OB inpatient certification practice 352 Questions with Verified Answers,100% CORRECT

OB inpatient certification practice 352 Questions with Verified Answers After delivery, progesterone levels fall causing what acid/base change? - CORRECT ANSWER Increase pco2 With what disorder would AFP be eleva ...

OB inpatient certification practice 352 Questions with Verified Answers After delivery, progesterone levels fall causing what acid/base change? - CORRECT ANSWER Increase pco2 With what disorder would AFP be elevated? - CORRECT ANSWER Esophageal atresia, neural tube defects Women with a history of GDM have increased risk of diabetes at what rate? - CORRECT ANSWER Onset within 20 years in 35-60% Glucose screen is done when? - CORRECT ANSWER 24-28 weeks If a mother has Insulin dependent diabetes during pregnancy, what electrolyte imbalance is the neonate at risk for? - CORRECT ANSWER Magnesium deficiency In which trimester is new onset of GHTN most common? - CORRECT ANSWER 3rd trimester In a pregnancy complicated by hypertension, what is a sign of deteriorating status? - CORRECT ANSWER Increased serum creatinine What difference can be expected between manual and electronic diastolic BP? - CORRECT ANSWER 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? - CORRECT ANSWER Stop mag and notify provider With no apparent HSV lesions what is the recommendation? - CORRECT ANSWER Oral acyclovir 4 weeks prior to delivery +IgG antibodies in PP period? - CORRECT ANSWER The recurrence is unlikely, no further action is required. (IgG chronic, IgM is active) The most common rheumatic valvular lesion in pregnancy is? - CORRECT ANSWER Mitral stenosis Cardiac defect with most complications in labor? - CORRECT ANSWER Mitral stenosis Methamphetamines are expected to last? - CORRECT ANSWER 7-24 hrs What is recommended L/S ratio? - CORRECT ANSWER 2:1 - lungs are probably mature 3:1 - indicative of maturity What causes a sinusoidal FHR tracing? - CORRECT ANSWER Fetal anemia What is the parenteral analgesic with most rapid peak effect? - CORRECT ANSWER Fentanyl What neonatal complication is increased with cesarean delivery? - CORRECT ANSWER Respiratory morbidity A woman who has a c/s is more likely to be re-hospitalized with what pp complication? - CORRECT ANSWER Wound infection During the postpartum period, low levels of placental lactogen, estrogen, cortisol, growth hormone and insulinase result in? - CORRECT ANSWER Lower glucose levels Due to the catabolic process of involution postpartum, which lab value is expected to be elevated postpartum? - CORRECT ANSWER BUN Avg weight loss with delivery? - CORRECT ANSWER 12 lbs Where would you expect to palpate fundus 24h pp? - CORRECT ANSWER 1cm below umbilicus What is the term for lochia appearing 3-10 days pp and pink or brown in colora - CORRECT ANSWER Lochia serosa The process of involution that allows for healing of the placental site preventing scarring is? - CORRECT ANSWER Exfoliation True or false 2500cc urine 2 days pp is a normal physiologic response to delivery - CORRECT ANSWER True If pp woman's fundus is deviated from midline first RN intervention is? - CORRECT ANSWER Empty bladder Why is UTI common in 1st few weeks pp? - CORRECT ANSWER Dilated ureters and renal pelvis By which pp day has circulating blood volume diminished secondary to diuresis, returning to prepregnancy volume? - CORRECT ANSWER Day 5 What intervention can increase physiological jaundice? - CORRECT ANSWER Delayed cord clamping A woman is 12 days pp and has WBC of 25,000. This indicates? - CORRECT ANSWER Expected range What is the antidote for Coumadin? - CORRECT ANSWER Vitamin k What is antidote to MAg? - CORRECT ANSWER Calcium glucinate What med for malignant hyperthermia? - CORRECT ANSWER Dantrolene sodium Uterotonic med contraindicated for elevated BP? - CORRECT ANSWER Methergine Following delivery, insulin requirements I'd diabetic woman.... - CORRECT ANSWER Decrease rapidly Rhinitis and nasal stuffiness increase in pregnancy are due to? - CORRECT ANSWER Estrogen A newly delivered postpartum woman received terbutaline and corticosteroids during labor is at risk for what potential drug interaction? - CORRECT ANSWER Hyperglycemia