180 OB/Maternity HESI Questions with Answers. 2022/2023. Graded A

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180 OB/Maternity HESI Questions with Answers Ovulation occurs how many days before the next menstrual period? (AKA between ovulation & beginning of next menstrual cycle, there are how many days?) >... >>14 To prevent pregnancy, a couple must avoid unprotected sex for ______days before anticipated ovulation & for ___ days after ovulation to prevent pregnancy >>>Several days before antcipated ovulation & 3 days after ovulation ---sperm live approx 3 days ---eggs live about 24 hrs Because some women experience _____ or _____, they do not know they are pregnant >>>implantation bleeding OR spotting Signs of maternal-fetal bonding in utero? >>>talking to fetus in utero massaging abdomen nicknaming fetus For women, battering (emotional/physcial abuse) begins during preg. How should women be assessed for abuse? >>>In private, away from male partner, by nurse who is familiar w/ local resources & knows how to determine safety of the client A women who is 6 wks preg has the following maternal history: -healthy 2 yo daughter -miscarriage at 10 wks -elective abortion at 6 weeks -5 years earlier (what is her GTPAL?) >>>4-1-0-2-1 gravida 4, para 1 (only 1 delivery after 20 wks gestation) What is EBD using Nagele's rule? --Woman's last menstrual period Oct. 17 >>>Count back 3 months +7 days --July 24 When does plasma volume increase during preg? >>>At approx 28 to 32 weeks, plasma volume increase 25-40%, resulting in hemodilution of Hct values 32-42% --High Hct values may look good, BUT in reality they represent a gestational HTN disorder & depleted vascular space Foods high in iron >>>-fish & red meats -cereals & yellow vegetables -green leafy vegetables & citrus fruits -egg yolks and dried fruitsWhat position increases perfusion to uterus, placenta, and fetus? >>>L side-lying Changes in ______ are the 1st & most important indicators of compromised blood flow to fetus, & these changes require action! >>>changes in FHR --fetal well-being determined by fundal height, fetal heart tones & rate, and uterine activity (contractions) Possible indications of preeclampsia & eclampsia are? >>>-*visual disturbances* -*swelling of face, fingers, or sacrum* -*severe, continuous headache* -*persistant vomiting* -*epigastric pain* -infection signs (*chills, temp >100.4, dysuria, pain in abd*) -*fluid discharge* or *bleeding from vagina* (anything besides norm leukorrhea) -*change in fetal movement* or *increased FHR* Nurse's responsibility regarding prenatal vitamins? >>>Teach about proper diet & about taking prescribed vitamins as they have been prescribed by HCP ---only HCP can prescribe prenatal vitamins (aka ensure client receives adequate intake of vitamins) What should preg women eat to ensure daily calcium needs are met to help alleviate leg cramps? >>>equivalent of 3 cups of milk or yogurt per day Name major discomforts of 1st trimester & suggestions to help relieve each >>>-N/V: crackers before rising -fatigue: rest periods & naps & 7-8 hrs sleep at night At 20 weeks gestation, the fundal height would be___; the fetus would weight approx ____ and would look like ____ >>>at umbilicus; 300-400g; a baby (w/ hair, lanugo, & vernix, BUT w/o any subq fat) Norm psychological responses to preg in 2nd trimester >>>-ambivalence wanes & acceptance of pregnancy occurs -preg becomes "real" -signs of maternal-fetal bonding occur Hemodilution of preg peaks at ____ weeks & result in an ____ in a women's Hct? >>>28-32 weeks; decrease 3 principles relative to pattern of weight gain in preg >>>-average 25-35 pounds -gain should be consistent throughout preg -an avg of 1lb/week in 2nd & 3rd trimesters During preg woman should add ____ cals & drink ____ cups of milk per day? >>>300 cals; 3 cupsFHR can be auscultated by Doppler at ____ wks gestation >>>10 to 12 weeks Describe schedule of prenatal visits for low-risk preg woman >>>-Once every 4 wks until 28 wks -Every 2 wks from 28 to 36 wks -Once per wk until delivery In some states, screening for neural tube defects by testing either _____ or _____ is mandated by state law. This screening test is highly associated w/ both false positives & false negatives >>>maternal serum alphafetoprotein (AFP) or amniotic fluid AFP levels When amniocentesis is done early in preg, bladder must be ____ vs done late bladder must be _____ >>>*Early in preg:* bladder must be full to help support the uterus & help push uterus up into abd for easy access *Late in preg:* bladder must be empty to avoid puncture Early decels, caused by _____ & ______, usually occur _____& ______ >>>Caused by head