OB Inpatient Certification 2022 Test Questions AND ANSWERS CORRECTLY ANSWERED

OB Inpatient Certification 2022 Test Questions After delivery, progesterone levels fall causing what acid/base change? Ans: Increase pco2 With what disorder would AFP be elevated? Ans: Esophageal atresia, neural tube defects Women with a history of GDM have increased risk of diabetes at what rate? Ans: Onset within 20 years in 35-60% Glucose screen is done when? Ans: 24-28 weeks If a mother has Insulin dependent diabetes during pregnancy, what electrolyte imbalance is the neonate at risk for? Ans: Magnesium deficiency In which trimester is new onset of GHTN most common? Ans: 3rd trimester In a pregnancy complicated by hypertension, what is a sign of deteriorating status? Ans: Increased serum creatinine What difference can be expected between manual and electronic diastolic BP? Ans: Manual are 5-7 mm HG higher On admission to L&D , a woman has 2+ reflexes. After IV mag, DTRs are absent. What is your immediate nursing intervention? Ans: Stop mag and notify provider With no apparent HSV lesions what is the recommendation? Ans: Oral acyclovir 4 weeks prior to delivery +IgG antibodies in PP period? Ans: The recurrence is unlikely, no further action is required. (IgG chronic, IgM is active) The most common rheumatic valvular lesion in pregnancy is? Ans: Mitral stenosis Cardiac defect with most complications in labor? Ans: Mitral stenosis Methamphetamines are expected to last? Ans: 7-24 hrs What is recommended L/S ratio? Ans: 2:1 - lungs are probably mature 3:1 - indicative of maturity What causes a sinusoidal FHR tracing? Ans: Fetal anemia What is the parenteral analgesic with most rapid peak effect? Ans: Fentanyl What neonatal complication is increased with cesarean delivery? Ans: Respiratory morbidity A woman who has a c/s is more likely to be re-hospitalized with what pp complication? Ans: Wound infection During the postpartum period, low levels of placental lactogen, estrogen, cortisol, growth hormone and insulinase result in? Ans: Lower glucose levels Due to the catabolic process of involution postpartum, which lab value is expected to be elevated postpartum? Ans: BUN Avg weight loss with delivery? Ans: 12 lbs Where would you expect to palpate fundus 24h pp? Ans: 1cm below umbilicus What is the term for lochia appearing 3-10 days pp and pink or brown in colora Ans: Lochia serosa The process of involution that allows for healing of the placental site preventing scarring is? Ans: Exfoliation True or false 2500cc urine 2 days pp is a normal physiologic response to delivery Ans: True If pp woman's fundus is deviated from midline first RN intervention is? Ans: Empty bladder Why is UTI common in 1st few weeks pp? Ans: Dilated ureters and renal pelvis By which pp day has circulating blood volume diminished secondary to diuresis, returning to prepregnancy volume? Ans: Day 5 What intervention can increase physiological jaundice? Ans: Delayed cord clamping A woman is 12 days pp and has WBC of 25,000. This indicates? Ans: Expected range What is the antidote for Coumadin? Ans: Vitamin k What is antidote to MAg? Ans: Calcium glucinate What med for malignant hyperthermia? Ans: Dantrolene sodium Uterotonic med contraindicated for elevated BP? Ans: Methergine Following delivery, insulin requirements I'd diabetic woman.... Ans: Decrease rapidly Rhinitis and nasal stuffiness increase in pregnancy are due to? Ans: Estrogen A newly delivered postpartum woman received terbutaline and corticosteroids during labor is at risk for what potential drug interaction? Ans: Hyperglycemia Antidote for heparin? Ans: Protamine sulfate Two IV anti hypertensives that may be used to treat severe maternal hypertension? Ans: Hydralazine, labatelol Severe BP values Ans: Over 160 sbp or over 110 dbp Another name for hydralazine? Ans: Apresoline Another name for labatelol? Ans: Trandate, normodyne At 12 hrs pp a breastfeeding mom is 180/114, what does the RN anticipate the provider will order? Ans: Labatelol A common side effect of pitocin is? Ans: Anti diuretic effect/water intoxication CDC requirement for a TDAP for a pt who had tetanus shot two years ago? Ans: Administer prior to d/c. All pts should have booster in pregnancy Pp woman has order for rubella vaccine and Rh immune globulin. The nurse knows they should be given? Ans: At the same time Unsensitized Rh- mom whose baby is Rh+ should? Ans: Receive 300 mcg of rhogham within 72hrs of delivery A pp woman has large hemorrhoid. She may be instructed to? Ans: Gently attempt to push back into rectum After birth pains usually last? Ans: 2-3 days A woman readmitted for wound infection shows signs of sleep disturbance, irritability, agitation and confusion. The nurse suspects? Ans: Post partum psychosis What is the chance of pregnancy when using the lactational amenorrhea method (LAM) at 12 months? Ans: Can approach 7% Woman wants to use breastfeeding as a contraceptive. The best response is? Ans: What have you heard or read about this method? When teaching a pt about the