RNSG: 2208: Final Exam Study Guide: Chapters 1,3,4,5,6,8,9,10-15,16-19-29-31-37 ALL ANSWERS 100% CORRECT FALL-2022 EDITION GUARANTEED GRADE A+

Chap. 1: Issues & Trends in Maternity Nursing - 2 questions The different childbirth practices- • Prenatal care can promote better pregnancy outcomes • Preconception care emphasizes health promoting behaviors • Family-centered care (partner/grandparents/siblings/friends) present. • Doula provides one on one caring presence throughout labor, newborn placed skin to skin immediately after birth and are encouraged. Joint Commission Do and Do not’s (See handout post on BB)- • Not U, use unit • Not QD us daily • Not QOD, use every other day • Not MS use morphine or magnesium sulfate. Standard of care- is the level of practice that a reasonably prudent nurse would provide in the same or similar circumstances. When you are uncertain about how to perform a procedure, consult the agency procedure book guidelines printed therein. Sentinel events- are unexpected occurrences involving deaths or serious physical or psychological injury, or the risk thereof such as loss of limb or function. These events signal a need for immediate investigation and response. When these occur there must be a root cause analysis and an action plan formulated that identifies strategies to reduce the risk of future similar events. Failure to rescue- is the failure to recognize or act on early signs of distress. Careful surveillance and identification of complications, and quick action to initiate appropriate interventions and activate a team response. Chap. 3 Nursing and Genomics: 1 questions Downs Syndrome newborn- Trisomal abnormality, trisomy 21 or an extra chromosome 21. There is some level of intellectual disability. Common characteristics: • oblique palpebral fissures or an upward slant to the eyes • epicanthal folds or small skinfolds on the inner corners of the eyes • small white crescent shaped spots on the irises called Brushfield spots • flat facial profile that usually includes a somewhat depressed nasal bridge and a small nose • enlargement of the tongue in relation to the size of the mouth • small ears, which may be abnormally shaped or abnormally rotated • short broad hands with a 5th finger that has one flexion crease instead of two • single deep crease across the center of the pal, (simian crease) • excessive space between the large and second toes • hyper flexibility and excessive ability to extend the joints • muscle hypotonia or low muscle tone Chap. 4 Assessment and Health Promotion: 2 questions Exercise and pregnancy- Lack of adequate exercise is an important RF to health. Weight bearing aerobic exercises such as walking, running, racquet sports, and dancing are preferred. 150 minutes per week of moderate exercise or 75 minutes of vigorous exercise (30 min/day, 5x/week). Physical activity builds healthy bones, muscles, and joints and reduces the risk of colon and breast cancer. During pregnancy an ongoing regimen can be continued but intensity and duration should be deceased. Beneficial activities include: regularly brisk walking, hiking, stair climbing, aerobic exercises, jogging, running, bicycling, rowing, swimming, soccer, and basketball. Breast self-exam- Detects signs of breast cancer or other changes. Best time is when breast are not tender or swollen, AFTER 5-7 days after menstruation. Perform BSE MONTHLY. Chap. 5 Chap. Violence Against Women: 1 questions Intimate Partner Violence- Most common form of VAW, it is the actual or threatened physical, sexual psychologic, or emotional abuse by a spouse, ex-spouse, boyfriend, ex-boyfriend, girlfriend, ex-girlfriend, fate, or cohabiting partner. Examine and interview in private. Never ask about abuse near partner, ask had client been hit, etc… foes the client feel controlled or isolated, feel safe in the relationship. Validate that they have been heard, establish safety and observe for injuries. Survivor, not a victim. Reassure the client she is not alone, belief that violence is not acceptable, confidentiality of the information being shared, documentation of the statement and descriptions of injuries, with evidence, consent, or photographs. Education that violence is likely absence of menstrual flow to recur and escalate, safety when client decides to leave. Chap. 6 Reproductive System Concerns: 2 questions Amenorrhea- Absence of menstrual flow. Once pregnancy has been ruled out by a β-human chorionic gonadotropin (β- hCG) pregnancy test, diagnostic tests can include FSH level, thyroid-stimulating hormone (TSH) and prolactin levels, radiographic or computed tomography scan of the sella turcica, and a progestational challenge. Counseling and education are primary interventions and appropriate nursing roles. Biofeedback or massage therapy may also be useful. K, Ca, and vit D, as well as oral contraceptives if dietary intake is not met. (1) the absence of both menarche and secondary sexual characteristics by age 14 years (2) absence of menses by age 16, regardless of presence of normal growth and development (primary amenorrhea) (3) a 3- to 6-month absence of menses after a period of menstruation (secondary amenorrhea) • Hypogonadotropic amenorrhea reflects a problem in the central hypothalamic-pituitary axis. • Amenorrhea is one of the classic signs of anorexia nervosa, and the interrelatedness of disordered eating, amenorrhea, and altered bone mineral density has been described as the female athlete triad • Exercise-associated amenorrhea can occur in women undergoing vigorous physical and athletic training. The pathophysiology is complex and is thought to be associated with many factors, including body composition (height, weight, and percentage of body fat); type, intensity, and frequency of exercise; nutritional status; and the presence of emotional or physical stressors Women who participate in sports emphasizing low body weight are at greatest risk including the following: • Sports in which performance is subjectively scored (e.g., distance running, cycling) • Endurance sports favoring participants with low body weight (e.g., distance running, cycling) • Sports in which body contour–revealing clothing is worn (e.g., swimming, diving, volleyball) • Sports with weight categories for participation (e.g., rowing, martial arts) • Sports in which prepubertal body shape favors success (e.g., gymnastics, figure skating) *Anatomic abnormalities are a possible cause of amenorrhea. Type 1 diabetes mellitus is a possible cause of amenorrhea. Pregnancy is the most common cause of amenorrhea. The interrelatedness of disordered eating, amenorrhea, and altered bone mineral density have been described as the female athlete triad. Primary dysmenorrhea- Condition associated with ovulatory cycles. Usually appears 6 to 12 months after menarche when ovulation is established. Nurses can correct myths and misinformation about menstruation and dysmenorrhea by providing facts about what is normal. Nurses must support their clients’ feelings of positive sexuality and self-worth. Heat (heating pad or hot bath), massaging the lower back, soft, rhythmic rubbing of the abdomen (effleurage), biofeedback, transcutaneous electrical nerve stimulation (TENS), progressive relaxation, Hatha yoga, acupuncture, and meditation are also used to decrease menstrual discomfort. Exercise helps relieve menstrual discomfort such as pelvic rocking, decrease salt intake and sugar intake 7-10 days before expected menses to reduce fluid intake. Natural diuretics such as asparagus, cranberry juice, peaches, parsley, or watermelon may help reduce edema and related discomforts. A low-fat vegetarian diet may also help minimize dysmenorrheal symptoms. Can be prescribed NSAIDS. * Primary dysmenorrhea, or pain during or shortly before menstruation, has a biochemical basis and arises from the release of prostaglandins with menses. Dysmenorrhea is painful menstruation that begins 2 to 6 months after menarche. * NSAIDs have the strongest research results for pain relief. If one NSAID is not effective, then another one may provide relief. Approximately 80% of women find relief from these prostaglandin inhibitors. Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. *Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as a low-fat vegetarian diet may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon, may help ease the symptoms associated with dysmenorrhea Chap. 7 Sexually Transmitted and Other Infections: 1 question Group Beta Strep- effects on unborn fetus: preterm labor/birth, premature rupture of membranes for a duration of 18 hours, maternal fever 38 degrees C or higher Herpes • HIV-Test for HIV antibody; timeframe for seroconversion is 6-12 weeks. o Interventions: Intrapartum antiviral med, c-section birth, AVOID breast feeding!!! • HSV Tpye 1 and 2 - possible triggers: menstruation, trauma, febrile illness, UV light; (HSV-2) characterized by primary infection followed by recurrent episodes; does NOT respond well to antibiotics; o Acyclovir 400mg tid oral 7-10days. TX (HSV-1 or HSV-2), compatible with breastfeeding or pregnant woman, suppression therapy 4 wks before birth can reduce need for cesarean birth Syphilis- The disease also can be transmitted through kissing, biting, or oral-genital sex. Primary s/s chancre that appears 5-90 days after infection. Chancre is painless papule that erodes to form a nontender, shallow, indurated, clean ulcer several millimeters to centimeters in size. Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre, s/s wide- spread, symmetric maculopapular rash on the palms and soles and generalized lymphadenopathy. The infected individual also may experience fever, headache, and malaise. Condylomata lata (broad, painless, pink-gray wartlike infectious lesions) may develop on the vulva, the perineum, or the anus. Chap. 8 Fertility: 2 questions Condom application- The sheath is applied over the erect penis before insertion and before the loss of preejaculatory drops of semen. Chap. 9- Infertility: 2 questions Semen analysis- Simple noninvasive test. Ejaculate into clean container or plastic sheath NO SPERMACIDALS, ABSTAIN 2-5 days PRIOR, KEEP @ room or body temp w/in 1HR! Postcoital procedure test- The postcoital test (PCT) (AKA Sims test, Huhner test or Sims-Huhner test) is a test