Antidote for heparin? - CORRECT ANSWER Protamine sulfate Two IV anti hypertensives that may be used to treat severe maternal hypertension? - CORRECT ANSWER Hydralazine, labatelol Severe BP values - CORRECT ANSWER Over 160 sbp or over 110 dbp Another name for hydralazine? - CORRECT ANSWER Apresoline Another name for labatelol? - CORRECT ANSWER Trandate, normodyne At 12 hrs pp a breastfeeding mom is 180/114, what does the RN anticipate the provider will order? - CORRECT ANSWER Labatelol A common side effect of pitocin is? - CORRECT ANSWER Anti diuretic effect/water intoxication CDC requirement for a TDAP for a pt who had tetanus shot two years ago? - CORRECT ANSWER 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? - CORRECT ANSWER At the same time Unsensitized Rh- mom whose baby is Rh+ should? - CORRECT ANSWER Receive 300 mcg of rhogham within 72hrs of delivery A pp woman has large hemorrhoid. She may be instructed to? - CORRECT ANSWER Gently attempt to push back into rectum After birth pains usually last? - CORRECT ANSWER 2-3 days A woman readmitted for wound infection shows signs of sleep disturbance, irritability, agitation and confusion. The nurse suspects? - CORRECT ANSWER Post partum psychosis What is the chance of pregnancy when using the lactational amenorrhea method (LAM) at 12 months? - CORRECT ANSWER Can approach 7% Woman wants to use breastfeeding as a contraceptive. The best response is? - CORRECT ANSWER 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? - CORRECT ANSWER 6 hours The hormone responsible for stimulation of the alveolar cells to produce milk? - CORRECT ANSWER Prolactin The lactation initiation stage is dependent on? - CORRECT ANSWER A cascade of hormones Compared to term breast milk, preterm breast milk is composed of? - CORRECT ANSWER Higher protein content In comparison to mature breast milk, the relative content of transitional breast milk has? - CORRECT ANSWER Increased protein content Immunoglobulin secreted in breast milk is - CORRECT ANSWER IgA Not getting recommended 2500-2700 kcal per day while breastfeeding can lead to? - CORRECT ANSWER Decreased milk production Minimum number of kcal for breastfeeding woman is? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER Prolactin levels are highest at night Most common reason fore sore nipples when breastfeeding? - CORRECT ANSWER Improper latch A pt reports sore nipples. The nurse knows that the characteristics of the pain will help to? - CORRECT ANSWER Identify the cause A pp woman who is breastfeeding delivered 48 hours ago and is reporting breast engorgement. The cause of this engorgement is? - CORRECT ANSWER 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? - CORRECT ANSWER Observe the baby at the breast during feeding A nursing mom needs an antihypertensive. A good choice is? - CORRECT ANSWER Nifedipine A woman on methadone wants to breastfeed. She should be advised that? - CORRECT ANSWER Supervised methadone is considered safe The type of neonatal jaundice caused by inadequate breast milk intake is? - CORRECT ANSWER Breastfeeding jaundice Extracellular fluid as % of body weight for a term neonate is? - CORRECT ANSWER A approx 40% Soy based formula is recommended for infants who have? - CORRECT ANSWER Galactosemia Which of the following may indicate a delay in bonding? - CORRECT ANSWER 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? - CORRECT ANSWER 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". - CORRECT ANSWER 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 - CORRECT ANSWER 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? - CORRECT ANSWER Postpartum blues Maternal role attainment? - CORRECT ANSWER Occurs within 3-10 months following birth A fathers reaction to stress - CORRECT ANSWER Is just as important as the mothers reaction Resources for adoptive vs biological parents are? - CORRECT ANSWER Less available Which of the following is true for a mother following the loss of one infant of a multiple birth? - CORRECT ANSWER 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? - CORRECT ANSWER Offer to stay with family until asked to leave The grief response associated with permanent, progressive, recurring