use of the sponge, the pt should be advised to leave in place for how many hours following intercourse? Ans: 6 hours The hormone responsible for stimulation of the alveolar cells to produce milk? Ans: Prolactin The lactation initiation stage is dependent on? Ans: A cascade of hormones Compared to term breast milk, preterm breast milk is composed of? Ans: Higher protein content In comparison to mature breast milk, the relative content of transitional breast milk has? Ans: Increased protein content Immunoglobulin secreted in breast milk is Ans: IgA Not getting recommended kcal per day while breastfeeding can lead to? Ans: Decreased milk production Minimum number of kcal for breastfeeding woman is? Ans: 1800 kcal A 36 hr old BF infant has nursed 8 times in the last 24hrs on one breast per feeding. The infant has had 2 wet diapers and 2 moderate sized green BM. The baby has rhythmic suck with audible swallow during feeds. This baby is? Ans: Eating well and as expected for this age It is important to breastfeed at night in the early weeks when lactation is being established because? Ans: Prolactin levels are highest at night Most common reason fore sore nipples when breastfeeding? Ans: Improper latch A pt reports sore nipples. The nurse knows that the characteristics of the pain will help to? Ans: Identify the cause A pp woman who is breastfeeding delivered 48 hours ago and is reporting breast engorgement. The cause of this engorgement is? Ans: Vascular changes Pp breastfeeding mom states baby is not satisfied after feeding. States the baby nurses 15 min on each breast then screams. Appropriate intervention? Ans: Observe the baby at the breast during feeding A nursing mom needs an antihypertensive. A good choice is? Ans: Nifedipine A woman on methadone wants to breastfeed. She should be advised that? Ans: Supervised methadone is considered safe The type of neonatal jaundice caused by inadequate breast milk intake is? Ans: Breastfeeding jaundice Extracellular fluid as % of body weight for a term neonate is? Ans: A approx 40% Soy based formula is recommended for infants who have? Ans: Galactosemia Which of the following may indicate a delay in bonding? Ans: When baby is fussy, mom sends to nursery The phase of maternal adjustment that typically starts on the 2nd or 3rd day pp where the mother focuses on care of the baby and resumes control of her body is? Ans: Taking hold Lasts about ten days Mothering tasks take priority Emphasis on present Impatient and drive. To organize self Teach baby care The phase of maternal adjustment for the first day or two after birth. Mothers need rest and "mothering". Ans: Taking in Primary concern is own needs, sleep and food. Talkative about birth experience. Perceptive, passive, teach self care The phase of maternal adjustment in which couples try to return to pre baby relationship and siblings get to know baby Ans: Letting go Must accept baby as separate person Establish new norms for family A nurse makes a home visit to pt who is overwhelmed from nursing baby all the time. Physical assessment of mom and baby are normal. The nurse knows this a manifestation of? Ans: Postpartum blues Maternal role attainment? Ans: Occurs within 3-10 months following birth A fathers reaction to stress Ans: Is just as important as the mothers reaction Resources for adoptive vs biological parents are? Ans: Less available Which of the following is true for a mother following the loss of one infant of a multiple birth? Ans: There is usually less support for grieving parents because the frequent response is they should be thankful for the survival of the living child A supportive intervention for the parents of a dying infant is? Ans: Offer to stay with family until asked to leave The grief response associated with permanent, progressive, recurring and cyclic loss is? Ans: Chronic sorrow When speaking to parents about impending neonatal death, the most appropriate term to use is? Ans: Natural death A pp pt is diagnosed with sheehans syndrome. This is caused by? Ans: Pituitary necrosis. Damage is from lack of oxygenation caused by massive blood loss and severe low BP during or after birth. Causes permanent hypopituitarism, sometimes called "postpartum hypopituitarism". Rare in industrialized nations Clinical signs of hemorrhage such as BP 90/70, pulse 118, and tachypnea can be seen when blood loss reaches Ans: 1500ml 1 hour after delivery of fetal demise, pt becomes tachypnecic, cold, and begins to lose consciousness. Labs are crit 28, fibrinogen 350, plt 75,000. What is the most likely issue? Ans: Hemorrhage Obstetric hemorrhage is defined by what parameter? Ans: Hemodynamic status of the patient G5 with large newborn for GA is likely to have what complication Ans: Hemorrhage 48 hrs post c/s, RN notes pt left calf and foot are cool and pale. Left pedal pulse is diminished and there is a decrease in capillary refill. Homans sign is neg bilaterally. Pt reports l leg tenderness. Most important initial intervention is? Ans: Place pt on bed rest and elevate