Online Reference Notes: Obstetric Nursing

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HI there....welcome To test visual acuity, the nurse should ask the patient to cover each eye separately and read the eye chart with glasses and without, as appropriate. Fundamental of Nursing Before teaching any procedure to the patient, the nurse must first assess the patient’s willingness to learn and his current knowledge. Fundamentals of Nursing A blood pressure cuff that is too narrow can cause a falsely elevated blood pressure reading. Fundamentals of Nursing When preparing a single injection for a patient who takes regular and NPH insulin, the nurse should draw the regular insulin into the syringe first because it is clear and can be measured more accurately than the NPH insulin, which is turbid. Fundamentals of Nursing Rhonchi refers to the rumbling sounds heard on lung auscultation; they are more pronounced during expiration than during inspiration. Fundamentals of Nursing Gavage refers to forced feeding, usually through a gastric tube (a tube passed into the stomach by way of the mouth). Fundamentals of Nursing According to Maslow’s hierarchy of needs, physiologic needs (air, water, food, shelter, sex, activity, and comfort) have the highest priority. Fundamentals of Nursing Checking the identification band on a patient’s wrist is the safest and surest way to verify a patient’s identity. Fundamentals of Nursing A patient’s safety is the priority concern in developing a therapeutic environment. Fundamentals of Nursing The nurse should place the patient with a Sengstaken-Blakemore tube in semi-Fowler’s position. Fundamentals of Nursing The nurse can elicit Trousseau’s sign by occluding the brachial or radial artery; hand and finger spasms during occlusion indicate Trousseau’s sign and suggest hypocalcemia. Fundamentals of Nursing For blood transfusion in an adult, the appropriate needle size is 16 to 20G. Fundamentals of Nursing Pain that incapacities a patient and can’t be relieved by drugs is called intractable pain. Fundamentals of Nursing In an emergency, consent for treatment can be obtained by fax, telephone, or other telegraphic transmission. Fundamentals of Nursing Decibel is the unit of measurement of sound. Fundamentals of Nursing Informed consent is required for any invasive procedure. Fundamentals of Nursing A patient who can’t write his or her name to give consent for treatment must have his or her X witnessed by two persons, such as a nurse, priest, or doctor. Fundamentals of Nursing The Z-track I.M. injection technique seals medication deep into the muscle, thereby minimizing skin irritation and staining. It requires a needle that is 1’’ (2.5 cm) or longer. Fundamentals of Nursing A registered nurse (RN) should assign a licensed vocational nurse (LVN) or licensed practical nurse (LPN) to perform bedside care, such as suctioning and medication administration. Fundamentals of Nursing The therapeutic purposed of a mist tent is to increase hydration of secretions. Fundamentals of Nursing If a patient can’t void, the first nursing action should be bladder palpation to assess for bladder distention. Fundamentals of Nursing The patient who uses a cane should carry it on the unaffected side and advance it at the same time as the affected extremity. Fundamentals of Nursing To fit a supine patient for crutches, the nurse should measure from the axilla to the sole and add 2” (5 cm) to that measurement. Fundamentals of Nursing Assessment begins with the nurse’s first encounter with the patient and continues throughout the patient’s stay. The nurse obtains assessment data through the health history, physical examination, and review of diagnostic studies. Fundamentals of Nursing The appropriate needle size for an insulin injection is 25G and ⅝" (1.5 cm) long. Fundamentals of Nursing Residual urine refers to urine that remains in the bladder after voiding. The amount of residual urine normally ranges from 50 to 100 ml. Fundamentals of Nursing The five stages of the nursing process are assessment, nursing diagnosis, planning, implementation, and evaluation. Fundamentals of Nursing Planning refers to the stage of the nursing process in which the nurse assigns priorities to nursing diagnoses, defines short-term and long-term goals and expected outcomes, and establishes the nursing care plan. Fundamentals of Nursing Implementation refers to the stage of the nursing process in which the nurse puts the nursing care plan into action, delegates specific nursing interventions to members of the nursing team, and charts patient responses to nursing interventions. Fundamentals of Nursing Evaluation refers to the stage of the nursing process in which the nurse compares objective and subjective data with the outcome criteria and, if needed, modifies the nursing care plan, making the nursing process circular. Fundamentals of Nursing In the event of fire, the nurse should (1) remove the patient, (2) call the fire department, (3) attempt to contain the fire by closing the door, and (4) extinguish the fire, if it can be done safely. Fundamentals of Nursing Before administering any as need pain medication, the nurse should ask the patient to indicate the pain’s location. Fundamentals of Nursing Jehovah’s Witnesses believe that they shouldn’t receive blood components donated by other people. Fundamentals of Nursing When providing oral care for an unconscious patient, the nurse should position the patient on the side to minimize the risk of aspiration. Fundamentals of Nursing During assessment of distance vision, the patient should stand 20’ (6.1 m) from the chart. Fundamentals of Nursing The ideal room temperature for a geriatric patient or one who is extremely ill ranges form 66º to 76º F (18.8º to 24.4º C). Fundamentals of Nursing Normal room humidity ranges from 30% to 60%. Fundamentals of Nursing Hand washing is the single best method of limiting the spread of microorganisms. Hands should be washed for 10 seconds after routine contact with a patient and after gloves are removed. Fundamentals of Nursing To catheterize a female patient, the nurse should place her in the dorsal recumbent position. Fundamentals of Nursing A positive Homan’s sign may indicate thrombophlebitis. Fundamentals of Nursing Electrolytes in a solution are measured in milliequivalents per liter (mEq/L). A milliequivalent equals the number of milligrams per 100 milliliters of a solution. Fundamentals of Nursing Metabolism takes a place in two phases: anabolism (the constructive phase) and catabolism (the destructive phase). Fundamentals of Nursing The basal metabolic rate represents the amount of energy needed to maintain essential body functions. It is measured when the patient is awake and resting, hasn’t eaten for 14 to 18 hours, and is in a comfortable, warm environment. Fundamentals of Nursing Dietary fiber (roughage), which is derived from cellulose, supplies bulk, maintains adequate intestinal motility, and helps establish regular bowel habits. Fundamentals of Nursing Alcohol is metabolized primarily in the liver. Smaller amounts are metabolized by the kidneys and lungs. Fundamentals of Nursing Petechiae refers to tiny, round, purplish red spots that appear on the skin and mucous membranes as a result of intradermal or submucosal hemorrhage. Fundamentals of Nursing Purpura refers to a purple skin discoloration caused by blood extravasation. Fundamentals of Nursing Glucose-6-phosphate dehydrogenase (C6PD) deficiency is an inherited metabolic disorder characterized by red blood cells that are deficient in G6PD, a critical enzyme in aerobic glycolysis. Fundamentals of Nursing According to the standard precautions recommended by the Centers for Disease Control and Prevention, the nurse shouldn’t recap needles after use because most needle sticks result from missed needle recapping. Fundamentals of Nursing The nurse administers a drug by I.V. push by delivering the dose directly into a vein, I.V. tubing, or catheter with a needle and syringe. Fundamentals of Nursing When changing the ties on a tracheostomy tube, the nurse should leave the old ties in place until the new ones are applied. Fundamentals of Nursing A nurse should have assistance when changing the ties on a tracheostomy tube. Fundamentals of Nursing A filter is always used for blood transfusions. Fundamentals of Nursing A four-point (quad) cane is indicated when a patient needs more stability than a regular cane can provide. Fundamentals of Nursing The patient should carry a cane on the unaffected side to promote a reciprocal gait pattern and distribute weight away from the affected leg. Fundamentals of Nursing A good way to begin a patient interview is to ask “What made you seek medical help?” Fundamentals of Nursing The nurse should adhere to standard precautions for blood and body fluids when caring for all patients. Fundamentals of Nursing Potassium (K+) is the most abundant cation in intracellular fluid. Fundamentals of Nursing In the four-point gait (or alternating gait), the patient first moves the right crutch followed by the left foot and then the left crutch followed by the right foot. Fundamentals of Nursing In the three-point gait, the patient moves two crutches and the affected leg simultaneously and then moves the unaffected leg. Fundamentals of Nursing In the two-point gait, the patient moves the right leg and the left crutch simultaneously and then moves the left leg and the right crutch. Fundamentals of Nursing Vitamin B complex, the water-soluble vitamins essential for metabolism, include thiamine (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), and cyanocobalamin (B12). Fundamentals of Nursing When being weighed, an adult patient should be lightly dressed and shoeless. Fundamentals of Nursing Before taking an adult’s oral temperature, the nurse should ensure that the patient hasn’t smoked or consumed hot or cold substances in the past 15 minutes. Fundamentals of Nursing The nurse shouldn’t take a rectal temperature on an adult patient if the patient has a cardiac disorder; anal lesions, or bleeding hemorrhoids or has recently undergone rectal surgery. Fundamentals of Nursing In a patient with cardiac problems, rectal temperature measurement may stimulate a vagal response, leading to vasodilation and decreased cardiac output. Fundamentals of Nursing When recording pulse amplitude and rhythm, the nurse should use these descriptive measures: +3 indicates a bounding pulse (readily palpable and forceful); +2, a normal pulse (easily palpable); +1, a thready or weak pulse (difficult to detect); and 0, an absent pulse (not detectable). Fundamentals of Nursing The intraoperative period begins when a patient is transferred to the operating room bed and ends when the patient is admitted to the postanesthesia recovery unit. Fundamentals of Nursing On the