in the evaluation of infertility. The test examines interaction between sperm and mucus of the cervix. The PCT, or Simms– Huhner test, examines sperm survival in cervical mucus and determines whether sperm are migrating into the female reproductive system. It does not predict whether pregnancy can occur. The test is performed after 2 days of sexual abstinence and 1 to 2 days before ovulation, when estrogen-stimulated cervical mucus is abundant. Basal body temperatures or the midcycle Luteinizing hormone surge may be used to determine the timing of the PCT. Mucus is withdrawn from the endocervical canal within 8 hours of coitus and examined. The presence of any forwardly motile sperm in alkaline mucus suggests adequate coital technique and a normal cervical mucus–sperm interaction. Chap. 10 Problems of the Breast: 2 questions Mastectomy- The woman should not be advised to wear snug clothing. She should be advised to avoid tight clothing, tight jewelry, and other apparel that might cause decreased circulation in the affected arm. As part of the teaching plan, the woman should be instructed to empty the surgical drains twice a day, to avoid lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon, and to report immediately any inflammation that develops at the incision site or in the affected arm. • The affected arm should not be used for BP readings, IV therapy, or venipuncture. The affected arm should be elevated with pillows above the level of the right atrium. Mastectomy is the removal of the breast, including the nipple and areola. Women who are advised to have mastectomy instead of BCS are women who have: • Had radiation to the breast • Multiple tumors in the breast occupying several quadrants of the breast • Invasive or extensive DCIS that occupies a large area of the breast tissue • A large tumor compared to breast volume There are several different types of mastectomies. These include: • Total simple mastectomy: This is removal of the breast, nipple, and areola. No lymph nodes from the axillae are taken. Recovery from this procedure, if no reconstruction is done at the same time, is usually 1 to 2 weeks. Hospitalization varies; for some it may be an outpatient procedure, whereas other women may require an overnight stay. • Modified radical mastectomy: This procedure is removal of the breast, nipple, and areola as well as axillary node dissection. Recovery, when surgery is done without reconstruction, is usually 2 to 3 weeks. • Skin-sparing mastectomy: This is the removal of the breast, nipple, and areola, keeping the outer skin of the breast intact. It is a special method of performing a mastectomy that allows for a good cosmetic outcome when combined with a reconstruction done at the same time. A tissue expander may also be placed as a space holder for later reconstruction. • Nipple-sparing mastectomy: This kind of mastectomy is reserved for a smaller number of women with tumors that are not near the nipple areola area. The surgeon makes an incision on the outer side of the breast or around the edge of the areola and hollows out the breast, removing the areola and keeping the nipple intact. Sometimes the completed reconstruction is performed at the same time, and in other cases a tissue expander is inserted as a space holder for later reconstruction. • Preventive/prophylactic mastectomy: Prophylactic mastectomy is designed to remove one or both breasts in order to dramatically reduce the risk of developing breast cancer. Women who test positive for certain genetic mutations like BRCA1 and BRCA2, or who have a strong family history of breast cancer, may elect this kind of surgery. When this type of mastectomy is performed, no lymph nodes need to be removed because there is no evidence of cancer present. It is necessary to have a mammogram within 90 days before the procedure to ensure that it is healthy breast tissue being removed for preventive purposes. Cystic Masses- The most common benign breast problem is fibrocystic change, found in varying degrees in healthy women’s breasts. Fibrocystic changes are characterized by lumpiness, with or without tenderness, in both breasts Solid Masses- A benign solid mass in contrast to a cystic mass has no fluid component. It is generally described as a smooth, round, mobile, painless lesion that is discrete on palpation. Solid masses are generally benign and described as smooth, round, mobile, and painless. An MRI is useful in women with masses that are difficult to find (occult breast cancer). Chap. 11 Structural Disorders and Neoplasms of the Reproductive System: 1 question Radiation Therapy- In preparation for radiation therapy the woman must maintain good nutritional status and a high- protein, high-vitamin, and high-calorie diet. Anemia, if present, should be corrected before initiating radiotherapy. External radiation may be given first to treat regional pelvic nodes and to shrink the tumor. External radiation is usually an outpatient procedure given 5 days a week for 4 to 6 weeks. Internal radiation therapy consists of one or two intracavitary treatments at least 2 weeks apart. External Therapy. Before external radiation