and cyclic loss is? - CORRECT ANSWER Chronic sorrow When speaking to parents about impending neonatal death, the most appropriate term to use is? - CORRECT ANSWER Natural death A pp pt is diagnosed with sheehans syndrome. This is caused by? - CORRECT ANSWER 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 - CORRECT ANSWER 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? - CORRECT ANSWER Hemorrhage Obstetric hemorrhage is defined by what parameter? - CORRECT ANSWER Hemodynamic status of the patient G5 with large newborn for GA is likely to have what complication - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER Septic shock Most persistent fevers after childbirth are caused by? - CORRECT ANSWER Genital tract infections 4 hrs pp, pt reports severe vulvar pain and severe rectal pressure. Most likely symptoms for? - CORRECT ANSWER Vulvar hematoma What kind of follow up for pt with GDM? - CORRECT ANSWER Will test blood sugars at 6 weeks then q 3 years from delivery Pp psychosis generally presents by what time frame? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER Pp hemorrhage What are the characteristics of a dizygotic pregnancy? - CORRECT ANSWER 2 placentas, 2 chorions, 2 sacs Assigning a ten min apgar is done when? - CORRECT ANSWER When 5 min < 7 To differentiate peripheral from acrocyanosis in a 2 hr old neonate, the best action to initiate is? - CORRECT ANSWER Warm infant and observe for improvement in color Serum glucose levels fluctuate for how many hours following birth? - CORRECT ANSWER 2 Increased perfusion of the newborns liver is initiated by closure of the? - CORRECT ANSWER 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? - CORRECT ANSWER Stress The RN auscultates lung sounds on one hour old newborn after nsvd. Moist sounds are heard on auscultation. This is a? - CORRECT ANSWER Normal finding, fluid will absorb naturally At birth the most potent stimulus for closure of the patent ductus arteriosis is? - CORRECT ANSWER PO2 In the fetus, patentcy of the ductus arteriosis is maintained by? - CORRECT ANSWER Low oxygen tension and prostaglandin E When resuscitating a neonate with suspected diaphragmatic hernia, the most appropriate intervention is? - CORRECT ANSWER 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? - CORRECT ANSWER On the lower 3rd of the sternum How should a baby with mec staining who is responsive be managed? - CORRECT ANSWER 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? - CORRECT ANSWER Conserving metabolic activity The process that triggers the metabolism of brown fat in the neonate occurs for what purpose? - CORRECT ANSWER Thermoregulation The initial process a newborn uses to regulate heat is? - CORRECT ANSWER Non shivering thermogenesis A newborn with hypothermia should be assessed for? - CORRECT ANSWER Metabolic acidosis When performing a GA assessment the RN should recognize that a finding that correlates with advancing GA is? - CORRECT ANSWER Resistance with scarf sign maneuver During GA assessment a 90degree square window sign is consistent with? - CORRECT ANSWER Preterm Assessment of newborn GA should be done? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER Rapid eye movement The finding of a 3rd fontanelle along the sagittal suture suggests? - CORRECT ANSWER Congenital anomaly (downs) In the assessment of the BP of the newborn which of the following is true regarding upper and lower extremities? - CORRECT ANSWER A slight difference is normal If a neonate has CHF, the nurse should recognize that this is a manifestation of? - CORRECT ANSWER Underlying disease Infants with hr <90 or > 200 should be first evaluated with? - CORRECT ANSWER Electrocardiogram Gases ph 7.29, p02 22mmhg, pCO2 47, base excess -4 - CORRECT ANSWER Normal values Decrease in 02 concentration that is responsible for the initiation of newborn respirations occurs in the? - CORRECT ANSWER Brain A normal breathing pattern in a 2 hour old neonate may include? - CORRECT ANSWER Episodic breathing Which of the following diagnoses is a result of delayed reabsorption of fetal lung fluid production? - CORRECT ANSWER Transient tachypnea of the newborn A newborn is noted to