morning of surgery, the nurse should ensure that the informed consent form has been signed; that the patient hasn’t taken anything by mouth since midnight, has taken a shower with antimicrobial soap, has had mouth care (without swallowing the water, has removed common jewelry, and has received preoperative medication as prescribed; and that vital signs have taken and recorded. Artificial limbs and other prostheses are usually removed. Fundamentals of Nursing Comfort measures, such as positioning the patient, performing backrubs, and providing a restful environment, may decrease the patient’s need for analgesics or may enhance their effectiveness. Fundamentals of Nursing A drug has three names: its generic name, which is used in official publications; its trade name or brand name (such as Tylenol), which is selected by the drug company; and its chemical name, which describes the drug’s chemical composition. Fundamentals of Nursing The patient should take a liquid iron preparation through a straw to avoid staining the teeth. Fundamentals of Nursing The nurse should use the Z-track method to administer an I.M. injection of iron dextran (Imferon). Fundamentals of Nursing An organism may enter the body through the nose, mouth, rectum, urinary or reproductive tract, or skin. Fundamentals of Nursing In descending order, the levels of consciousness are alertness, lethargy, stupor, light coma, and deep coma. Fundamentals of Nursing To turn a patient by logrolling, the nurse folds the patient’s arms across the chest; extends the patient’s legs and inserts a pillow between them, if indicated; places a draw sheet under the patient; and turns the patient by slowly and gently pulling on the draw sheet. Fundamentals of Nursing The diaphragm of the stethoscope is used to hear high-pitched sounds such as breath sounds. Fundamentals of Nursing A slight blood pressure difference (5 to 10 mm Hg) between right and left arms is normal. Fundamentals of Nursing The nurse should place the blood pressure cuff 1'' (2.5 cm) above the antecubital fossa. Fundamentals of Nursing When instilling ophthalmic ointments, waste the first bed of ointment and then apply from the inner canthus to the outer canthus; twist the medication tube to detach the ointment. Fundamentals of Nursing The nurse should use a leg cuff to measure blood pressure in an obese patient. Fundamentals of Nursing If the blood pressure cuff is applied too loosely, the reading will be falsely elevated. Fundamentals of Nursing Ptosis refers to eyelid drooping. Fundamentals of Nursing A tilt table is useful for a patient with a spinal cord injury, orthostatic hypotension, or brain damage because it can move the patient gradually from a horizontal to a vertical (upright) position. Fundamentals of Nursing To perform venipuncture with the least injury to the vessel, the nurse should turn the bevel upward when the vessel’s lumen is larger than the needle and turn it downward when the lumen is only slightly larger than the needle. Fundamentals of Nursing To move the patient to the edge of the bed for transfer, follow these steps: (1) Move the patient’s head and shoulders toward the edge of the bed. (2) Move the patient’s feet and legs to the edge of the bed (crescent position). (3) Place both the arms well under the patient’s hips and straighten the back while moving the patient toward the edge of the bed. Fundamentals of Nursing When being measured for crutches, a patient should wear his or her shoes. Fundamentals of Nursing The nurse should attach a restraint to a part of the bed frame that moves with the head, not to the mattress or side rails. Fundamentals of Nursing The mist in a mist tent should never become so dense that it obscures clear visualization of the patient’s respiratory pattern. Fundamentals of Nursing To administer heparin subcutaneously, the nurse should follow these steps: (1) Clean, but don’t rub, the site with alcohol. (2) Stretch the skin taut or pick up a well-defined skin fold. (3)Hold the shaft of the needle in a dart position. (4)Insert the needle into the skin at a right (90-degree) angle. (5)Firmly depress the plunger; but don’t aspirate. (6)Leave the needle in place for 10 seconds. (7)Withdraw the needle gently at the same angle it was inserted. (8)Apply pressure to the injection site with an alcohol pad. Fundamentals of Nursing For a sigmoidoscopy, the nurse should place the patient in a knee-chest or Sims’ position, depending on the doctor’s preference. Fundamentals of Nursing Maslow’s hierarchy of needs must be met in the following order: physiologic (oxygen, food, water, sex, rest, and comfort) safety and security, love and belonging, self-esteem and recognition, and self-actualization. Fundamentals of Nursing When caring for patient with a nasogastric tube, the nurse should apply a water-soluble lubricant to the nostril to prevent soreness. Fundamentals of Nursing During gastric lavage, a nasogastric tube is inserted, the stomach is flushed, and ingested substances are removed through the tube. Fundamentals of Nursing In documenting drainage on a surgical dressing, the nurse should include the size, color, and consistency of the drainage, for example, “10 mm of brown mucoid drainage noted on dressing.” Fundamentals of Nursing To elicit Babinski’s reflex, the nurse strokes the sole of the patient’s foot with a moderately sharp object, such as thumbnail. Fundamentals of Nursing In a positive Babinski’s reflex, the great toe dorsiflexes and the other toes fan out. Fundamentals of Nursing When assessing a patient for bladder distention, the nurse should check the contour of the lower abdomen for a rounded mass above the symphysis pubis. Fundamentals of Nursing The best way to prevent pressure ulcers is to reposition the bedridden patient at least every 2 hours. Fundamentals of Nursing Antiembolism stockings decompress the superficial blood vessels, thereby reducing the risk of thrombus formation. Fundamentals of Nursing The most convenient veins for venipuncture in a adult patient are the basilic and median cubital veins in the antecubital space. Fundamentals of Nursing From 2 to 3 hours before beginning a tube feeding, the nurse should aspirate the patient’s stomach contents to verify adequate gastric emptying. Fundamentals of Nursing People with type O blood are considered to be universal donors. Fundamentals of Nursing People with type AB blood are considered to be universal recipients. Fundamentals of Nursing Herts (Hz) refers to the unit of measurement of sound frequency. Fundamentals of Nursing Hearing protection is required when the sound intensity exceeds 84 dB; double hearing protection is required if it exceeds 104 dB. Fundamentals of Nursing Prothrombin, a clotting factor, is produced in the liver. Fundamentals of Nursing If a patient is menstruating when a urine sample is collected, the nurse should note this on the laboratory slip. Fundamentals of Nursing During lumbar puncture, the nurse must note the initial intracranial pressure and the cerebrospinal fluid color. Fundamentals of Nursing A patient who can’t cough to provide a sputum sample for culture may require a heated aerosol treatment to facilitate removal of a sample. Fundamentals of Nursing If eye ointment and eyedrops must be instilled in the same eye, the eyedrops should be instilled first. Fundamentals of Nursing When leaving an isolation room, the nurse should remove the gloves before the mask because fewer pathogens are on the mask. Fundamentals of Nursing Skeletal traction is applied to a bone using wire pins or tons. It is the most effective means of traction. Fundamentals of Nursing The total parenteral nutrition solution should be stored in a refrigerator and removed 30 to 60 minutes before use because delivery of a chilled solution can cause pain, hypothermia, venous spasm, and venous constriction. Fundamentals of Nursing Medication isn’t routinely injected I.M. into edematous tissue because it may not be absorbed. Fundamentals of Nursing When caring for a comatose patient, the nurse should explain each action to the patient in a normal voice. Fundamentals of Nursing When cleaning dentures, the sink should be lined with a washcloth. Fundamentals of Nursing A patient should void within 8 hours after surgery. Fundamentals of Nursing An EEG identifies normal and abnormal brain waves. Fundamentals of Nursing Stool samples for ova and parasite tests should be delivered to the laboratory without delay or refrigeration. Fundamentals of Nursing The autonomic nervous system regulates the cardiovascular and respiratory systems. Fundamentals of Nursing When providing tracheostomy care, the nurse should insert the catheter gently into the tracheostomy tube. When withdrawing the catheter, the nurse should apply intermittent suction for no more than 15 seconds and use a slight twisting motion. Fundamentals of Nursing A low-residue diet includes such as foods as roasted chicken, rice, and pasta. Fundamentals of Nursing A rectal tube should not be inserted for longer than 20 minutes; it can irritate the mucosa of the rectum and cause a loss of sphincter control. Fundamentals of Nursing A patient’s bed bath should proceed in this order: face, neck, arms, hands, chest, abdomen, back, legs, perineum. Fundamentals of Nursing When lifting and moving a patient, the nurse should use the upper leg muscles most to prevent injury. Fundamentals of Nursing Patient preparation for cholecystography includes ingestion of a contrast medium and a low-fat evening meal. Fundamentals of Nursing During occupied bed changes, the patient should be covered with a black blanket to promote warmth and prevent exposure. Fundamentals of Nursing Anticipatory grief refers to mourning that occurs for an extended time when one realizes that death is inevitable. Fundamentals of Nursing The following foods can alter stool color: beets (red), cocoa (dark red or brown), licorice (black), spinach (green), and meat protein (dark brown). Fundamentals of Nursing When preparing a patient for a skull X-ray, have the patient remove all jewelry and dentures. Fundamentals of Nursing The fight-or-flight response is a sympathetic nervous system response. Fundamentals of Nursing Bronchovesicular breath sounds in peripheral lung fields are abnormal and suggest pneumonia. Fundamentals of Nursing Wheezing refers to an abnormal, high-pitched breath sound that is accentuated on expiration. Fundamentals of Nursing Wax or a foreign body in the ear should be gently flushed out by irrigation with warm saline solution. Fundamentals of Nursing If a patient complains that his hearing aid is “not working,” the nurse should check the switch first to see if it’s turned on and then check the batteries. Fundamentals of Nursing The nurse should grade hyperactive biceps and triceps reflexes +4. Fundamentals of Nursing If two eye