left leg Pt diagnosed with pp infection denies pain but seems confused, agitated. VS T 99.9, BP 98/50, p 125. Urine output is decreased. Most likely diagnosis? Ans: Septic shock Most persistent fevers after childbirth are caused by? Ans: Genital tract infections 4 hrs pp, pt reports severe vulvar pain and severe rectal pressure. Most likely symptoms for? Ans: Vulvar hematoma What kind of follow up for pt with GDM? Ans: Will test blood sugars at 6 weeks then q 3 years from delivery Pp psychosis generally presents by what time frame? Ans: Within 2 weeks from delivery Pp pt c/o HA and heartburn. She has not voided in 4 hrs. Bladder scan shows empty bladder. RN is concerned about? Ans: Preeclampsia Following c/s for abruption a clot observation test is initiated. Placing a small amt of blood in a test tube for 30 min yields a soft clot that dissolves easily. This is consistent with? Ans: Hypofibrinogenemia A pt is 24hr pp, BP 100/60, T 99. Lochia has steady flow of red bleeding since delivery without odor or pain. RN should consider? Ans: Pp hemorrhage What are the characteristics of a dizygotic pregnancy? Ans: 2 placentas, 2 chorions, 2 sacs Assigning a ten min apgar is done when? Ans: When 5 min 7 To differentiate peripheral from acrocyanosis in a 2 hr old neonate, the best action to initiate is? Ans: Warm infant and observe for improvement in color Serum glucose levels fluctuate for how many hours following birth? Ans: 2 Increased perfusion of the newborns liver is initiated by closure of the? Ans: Ductus venosus 36 week infant apgars 8/8 and appears to be physiologically stable. RN notes infant has assumed a fetal tuck position, yawns and engages in finger splays. These are signs of? Ans: Stress The RN auscultates lung sounds on one hour old newborn after nsvd. Moist sounds are heard on auscultation. This is a? Ans: Normal finding, fluid will absorb naturally At birth the most potent stimulus for closure of the patent ductus arteriosis is? Ans: PO2 In the fetus, patentcy of the ductus arteriosis is maintained by? Ans: Low oxygen tension and prostaglandin E When resuscitating a neonate with suspected diaphragmatic hernia, the most appropriate intervention is? Ans: Insertion of an endotracheal tube should be done as quickly as possible to prevent gas from entering the intestines During neonatal resuscitation finger placement using the two thumb method for external cardiac compression should be where? Ans: On the lower 3rd of the sternum How should a baby with mec staining who is responsive be managed? Ans: No suction if baby is active and does not require resuscitation A neutral thermal environment helps support basic physiologic function and growth in the neonate by? Ans: Conserving metabolic activity The process that triggers the metabolism of brown fat in the neonate occurs for what purpose? Ans: Thermoregulation The initial process a newborn uses to regulate heat is? Ans: Non shivering thermogenesis A newborn with hypothermia should be assessed for? Ans: Metabolic acidosis When performing a GA assessment the RN should recognize that a finding that correlates with advancing GA is? Ans: Resistance with scarf sign maneuver During GA assessment a 90degree square window sign is consistent with? Ans: Preterm Assessment of newborn GA should be done? Ans: Within 4 hrs of birth In assessing reflexes of a term infant, the nurse lifts the newborn slightly from the bed and slow.y lowers the baby back to the surface. What is the expected response? Ans: Fingers for a C and arms returning to chest as if in embrace - Moro reflex The most distinct characteristic of active sleep state in the neonate is? Ans: Rapid eye movement The finding of a 3rd fontanelle along the sagittal suture suggests? Ans: Congenital anomaly (downs) In the assessment of the BP of the newborn which of the following is true regarding upper and lower extremities? Ans: A slight difference is normal If a neonate has CHF, the nurse should recognize that this is a manifestation of? Ans: Underlying disease Infants with hr 90 or 200 should be first evaluated with? Ans: Electrocardiogram Gases ph 7.29, p02 22mmhg, pCO2 47, base excess -4 Ans: Normal values Decrease in 02 concentration that is responsible for the initiation of newborn respirations occurs in the? Ans: Brain A normal breathing pattern in a 2 hour old neonate may include? Ans: Episodic breathing Which of the following diagnoses is a result of delayed reabsorption of fetal lung fluid production? Ans: Transient tachypnea of the newborn A newborn is noted to have cyanosis when quiet but is pink when crying. The most likely diagnosis is? Ans: Choanal atresia On physical exam of the newborn abdomen a normal finding is? Ans: Lower edge is palpated up to 2.5 cm below the right costal margin in the midclavicular line A preterm pts at 30 weeks received indocin. Her baby should be observed for? Ans: Necrotizing enterocolitis If a newborn is born with a port wine stain the RN should watch for problems involving what system? Ans: Neurologic A new mother