have cyanosis when quiet but is pink when crying. The most likely diagnosis is? - CORRECT ANSWER Choanal atresia On physical exam of the newborn abdomen a normal finding is? - CORRECT ANSWER 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? - CORRECT ANSWER Necrotizing enterocolitis If a newborn is born with a port wine stain the RN should watch for problems involving what system? - CORRECT ANSWER 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? - CORRECT ANSWER Mongolian spot In a 32 week neonate expected muscle development would include? - CORRECT ANSWER A good grasp reflex To assess the fontanelles a newborn should be in what position? - CORRECT ANSWER Sitting What is craniotabes? - CORRECT ANSWER 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? - CORRECT ANSWER Parietal and occipital The primary mechanism of action of glucagon when given for tx of hypoglycemia is? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER Klumpkes paralysis Breastfeeding mom asks when iron supplements should be given to her baby? - CORRECT ANSWER Adequate in breastfeeding until about 6 months of age Hygiene care of the uncircumcised neonate? - CORRECT ANSWER Avoid retraction of the foreskin until separation naturally occurs AAP recommends supplementation of 400IU of vitamin D/day for breastfed and partially breastfed infants. - CORRECT ANSWER 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? - CORRECT ANSWER 2&4 months Neonate born to a mom with HBsAg+ should have? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER Ampicillin and gentamicin Natal teeth are often seen in? - CORRECT ANSWER Native population A newborn is diagnosed with cyanotic heart disease. This would indicate which of the following? - CORRECT ANSWER Epsteins anomaly The most appropriate diagnostic procedure to confirm a pneumothorax is? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER African Americans Pts whose neonate in pavlik harness (for hip dysplasia) should be taught at discharge that the harness? - CORRECT ANSWER Should not exceed 1 hour per day Non-symmetrical crease over the back of the thigh. The Barlow maneuver is performed to? - CORRECT ANSWER Detect a dislocated hip Diagnostic study used to r/o brachial plexus injury in the neonate is? - CORRECT ANSWER U/s Which clinical event can increase the neutrophil count? - CORRECT ANSWER Prolonged crying A hematological change in pregnancy that predisposes a pt to venous thrombosis is i - CORRECT ANSWER Hypercoagulability A physiologic change that predisposes pregnant women to venous thrombosis is - CORRECT ANSWER Venous stasis A pregnant woman with New York heart association NYHA class II cardiac disease is symptomatic with - CORRECT ANSWER Mild exertion A newborn of an insulin defendant mother is at risk for? - CORRECT ANSWER Polycythemia Generalized petechiae could be a sign of? - CORRECT ANSWER Clotting disorder Physiologic jaundice is d/t a combination of increased bilirubin load to the liver and? - CORRECT ANSWER Decreased excretion of bilirubin A neonate at 36 weeks weighing 3000 grams is at risk for? - CORRECT ANSWER Jaundice The appropriate management of a breastfeeding newborn with physiologic jaundice is? - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER Cardiomegaly GBS+, what other organisms are currently the most common pathogens seen in neonatal sepsis? - CORRECT ANSWER E. Coli Which of the following tests would be appropriate for a newborn whose mom has HIV? - CORRECT ANSWER DNA and polymerase chain reaction test 48 hours of age Congenital varicella syndrome is characterized by? - CORRECT ANSWER Early death In the newborn a tense fontanelle is a? - CORRECT ANSWER 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? - CORRECT ANSWER Persistent cough, rales and wheezes Informed consent rests on the assumption of competence and? - CORRECT ANSWER Capacity The foundation for nursing education, practice and documentation is? - CORRECT ANSWER Nursing process The means of insuring enforcement of the nursing practice act is through the? - CORRECT ANSWER State board of nursing Most medical and nursing errors occur because of? - CORRECT ANSWER Non-adherence system failures Validity