medications are prescribed for twice-daily instillation, they should be administered 5 minutes apart. Fundamentals of Nursing In a postoperative patient, forcing fluids helps prevent constipation. Fundamentals of Nursing The nurse must administer care in accordance with standards of care established by the American Nurses Association, state regulations, and facility policy. Fundamentals of Nursing The kilocalorie (kcal) is a unit of energy measurement that represents the amount of heat needed to raise the temperature of 1 kilogram of water 1º C. Fundamentals of Nursing As nutrients move through the body, they undergo ingestion, digestion, absorption, transport, cell metabolism, and excretion. Fundamentals of Nursing The body metabolizes alcohol at a fixed rate regardless of serum concentration. Fundamentals of Nursing In an alcoholic beverage, its proof reflects its percentage of alcohol multiplied by 2. For example, a 100-proof beverage contains 50% alcohol. Fundamentals of Nursing A living will is a witnessed document that states a patient’s desire for certain types of care and treatment, which depends on the patient’s wishes and views and quality of life. Fundamentals of Nursing The nurse should flush a peripheral heparin lock every 8 hours (if it wasn’t used during the previous 8 hours) and as needed with normal saline solution to maintain patency. Fundamentals of Nursing Quality assurance is a method of determining whether nursing actions and practices meet established standards. Fundamentals of Nursing The five rights of medication administration are the right patient, right medication, right dose, right route of administration, and the right time. Fundamentals of Nursing Outside of the hospital setting, only the sublingual and transligual forms of nitroglycerin should be used to relieve acute anginal attacks. Fundamentals of Nursing The implementation phase of the nursing process involves recording the patient’s response to the nursing plan, putting the nursing plan into action, delegating specific nursing interventions, and coordinating the patient’s activities. Fundamentals of Nursing The Patient’s Bill of Rights offers guidance and protection to patients by stating the responsibilities of the hospital and its staff toward patients and their families during hospitalization. Fundamentals of Nursing To minimize the omissions and distortion of facts, the nurse should record information as soon as it is gathered. Fundamentals of Nursing When assessing a patient’s health history, the nurse should record the current illness chronologically, beginning with the onset of the problem and continuing to the present. Fundamentals of Nursing Drug administration is a dependent activity. The nurse can administer or withhold a drug only with the doctor’s permission. Fundamentals of Nursing The nurse shouldn’t give false assurance to a patient. Fundamentals of Nursing After receiving preoperative medication, a patient isn’t competent to sign an informed consent form. Fundamentals of Nursing When lifting a patient, a nurse uses the weight of her body instead of the strength in her arms. Fundamentals of Nursing A nurse may clarify a doctor’s explanation to a patient about an operation or a procedure but must refer questions about informed consent to the doctor. Fundamentals of Nursing The nurse shouldn’t use her thumb to take a patient’s pulse rate because the thumb has a pulse of its own and may be confused with the patient’s pulse. Fundamentals of Nursing An inspiration and an expiration count as one respiration. Fundamentals of Nursing Normal respirations are known as eupnea. Fundamentals of Nursing During a blood pressure measurement, the patient should rest the arm against a surface because using muscle strength to hold up the arm may raise the blood pressure. Fundamentals of Nursing Major unalterable risk factors for coronary artery disease include heredity, sex, race, and age. Fundamentals of Nursing Inspection is the most frequently used assessment technique. Fundamentals of Nursing Family members of an elderly person in a long-term care facility should transfer some personal items (such as photographs, a favorite chair, and knickknacks) to the person’s room to provide a homey atmosphere. Fundamentals of Nursing The upper respiratory tract warms and humidifies inspired air and plays a role in taste, smell, and mastication. Fundamentals of Nursing Signs of accessory muscle use include shoulder elevation, intercostal muscle retraction, and scalene and sternocleidosmastoid muscle use during respiration. Fundamentals of Nursing When patients use axillary crutches, their palms should bear the brunt of the weight. Fundamentals of Nursing Activities of daily living include eating, bathing, dressing, grooming, toileting, and interacting socially. Fundamentals of Nursing Normal gait has two phases: the stance phase, in which the patient’s foot rests on the ground, and the swing phase, in which that patient’s foot moves forward. Fundamentals of Nursing The phases of mitosis are prophase, metaphase, anaphase, and telophase. Fundamentals of Nursing The nurse should follow standard precautions in the routine care of all patients. Fundamentals of Nursing The nurse should use the bell of the stethoscope to listen for venous hums and cardiac murmurs. Fundamentals of Nursing The nurse can assess a patient’s general knowledge by asking questions such as “Who is the president for the United States?” Fundamentals of Nursing Cold packs are applied for the first 20 to 48 hours after an injury; then heat is applied. During cold application, the pack is applied for 20 minutes and then removed for 10 to 15 minutes to prevent reflex dilation (rebound phenomenon) and frostbite injury. Fundamentals of Nursing The pons is located above the medulla and consists of white matter (sensory and motor tracts) and gray matter (reflex centers). Fundamentals of Nursing The autonomic nervous system controls the smooth muscles. Fundamentals of Nursing A correctly written patient goal expresses the desired patient behavior, criteria for measurement, time frame for achievement, and conditions under which the behavior will occur. It is developed in collaboration with the patient. Fundamentals of Nursing The optic disk is yellowish pink and circular with a distinct border. Fundamentals of Nursing A primary disability results from a pathologic process; a secondary disability, from inactivity. Nurses usually are held liable for failing to keep an accurate count of sponges and other devices during surgery. Fundamentals of Nursing The best dietary sources of vitamin B6 are liver, kidney, pork, soybeans, corn, and whole-grain cereals. Fundamentals of Nursing Iron-rich foods, such as organ meats, nuts, legumes, dried fruit, leafy vegetables, eggs, and whole gains, generally have low water content. Fundamentals of Nursing Collaboration refers to joint communication and decision making between nurses and doctors designed to meet patients’ needs by integrating the care regimens of both professions in one comprehensive approach. Fundamentals of Nursing Bradycardia refers to a heart rate of fewer than 60 beats/minute. Fundamentals of Nursing A nursing diagnosis is a statement of a patient’s actual or potential health problems that can be resolved, diminished, or otherwise changed by nursing interventions. Fundamentals of Nursing During the assessment phase of the nursing process, the nurse collects and analyzes three types of data: health history, physical examination, and laboratory and diagnostic test data. Fundamentals of Nursing The patient’s health history consists primarily of subjective data, information supplied by patient. Fundamentals of Nursing The physical examination includes objective data obtained by inspection, palpation, percussion, and auscultation. Fundamentals of Nursing When documenting patient care, the nurse should write legibly, use only standard abbreviations, and sign every entry. The nurse should never destroy or attempt to obliterate documentation or leave vacant lines. Fundamentals of Nursing Factors that affect body temperature include time of day, age, physical activity, phase of menstrual cycle, and pregnancy. Fundamentals of Nursing The most accessible and commonly used artery for measuring a patient’s pulse rate is the radial artery, which is compressed against the radius to take the pulse rate. Fundamentals of Nursing The normal pulse rate of a resting adult is 60 to 100 beats/minute. The rate is slightly faster in women than in men and much faster in children than in adults. Fundamentals of Nursing Laboratory test results are an objective form of assessment data. Fundamentals of Nursing The measurement systems most often used in clinical practice are the metric system, apothecaries’ system, and household system. Fundamentals of Nursing Before signing an informed consent, a patient should know whether other treatment options are available and should understand what will occur during the preoperative, intraoperative, and postoperative phase; the risk involved; and the possible complications. The patient also should have a general idea of the time required from surgery to recovery and should have an opportunity to ask questions. Fundamentals of Nursing A patient must sign a separate informed consent form for each procedure. Fundamentals of Nursing During percussion, the nurse uses quick, sharp tapping of the fingers or hands against body surfaces to produce sounds (that helps determine the size, shape, position, and density of underlying organs and tissues), elicit tenderness, or assess reflexes. Fundamentals of Nursing Ballottement is a form of light palpation involving gentle, repetitive bouncing of tissues against the hand and feeling their rebound. Fundamentals of Nursing A foot cradle keeps bed linen off the patient’s feet, which prevent skin irritation and breakdown, especially in a patient with peripheral vascular disease or neuropathy. Fundamentals of Nursing If the patient is a married minor, permission to perform a procedure can be obtained form the patient’s spouse. Fundamentals of Nursing Gastric lavage is the flushing of the stomach and removal of ingested substances through a nasogastric tube. It can be used to treat poisoning or drug overdose. Fundamentals of Nursing During the evaluation step of the nursing process, the nurse assesses the patient’s response to therapy. Fundamentals of Nursing Bruits commonly indicate a life- or limb-threatening vascular disease. Fundamentals of Nursing O.U. means each eye; O.D., right eye; and O.S, left eye. Fundamentals of Nursing To remove a patient’s artificial eye, the nurse depresses the lower lid. Fundamentals of Nursing The nurse should use a warm saline solution to clean an artificial eye. Fundamentals of Nursing A thready pulse is very fine and scarcely