratio (lung maturity, lung surfactant development) 3 most common complications of amniocentesis - ANS- 1. Spontaneous abortion 2. Fetal injury 3. Infection 4 changes of FHR - ANS- 1. Accelerations 2. Early decelerations 3. Variable decelerations 4. Late decelerations Cause of FHR accelerations and nursing treatment - ANS- -Caused by burst of sympathetic activity -Reassuring and require no treatment Cause of FHR early decelerations and nursing treatment - ANS- -Caused by head compression -Benign and alert nurse to monitor for labor progress and fetal descent Cause of FHR variable decelerations and nursing treatment - ANS- -Caused by cord compression -Change of position should be tried first Cause of FHR late decelerations and nursing treatment - ANS- -Caused by uteroplacental insufficiency (UPI) -Place client on side and administer O2 VEAL CHOP (acronym for FHR interpretation) - ANS- Variables=Cord compression Early decel=Head compression Accelerations=OK Late decel=Placental insufficiency Most important indicator of fetal autonomic nervous system integrity and health - ANS- FHR variability 4 causes of decreased FHR variability - ANS- 1. Hypoxia 2. Acidosis 3. Drugs 4. Fetal sleep Most important action when cord prolapse is determined - ANS- Position mother to relieve pressure on cord or push presenting part off cord with fingers until emergency delivery is accomplished Reactive non-stress test - ANS- FHR acceleration of 15 bpm for 15 sec in response to fetal movement Dangers of nipple-stimulation stress test - ANS- -Inability to control oxytocin "dosage" -Tetany/hyperstimulation Normal fetal scalp pH in labor - ANS- 7.25-7.35 Fetal scalp pH in labor of 7.2 indicates what? - ANS- True acidosis 6 prodromal signs of labor - ANS- Lightening, Braxton Hicks contractions, increased bloody show, loss of mucous plug, burst of energy, & nesting behaviors True labor vs. False labor - ANS- True: regular, rhythmic contractions that intensify with ambulation, pain in abdomen sweeping around from back, cervical changes. False: Irregular rhythm, abdominal pain (not in back) that decreases with ambulation 2 ways to determine whether membranes have truly ruptured - ANS- Nitrazine testing paper turns dark blue or black, & Demonstration of fluid ferning under microscope Are psychoprophylactic breathing techniques prescribed for use according to the stage and phase of labor? - ANS- No. Clients should use these techniques according to their discomfort level and should change techniques when one is no longer working for relaxation. 2 reasons to withhold anesthesia and analgesia until the midactive phase of stage I labor - ANS- If given too early it can retard labor, if given too late it can cause fetal distress. Results of hyperventilation in the laboring client and nursing actions to relieve condition - ANS- Respiratory alkalosis occurs. Relieved by breathing into a paper bag or cupped hands. Maternal changes that characterize the transition phase of labor - ANS- Irritability and unwillingness to be touched. Does not want to be left alone. N/V, hiccups When should a laboring client have a vaginal exam? - ANS- Vaginal exam should be done prior to analgesia and anesthesia to R/O cord prolapse, to determine labor progress, and to determine when pushing can begin. Cervical effacement - ANS- The taking up of the lower cervical segment into the upper segment; the shortening of the cervix expressed in percentages from 0-100% or complete effacement Where is FHR best heard? - ANS- Fetal back in vertex, OA positions Normal FHR during labor - ANS- 110-160 bpm Normal maternal BP during labor - ANS- <140/90 Normal maternal HR during labor - ANS- <100 Normal maternal temperature during labor - ANS- <100.4F 4 nursing actions for 2nd stage of labor - ANS- 1. Make sure cervix is completely dilated before pushing is allowed. 2. Assess FHR with each contraction. 3. Teach woman to hold breath for no longer than 10 seconds. 4. Teach pushing technique. 