therapy the woman’s anxiety may be so high that information given by the radiologist may not be processed. The nurse should reinforce or fill in gaps, especially related to the following: the equipment, which is similar to that used for x-ray examination except larger; the hyperbaric oxygen chamber, which may be used to increase cellular oxygen and thus make tumor cells more radiosensitive; the radiotherapist, who will be behind a shield, but still close by and in communication with her; the position she will be put in and asked to maintain for some minutes; and the therapy, which is painless. Internal Therapy. Internal radiation therapy may require hospitalization or may be done in a special outpatient unit. Radiation safety officers determine the precautions to be observed in each situation. This discussion focuses on treatment in the hospital setting, but similar precautions are used in the outpatient setting. Printed instruction sheets are usually available, stating precautions to be followed for each type of radiation substance used. A precaution sign is placed on the door of the woman’s room. Nurses must protect themselves from overexposure to radiation. Precautions include the following: Careful isolation techniques: wearing gloves while handling bodily fluids and observing good handwashing technique. These behaviors reflect knowledge that alpha and beta rays cannot pass through skin but may be in body fluids and excrement. Careful planning of nursing activity to limit time (to 30 minutes or less per 8 hours) spent in proximity to the woman to avoid exposure to gamma rays, which can penetrate several inches of lead. *Radiation therapy in the form of either brachytherapy or accelerated breast radiation, is the standard therapy after lumpectomy for the treatment of early-stage breast cancer. *The woman is counseled about good skin care and taught to avoid soaps, ointments, cosmetics, and deodorants because these may contain metals that would alter the radiation dose she receives. Staff and visitor exposure should be limited to 30 minutes or less in an 8-hour period to reduce the risk of overexposure to radiation. Nurses need to protect themselves from overexposure to radiation. Wearing a shield is one method of protection. Complications of Radiation Therapy. Morbidity as a direct result from properly conducted therapy is usually minimal. Some of the morbidity seen may be caused by the uncontrolled tumor and not by the therapy. Acute treatment complications occurring during or shortly after therapy include irritation of the rectum, the small bowel, and the bladder; reactions in the skinfolds; and mild bone marrow suppression. Dysuria and frequency may occur. Late complications, although not common, include genital fistulas and necrosis Chap. 12 Conception and Fetal Development: 2 questions The functioning’s of the placenta (hormones) ∙ A. The maternal-placental-embryonic circulation is in place by day 17 when the embryonic heart starts beating. Structure of the placenta is complete by the 12th week. ∙ B. Placenta functions as a means of metabolic exchange. ∙ Respiration/ circulation: dependent on maternal blood pressure ∙ Nutrition: carbs, protein, calcium, iron, fats, water, vitamins ∙ Excretion: waste goes to maternal blood and maternal kidneys excrete them ∙ Storage: of nutrients ∙ C. Endocrine functions (produces hormones to support pregnancy) ∙ hCG: can be detected in maternal serum 8-10 days after conception and is THE BASIS FOR PREGNANCY TESTS. It ensures the function of the ovarian corpus luteum, ensuring the continuous supply of estrogen and progesterone needed to maintain pregnancy. ∙ hCS: similar to a growth hormone. Stimulates the maternal metabolism to supply nutrients needed for fetal growth ∙ Progesterone: steroid hormone. Maintains endometrium, decreases contractility of the uterus, and stimulates maternal metabolism and development of breast alveoli ∙ Estrogens: stimulates uterine growth and utero-placental blood flow, causes proliferation of breast glandular tissue, and stimulates myometrial contractility (L/S ratio) test ∙ Surfactants: Lecithin is the most critical alveolar surfactant required for postnatal lung expansion, it is detectable at 21 weeks and increases after week 24. Another pulmonary phospholipid, sphingomyelin, remains constant in amount. ∙ The measure of Lecithin to sphingomyelin (AKA the L/S ratio) is used to determine fetal lung maturity. ∙ When the L/S ratio reaches 2:1 the infants lungs are considered to be mature Chapter 13 Anatomy and Physiology of Pregnancy: 4 questions Positive, Presumptive and Probable signs of pregnancy ∙ Positive: Visualization of fetus, fetal heart tones, fetal movements palpated or visible to examiner. ∙ Presumptive: Breast changes, amenorrhea, nausea/ vomiting, urinary frequency, fatigue, quickening. ∙ Probable: Goodell sign (softening of the cervix), chadwick sign (purple/ blue vaginal mucous membrane), hegar sign (softening of lower uterine segment), positive pregnancy test (serum or urine), Braxton hicks contractions, ballottment (movability of a floating object) Fundal height measurements (fig. 13-3) ∙