perceptible. Fundamentals of Nursing Axillary temperature usually is 1º F lower than oral temperature. Fundamentals of Nursing After suctioning a tracheostomy tube, the nurse must document the color, amount, consistency, and odor of secretions. Fundamentals of Nursing On a medication prescription, the abbreviation p.c. means that the medication should be administered after meals. Fundamentals of Nursing After bladder irrigation, the nurse should document the amount, color, and clarity of the urine and the presence of clots or sediment. Fundamentals of Nursing Laws regarding patient self-determination vary from state to state. Therefore, the nurse must be familiar with the laws of the state in which she works. Fundamentals of Nursing Gauge refers to the inside diameter of a needle. The smaller the gauge, the larger the diameter. Fundamentals of Nursing An adult normally has 32 permanent teeth. Fundamentals of Nursing After turning a patient, the nurse should document the position used, time turned, and skin assessment findings. Fundamentals of Nursing PERRLA is an abbreviation for normal pupil assessment findings: pupils equal, round, and reactive to light with accommodation. Fundamentals of Nursing When purcussing a patient’s chest for postural drainage, the nurse’s hands should be cupped. Fundamentals of Nursing When measuring a patient’s pulse, the nurse should assess the rate, rhythms, quality, and strength. Fundamentals of Nursing Before transferring a patient from a bed to a wheelchair, the nurse should push the wheelchair’s footrests to the sides and lock its wheels. Fundamentals of Nursing When assessing respirations, the nurse should document the rate, rhythm, depth, and quality. Fundamentals of Nursing For a subcutaneous injection, the nurse should use a ⅝" 25G needle. Fundamentals of Nursing The notation “AA & O x 3” indicates that the patient is awake, alert, and oriented to person (knows who he is), place (knows where he is), and time (knows the date and time). Fundamentals of Nursing Fluid intake includes all fluids taken by mouth, including foods that are liquid at room temperature, such as gelatin, custard, and ice cream; I.V. fluids; and fluids administered in feeding tubes. Fluid output includes urine, vomitus, and drainage (such as from a nasogastric tube or from a wound) as well as blood loss, diarrhea or stool, and perspiration. Fundamentals of Nursing After administering an intradermal injection, the nurse shouldn’t massage the area because massage can irritate the site and interfere with results. Fundamentals of Nursing When administering an intradermal injection, the nurse should hold the syringe almost flat against the patient’s skin (at about a 15-degree angle) with the bevel up. Fundamentals of Nursing To obtain an accurate blood pressure, the nurse should inflate the manometer 20 to 30 mm Hg above the disappearance of the radial pulse before releasing the cuff pressure. Fundamentals of Nursing The nurse should count an irregular pulse for 1 full minute. Fundamentals of Nursing A patient who is vomiting while lying down should be placed in a lateral position to prevent aspiration of vomitus. Fundamentals of Nursing Prophylaxis is disease prevention. Fundamentals of Nursing Body alignment is achieved when the body parts are in proper relation to their natural position. Fundamentals of Nursing Trust is the foundation of a nurse-patient relationship. Fundamentals of Nursing Blood pressure in the force exerted by the circulating volume of blood on arterial walls. Fundamentals of Nursing Malpractice refers to the professional’s wrongful conduct, improper discharge of duties, or failure to meet standers of care, which causes harm to another. Fundamentals of Nursing As a general rule, nurses can’t refuse a patient care assignment; however, they may refuse to participate in abortions in most states. Fundamentals of Nursing A nurse can be found negligent if a patient is injured because the nurse failed to perform a duty that a reasonable and prudent person would perform or because the nurse performed an act that a reasonable and prudent person wouldn’t perform. Fundamentals of Nursing States have enacted Good Samaritan laws to encourage professionals to provide medical assistance at the scene of an accident without fear of a lawsuit arising from such assistance. These laws don’t apply to care provided in a health care facility. Fundamentals of Nursing A doctor should sign verbal and telephone orders within the time established by institutional policy, usually within 24 hours. Fundamentals of Nursing A competent adult has the right to refuse lifesaving medical treatment; however, the individual should be fully informed of the consequences of this refusal. Fundamentals of Nursing Although a patient’s health record or chart is the health care facility’s physical property, its contents belong to the patient. Fundamentals of Nursing Before a patient’s record can be released to a third party, the patient or patient’s legal guardian must give written consent. Fundamentals of Nursing Under the Controlled Substances Act, every dose of a controlled drug dispensed by the pharmacy must be counted for, whether the dose was administered to a particular patient or discarded accidentally. Fundamentals of Nursing A nurse can’t perform duties that violate a rule or regulation established by a state licensing board even if it is authorized by a health care facility or doctor. Fundamentals of Nursing The nurse should select a private room, preferably with a door that can be closed, to minimize interruptions during a patient interview. Fundamentals of Nursing In categorizing nursing diagnosis, the nurse should address actual life-threatening problems first, followed by potentially life-threatening concerns. Fundamentals of Nursing The major components of a nursing care plan are outcome criteria (patient goals) and nursing interventions. Fundamentals of Nursing Standing orders, or protocols, establish guidelines for treating a particular disease or set of symptoms. Fundamentals of Nursing In assessing a patient’s heart, the nurse normally finds the point of maximal impulse at the fifth intercostals space near the apex. Fundamentals of Nursing The S1 sound heard on auscultation is caused by closure of the mitral and tricuspid valves. Fundamentals of Nursing To maintain package sterility, the nurse should open the wrapper’s top flap away from the body, open side flap by touching only the outer part of the wrapper, and open the final flap by grasping the turned-down corner and pulling it toward the body. Fundamentals of Nursing The nurse shouldn’t use a cotton-tipped applicator to dry a patient’s ear canal or remove wax because it may force cerumen against the tympanic membrane. Fundamentals of Nursing A patient’s identification bracelet should remain in place until the patient has been discharged from the health care facility and has left the premises. Fundamentals of Nursing The Controlled Substances Act designated five categories, or schedules, that classify controlled drugs according to their abuse liability. Fundamentals of Nursing Schedule I drugs, such as heroin, have a high abuse potential and have no currently accepted medical use in the United States. Fundamentals of Nursing Schedule II drugs, such as morphine, opium, and meperidine (Demerol), have a high abuse potential but have currently accepted medical uses. Their use may lead to physical or psychological dependence. Fundamentals of Nursing Schedule III drugs, such as paregoric and butabarbital (Butisol), have a lower abuse potential than Schedule I or II drugs. Abuse of Schedule III drugs may lead to moderate or low physical or psychological dependence, or both. Fundamentals of Nursing Schedule IV drugs, such as chloral hydrate, have a low abuse potential compared with Schedule III drugs. Fundamentals of Nursing Schedule V drugs, such as cough syrups that contain codeine, have the lowest abuse potential of the controlled substances. Fundamentals of Nursing Activities of daily living are actions that the patient must perform every day to provide self-care and interact with society. Fundamentals of Nursing Testing of the six cardinal fields of gaze evaluates the function of all extraocular muscles and cranial nerves III, IV, and VI. Fundamentals of Nursing The six types of heart murmurs are graded from 1 to 6. A grade 6 heart murmur can be heard with stethoscope slightly raised from the chest. Fundamentals of Nursing The most important goal to include in a care plan is the patient’s goal. Fundamentals of Nursing Fruits are high in fiber and low in protein and should be omitted from a low-residue diet. Fundamentals of Nursing The nurse should use an objective scale to assess and quantify pain because postoperative pain varies greatly among individuals. Fundamentals of Nursing Postmortem care includes cleaning and preparing the deceased patient for family viewing, arranging transportation to the morgue or funeral home, and determining the disposition of belongings. Fundamentals of Nursing The nurse should provide honest answers to the patient’s questions. Fundamentals of Nursing Milk shouldn’t be included in a clear liquid diet. Fundamentals of Nursing Consistency in nursing personnel is paramount when caring for a child, and infant, or a confused patient. Fundamentals of Nursing The hypothalamus secretes vasopressin and oxytocin, which are stored in the pituitary gland. Fundamentals of Nursing The three membranes that enclose that brain and spinal cord are the dura mater, pia mater, and arachnoid. Fundamentals of Nursing A nasogastric tube is used to remove fluid and gas from the small intestine preoperatively or postoperatively. Fundamentals of Nursing Psychologists, physical therapists, and chiropractors aren’t authorized to write prescriptions for medication. Fundamentals of Nursing The area around a stoma should be cleaned with mild soap and water. Fundamentals of Nursing Vegetables have a high fiber content. Fundamentals of Nursing The nurse should use a tuberculin syringe to administer an S.C. injection of less than 1 ml. Fundamentals of Nursing For adults, S.C. injections require a 25G 1" needle; for infants, children, elderly, or very thin patients, they require a 25G to 27G ½" needle. Fundamentals of Nursing Before administering medication, the nurse should identify the patient by checking the identification band and asking the patient to state his name. Fundamentals of Nursing To clean the skin before an injection, the nurse should use a sterile alcohol swab and wipe from the center of the site outward in a circular motion. Fundamentals of Nursing The nurse always should inject heparin deep into S.C. tissue at a 90-degree angle (perpendicular to the skin) to prevent skin irritation. Fundamentals of Nursing If blood is aspirated into the