asks about a mark that looks like a bruise. Physical exam reveals large gray non blanching macules over buttocks. This is most likely? Ans: Mongolian spot In a 32 week neonate expected muscle development would include? Ans: A good grasp reflex To assess the fontanelles a newborn should be in what position? Ans: Sitting What is craniotabes? Ans: Finding of softening or thinning of the skull. Can be normal esp preterm but may be first sign of rickets/ vit d deficiency Craniotabes is typically found in what region of the skull? Ans: Parietal and occipital The primary mechanism of action of glucagon when given for tx of hypoglycemia is? Ans: Stimulation of glycogen release from the liver A neonate has scrotal swelling which is soft, nontender and transilluminates and there are no palpable masses. The the most likely diagnosis? Ans: Hydrocele After delivery, a newborn exhibits flaccidity of both the lower arm and hand. The birth was complicated by shoulder dystocia and subsequent forceps. The expected diagnosis? Ans: Klumpkes paralysis Breastfeeding mom asks when iron supplements should be given to her baby? Ans: Adequate in breastfeeding until about 6 months of age Hygiene care of the uncircumcised neonate? Ans: Avoid retraction of the foreskin until separation naturally occurs AAP recommends supplementation of 400IU of vitamin D/day for breastfed and partially breastfed infants. Ans: Within a few days of birth PP d/c instructions given to mother whose newborn received Hep B at birth include flu vaccines to be given at what age? Ans: 2&4 months Neonate born to a mom with HBsAg+ should have? Ans: Hep B immunoglobulin and Heb B vaccine within 12 hours of birth A few hours after administering eye prophylaxis to the newborn, The nurse notes edema and a greenish yellow discharge. This reaction is due to? Ans: Silver nitrate 1 day old neonate demonstrates temp. Instability, lethargy, and poor muscle tone. Sepsis is suspected. The nurse anticipates that prophylactic antibiotics prescribed is? Ans: Ampicillin and gentamicin Natal teeth are often seen in? Ans: Native population A newborn is diagnosed with cyanotic heart disease. This would indicate which of the following? Ans: Epsteins anomaly The most appropriate diagnostic procedure to confirm a pneumothorax is? Ans: X-ray A mother calls the mother baby unit 2 weeks following delivery and reports that her baby is crying inconsolably for periods of 1-2 hours. Otherwise the baby is healthy and eating well. The nurse should explain that if the baby has colic, it is? Ans: Generally resolved with continued behavior After delivery, a term neonate begins gagging on secretions and has episodes of vomitting. An orogastric tube is passed and 30ml of gastric aspirated is obtained. The maternal hx is likely to include? Ans: Polyhydramnios At birth the newborn is noted have absent breath sounds on the left with heart sounds shifted to the right, the abdomen is noted to be scaphoid and ventilation is difficult. The most likely diagnosis? Ans: Diaphragmatic hernia The delivery record of a newborn pt reports hydramnios in the 3rd trimester. The newborn should be closely assessed for anomalies of the? Ans: Intestinine When the nurse examines the umbilical cord of a newborn, she notes an umbilical cord hernia. This is more commonly seen in ethnic populations? Ans: African Americans Pts whose neonate in pavlik harness (for hip dysplasia) should be taught at discharge that the harness? Ans: Should not exceed 1 hour per day Non-symmetrical crease over the back of the thigh. The Barlow maneuver is performed to? Ans: Detect a dislocated hip Diagnostic study used to r/o brachial plexus injury in the neonate is? Ans: U/s Which clinical event can increase the neutrophil count? Ans: Prolonged crying A hematological change in pregnancy that predisposes a pt to venous thrombosis is i Ans: Hypercoagulability A physiologic change that predisposes pregnant women to venous thrombosis is Ans: Venous stasis A pregnant woman with New York heart association NYHA class II cardiac disease is symptomatic with Ans: Mild exertion A newborn of an insulin defendant mother is at risk for? Ans: Polycythemia Generalized petechiae could be a sign of? Ans: Clotting disorder Physiologic jaundice is d/t a combination of increased bilirubin load to the liver and? Ans: Decreased excretion of bilirubin A neonate at 36 weeks weighing 3000 grams is at risk for? Ans: Jaundice The appropriate management of a breastfeeding newborn with physiologic jaundice is? Ans: Frequent effective breastfeeding A woman and her infant are being d/c'd 12 hrs after birth. Metabolic screening for PKU was done at 6 hours of age on d/c the nurse should advise that the 2nd screening be obtained? Ans: Within 1-2 weeks A newborn born to a mom who is an insulin controlled diabetic, a common malformation that the newborn should be evaluated for is? Ans: Cardiomegaly GBS+, what other organisms are currently the most common pathogens seen in neonatal sepsis? Ans: E. Coli Which of the following tests would