as applied to a research instrument demonstrates? - CORRECT ANSWER Degree to which the instrument measures what it was purported to measure Parasympathetic vs sympathetic work together to regulate variability - CORRECT ANSWER Pokey slow = p, s= stimulus When the sympathetic nervous system is dominant, fetal variability.... - CORRECT ANSWER Decreases Cord compression can cause accelerate true or false - CORRECT ANSWER True Overshoot/shoulder - CORRECT ANSWER No longer a term. Cause by umbilical vein compression Cerebral blood flow interruption causes - CORRECT ANSWER Early decal think head compression Vagal response As fetus matures which branch of the nervous system has more influence over FHR variability - CORRECT ANSWER Parasympathetic takes over after 32 weeks Max 24 hour IV dose labetelol - CORRECT ANSWER 220 Hyperventilation is caused by what hormone? - CORRECT ANSWER Progesterone Fetal attitude - CORRECT ANSWER Relation of fetal parts to each other - I.e. Flexed or not flexed Leopolds 1 st manueveur - CORRECT ANSWER Presentation FLM using lamellalar body count - CORRECT ANSWER 30,000-50,000 = mature Nitrazine - CORRECT ANSWER Blue 7.1 rupture 7.5 blood or mucus Burr cells - CORRECT ANSWER Hemolysis on smear = HELLP Gaskin manueveur - CORRECT ANSWER All 4's for shoulder Normally during pregnancy, maternal sitting and standing blood pressure readings - CORRECT ANSWER Decrease, then increase What happens to maternal PaO2 and PaCO2 during pregnancy? - CORRECT ANSWER PaO2 increases and PaCO2 decreases The slight increase in pH that occurs during pregnancy is due to - CORRECT ANSWER An increase in ventilatory rate During pregnancy, serum urea and creatinine levels - CORRECT ANSWER Decrease During pregnancy cardiac out put increases approx - CORRECT ANSWER 30-50% By term blood flow to the uterus is approximately - CORRECT ANSWER 500ml/min Metabolic changes in pregnancy are - CORRECT ANSWER Anabolic -1st half, catabolic 2nd half The primary determinant of volume hemostasis - CORRECT ANSWER Renal sodium Increased absorption of calcium is due to increased - CORRECT ANSWER Vitamin D (or calciferol) Placental production of this hormone requires interaction of the mother, fetus and placenta - CORRECT ANSWER Estriol The 5 diabetogenic hormones of pregnancy - CORRECT ANSWER Prolactin, estrogen, progesterone, human placental lactogen, cortisol Congenital cardiac disease occurs in what approximate percentage of live births? - CORRECT ANSWER 0.8% Mitral and aortic stenosis are examples of cardiac diseases caused by - CORRECT ANSWER Rheumatic fever During pregnancy, predicted values of peak expiratory flow rates are - CORRECT ANSWER Unchanged During a asthma exacerbation there is - CORRECT ANSWER Increased peripheral vascular resistance A complication seen in up to 26% of women with varicella pneumonia in the first 20weeks of gestation is - CORRECT ANSWER Intrauterine infection The prenatal diagnostic screening test most accurate in multiple gestations is - CORRECT ANSWER Nuchal translucency Multiple congenital anomalies have been associated with maternal obesity such as - CORRECT ANSWER Cleft lip and palate Fetal programming refers to - CORRECT ANSWER 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 - CORRECT ANSWER Decreased Extremely obese women have a what % higher risk of stillbirth than a woman of normal weight - CORRECT ANSWER 40% The normal length of the pre gravid cervix is - CORRECT ANSWER 3.5 to 4 cm Bishop score evaluates - CORRECT ANSWER Dilation Effacement Station Consistency Position Oxygen is transferred from mother to fetus by - CORRECT ANSWER Passive diffusion Most fetal dysthymias are benign. The exception is which dysthymia that may lead to fetal congestive heart failure? - CORRECT ANSWER Supraventricular tachycardia The greatest complication of tocolytic therapy for women with multiple gestations is - CORRECT ANSWER Pulmonary edema Pain in 1st stage of labor is caused by - CORRECT ANSWER Cervical and lower uterine segment stretching and traction on ovaries, Fallopian tubes and uterine ligaments The release of maternal catecholamines during labor results in - CORRECT ANSWER Uterine hypoperfusion and decreased