3 signs of placental separation - ANS- 1. Gush of blood 2. Lengthening of cord 3. Globular shape of fetus Why and when should postpartum Pitocin be administered? - ANS- Administered to prevent postpartum hemorrhage and atony. Give immediately after delivery of placenta. Contraindication of ergot drugs (Methergine) - ANS- HTN 5 S/S respiratory distress in newborn - ANS- 1. Tachypnea 2. Dusky color 3. Flaring nares 4. Retractions 5. Grunting If meconium is passed in utero, what action must the nurse take in the delivery room? - ANS- Arrange for immediate ET tube insertion to determine the presence of meconium below the vocal cords (prevent pneumonitis and meconium aspiration syndrome) What is considered a good Apgar score? - ANS- 7-10 Purpose of eye prophylaxis in newborn - ANS- Prevent opthalmia neonatorum (results from exposure to gonorrhea in vagina) Danger associated with regional blocks - ANS- Hypotension resulting from vasodilation below block, pools blood in periphery, reducing venous return Major cause of maternal death when general anesthesia is administered? - ANSAspiration of gastric contents Why are PO meds avoided in labor? - ANS- Gastric activity slows or stops in labor, decreasing absorption from PO route; may cause vomiting Best way to administer IV drugs in labor - ANS- At beginning of contraction, push a little medication in while uterine blood vessels are constricted=reduces dose to fetus When is it dangerous to administer butorphanol (Stadol), an agonist/antagonist narcotic? - ANS- When client is an undiagnosed drug abuser of narcotics, it can cause immediate withdrawal S/S One of the first S/S of hypotension after receiving regional block - ANS- Nausea 3 nursing actions when hypotension occurs in laboring client - ANS- 1. Turn client to left side 2. Administer O2 via mask @ 10L/min 3. Increase rate of IV infusion (if it doesn't contain med) 4th stage of labor - ANS- 1st 4 hr after delivery of placenta Nursing actions to assist in preventing postpartum hemorrhage - ANS- Massage fundus and keep bladder emptied Nursing actions to promote comfort in 3rd degree episiotomy extending to the anal sphincter - ANS- Ice pack, witch hazel compress, no rectal manipulation Nursing interventions to enhance maternal-infant bonding during 4th stage of labor - ANS- 1. Withhold eye prophylaxis for up to 2hr 2. Perform newborn admission & routine procedures in room w/parents 3. Encourage early initiation of breastfeeding 4. Darken room to encourage newborn to open eyes 5. Skin-to-skin 3 nursing interventions to ease discomfort of afterpains - ANS- 1. Keep bladder empty 2. Provide warm blanket for abdomen 3. Administer analgesics prescribed by HCP S/S full bladder that might occur in 4th stage of labor - ANS- Fundus above umbilicus, uterus not at midline, increased bleeding (uterine atony) 1st action by nurse when soft, boggy uterus is palpated - ANS- Fundal massage S/S hypovolemic shock - ANS- Pallor, clammy skin, tachycardia, lightheadedness, hypotension How often should nurse check fundus during 4th stage of labor? - ANS- Q15 min for 1hr; Q30 for 2hr if normal A nurse discovers a postpartum client w/a boggy uterus that is displaced above and to the right of the umbilicus. Immediate nursing action? - ANS- Perform immediate fundal massage. Ambulate to bathroom or use bedpan to empty bladder (bladder distention) Which women experience afterpains more than others? - ANS- Breastfeeding women, multiparas, women who experience overdistention of uterus 3hr after delivery client has temp of 99.5. What nursing actions are indicated? - ANSElevated temp probably due to dehydration and work of labor. Force fluids and reassess temp in 1hr. Notify HCP if temp >100.4F Client feels faint on way to bathroom. What nursing assessments should be made? - ANS- Assess BP sitting and lying. Assess Hgb & Hct for anemia Factor that places postpartum client at risk for thromboembolism? - ANS- Increased clotting factors Breastfeeding mother complains of very tender nipples. What nursing actions should be taken? - ANS- 1. Have client demonstrate infant position on breast. 2. Leave bra open to air-dry nipples for 15 min, 3x daily. 3. Express colostrum and rub on nipples. 