be appropriate for a newborn whose mom has HIV? Ans: DNA and polymerase chain reaction test 48 hours of age Congenital varicella syndrome is characterized by? Ans: Early death In the newborn a tense fontanelle is a? Ans: Late meningitis A woman diagnosed with chlamydia delivers a newborn who is treated with erythromycin ointment. The woman should be advised to watch for what symptoms once they are home? Ans: Persistent cough, rales and wheezes Informed consent rests on the assumption of competence and? Ans: Capacity The foundation for nursing education, practice and documentation is? Ans: Nursing process The means of insuring enforcement of the nursing practice act is through the? Ans: State board of nursing Most medical and nursing errors occur because of? Ans: Non-adherence system failures Validity as applied to a research instrument demonstrates? Ans: Degree to which the instrument measures what it was purported to measure Parasympathetic vs sympathetic work together to regulate variability Ans: Pokey slow = p, s= stimulus When the sympathetic nervous system is dominant, fetal variability.... Ans: Decreases Cord compression can cause accelerate true or false Ans: True Overshoot/shoulder Ans: No longer a term. Cause by umbilical vein compression Cerebral blood flow interruption causes Ans: Early decal think head compression Vagal response As fetus matures which branch of the nervous system has more influence over FHR variability Ans: Parasympathetic takes over after 32 weeks Max 24 hour IV dose labetelol Ans: 220 Hyperventilation is caused by what hormone? Ans: Progesterone Fetal attitude Ans: Relation of fetal parts to each other - I.e. Flexed or not flexed Leopolds 1 st manueveur Ans: Presentation FLM using lamellalar body count Ans: 30,000-50,000 = mature Nitrazine Ans: Blue 7.1 rupture 7.5 blood or mucus Burr cells Ans: Hemolysis on smear = HELLP Gaskin manueveur Ans: All 4's for shoulder Normally during pregnancy, maternal sitting and standing blood pressure readings Ans: Decrease, then increase What happens to maternal PaO2 and PaCO2 during pregnancy? Ans: PaO2 increases and PaCO2 decreases The slight increase in pH that occurs during pregnancy is due to Ans: An increase in ventilatory rate During pregnancy, serum urea and creatinine levels Ans: Decrease During pregnancy cardiac out put increases approx Ans: 30-50% By term blood flow to the uterus is approximately Ans: 500ml/min Metabolic changes in pregnancy are Ans: Anabolic -1st half, catabolic 2nd half The primary determinant of volume hemostasis Ans: Renal sodium Increased absorption of calcium is due to increased Ans: Vitamin D (or calciferol) Placental production of this hormone requires interaction of the mother, fetus and placenta Ans: Estriol The 5 diabetogenic hormones of pregnancy Ans: Prolactin, estrogen, progesterone, human placental lactogen, cortisol Congenital cardiac disease occurs in what approximate percentage of live births? Ans: 0.8% Mitral and aortic stenosis are examples of cardiac diseases caused by Ans: Rheumatic fever During pregnancy, predicted values of peak expiratory flow rates are Ans: Unchanged During a asthma exacerbation there is Ans: Increased peripheral vascular resistance A complication seen in up to 26% of women with varicella pneumonia in the first 20weeks of gestation is Ans: Intrauterine infection The prenatal diagnostic screening test most accurate in multiple gestations is Ans: Nuchal translucency Multiple congenital anomalies have been associated with maternal obesity such as Ans: Cleft lip and palate Fetal programming refers to Ans: Process in which an in utero stimulus establishes a permanent fetal response that can lead to increased susceptibility to disease throughout life Uterine crontactility may be what in overweight and obese women Ans: Decreased Extremely obese women have a what % higher risk of stillbirth than a woman of normal weight Ans: 40% The normal length of the pre gravid cervix is Ans: 3.5 to 4 cm Bishop score evaluates Ans: Dilation Effacement Station Consistency Position Oxygen is transferred from mother to fetus by Ans: Passive diffusion Most fetal dysthymias are benign. The exception is which dysthymia that may lead to fetal congestive heart failure? Ans: Supraventricular tachycardia The greatest complication of tocolytic therapy for women with multiple gestations is Ans: Pulmonary edema Pain in 1st stage of labor is caused by Ans: Cervical and lower uterine segment stretching and traction on ovaries, Fallopian tubes and uterine ligaments The release of maternal catecholamines during labor results in Ans: Uterine hypoperfusion and decreased blood flow to the placenta Baroreceptors mediate what kind of decel Ans: Variable Normal metabolic changes during the postpartum period include increased levels of Ans: Plasma renin and angiotensin II Peak cardiac output at birth occurs at Ans: 10 to 15 minutes Intrauterine infection should be suspected when newborn has elevated Ans: IgM Maternal transmission of which antibodies protects the