blood flow to the placenta Baroreceptors mediate what kind of decel - CORRECT ANSWER Variable Normal metabolic changes during the postpartum period include increased levels of - CORRECT ANSWER Plasma renin and angiotensin II Peak cardiac output at birth occurs at - CORRECT ANSWER 10 to 15 minutes Intrauterine infection should be suspected when newborn has elevated - CORRECT ANSWER IgM Maternal transmission of which antibodies protects the newborn from bacterial and viral infections for which the mother has already produced antibodies - CORRECT ANSWER IgG Non shivering thermogenesis generates heat In the newborn through - CORRECT ANSWER Brown fat Tears are normally absent in a baby until - CORRECT ANSWER 4 to 6 months Newborn femoral pulses should characteristically be decreased or absent in - CORRECT ANSWER Hip dysplasia A persistent newborn heart rate of less than 100 is consistent with - CORRECT ANSWER Congenital Heart block In the neonate blood pressure in the lower extremities is usually - CORRECT ANSWER Higher than in the upper extremities To measure fontanelles accurately a ruler or measuring tape is placed - CORRECT ANSWER Diagonally Bone to bone Bowel sounds are expected to be present in the newborn - CORRECT ANSWER After passage of the first meconium stool The most common abnormal neck finding in newborns - CORRECT ANSWER Cystic hygroma Popping sensations (similar to indenting a ping pong ball) felt when palpating the parietal or occipital bones of the newborn are called - CORRECT ANSWER Craniotabes The anterior fontanelle normally closes at - CORRECT ANSWER 18 months The posterior fontanelle normally closes at about - CORRECT ANSWER 2 to 4 months Apnea refers to pauses in respiration that last - CORRECT ANSWER 20 seconds or longer Newborns cam clearly see an object that is - CORRECT ANSWER 8 to 10 inches away What is phimosis - CORRECT ANSWER 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 - CORRECT ANSWER Torticollis What causes acrocyanosis - CORRECT ANSWER Vasomotor instabilty - worsens if chilled The onset of milk production in a postpartum woman is triggered by - CORRECT ANSWER Sudden decrease in progesterone The hormone responsible for milk ejection - CORRECT ANSWER Oxytocin In order to prevent damage to the fetus, syphyllis should be treated by... - CORRECT ANSWER 16-18 weeks gestation The ischial tuberosity diameter considered adequate for delivery of the fetal head is - CORRECT ANSWER 11 cm Distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis - CORRECT ANSWER 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 - CORRECT ANSWER True conjugate - 10.5-11cm How much weight should a pregnant pt with twins or triplets gain - CORRECT ANSWER 25-35 lbs Damage to brachial plexus (c5-c7) - CORRECT ANSWER Erb palsy Before compressing the uterus to expel clots it is essential to: - CORRECT ANSWER Make sure uterus is contracted . Applying external pressure on a non contracted uterus may result in uterine inversion Newborn polycythemia - CORRECT ANSWER 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 - CORRECT ANSWER Sleep deprivation Long term inhaled corticosteroid therapy to treat asthma has been implicated in increased incidence of - CORRECT ANSWER 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? - CORRECT ANSWER No need for testing What is the most common maternal congenital cardiac lesion with a left-to-right shunt that is detected during pregnancy? - CORRECT ANSWER Mitral stenosis During pregnancy which of the following cardiovascular parameters decreases by at least 20% - CORRECT ANSWER 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 - CORRECT ANSWER Abdominal prep is initiated Ultrasound for antepartum testing uses high frequency sound waves to produce an image that varies based on - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER Come in for evaluation Which FHR pattern characteristic determines fetal oxygen reserve? - CORRECT ANSWER Presence of variability With an fse with artifact, what nursing intervention is appropriate? - CORRECT ANSWER Auscultate to r/o arrhythmia Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? - CORRECT ANSWER Early decel Vagal stimulation would