syringe before an I.M. injection, the nurse should withdraw the needle, prepare another syringe, and repeat the procedure. Fundamentals of Nursing The nurse shouldn’t cut the patient’s hair without written consent from the patient or an appropriate relative. Fundamentals of Nursing If bleeding occurs after an injection, the nurse should apply pressure until the bleeding stops; if bruising occurs, the nurse should monitor the site for an enlarging hematoma. Fundamentals of Nursing When providing hair and scalp care, the nurse should begin combing at the end of the hair and work toward the head. Fundamentals of Nursing Frequency of patient hair care depends on the length and texture of the hair, duration of hospitalization, and patient’s condition. Fundamentals of Nursing Proper hearing aid function requires careful handling during insertion and removal, regular cleaning of the ear piece to prevent wax buildup, and prompt replacement of dead batteries. Fundamentals of Nursing The hearing aid marked with a blue dot is for the left ear; the one with the red dot is for the right ear. Fundamentals of Nursing A hearing aid shouldn’t be exposed to heat or humidity and shouldn’t be immersed in water. Fundamentals of Nursing The nurse should instruct a patient not to use hair spray while wearing a hearing aid. Fundamentals of Nursing The five branches of pharmacology are pharmacokinetics, pharmacodynamics, pharmacotherapeutics, toxicology, and pharmacognosy. Fundamentals of Nursing The nurse should remove heel protectors every 8 hours to inspect the foot for signs of skin breakdown. Fundamentals of Nursing The purpose of heat application is to promote vasodilation, which reduces pain caused by inflammation. Fundamentals of Nursing A sutured surgical incision is an example of healing by first intention (healing directly, without granulation). Fundamentals of Nursing Healing by secondary intention (healing by granulation) is closure of the wound by the granulation tissue filling the defect and allowing reepithelialization to occur, beginning at the wound edges and continuing to the center, until the entire wound is covered. Fundamentals of Nursing Keloid formation is an abnormality in healing characterized by overgrowth of scar tissue at the wound site. Fundamentals of Nursing The nurse should administer procaine penicillin by deep I.M. injection in the upper outer portion of the buttocks in the adult or in the midlateral thigh in the child. The nurse shouldn’t massage the injection site. Fundamentals of Nursing The ascending colostomy drains fluid feces; the descending colostomy drains solid fecal matter. Fundamentals of Nursing A folded towel (called a scrotal bridge) can provide scrotal support for the patient with scrotal edema caused by vasectomy, epididymitis, or orchitis. Fundamentals of Nursing When giving an injection to the patient with a bleeding disorder, the nurse should use a small-gauge needle and apply pressure to the site for 5 minutes after the injection. Fundamentals of Nursing Platelets are the smallest and most fragile formed element of the blood and are essential for coagulation. Fundamentals of Nursing To insert a nasogastric tube, the nurse should first instruct the patient to tilt the head back slightly and then insert the tube. When the tube is felt curving at the pharynx, the nurse should tell the patient to tilt the head forward to close the trachea and open the esophagus by swallowing. (Sips of water can facilitate this action.) Fundamentals of Nursing According to families whose loved ones are in intensive care units, their four most important needs are to have questions answered honestly, to be assured that the best possible car is being provided, to know the prognosis, and to feel there is hope. Fundamentals of Nursing A double-bind communication when the verbal message contradicts the nonverbal message and the receiver is unsure of which message to respond to. Fundamentals of Nursing A nonjudgmental attitude displayed by the nurse demonstrates that she neither approves nor disapproves of the patient. Fundamentals of Nursing Target symptoms are those that the patient and others find most distressing. Fundamentals of Nursing Advise the patient to take aspirin on an empty stomach with a full glass of water and to avoid foods with acid such as coffee, citrus fruits, and cola. Fundamentals of Nursing For every patient problem, there is a nursing diagnosis; for every nursing diagnosis, there is a goal; and for every goal, there are interventions designed to make the goal a reality. The keys to answering examination questions correctly are identifying the problem presented, formulating a goal for that specific problem, and then selecting the intervention from the choices provided that will enable the patient to reach that goal. Fundamentals of Nursing Fidelity means loyalty and can be shown as a commitment to the profession of nursing and to the patient. Fundamentals of Nursing Giving an I.M. injection against the patient’s will and without legal authority is battery. Fundamentals of Nursing An example of a third-party payor is an insurance company. Fundamentals of Nursing On-call medication should be given within 5 minutes of receipt of the call. Fundamentals of Nursing Generally, the best method to determine the cultural or spiritual needs of the patient is to ask him. Fundamentals of Nursing An incident report shouldn’t be made part of the patient’s record but is an in-house document for the purpose of correcting the problem. Fundamentals of Nursing Critical pathways are a multidisciplinary guideline for patient care. Fundamentals of Nursing When prioritizing nursing diagnoses, use this hierarchy: (1) problems associated with airway, (2) those concerning breathing, and (3) those related to circulation. Fundamentals of Nursing The two nursing diagnoses with the highest priority that the nurse can assign are Ineffective airway clearance and Ineffective breathing pattern. Fundamentals of Nursing A subjective sign that a sitz bath has been effective is that patient expresses a decrease in pain or discomfort. Fundamentals of Nursing For the nursing diagnosis Diversional activity deficit to be valid, the patient must make the statement that he’s “bored, there is nothing to do” or words to that effect. Fundamentals of Nursing The most appropriate nursing diagnosis for an individual who doesn’t speak English is Communication, impaired, related to inability to speak dominant language (English). Fundamentals of Nursing The family of the patient who has been diagnosed as hearing impaired should be instructed to face the individual when they speak to him. Fundamentals of Nursing Up to age 3, the pinna should be pulled down and back to straighten the eustachian tube before instilling medication. Fundamentals of Nursing When administering eyedrops, the nurse should waste the first drop and instill the medication in the lower conjunctival sac to prevent injury to the cornea. Fundamentals of Nursing When administering eye ointment, the nurse should waste the first bead of medication and then apply the medication from the inner to the outer canthus. Fundamentals of Nursing When removing gloves and mask, the gloves, which most likely contain pathogens and are soiled, should be removed first. Fundamentals of Nursing Crutches should placed 6" (15 cm) in front of the patient and 6" to the side to assume a tripod position. Fundamentals of Nursing Listening is the most effective communication technique. Fundamentals of Nursing Process recording is a method of evaluating one’s communication effectiveness. Fundamentals of Nursing When feeding the elderly, limit high-carbohydrate foods because of the risk of glucose intolerance. Fundamentals of Nursing Passive range of motion maintains joint mobility whereas resistive exercises increase muscle mass. Fundamentals of Nursing Isometric exercises are performed on an extremity in a cast. Fundamentals of Nursing A back rub is an example of the gate-control theory of pain. Fundamentals of Nursing Anything below the waist is considered unsterile, a sterile field becomes unsterile when it comes in contact with nay unsterile item, a sterile field must be continuously monitored, and the 1" (2.5 cm) border around a sterile field is considered unsterile. Fundamentals of Nursing A “shift to the left” is evident when there is an increase in immature cells (bands) in the blood to fight an infection. Fundamentals of Nursing A “shift to the right” is evident when there is an increase in mature cells in the blood as seen in advanced liver diseases and pernicious anemia. Fundamentals of Nursing Before administering preoperative medication, make sure that an informed consent form has been signed and attached to the patient’s record. Fundamentals of Nursing The nurse should spend no more than 30 minutes per 8-hour shift in providing care to the patient with a radiation implant. Fundamentals of Nursing The nurse should stand near the patient’s shoulders for cervical implants and at the foot of the bed for head and neck implants. Fundamentals of Nursing The nurse should never be assigned to care for more than one patient with radiation implants. Fundamentals of Nursing Long-handled forceps and a lead-lined container should be in the room of the patient who has a radiation implant. Fundamentals of Nursing Generally, patients who have the same infection and are in strict isolation can share the same room. Fundamentals of Nursing Diseases requiring strict isolation include chickenpox, diphtheria, and viral hemorrhagic fever such as Marburg virus disease. Fundamentals of Nursing For the patient abiding by Jewish custom, milk and meat shouldn’t be served in the same meal. Fundamentals of Nursing Whether the patient can perform a procedure (psychomotor domain of learning) is a better indicator of the effectiveness of patient teaching than whether the patient can simply state the steps of the procedure (cognitive domain of learning). Fundamentals of Nursing Developmental stages according to Erik Erikson are trust versus mistrust (birth to 18 months), autonomy versus shame and doubt (18 months to 3 years), initiative versus guilt (3 to 5 years), industry versus inferiority (5 to 12 years), identity versus identity diffusion (12 to 18 years), intimacy versus isolation (18 to 25 years), generativity versus stagnation (25 to 60 years), and ego integrity versus despair (older than 60 years). Fundamentals of Nursing Face the hearing impaired patient when communicating with him. Fundamentals of Nursing A proper nursing intervention for the spouse of the patient who has suffered a serious incapacitating disease is to assist him in mobilizing a support system. Fundamentals of Nursing Hyperpyrexia refers to extreme elevation in temperature above 106º F (41.1º C). Fundamentals of Nursing