newborn from bacterial and viral infections for which the mother has already produced antibodies Ans: IgG Non shivering thermogenesis generates heat In the newborn through Ans: Brown fat Tears are normally absent in a baby until Ans: 4 to 6 months Newborn femoral pulses should characteristically be decreased or absent in Ans: Hip dysplasia A persistent newborn heart rate of less than 100 is consistent with Ans: Congenital Heart block In the neonate blood pressure in the lower extremities is usually Ans: Higher than in the upper extremities To measure fontanelles accurately a ruler or measuring tape is placed Ans: Diagonally Bone to bone Bowel sounds are expected to be present in the newborn Ans: After passage of the first meconium stool The most common abnormal neck finding in newborns Ans: Cystic hygroma Popping sensations (similar to indenting a ping pong ball) felt when palpating the parietal or occipital bones of the newborn are called Ans: Craniotabes The anterior fontanelle normally closes at Ans: 18 months The posterior fontanelle normally closes at about Ans: 2 to 4 months Apnea refers to pauses in respiration that last Ans: 20 seconds or longer Newborns cam clearly see an object that is Ans: 8 to 10 inches away What is phimosis Ans: The inability to completely retract the foreskin of the penis An asymmetric neck deformity in which the head is noted to be pulled toward the affected side, with the chin pointing towards the opposite shoulder, due to injury to the sternocleidomastoid Ans: Torticollis What causes acrocyanosis Ans: Vasomotor instabilty - worsens if chilled The onset of milk production in a postpartum woman is triggered by Ans: Sudden decrease in progesterone The hormone responsible for milk ejection Ans: Oxytocin In order to prevent damage to the fetus, syphyllis should be treated by... Ans: 16-18 weeks gestation The ischial tuberosity diameter considered adequate for delivery of the fetal head is Ans: 11 cm Distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis Ans: Diagonal conjugate - should be more than 12.5 cm Distance between the anterior surface of the sacral prominence and the posterior surface of the inferior margin of the symphysis pubis Ans: True conjugate - 10.5-11cm How much weight should a pregnant pt with twins or triplets gain Ans: 25-35 lbs Damage to brachial plexus (c5-c7) Ans: Erb palsy Before compressing the uterus to expel clots it is essential to: Ans: Make sure uterus is contracted . Applying external pressure on a non contracted uterus may result in uterine inversion Newborn polycythemia Ans: Hematocrit over 65%. Occurs in response to hypoxia or intrauterine transfusion. Risk factors include preeclampsia, post dates, poorly controlled GDM, twin to twin transfusion, delayed umbilical cord clamping, chromosomal disorders One factor that predisposes an epileptic woman to seizures during pregnancy Ans: Sleep deprivation Long term inhaled corticosteroid therapy to treat asthma has been implicated in increased incidence of Ans: Preeclampsia A 24 yr old Caucasian woman at 28 weeks gestation presents for regular prenatal visit. According to the American diabetes association, what is the appropriate screening for gestational diabetes? Ans: No need for testing What is the most common maternal congenital cardiac lesion with a left-to-right shunt that is detected during pregnancy? Ans: Mitral stenosis During pregnancy which of the following cardiovascular parameters decreases by at least 20% Ans: Systemic vascular resistance A pt has been moved to the surgery suite for a cesarean birth. There is an internal fetal scalp electrode in place. This should be removed when the Ans: Abdominal prep is initiated Ultrasound for antepartum testing uses high frequency sound waves to produce an image that varies based on Ans: Density of the structure under the transducer A fetus at 36 weeks receives a BPP score of 6. The amniotic fluid was scored as normal. The expected management is Ans: Repeat the test in 24 hours A woman at 37 weeks with no risk factors and no complications to date. She calls because she thinks the baby is not moving as much as previously. She should be instructed to Ans: Come in for evaluation Which FHR pattern characteristic determines fetal oxygen reserve? Ans: Presence of variability With an fse with artifact, what nursing intervention is appropriate? Ans: Auscultate to r/o arrhythmia Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? Ans: Early decel Vagal stimulation would be manifested as what type of FHR pattern? Ans: Early A risk of aminofusion is Ans: Uterine overdistension A fetal hr pattern that can occur with a prolapsed cord is? Ans: Prolonged Palpating the uterus is best performed by using the Ans: Fingertips At a prenatal visit, a woman's uterus is palpated at the xiphoid process. This would normally be found at how many weeks gestation? Ans: 36 In evaluating a cord blood gas, if the ph is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? Ans: HCO3 For what gestational ages would you test FFN? Ans: 