OB ATI Remediation Exam Questions and Answers

Fetal Assessment During Labor: Determining Priority Deceleration - ANSWER 1. Early decelerations could be caused by compression of fetal head during uterine contractions, uterine contractions, vaginal exam, or fundal pressure, they are benign. 2. Late decelerations can be due to uteroplacenta insufficiency causing inadequate fetal oxygenation, maternal hypotension, placenta previa, abruptio placentae, uterine hyperstimulation with oxytocin, preeclampsia, late- or post- term pregnancy, and maternal diabetes mellitus. 3. Late decelerations need nursing interventions such as changing maternal position (side-lying), increased IV fluids, discontinuing oxytocin, 8 to 20 L of O2 via face mask, elevate the client's legs, notify provider and delivering newborn if FHR pattern is persistent. 4. Variable decelerations are caused by umbilical cord compression, short cord, prolapsed cord, and nuchal cord (around fetal neck) these usually respond well to nursing interventions and are typically transient. 5. Prolonged decelerations may result in fetal deal if intrauterine resuscitation does not help, notify physician immediately and prepare for C-section. Chp 13 p.88-89 Medical Conditions: First Trimester Complication - ANSWER 1. Iron-deficiency anemia occurs during pregnancy due to inadequacy in maternal iron stores and consuming insufficient amount of iron. 2. Hyperemesis gravidarum is excessive nausea and vomiting. 3. Gestational diabetes mellitus is impaired tolerance to glucose with the first onset or recognition during pregnancy. 4. Cervical insufficiency is a variable condition whereby expulsion of the products of conception occurs. Chp 9 p.57 Nursing Care and Discharge Teaching: Bathing the Newborn - ANSWER 1. Do not bathe the NB daily (3 to 5 times a week) or use soap between baths because it can cause dryness and alters the acid mantle of the newborn's skin. The mom should wait till the cord falls off to immerse the NB. The bath water should be between 36.6 and 37.2 C. 2. Do not pull the foreskin back when cleaning an uncircumcised penis, but you may you soap on an uncircumcised penis. 3. Expose only the body part that is getting bathed, and dry the newborn throughly to prevent chilling and heat loss. Chp 26 p.176 Nursing Care of Newborns: Priority Action Following Delivery - ANSWER 1. The greatest risk to the newborn is cold stress, the first nurse action after delivery should be to dry the newborn. 2. Weight the infant shortly after birth to obtain baseline, but it is not a first action the nurse needs to take. 3. The nurse should place identification bracelets on the newborn shortly after birth, but it is not a first action the nurse needs to take. 4. The nurse should obtain the Apgar score at 1 and 5 minutes after birth. Chp 24 p. 163 Cultural and Spiritual Nursing Care: Providing Traditional Hispanic Care - ANSWER 1. It is important to protect the client's head and feet from cold air in Hispanic culture. 2. Hispanic culture patients will want to delay bathing for 14 days following delivery. 3. Patients of the Hispanic culture prefer to be on bed rest for 3 days following delivery. 4. The Hispanic culture believes that patients should be drinking warm beverages following birth. Chp 35 Early Onset of Labor: Teaching About Complications of Pregnancy - ANSWER 1. Dull, intermittent back pain can be a clinical manifestation of preterm labor and should be reported to the provider. 2. The client needs to stay hydrated because dehydration stimulates the pituitary gland to secrete ADH and oxytocin which lead to uterine contractions. 3. The client should restrict her activity, she should be on modified bed rest, rest on the left lateral position and avoid sexual activity. 4. The client needs to know how to identify infection, the nurse needs to educate them on reporting any vaginal discharge, noting amount, color, consistency, and odor as well as changes in vital signs and temperature. Chp 10 p.65 Fetal Assessment During Labor: Performing Leopold Maneuvers - ANSWER 1. Do it to find out number of fetuses, presenting part, fetal lie, and fetal attitude, degree of descent of the presenting part into the pelvis, location of the fetus's back to assess for fetal heart tones. 2. The nurse should first palpate the client's fundus to identify the fetal part to perform Leopold maneuvers. Second, the nurse should determine the location of the fetal back. Third, the nurse should palpate for the fetal part presenting at the inlet. Finally, the nurse should palpate the cephalic prominence to identify the attitude of the head. 3. The client must empty her bladder before the assessment, then position her supine with a pillow under her head, and knees slightly flexed then placed a rolled towel under one of the client's hips to prevent supine hypotension. Chp 13 p.85 Medical Conditions: Findings to Report - ANSWER 1. The nurse should assess the client for pitting edema of the ankles and report the finding to the provider. Although this may not be an abnormal finding, it indicates to the provider to assess for additional indications of preeclampsia. 2. If the patient as signs of either hypoglycemia (nervousness, headache, weakness, blurred vision) or hyperglycemia (polydipsia, abdominal pain, flushed dry skin, fruity breath) the provider should be notified. 3. If the client feels the urge to eat non-food items, pica, then the provider should be notified because the client most likely has iron- deficiency anemia. Chp 9 p.57 Nursing Care and Discharge Teaching: Care of the Circumcised Newborn - ANSWER 1. Parents need to change the diaper at least every for 4 hours so the penis doesn't stick, also the parents should put petroleum jelly (not for PlastiBell circ) on the penis after each diaper change for at least 24 hours for the same reasons. 2. They should not wipe off the yellow exudate as it is part of the healing process within 24 hours of the circ. 3. Parents should avoid soap and water because it can be an irritant to healing, instead they should clean the penis with warm water each diaper change. 4. PlastiBell rims usually fall off within 1 week. 5. A tub bath should not be given until the circ is healed. Chp 26 Postpartum Disorders: Findings to Indicate Medication Administration - ANSWER 1. If the client has apprehension, pleuritic chest pain, dyspnea, tachycardia, hemoptysis, heart murmurs, peripheral edema, distended neck veins, elevated temperature, hypotension or hypoxia they may have a serious condition called pulmonary embolus which would require aleteplase or strepokinase. 2. Patient's who have deep vein thrombosis will be given heparin or warfarin. 3. The options for medication with postpartum hemorrhage are oxytocin, methylergonovine, misoprostol, or carboprost thromethamine. Chp 20 Postpartum Infections: Laboratory Values - ANSWER 1. Blood, intracervical, or intrauterine bacteria cultures will reveal the offending organism that is causing the infection. 2. The WBC count will show leukocytosis. 3. The RBC sedimentation rate will be distinctly increased. 4. The RBC will also so anemia, or decreased iron as a indicator of infection. Chp 21 p.144 Postpartum Physiological Adaptations: Breastfeeding Techniques - ANSWER 1. Average time per breast 15-20 minutes. 2. Infants should feed on demand, doing this early will stimulate oxytocin release that will help uterine hemorrhage through uterine contractions. 3. Baby needs to latch onto nipple and areola to prevent breast soreness. 4. Mom should hold baby tummy to tummy. 5. The four positions of breastfeeding are football hold (under the arm), cradle, across lap (modified cradle), and side-lying. Chp 17 p.120 Postpartum Physiological Adaptations: Nursing Interventions for a client who is Postpartum - ANSWER 1. Encourage early breastfeeding for a client who is lactating to help stimulate production of natural oxytocin and prevent hemorrhage. 2. Nursing interventions for abnormal lochia include notifying the provider as well as other interventions based on the abnormality.