Showing posts with label Obstetric Nursing. Show all posts

Maternal/OB Drill 2

1. For the client who is using oral contraceptives, the nurse informs the client about the need to take the pill at the same time each day to accomplish which of the following?
a. Decrease the incidence of nausea
b. Maintain hormonal levels
c. Reduce side effects
d. Prevent drug interactions
2. When teaching a client about contraception. Which of the following would the nurse include as the most effective method for preventing sexually transmitted infections?
a. Spermicides
b. Diaphragm
c. Condoms
d. Vasectomy
3. When preparing a woman who is 2 days postpartum for discharge, recommendations for which of the following contraceptive methods would be avoided?
a. Diaphragm
b. Female condom
c. Oral contraceptives
d. Rhythm method
4. For which of the following clients would the nurse expect that an intrauterine device would not be recommended?
a. Woman over age 35
b. Nulliparous woman
c. Promiscuous young adult
d. Postpartum client
5. A client in her third trimester tells the nurse, “I’m constipated all the time!” Which of the following should the nurse recommend?
a. Daily enemas
b. Laxatives
c. Increased fiber intake
d. Decreased fluid intake
6. Which of the following would the nurse use as the basis for the teaching plan when caring for a pregnant teenager concerned about gaining too much weight during pregnancy?
a. 10 pounds per trimester
b. 1 pound per week for 40 weeks
c. ½ pound per week for 40 weeks
d. A total gain of 25 to 30 pounds
7. The client tells the nurse that her last menstrual period started on January 14 and ended on January 20. Using Nagele’s rule, the nurse determines her EDD to be which of the following?
a. September 27
b. October 21
c. November 7
d. December 27
8. When taking an obstetrical history on a pregnant client who states, “I had a son born at 38 weeks gestation, a daughter born at 30 weeks gestation and I lost a baby at about 8 weeks,” the nurse should record her obstetrical history as which of the following?
a. G2 T2 P0 A0 L2
b. G3 T1 P1 A0 L2
c. G3 T2 P0 A0 L2
d. G4 T1 P1 A1 L2
9. When preparing to listen to the fetal heart rate at 12 weeks’ gestation, the nurse would use which of the following?
a. Stethoscope placed midline at the umbilicus
b. Doppler placed midline at the suprapubic region
c. Fetoscope placed midway between the umbilicus and the xiphoid process
d. External electronic fetal monitor placed at the umbilicus
10. When developing a plan of care for a client newly diagnosed with gestational diabetes, which of the following instructions would be the priority?
a. Dietary intake
b. Medication
c. Exercise
d. Glucose monitoring
11. A client at 24 weeks gestation has gained 6 pounds in 4 weeks. Which of the following would be the priority when assessing the client?
a. Glucosuria
b. Depression
c. Hand/face edema
d. Dietary intake
12. A client 12 weeks’ pregnant come to the emergency department with abdominal cramping and moderate vaginal bleeding. Speculum examination reveals 2 to 3 cms cervical dilation. The nurse would document these findings as which of the following?
a. Threatened abortion
b. Imminent abortion
c. Complete abortion
d. Missed abortion
13. Which of the following would be the priority nursing diagnosis for a client with an ectopic pregnancy?
a. Risk for infection
b. Pain
c. Knowledge Deficit
d. Anticipatory Grieving
14. Before assessing the postpartum client’s uterus for firmness and position in relation to the umbilicus and midline, which of the following should the nurse do first?
a. Assess the vital signs
b. Administer analgesia
c. Ambulate her in the hall
d. Assist her to urinate
15. Which of the following should the nurse do when a primipara who is lactating tells the nurse that she has sore nipples?
a. Tell her to breast feed more frequently
b. Administer a narcotic before breast feeding
c. Encourage her to wear a nursing brassiere
d. Use soap and water to clean the nipples
16. The nurse assesses the vital signs of a client, 4 hours’ postpartum that are as follows: BP 90/60; temperature 100.4ºF; pulse 100 weak, thready; R 20 per minute. Which of the following should the nurse do first?
a. Report the temperature to the physician
b. Recheck the blood pressure with another cuff
c. Assess the uterus for firmness and position
d. Determine the amount of lochia
17. The nurse assesses the postpartum vaginal discharge (lochia) on four clients. Which of the following assessments would warrant notification of the physician?
a. A dark red discharge on a 2-day postpartum client
b. A pink to brownish discharge on a client who is 5 days postpartum
c. Almost colorless to creamy discharge on a client 2 weeks after delivery
d. A bright red discharge 5 days after delivery
18. A postpartum client has a temperature of 101.4ºF, with a uterus that is tender when palpated, remains unusually large, and not descending as normally expected. Which of the following should the nurse assess next?
a. Lochia
b. Breasts
c. Incision
d. Urine
19. Which of the following is the priority focus of nursing practice with the current early postpartum discharge?
a. Promoting comfort and restoration of health
b. Exploring the emotional status of the family
c. Facilitating safe and effective self-and newborn care
d. Teaching about the importance of family planning
20. Which of the following actions would be least effective in maintaining a neutral thermal environment for the newborn?
a. Placing infant under radiant warmer after bathing
b. Covering the scale with a warmed blanket prior to weighing
c. Placing crib close to nursery window for family viewing
d. Covering the infant’s head with a knit stockinette
21. A newborn who has an asymmetrical Moro reflex response should be further assessed for which of the following?
a. Talipes equinovarus
b. Fractured clavicle
c. Congenital hypothyroidism
d. Increased intracranial pressure
22. During the first 4 hours after a male circumcision, assessing for which of the following is the priority?
a. Infection
b. Hemorrhage
c. Discomfort
d. Dehydration
23. The mother asks the nurse. “What’s wrong with my son’s breasts? Why are they so enlarged?” Whish of the following would be the best response by the nurse?
a. “The breast tissue is inflamed from the trauma experienced with birth”
b. “A decrease in material hormones present before birth causes enlargement,”
c. “You should discuss this with your doctor. It could be a malignancy”
d. “The tissue has hypertrophied while the baby was in the uterus”
24. Immediately after birth the nurse notes the following on a male newborn: respirations 78; apical hearth rate 160 BPM, nostril flaring; mild intercostal retractions; and grunting at the end of expiration. Which of the following should the nurse do?
a. Call the assessment data to the physician’s attention
b. Start oxygen per nasal cannula at 2 L/min.
c. Suction the infant’s mouth and nares
d. Recognize this as normal first period of reactivity
25. The nurse hears a mother telling a friend on the telephone about umbilical cord care. Which of the following statements by the mother indicates effective teaching?
a. “Daily soap and water cleansing is best”
b. ‘Alcohol helps it dry and kills germs”
c. “An antibiotic ointment applied daily prevents infection”
d. “He can have a tub bath each day”
26. A newborn weighing 3000 grams and feeding every 4 hours needs 120 calories/kg of body weight every 24 hours for proper growth and development. How many ounces of 20 cal/oz formula should this newborn receive at each feeding to meet nutritional needs?
a. 2 ounces
b. 3 ounces
c. 4 ounces
d. 6 ounces
27. The postterm neonate with meconium-stained amniotic fluid needs care designed to especially monitor for which of the following?
a. Respiratory problems
b. Gastrointestinal problems
c. Integumentary problems
d. Elimination problems
28. When measuring a client’s fundal height, which of the following techniques denotes the correct method of measurement used by the nurse?
a. From the xiphoid process to the umbilicus
b. From the symphysis pubis to the xiphoid process
c. From the symphysis pubis to the fundus
d. From the fundus to the umbilicus
29. A client with severe preeclampsia is admitted with of BP 160/110, proteinuria, and severe pitting edema. Which of the following would be most important to include in the client’s plan of care?
a. Daily weights
b. Seizure precautions
c. Right lateral positioning
d. Stress reduction
30. A postpartum primipara asks the nurse, “When can we have sexual intercourse again?” Which of the following would be the nurse’s best response?
a. “Anytime you both want to.”
b. “As soon as choose a contraceptive method.”
c. “When the discharge has stopped and the incision is healed.”
d. “After your 6 weeks examination.”
31. When preparing to administer the vitamin K injection to a neonate, the nurse would select which of the following sites as appropriate for the injection?
a. Deltoid muscle
b. Anterior femoris muscle
c. Vastus lateralis muscle
d. Gluteus maximus muscle
32. When performing a pelvic examination, the nurse observes a red swollen area on the right side of the vaginal orifice. The nurse would document this as enlargement of which of the following?
a. Clitoris
b. Parotid gland
c. Skene’s gland
d. Bartholin’s gland
33. To differentiate as a female, the hormonal stimulation of the embryo that must occur involves which of the following?
a. Increase in maternal estrogen secretion
b. Decrease in maternal androgen secretion
c. Secretion of androgen by the fetal gonad
d. Secretion of estrogen by the fetal gonad
34. A client at 8 weeks’ gestation calls complaining of slight nausea in the morning hours. Which of the following client interventions should the nurse question?
a. Taking 1 teaspoon of bicarbonate of soda in an 8-ounce glass of water
b. Eating a few low-sodium crackers before getting out of bed
c. Avoiding the intake of liquids in the morning hours
d. Eating six small meals a day instead of thee large meals
35. The nurse documents positive ballottement in the client’s prenatal record. The nurse understands that this indicates which of the following?
a. Palpable contractions on the abdomen
b. Passive movement of the unengaged fetus
c. Fetal kicking felt by the client
d. Enlargement and softening of the uterus
36. During a pelvic exam the nurse notes a purple-blue tinge of the cervix. The nurse documents this as which of the following?
a. Braxton-Hicks sign
b. Chadwick’s sign
c. Goodell’s sign
d. McDonald’s sign
37. During a prenatal class, the nurse explains the rationale for breathing techniques during preparation for labor based on the understanding that breathing techniques are most important in achieving which of the following?
a. Eliminate pain and give the expectant parents something to do
b. Reduce the risk of fetal distress by increasing uteroplacental perfusion
c. Facilitate relaxation, possibly reducing the perception of pain
d. Eliminate pain so that less analgesia and anesthesia are needed
38. After 4 hours of active labor, the nurse notes that the contractions of a primigravida client are not strong enough to dilate the cervix. Which of the following would the nurse anticipate doing?
a. Obtaining an order to begin IV oxytocin infusion
b. Administering a light sedative to allow the patient to rest for several hour
c. Preparing for a cesarean section for failure to progress
d. Increasing the encouragement to the patient when pushing begins
39. A multigravida at 38 weeks’ gestation is admitted with painless, bright red bleeding and mild contractions every 7 to 10 minutes. Which of the following assessments should be avoided?
a. Maternal vital sign
b. Fetal heart rate
c. Contraction monitoring
d. Cervical dilation
40. Which of the following would be the nurse’s most appropriate response to a client who asks why she must have a cesarean delivery if she has a complete placenta previa?
a. “You will have to ask your physician when he returns.”
b. “You need a cesarean to prevent hemorrhage.”
c. “The placenta is covering most of your cervix.”
d. “The placenta is covering the opening of the uterus and blocking your baby.”
41. The nurse understands that the fetal head is in which of the following positions with a face presentation?
a. Completely flexed
b. Completely extended
c. Partially extended
d. Partially flexed
42. With a fetus in the left-anterior breech presentation, the nurse would expect the fetal heart rate would be most audible in which of the following areas?
a. Above the maternal umbilicus and to the right of midline
b. In the lower-left maternal abdominal quadrant
c. In the lower-right maternal abdominal quadrant
d. Above the maternal umbilicus and to the left of midline
43. The amniotic fluid of a client has a greenish tint. The nurse interprets this to be the result of which of the following?
a. Lanugo
b. Hydramnio
c. Meconium
d. Vernix
44. A patient is in labor and has just been told she has a breech presentation. The nurse should be particularly alert for which of the following?
a. Quickening
b. Ophthalmia neonatorum
c. Pica
d. Prolapsed umbilical cord
45. When describing dizygotic twins to a couple, on which of the following would the nurse base the explanation?
a. Two ova fertilized by separate sperm
b. Sharing of a common placenta
c. Each ova with the same genotype
d. Sharing of a common chorion
46. Which of the following refers to the single cell that reproduces itself after conception?
a. Chromosome
b. Blastocyst
c. Zygote
d. Trophoblast
47. In the late 1950s, consumers and health care professionals began challenging the routine use of analgesics and anesthetics during childbirth. Which of the following was an outgrowth of this concept?
a. Labor, delivery, recovery, postpartum (LDRP)
b. Nurse-midwifery
c. Clinical nurse specialist
d. Prepared childbirth
48. A client has a midpelvic contracture from a previous pelvic injury due to a motor vehicle accident as a teenager. The nurse is aware that this could prevent a fetus from passing through or around which structure during childbirth?
a. Symphysis pubis
b. Sacral promontory
c. Ischial spines
d. Pubic arch
49. When teaching a group of adolescents about variations in the length of the menstrual cycle, the nurse understands that the underlying mechanism is due to variations in which of the following phases?
a. Menstrual phase
b. Proliferative phase
c. Secretory phase
d. Ischemic phase
50. When teaching a group of adolescents about male hormone production, which of the following would the nurse include as being produced by the Leydig cells?
a. Follicle-stimulating hormone
b. Testosterone
c. Leuteinizing hormone
d. Gonadotropin releasing hormone