compression & fetal descent Usually occur btw 4 and 7 cm & in 2nd stage of labor ---check for labor progress if early decels are noted If cord prolapse is detected, what should examiner do? >>>Position mother knee-tochest (or l lateral) to relieve pressure on cord OR Push the presenting part off the cord until immediate c/s can be accomplished Late decels indicate ___ & are associated w/ what conditions? >>>*indicate UPI* -associated w/ conditions such as: *post maturity, preeclampsia, diabetes mellitus, cardiac disease, & abruptio placentae* When decels patterns (late or variable) are associated w/ decreased or absent variability & tachycardia, the situation is _____ & requires what? >>>Situation is ominous (potentially disastrous) & requires immediate intervention & fetal assessment A decrease in uteroplacental perfusion results from ____. Cord compression results from _____. Nursing interventions include? >>>-*⬇ uteroplacental perfusion = late decels* (uniform shape, return to baseline after contraction, depth doesn't indicate severity, rarely falls below 100 bpm) -*cord compression = variable decels* (severe variable = below 70 bpm lasting longer than 30-60 sec & slow return to baseline) ---*interventions: change positon, discontinue Pitocin, administer O2, notify HCP* Most important determinant of fetal maturity for extrauterine survival? >>>L/S ratio (lung maturity, lung surfactant development)5 maternal variables associated w/ high-risk preg >>>-age (<17 or >34) -parity (>5) -<3 months between pregnancies -preeclampsia -diabetes or cardiac disease Is one ultrasound examination useful in determining presence of IUGR? >>>No. Serial measurements needed to determine IUGR What does BPP determine? >>>fetal well-being -5 variables assessed: fetal breathing movements, gross body movements, fetal tone, reactivity of FHR, amniotic fluid volume -often done when NST is nonreactive 3 necessary nursing actions prior to ultrasound in 1st trimester >>>1. have client fill bladder 2. do not allow client to void 3. position client supine & w/ uterine wedge Advantage of CVS (chorionic villus sampling) over amniocentesis >>>can be done btwn 8 to 12 wks, w/ results returned within 1 wk, which allows decision about termination while still in 1st trimester Why are serum or amniotic AFP levels done prenatally? >>>-to determine whether AFP levels are elevated ---which may indicate presence of neural tube defects ---OR whether they are low, which may indicate trisomy 21 3 most common complications of amniocentesis >>>1. spontaneous abortion 2. fetal injury 3. infection Name 4 periodic changes of FHR, their causes, and one nursing treatment of each >>>1. *accelerations*: caused by burst of sympathetic activity, they are reassuring & require no treatment 2. *early decels*: head compression, they are benign & alert nurse to monitor for labor progress & fetal descent 3. *variable decels*: cord compression, change position should be tried 1st 4. *late decels*: UPI, place client on side & admin O2 What is most important indicator of fetal autonomic nervous system integrity & health? >>>FHR variability Name 4 causes of decreased FHR variability >>>1. hypoxia 2. acidosis 3. drugs4. fetal sleep What are dangers of nipple stimulation stress test? >>>inability to control oxytocin "dosage" & chance of tetany/hyperstimulation Norm fetal scalp pH in labor is_____, & values below ____ indicate true acidosis >>>Norm pH: 7.25-7.35 True acidosis: 7.2 What should be determined before allowing client to push? What can occur if pushing starts too early? >>>Cervical dilation --cervix should be completely dilated (10cm) before pushing --if pushing starts to early, cervix can become edematous & never fully dilate Give oxytocin before/after placenta delivered? What can occur if not given at right time? >>>Give after delivery of placenta - if admin before, can have retained placenta & predispose client to hemorrhage & infection Methergine & pitocin administration regarding HTN? >>>-Methergine is NOT given to clients w/ HTN b/c of its vasoconstrictive action -Pitocin is given w/ caution to those w/ HTN What is one of most common reasons for uterine atony or hemorrhage in first 24 hrs after delivery? >>>full bladder If nurse finds funds soft, boggy, & displaced above to right of umbilicus, what action should be taken 1st? >>>1st: perform fundal massage --then: have client empty bladder --recheck q15 min for 1 hr, then q30 min for 2 hrs 1st degree tear involves? 2nd degree? 3rd degree? 