be manifested as what type of FHR pattern? - CORRECT ANSWER Early A risk of aminofusion is - CORRECT ANSWER Uterine overdistension A fetal hr pattern that can occur with a prolapsed cord is? - CORRECT ANSWER Prolonged Palpating the uterus is best performed by using the - CORRECT ANSWER 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? - CORRECT ANSWER 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? - CORRECT ANSWER HCO3 For what gestational ages would you test FFN? - CORRECT ANSWER 22-35 In post term preg, the most important u/s parameter is - CORRECT ANSWER AFI One theory of labor initiation is an increase in? - CORRECT ANSWER Progesterone A pt had an unsuccessful external cephalic version. How soon can this be repeated? - CORRECT ANSWER 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? - CORRECT ANSWER No action An episiotomy is selectively used for? - CORRECT ANSWER Abnormal FHR pattern Compared to a mediolateral episiotomy, a midline episiotomy results in? - CORRECT ANSWER Less blood loss A newborn is at higher risk of jaundice when? - CORRECT ANSWER 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? - CORRECT ANSWER 3 in 20 minutes The risk of water intoxication is decreased during induction of labor if oxytocin is given in a - CORRECT ANSWER Balanced electrolyte solution The mechanism of action of sterile water injections for labor pain - CORRECT ANSWER Gate control theory Discontinuing an epidural when a woman has the urge to push may - CORRECT ANSWER Lead to dysfunctional uterine activity A characteristic of velementous cord insertion is - CORRECT ANSWER Lack of whartons jelly What type of breech has the highest risk of cord prolapse - CORRECT ANSWER Footling A 36 weeks woman needs cpr for cardiac arrest. Recommended action to facilitate cardiac output during resuscitation is - CORRECT ANSWER Uterine displacement A placental condition that occurs when the fetal vessels course through the amniotic membranes and are present at the cervical os is - CORRECT ANSWER Vasa previa When 2nd stage labor lasts longer than 2 hours with normal FHR current recommendations are to - CORRECT ANSWER Continue to watch if there is evidence of descent One absolute contraindication to epidural anesthesia is - CORRECT ANSWER Coagulapathy A woman with hydramnios is experiencing abdominal pain and dyspnea. Treatment with indomethacin will - CORRECT ANSWER Decrease fetal urine production Research has shown that administration of IV fluids during preterm labor - CORRECT ANSWER Increases risks when combined with tocolytics A clinical sign of plancental abruption is - CORRECT ANSWER 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 - CORRECT ANSWER Low segment vertical Treating the preterm pt with bed rest increases - CORRECT ANSWER Glucose intolerance FDA warns against oral or injectible terbutaline longer than 72 hrs due to - CORRECT ANSWER 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 - CORRECT ANSWER Calcium activity Neurological injury in a twin who survives the IUFD of the co-twin is most likely due to - CORRECT ANSWER Significant hypotension at the time of the demise The interactive process of the father with the newborn is termed - CORRECT ANSWER Engrossment Maternal contraindication to breastfeeding - CORRECT ANSWER 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 - CORRECT ANSWER Sterile water, then plain water What neonatal complication is reduced with vaginal delivery - CORRECT ANSWER 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 - CORRECT ANSWER 4.0 mg 2nd Leopold - CORRECT ANSWER Palpate fetal back 3rd Leopold - CORRECT ANSWER Determine if engaged 4th Leopold - CORRECT ANSWER Fetal descent and fetal attitude 1st Leopold manuever - CORRECT ANSWER To determine presenting part at the fund us Respiratory acidosis - CORRECT ANSWER Results from a build up of CO2 in the blood by lungs retaining Main cause of respiratory acidosis - CORRECT ANSWER Apnea, poor ventilation In respiratory acidosis - CORRECT ANSWER CO2 is increased, bicarbonate (HCO3-)is either normal (uncompensated) or increased (compensated) Respiratory alkalosis is - CORRECT ANSWER Hyperventilation is the main cause,resulting in a