ANSWERS

Maternal/OB Drill 1

1. When assessing the adequacy of sperm for conception to occur, which of the following is the most useful criterion?
a. Sperm count
b. Sperm motility
c. Sperm maturity
d. Semen volume
2. A couple who wants to conceive but has been unsuccessful during the last 2 years has undergone many diagnostic procedures. When discussing the situation with the nurse, one partner states, “We know several friends in our age group and all of them have their own child already, Why can’t we have one?”. Which of the following would be the most pertinent nursing diagnosis for this couple?
a. Fear related to the unknown
b. Pain related to numerous procedures.
c. Ineffective family coping related to infertility.
d. Self-esteem disturbance related to infertility.
3. Which of the following urinary symptoms does the pregnant woman most frequently experience during the first trimester?
a. Dysuria
b. Frequency
c. Incontinence
d. Burning
4. Heartburn and flatulence, common in the second trimester, are most likely the result of which of the following?
a. Increased plasma HCG levels
b. Decreased intestinal motility
c. Decreased gastric acidity
d. Elevated estrogen levels
5. On which of the following areas would the nurse expect to observe chloasma?
a. Breast, areola, and nipples
b. Chest, neck, arms, and legs
c. Abdomen, breast, and thighs
d. Cheeks, forehead, and nose

6. A pregnant client states that she “waddles” when she walks. The nurse’s explanation is based on which of the following as the cause?
a. The large size of the newborn
b. Pressure on the pelvic muscles
c. Relaxation of the pelvic joints
d. Excessive weight gain
7. Which of the following represents the average amount of weight gained during pregnancy?
a. 12 to 22 lb
b. 15 to 25 lb
c. 24 to 30 lb
d. 25 to 40 lb
8. When talking with a pregnant client who is experiencing aching swollen, leg veins, the nurse would explain that this is most probably the result of which of the following?
a. Thrombophlebitis
b. Pregnancy-induced hypertension
c. Pressure on blood vessels from the enlarging uterus
d. The force of gravity pulling down on the uterus
9. Cervical softening and uterine souffle are classified as which of the following?
a. Diagnostic signs
b. Presumptive signs
c. Probable signs
d. Positive signs
10. Which of the following would the nurse identify as a presumptive sign of pregnancy?
a. Hegar sign
b. Nausea and vomiting
c. Skin pigmentation changes
d. Positive serum pregnancy test
11. Which of the following common emotional reactions to pregnancy would the nurse expect to occur during the first trimester?
a. Introversion, egocentrism, narcissism
b. Awkwardness, clumsiness, and unattractiveness
c. Anxiety, passivity, extroversion
d. Ambivalence, fear, fantasies