22-35 In post term preg, the most important u/s parameter is Ans: AFI One theory of labor initiation is an increase in? Ans: Progesterone A pt had an unsuccessful external cephalic version. How soon can this be repeated? Ans: 7 days if 37 weeks, reactive tracing, adequate fluid During the bearing down phase of 2nd stage labor , the nurse should help facilitate the woman's perineum to stretch by? Ans: No action An episiotomy is selectively used for? Ans: Abnormal FHR pattern Compared to a mediolateral episiotomy, a midline episiotomy results in? Ans: Less blood loss A newborn is at higher risk of jaundice when? Ans: Delivery is assisted by vacuum extraction When a vacuum procedure is unsuccessful the max number of attempts or pop offs recommended before declaring the procedure unsuccessful is? Ans: 3 in 20 minutes The risk of water intoxication is decreased during induction of labor if oxytocin is given in a Ans: Balanced electrolyte solution The mechanism of action of sterile water injections for labor pain Ans: Gate control theory Discontinuing an epidural when a woman has the urge to push may Ans: Lead to dysfunctional uterine activity A characteristic of velementous cord insertion is Ans: Lack of whartons jelly What type of breech has the highest risk of cord prolapse Ans: Footling A 36 weeks woman needs cpr for cardiac arrest. Recommended action to facilitate cardiac output during resuscitation is Ans: Uterine displacement A placental condition that occurs when the fetal vessels course through the amniotic membranes and are present at the cervical os is Ans: Vasa previa When 2nd stage labor lasts longer than 2 hours with normal FHR current recommendations are to Ans: Continue to watch if there is evidence of descent One absolute contraindication to epidural anesthesia is Ans: Coagulapathy A woman with hydramnios is experiencing abdominal pain and dyspnea. Treatment with indomethacin will Ans: Decrease fetal urine production Research has shown that administration of IV fluids during preterm labor Ans: Increases risks when combined with tocolytics A clinical sign of plancental abruption is Ans: Pain with ctx not congruent with ctx intensity A pt with previa is scheduled for c/s. The RN can anticipate what kind of incision Ans: Low segment vertical Treating the preterm pt with bed rest increases Ans: Glucose intolerance FDA warns against oral or injectible terbutaline longer than 72 hrs due to Ans: Cardiac complications and death While the exact mechanism of action is not fully known, mag sulfate inhibits smooth muscle contractions by direct effect on myometrial Ans: Calcium activity Neurological injury in a twin who survives the IUFD of the co-twin is most likely due to Ans: Significant hypotension at the time of the demise The interactive process of the father with the newborn is termed Ans: Engrossment Maternal contraindication to breastfeeding Ans: HIV, Is infected with human T-cell lymphotropic virus type I or type II Active untreated tuberculosis Current AWHONN recommendation for umbilical cord cleaning are initially Ans: Sterile water, then plain water What neonatal complication is reduced with vaginal delivery Ans: Respiratory morbidity A woman with hx of anencephaly should be advised to supplement her diet with foods high in folate along with what dose of folic acid Ans: 4.0 mg 2nd Leopold Ans: Palpate fetal back 3rd Leopold Ans: Determine if engaged 4th Leopold Ans: Fetal descent and fetal attitude 1st Leopold manuever Ans: To determine presenting part at the fund us Respiratory acidosis Ans: Results from a build up of CO2 in the blood by lungs retaining Main cause of respiratory acidosis Ans: Apnea, poor ventilation In respiratory acidosis Ans: CO2 is increased, bicarbonate (HCO3-)is either normal (uncompensated) or increased (compensated) Respiratory alkalosis is Ans: Hyperventilation is the main cause,resulting in a loss of CO2 Metabolic acidosis Ans: Increased production of H+ by the body or increased excretion of bicarb by the kidney Metabolic acidosis main causes Ans: Hypoxia, lactic acidosis, ketoacidosis, and chronic renal failure Labs in metabolic acidosis Ans: PH is low, bicarb is decreased, CO 2 decreased, O2 increased In metabolic acidosis, Ans: Due to respiratory compensation (hyperventilation)', Co2 decreased, O2 increased In metabolic alkalosis Ans: Kidneys retain HC03, causes dehydration, labor, disease The pt in triage is diagnosed with PTL the RN should expect the physician will order? A) betamethasone 12mg, IM B) discharge with orders for off work C) mgsulfate IV and pro cardio PO Ans: Betamethasone 12mg IM The new pt in triage is a 32 week 18yo G3P0110 African American woman. She presents with complaints of intermittent lower back pain. You are awaiting the FFN results. What other hx factors may be contributory? A. Further obstetrical hx details B. Non gynecologic surgery hx c. 6 week u/s result from the ER Ans: Further obstetrical history details The tocolytic that is contraindicated in the diabetic woman is A. Mag sulfate