loss of CO2 Metabolic acidosis - CORRECT ANSWER Increased production of H+ by the body or increased excretion of bicarb by the kidney Metabolic acidosis main causes - CORRECT ANSWER Hypoxia, lactic acidosis, ketoacidosis, and chronic renal failure Labs in metabolic acidosis - CORRECT ANSWER PH is low, bicarb is decreased, CO 2 decreased, O2 increased In metabolic acidosis, - CORRECT ANSWER Due to respiratory compensation (hyperventilation)', Co2 decreased, O2 increased In metabolic alkalosis - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER Further obstetrical history details The tocolytic that is contraindicated in the diabetic woman is A. Mag sulfate B. Nifedipine C. Terbutaline (beta-mimetic) - CORRECT ANSWER Terbutaline (beta-MIMETICS) A woman received mag sulfate during labor GHTN. What effect can this have on the newborn? - CORRECT ANSWER 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? - CORRECT ANSWER Trisomy 21 What is associated with elevated maternal serum alpha protein? - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER Septic shock A postpartum pt is diagnosed with sheehans syndrome which is caused by - CORRECT ANSWER Postpartum necrosis A woman 4 hours postpartum reports sudden, excruciating vulvar pain and severe rectal pressure. This pt is likely exhibiting symptoms of - CORRECT ANSWER Vulvar hematoma Functional closure of the ductus arteriosis occurs as a result of - CORRECT ANSWER Increased arterial oxygen tension A woman with hydramnios is experiencing abdominal pain and dyspnea. Treatment with indomethacin will - CORRECT ANSWER 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 - CORRECT ANSWER Maintain the infusion rate A woman with a BMI of 18 gains 25 pounds during her pregnancy. The pregnancy is at increased risk for - CORRECT ANSWER Low birthweight infant Within the first two days after birth, progesterone levels fall causing what acid base change - CORRECT ANSWER Increased PaCO2 and low ph What acid base change is normal in pregnancy? - CORRECT ANSWER 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? - CORRECT ANSWER BUN The cause of sudden late onset postpartum hemorrhage secondary to retained placental fragments is due to - CORRECT ANSWER Necrotic tissue separation from the uterus The insulin requirement for most breastfeeding women is - CORRECT ANSWER 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 - CORRECT ANSWER Vital signs including lung sounds and assessment of pedal edema What % of women with gestation Htn will develop proteinuria - CORRECT ANSWER 25% In the absence of proteinuria, preeclampsia can be diagnosed with new onset of any of the following: - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER Must have prior diagnoses of CHTN or before 20 weeks Superimposed pre-e diagnosed when - CORRECT ANSWER 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 - CORRECT ANSWER New onset grand mal sx in pt with pre-e HELLP - CORRECT ANSWER Hemolysis - abnormal peripheral smear (shistocytes, burr cells), LDH > 600, total bilirubin >= 1.2, elevated liver enzymes, serum asparate amniotransferase>70, low pots< 150,000 Secondary causes of hypertension - CORRECT ANSWER Cortisol, pituitary tumor, glucocorticoid meds, sleep apnea, meth/cocaine, renal artery stenosis Path physiology of Htn - CORRECT ANSWER 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 - CORRECT ANSWER Constriction of spiral arterioles and decreased blood flow in the intervillous space, risk for fetal hypoxemia and metabolic acidemia Acidosis - CORRECT ANSWER Increase in hydrogen ions in tissue Metabolic acidosis - CORRECT ANSWER Low bicarb (base excess) in the presence of normal (PCO2) Respiratory acidosis - CORRECT ANSWER High pco2 with normal bicarb Asphyxia - CORRECT ANSWER Hypoxia with metabolic acidosis Cord ph - arteries - CORRECT ANSWER From fetus - deoxygenated Cord ph - vein - CORRECT ANSWER To fetus oxygenated FHR tones of baby in ROP position best assessed over - CORRECT ANSWER Right lower quad Crettas - CORRECT ANSWER Think alphabet in order of badness Doppler flow - rising s/d ratios - CORRECT ANSWER Reflect blood flow resistance to placenta, demonstrates dismissed vessel flow volume