4th degree? >>>1st: only epidermis 2nd: dermis, muscle, & fascia 3rd: tear extends into anal sphincter 4th: tear extends up rectal mucosa --tears cause pain & swelling; avoid rectal manipulations Apgar of 6 or lower at 5 min require? >>>an additional apgar at 10 min Compromised neonate requires resuscitation. Should the nurse wait until 1-min apgar is assigned? >>>NO - do not wait to begin resuscitation! List 5 prodromal signs of labor the nurse might teach the client >>>Pre-labor signs/signs before labor starts 1. lightening 2. Braxton Hicks contractions 3. increased bloody show, loss of mucous plug4. cervical softening & slight effacement 5. burst of energy, nesting behaviors How is true labor discriminated from false labor? >>>-*True labor*: regular, rhythmic contractions that intensify w/ ambulation, pain in abdomen sweeping around back, & cervical changes -*False labor*: irregular rhythm, abd pain (not in back) that decreases w/ ambulation State 2 ways to determine membranes have truly ruptured >>>1. Nitrazine testing: paper turns dark blue or black 2. Demonstration of fluid ferning under microscope Are psychoprophylactic breathing techniques prescribed for use according to the stage & phase of labor? >>>No. Clients should use techniques according to their discomfort level & should change techniques when one is no longer working for relaxation Identify 2 reasons to withhold anesthesia until the mid active phase of stage 1 labor >>>1. If analgesic & anesthesia given too early, they can retard labor 2. If given too late, they can cause fetal distress Hyperventilation often occurs in laboring client. What results from hyperventilation & what actions should nurse take to relieve? >>>Resp alkalosis occurs, caused by blowing off CO2 ---Relived by breathing into paper bag or cupped hands Describe maternal changes that characterize transition phase of labor >>>Irritability and unwillingness to be touched, but does not want to be left alone; nausea vomiting and hiccuping When should laboring client be examined vaginally? >>>Prior to analgesia & anesthesia to rule out cord prolapse To determine labor progress if it is questioned To determine when pushing can begin Where is FHR best heard? >>>through fetal back in vertex, occiput anterior positions Norm FHR during labor >>>100-160 Norm maternal BP, pulse, temp *during labor* >>>BP: <140/90 pulse: <100 bpm temp: <100.4 4 nursing actions for 2nd stage of labor >>>1. make sure cervix completely dilated before pushing 2. assess FHR w/ each contraction 3. teach woman to hold breath for no longer than 10 sec4. teach pushing technique 3 signs of placental separation >>>1. gush of blood 2. lengthening of cord 3. globular shape of uterus When should PP dose of Pitocin be admin? Why? >>>Give immediately after placenta delivered to prevent PP hemorrhage & uterine atony State one contraindication to use of ergot drugs (Methergine) >>>hypertension 5 symptoms of resp distress in newborn >>>1. tachypnea 2. dusky color 3. flaring nares 4. retractions 5. grunting If meconium passed in utero, what action must nurse take in delivery room? >>>arrange for immediate endotracheal tube observation to determine presence of meconium below vocal cords (prevents pneumonitis & meconium aspiration syndrome) What is considered good Apgar score? >>>7 to 1o Danger associated w/ regional blocks? >>>hypotension resulting from vasodilation below the block, which pools blood in periphery, reducing venous return Why are PO meds avoided in labor? >>>aspiration of gastric contents When is it dangerous to admin butorphanol (Stadol), an agonist/antagonist narcotic? >>>when client undiagnosed drug abuser of narcotics, can cause immediate withdrawal symptoms Hypotension commonly occurs after laboring client receives regional block. What is one of 1st signs nurse might observe? >>>Nausea 3 actions nurse should take when hypotension occurs in laboring client >>>1. turn to left side 2. admin O2 by mask 10L/min 3. increase speed IV infusion (if it doesn't contain meds) Nursing interventions to promote maternal-infant bonding during 4th stage of labor >>>1. withhold eye prophylaxis up to 1 hr 2. perform newborn admission & routine procedures in room w/ parents 3. encourage early initiation of feeds 4. darken room to encourage newborn to open eyes3 interventions to reduce afterpains >>>1. keep bladder empty 2. provide warm blanket for abd 3. admin analgesics as prescribed To promote comfort, what nursing interventions are used for 3rd-degree episiotomy that extends into anal sphincter? >>>1. ice pack 2. witch hazel 3. no rectal manipulation Symptoms of hypovolemic shock >>>pallor, clammy skin, tachycardia, lightheadedness, hypotension List symptoms of full bladder that might occur in 4th stage [Show More]

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