3 days postpartum lactating mother has full, warm, taut, tender breasts. What nursing action should be taken? - ANS- She is engorged. Have newborn suckle frequently, take measures to increase milk flow: warm water, massage breast, & supportive bra Resuming sexual intercourse after delivery - ANS- Avoid until postpartum exam. Use water-soluble lubricant. Expect slight discomfort due to vaginal changes. Miss 2 consecutive days of birth control pills - ANS- Take 2 pills for 2 days and use alternative form of birth control Reason for increased urination in postpartum period - ANS- Up to 3000 ml/day can be voided because of reduction in the 40% plasma increase during pregnancy Most common cause of uterine atony in 1st 24hr postpartum - ANS- Full bladder Postpartum woman: WBC 17,000, afebrile, no S/S infection. Nursing actions? - ANSContinue routine assessments. Normal leukocytosis occurs during postpartal period because of placental site healing Purpose of giving docusate sodium (Colace) to postpartum client? - ANS- To soften stool in mothers w/3rd or 4th degree episiotomies, hemorrhoids, or C-section delivery What should the fundal height be at 3 days postpartum for a woman who has had a vaginal delivery? - ANS- 3 fingerbreadths/cm below umbilicus 3 signs of positive bonding between parents and infant - ANS- 1. Call infant by name 2. Exploring newborn head to toe 3. Using en face position Newborn transitional period - ANS- 6-8hr 3 factors that predispose to respiratory depression in newborn - ANS- 1. C-section delivery 2. Magnesium sulfate given to mother in labor 3. Asphyxia or fetal distress during labor Danger of heat loss to newborn in 1st few hours of life - ANS- Leads to depletion of glucose, body begins to use brown fat for energy, producing ketones (causing ketoacidosis and shock) Normal newborn temperature - ANS- 97.7-99.4F Normal newborn HR - ANS- 110-160 bpm Normal newborn respiratory rate - ANS- 30-60 breaths per minute Normal newborn BP - ANS- 80/50 Newborn temp <97F, what nursing actions should be taken? - ANS- 1. Place newborn in isolette or under radiant warmer & attach skin probe to regulate temp in warmer. 2. Wrap newborn double if isolette/warmer not available 3. Put cap on head 4. WATCH FOR S/S HYPOTHERMIA & HYPOGLYCEMIA Size of newborn head in relation to chest - ANS- Head is usually 2 cm larger unless severe molding occurred Possible causes of shrill, high-pitched, weak cry of newborn - ANS- CNS anomalies, brain damage, hypoglycemia, drug withdrawal Caput - ANS- Edema on newborn's head. Caput crosses suture lines. NORMAL finding Cephalohematoma - ANS- Cephalohematoma. Bleeding between skull and periosteum (could cause hyperbilirubinemia). Does not cross suture lines. ABNORMAL finding. Common symptoms of newborns w/Downs Syndrome - ANS- Low-set ears, simian crease on palm, protruding tongue, Brushfield spots in iris, epicanthal folds 3 ways to determine congenital hip dislocation in newborn - ANS- 1. Hip click 2. Asymmetric gluteal folds 3. Unequal limb lengths Babinski reflex present for how long? - ANS- Present until 12-18 months of age Small for gestational age (SGA) - ANS- Weight below 10th percentile for estimated weeks of gestation Large for gestational age (LGA) - ANS- Weight above 90th percentile for estimated weeks of gestation Average for gestational age (AGA) - ANS- Weight between 10th and 90th percentiles for estimated weeks of gestation Suctioning baby's nose and mouth with bulb syringe, which should be suctioned first? - ANS- Mouth suctioned first. Stimulating the nares can initiate inspiration, which could cause aspiration of the mucus in oral pharynx Normal blood glucose in term neonate - ANS- 40-80 mg/dl Why does newborn need Vitamin K in the 1st hr after birth? - ANS- Sterile gut at delivery lacks intestinal bacteria necessary for synthesis of Vitamin K. Vitamin K is needed in the clotting cascade to prevent hemorrhagic disorders. Physiologic jaundice caused by what in newborn? - ANS- Occurs at 2-3 days of life. Caused by immature liver's inability to metabolize amino acid phenylalanine When is screening test for phenylketonuria done? - ANS- At 2-3 days of life, or after enough milk is ingested to allow for determination of body's ability to metabolize amino acid phenylalanine A term newborn should take in how many calories each day? - ANS- 110 kcal/day CONTINUES... [Show More]

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