B. Nifedipine C. Terbutaline (beta-mimetic) Ans: Terbutaline (beta-MIMETICS) A woman received mag sulfate during labor GHTN. What effect can this have on the newborn? Ans: Muscle weakness Prenatal hx shows a quad screen with a maternal serum alpha protein (MSAFP) lower than normal and higher than normal HCG and inhibin A. The nurse can expect what diagnosis of the newborn? Ans: Trisomy 21 What is associated with elevated maternal serum alpha protein? Ans: Neural tube defects Subsequent to a massive hemorrhage after delivery of a macerated fetus, a woman appears to stabilize. Suddenly a 1hr postpartum, her respirations become shallow and rapid. She states she feels cold and begins to lose consciousness. Lab tests are: Hct 34, fibrinogen 350, plt 125,000. The most appropriate management includes Ans: Blood products Pt diagnosed with a pp infection states she has no pain. She seems confused and agitated. 98/50, pulse 125, and output is decreased Ans: Septic shock A postpartum pt is diagnosed with sheehans syndrome which is caused by Ans: Postpartum necrosis A woman 4 hours postpartum reports sudden, excruciating vulvar pain and severe rectal pressure. This pt is likely exhibiting symptoms of Ans: Vulvar hematoma Functional closure of the ductus arteriosis occurs as a result of Ans: Increased arterial oxygen tension A woman with hydramnios is experiencing abdominal pain and dyspnea. Treatment with indomethacin will Ans: Decrease fetal urine production A pregnant woman on a continuous mag sulfate infusion for preeclampsia exhibits the following: rr 14, decreased deep tendon reflexes clonus absent Ans: Maintain the infusion rate A woman with a BMI of 18 gains 25 pounds during her pregnancy. The pregnancy is at increased risk for Ans: Low birthweight infant Within the first two days after birth, progesterone levels fall causing what acid base change Ans: Increased PaCO2 and low ph What acid base change is normal in pregnancy? Ans: Slight alkalosis, elevated ph due to decrease PaCO2 Compared to the value seen in the 3rd trimester, the catabolic process of involution causes an increase in which of the following values postpartum? Ans: BUN The cause of sudden late onset postpartum hemorrhage secondary to retained placental fragments is due to Ans: Necrotic tissue separation from the uterus The insulin requirement for most breastfeeding women is Ans: Decreased You are caring for a new mother in the recovery room who delivered by c/s at 35weeks. She has a personal history of Tetraology of Fallot. Your nursing care Ans: Vital signs including lung sounds and assessment of pedal edema What % of women with gestation Htn will develop proteinuria Ans: 25% In the absence of proteinuria, preeclampsia can be diagnosed with new onset of any of the following: Ans: Plt 100,00, serum creatinine 1.1 or doubling of serum creating conc. In absence of other renal disease, elevated liver enzymes to 2x normal Severe pre-e = any ONE of the following 20 weeks Ans: BP 160 or 110 at least 4 hrs apart while on bed rest, plt 100,000, 2x normal liver functions or severe ft upper quad or epigastric pain unresponsive to meds and not accountable to alt diagnoses or both, creatinine greater than 1.1 or double normal, pulmonary edema, new onset cerebral or visual disturbances Superimposed pre-e Ans: Must have prior diagnoses of CHTN or before 20 weeks Superimposed pre-e diagnosed when Ans: New onset proteinuria after 20wks, sudden change in proteinuria, sudden change in BP requiring dose inc, change in symptoms, inc ALT, AST, plt 100,000, rt upper quad pain, severe ha, pulmonary congestion or edema, renal insuff (creatinine 1.1 or double) Eclampsia Ans: New onset grand mal sx in pt with pre-e HELLP Ans: Hemolysis - abnormal peripheral smear (shistocytes, burr cells), LDH 600, total bilirubin = 1.2, elevated liver enzymes, serum asparate amniotransferase70, low pots 150,000 Secondary causes of hypertension Ans: Cortisol, pituitary tumor, glucocorticoid meds, sleep apnea, meth/cocaine, renal artery stenosis Path physiology of Htn Ans: Starts early in placental development with incomplete trophoblastic invasion into maternal spiral arteries that perfume the placenta. Results in tortuous vessels, high resistance, I paired p,acetal functioning and decreased placental perfusion Pathophysiology of tachysystole Ans: Constriction of spiral arterioles and decreased blood flow in the intervillous space, risk for fetal hypoxemia and metabolic acidemia Acidosis Ans: Increase in hydrogen ions in tissue Metabolic acidosis Ans: Low bicarb (base excess) in the presence of normal (PCO2) Respiratory acidosis Ans: High pco2 with normal bicarb Asphyxia Ans: Hypoxia with metabolic acidosis Cord ph - arteries Ans: From fetus - deoxygenated Cord ph - vein Ans: To fetus oxygenated FHR tones of baby in ROP position best assessed over Ans: Right lower quad Crettas Ans: Think alphabet in order of badness Doppler flow - rising s/d ratios Ans: Reflect blood flow resistance to placenta, demonstrates dismissed vessel flow volume