RNC-OB Inpatient Obstetric QUESTIONS WITH COMPLETE SOLUTION 2022

RNC-OB Inpatient Obstetric Signs of Placental Separation during third stage of labor? Ans: Third stage of labor is delivery of placenta, after the placenta separates from the uterine wall the uterus changes from discoid to globular. If patient SROMs and heart rates drop below normal limits (ex. 60 bpm) What is RN's initial action? Ans: Perform vaginal exam, to check for cord prolapse. The primary goal of intervention in working with women who are in an abusive relationship is to: Ans: Empower her and improve her self-esteem to regain control of her own life. (Enable her to make necessary changes to protect her and her children, do not victimized) Cardinal movement of restitution during second stage of labor. Ans: Second stage of labor is pushing stage. Rotation of the fetal head 45 degrees after head delivery Risks for toxoplasmosis Ans: 1. Eating under-cooked meats and/or not washing hands after handling raw meat. 2. Handling cat litter. 3. Not washing hands/wearing gloves when handling raw fruits and vegetables or gardening. 4. Eating unpasteurized cheese or milk. Complication that occurs with cordocentesis (percutaneous umbilical blood sampling) 3% of the time is... Ans: Miscarriage Time allotted to very that epidural anesthetic is causing a motor/sensory block... Ans: 20 minutes Primary Cesarean Section Ans: First time having a C/S. Potential Complications of Multiple Pregnancies: Ans: 1. Preterm labor 2. Gestational HTN 3. Anemia 4. Birth Defects 5. Miscarriage 6. Twin-to-twin Transfusion Syndrome 7. Hydramnios 8. Oligohydramnios 9. Cesarean Delivery 10. Postpartum Hemorrhage Second Period of Reactivity Ans: Characterized by infant alertness, stabilized heart and respiratory rates, and the passage of meconium. Which condition may be missed if an infant has newborn screen test performed before it has tolerated protein feedings for at least 24-48 hrs? Ans: Phenylketonuria- in order for this to be detected in newborn screen, certain amino acids found in breastmilk or formula must accumulate so then the deficiency of the enzyme that should metabolized these proteins can be detected. False Labor vs. True Labor Ans: Progressive cervical change is a finding that indicates true labor. Breast engorgement is caused by what physiological change? Ans: An increase in blood and lymph supply to the breasts to produce milk for newborn. Taking-in Phase of Maternal Role Adaptation Ans: Mother is passive and dependent on others the first 24 hours after delivery. Maternal Supine Hypotension Ans: caused by the compression of the aorta and vena cava. EFM monitoring during first stage of labor. Ans: Every 30 minutes Hyperventilation Ans: Condition of breathing deeper and faster than normal, decreasing CO2 in blood stream, leading to a sense of lightheadedness, tachycardia, and shortness of breath ( also may cause numbness or tingling of extremities, anxiety, syncope, and sore chest muscles). Which BPP finding would confirm poor oxygenation to fetus? Ans: Decreased muscle tone. GBS Testing Ans: Done between 35-37 weeks For Forceps use by Practitioner... Ans: The patient should be fully dilated, membranes ruptured, fetus vertex, and no possibility of cephalopelvic disproportion. Goal of Amnioinfusion Ans: To relieve umbilical cord compression which may cause repeated variable decelerations. Amniotic Fluid Embolus/Anaphylactoid Syndrome of Pregnancy Ans: Rare but potentially lethal condition with sudden and rapid onset. Symptoms include: shortness of breath, pulmonary edema, drop in BP, cardiovascular collapse, DIC, altered mental status (anxiety), nausea, vomiting, chills, tachycardia, dysrhythmias, seizures and coma. In an undelivered pt, fetal distress is noted (usually fetal bradycardia. Normal Cord Blood Gases Ans: pH: 7.27-7.28 PCO2: 49.2-50.3 mmHg HCO3: 22-23.1 Base excess: 2.7-3-6 Positive Contraction Stress Test (CST) Ans: Key: Positive = Abnormal Late decelerations 50% of contractions Cesarean Section Incision for Placenta Previa Ans: Low segment vertical: Which tocolytic should not be used in a preterm patient with gestational diabetes? Ans: Terbutaline (Brethine): this is a beta 2 receptor agonist and has the potential to elevate blood sugars. If shoulder dystocia is suspected what procedure should be avoided? Ans: Fundal Pressure due to increase risk for uterine rupture among others. Greatest risk for preterm labor? Ans: History of preterm labor. Hypotonic labor Ans: most commonly noted in active phase of Stage 1 labor, is defined by ineffective contractions which are unable to dilate the cervix and thus lead to secondary inertia. Post-term Gestation Ans: after 42 weeks Vasa Previa Ans: Fetal blood vessels cross over the cervical os and may rupture when the amniotic sac ruptures. Requires emergency cesarean section under general anesthesia. Transient Tachypnea Ans: Often seen in infants who are delivered by cesarean section. Placenta Abruptio Ans: a risk factor is high blood pressure. Which factor would most likely be responsible for a pregnant women's failure to receive adequate prenatal care in the US? Ans: Lack of health insurance What fetal heart rate change can Stadol cause? Ans: Sinusoidal Low level alpha fetoprotein may indicate.... Ans: Down Syndrome Nutrition during Lactation Ans: Mother should intake approximately 500 additional calories for metabolic maintenance and an additional 20 g of protein to build and regenerate body cells. Epidural Anesthesia Ans: Performed to control pain in labor and delivery. Complications include marked hypotension, impaired placental perfusion, and impaired breathing patterns. Labor Initiation Theory Ans: An increase in estrogen defeating progesterone's ability to maintain pregnancy. Cardiac Condition with highest maternal mortality... Ans: Pulmonary hypertension STD that does not cross placenta? Ans: Neisseria Gonorrhea How long after giving cytotec do you have to wait before giving Pitocin? Ans: 4-6 hours Most accurate dating of pregnancy by ultrasound is... Ans: Crown rump length during 1st trimester Antihypertensives contraindicated during second and third trimester... Ans: ACE inhibitors.