12. During which of the following would the focus of classes be mainly on physiologic changes, fetal development, sexuality, during pregnancy, and nutrition?
a. Prepregnant period
b. First trimester
c. Second trimester
d. Third trimester
13. Which of the following would be disadvantage of breast feeding?
a. Involution occurs more rapidly
b. The incidence of allergies increases due to maternal antibodies
c. The father may resent the infant’s demands on the mother’s body
d. There is a greater chance for error during preparation
14. Which of the following would cause a false-positive result on a pregnancy test?
a. The test was performed less than 10 days after an abortion
b. The test was performed too early or too late in the pregnancy
c. The urine sample was stored too long at room temperature
d. A spontaneous abortion or a missed abortion is impending
15. FHR can be auscultated with a fetoscope as early as which of the following?
a. 5 weeks gestation
b. 10 weeks gestation
c. 15 weeks gestation
d. 20 weeks gestation
16. A client LMP began July 5. Her EDD should be which of the following?
a. January 2
b. March 28
c. April 12
d. October 12
17. Which of the following fundal heights indicates less than 12 weeks’ gestation when the date of the LMP is unknown?
a. Uterus in the pelvis
b. Uterus at the xiphoid
c. Uterus in the abdomen
d. Uterus at the umbilicus
18. Which of the following danger signs should be reported promptly during the antepartum period?
a. Constipation
b. Breast tenderness
c. Nasal stuffiness
d. Leaking amniotic fluid
19. Which of the following prenatal laboratory test values would the nurse consider as significant?
a. Hematocrit 33.5%
b. Rubella titer less than 1:8
c. White blood cells 8,000/mm3
d. One hour glucose challenge test 110 g/dL
20. Which of the following characteristics of contractions would the nurse expect to find in a client experiencing true labor?
a. Occurring at irregular intervals
b. Starting mainly in the abdomen
c. Gradually increasing intervals
d. Increasing intensity with walking
21. During which of the following stages of labor would the nurse assess “crowning”?
a. First stage
b. Second stage
c. Third stage
d. Fourth stage
22. Barbiturates are usually not given for pain relief during active labor for which of the following reasons?
a. The neonatal effects include hypotonia, hypothermia, generalized drowsiness, and reluctance to feed for the first few days.
b. These drugs readily cross the placental barrier, causing depressive effects in the newborn 2 to 3 hours after intramuscular injection.
c. They rapidly transfer across the placenta, and lack of an antagonist make them generally inappropriate during labor.
d. Adverse reactions may include maternal hypotension, allergic or toxic reaction or partial or total respiratory failure
23. Which of the following nursing interventions would the nurse perform during the third stage of labor?
a. Obtain a urine specimen and other laboratory tests.
b. Assess uterine contractions every 30 minutes.
c. Coach for effective client pushing
d. Promote parent-newborn interaction.
24. Which of the following actions demonstrates the nurse’s understanding about the newborn’s thermoregulatory ability?
a. Placing the newborn under a radiant warmer.
b. Suctioning with a bulb syringe
c. Obtaining an Apgar score
d. Inspecting the newborn’s umbilical cord
25. Immediately before expulsion, which of the following cardinal movements occur?
a. Descent
b. Flexion
c. Extension
d. External rotation
26. Before birth, which of the following structures connects the right and left auricles of the heart?
a. Umbilical vein
b. Foramen ovale
c. Ductus arteriosus
d. Ductus venosus
27. Which of the following when present in the urine may cause a reddish stain on the diaper of a newborn?
a. Mucus
b. Uric acid crystals
c. Bilirubin
d. Excess iron
28. When assessing the newborn’s heart rate, which of the following ranges would be considered normal if the newborn were sleeping?
a. 80 beats per minute
b. 100 beats per minute
c. 120 beats per minute
d. 140 beats per minute
29. Which of the following is true regarding the fontanels of the newborn?
a. The anterior is triangular shaped; the posterior is diamond shaped.
b. The posterior closes at 18 months; the anterior closes at 8 to 12 weeks.
c. The anterior is large in size when compared to the posterior fontanel.
d. The anterior is bulging; the posterior appears sunken.
30. Which of the following groups of newborn reflexes below are present at birth and remain unchanged through adulthood?
a. Blink, cough, rooting, and gag
b. Blink, cough, sneeze, gag
c. Rooting, sneeze, swallowing, and cough
d. Stepping, blink, cough, and sneeze
31. Which of the following describes the Babinski reflex?
a. The newborn’s toes will hyperextend and fan apart from dorsiflexion of the big toe when one side of foot is stroked upward from the ball of the heel and across the ball of the foot.
b. The newborn abducts and flexes all extremities and may begin to cry when exposed to sudden movement or loud noise.
c. The newborn turns the head in the direction of stimulus, opens the mouth, and begins to suck when cheek, lip, or corner of mouth is touched.
d. The newborn will attempt to crawl forward with both arms and legs when he is placed on his abdomen on a flat surface
32. Which of the following statements best describes hyperemesis gravidarum?
a. Severe anemia leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems.
b. Severe nausea and vomiting leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems.
c. Loss of appetite and continuous vomiting that commonly results in dehydration and ultimately decreasing maternal nutrients
d. Severe nausea and diarrhea that can cause gastrointestinal irritation and possibly internal bleeding
33. Which of the following would the nurse identify as a classic sign of PIH?
a. Edema of the feet and ankles
b. Edema of the hands and face
c. Weight gain of 1 lb/week
d. Early morning headache
34. In which of the following types of spontaneous abortions would the nurse assess dark brown vaginal discharge and a negative pregnancy tests?
a. Threatened
b. Imminent
c. Missed
d. Incomplete
35. Which of the following factors would the nurse suspect as predisposing a client to placenta previa?
a. Multiple gestation
b. Uterine anomalies
c. Abdominal trauma
d. Renal or vascular disease
36. Which of the following would the nurse assess in a client experiencing abruptio placenta?
a. Bright red, painless vaginal bleeding
b. Concealed or external dark red bleeding
c. Palpable fetal outline
d. Soft and nontender abdomen
37. Which of the following is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage?
a. Placenta previa
b. Ectopic pregnancy
c. Incompetent cervix
d. Abruptio placentae
38. Which of the following may happen if the uterus becomes overstimulated by oxytocin during the induction of labor?
a. Weak contraction prolonged to more than 70 seconds
b. Tetanic contractions prolonged to more than 90 seconds
c. Increased pain with bright red vaginal bleeding
d. Increased restlessness and anxiety
39. When preparing a client for cesarean delivery, which of the following key concepts should be considered when implementing nursing care?
a. Instruct the mother’s support person to remain in the family lounge until after the delivery
b. Arrange for a staff member of the anesthesia department to explain what to expect postoperatively
c. Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth
d. Explain the surgery, expected outcome, and kind of anesthetics
40. Which of the following best describes preterm labor?
a. Labor that begins after 20 weeks gestation and before 37 weeks gestation
b. Labor that begins after 15 weeks gestation and before 37 weeks gestation
c. Labor that begins after 24 weeks gestation and before 28 weeks gestation
d. Labor that begins after 28 weeks gestation and before 40 weeks gestation
41. When PROM occurs, which of the following provides evidence of the nurse’s understanding of the client’s immediate needs?
a. The chorion and amnion rupture 4 hours before the onset of labor.
b. PROM removes the fetus most effective defense against infection
c. Nursing care is based on fetal viability and gestational age.
d. PROM is associated with malpresentation and possibly incompetent cervix
42. Which of the following factors is the underlying cause of dystocia?
a. Nurtional
b. Mechanical
c. Environmental
d. Medical
43. When uterine rupture occurs, which of the following would be the priority?
a. Limiting hypovolemic shock
b. Obtaining blood specimens
c. Instituting complete bed rest
d. Inserting a urinary catheter
44. Which of the following is the nurse’s initial action when umbilical cord prolapse occurs?
a. Begin monitoring maternal vital signs and FHR
b. Place the client in a knee-chest position in bed
c. Notify the physician and prepare the client for delivery
d. Apply a sterile warm saline dressing to the exposed cord
45. Which of the following amounts of blood loss following birth marks the criterion for describing postpartum hemorrhage?
a. More than 200 ml
b. More than 300 ml
c. More than 400 ml
d. More than 500 ml
46. Which of the following is the primary predisposing factor related to mastitis?
a. Epidemic infection from nosocomial sources localizing in the lactiferous glands and ducts
b. Endemic infection occurring randomly and localizing in the periglandular connective tissue
c. Temporary urinary retention due to decreased perception of the urge to avoid
d. Breast injury caused by overdistention, stasis, and cracking of the nipples
47. Which of the following best describes thrombophlebitis?
a. Inflammation and clot formation that result when blood components combine to form an aggregate body
b. Inflammation and blood clots that eventually become lodged within the pulmonary blood vessels
c. Inflammation and blood clots that eventually become lodged within the femoral vein
d. Inflammation of the vascular endothelium with clot formation on the vessel wall
48. Which of the following assessment findings would the nurse expect if the client develops DVT?
a. Midcalf pain, tenderness and redness along the vein
b. Chills, fever, malaise, occurring 2 weeks after delivery
c. Muscle pain the presence of Homans sign, and swelling in the affected limb
d. Chills, fever, stiffness, and pain occurring 10 to 14 days after delivery
49. Which of the following are the most commonly assessed findings in cystitis?
a. Frequency, urgency, dehydration, nausea, chills, and flank pain
b. Nocturia, frequency, urgency dysuria, hematuria, fever and suprapubic pain
c. Dehydration, hypertension, dysuria, suprapubic pain, chills, and fever
d. High fever, chills, flank pain nausea, vomiting, dysuria, and frequency
50. Which of the following best reflects the frequency of reported postpartum “blues”?
a. Between 10% and 40% of all new mothers report some form of postpartum blues
b. Between 30% and 50% of all new mothers report some form of postpartum blues
c. Between 50% and 80% of all new mothers report some form of postpartum blues
d. Between 25% and 70% of all new mothers report some form of postpartum blues

ANSWERS

Maternal Review Notes

TABLE OF CONTENTS
Human sexuality 1
Sexual anatomy and physiology
Stages of pubic hair development

Three parts of the uterus 2

Male and female homologues 3

Basic knowledge in genetics and obstetrics 4
Menstrual cycle

Stages of sexual responses 5

Stages of fetal growth & development 6
3 processes of implantation

diagnostic test for amniotic fluid 7
placenta

Trimester 8

Torch 9
Physiological adaptation of the mother to pregnancy
Pathogenic anemia

Edema 10
Varicosities
Vulbar varicosities
Thrombophlebitis
Morning sickness
Constipation
Flatulence
Heartburn

Hemorrhoids 11
Local changes
Problems related to the change of vaginal environment
Vaginititis
Moniliasis or candidiasis

Breast self exam 12
Test to determine breast cancer
Signs and symptoms of pregnancy
Placental gradin
Psychological adaptation of pregnancy

Pre natal visit 13
Nagele’s rule

McDonald’s rule 14
Bartholomew’s rule
Haases rule
Physical examination

Pap smear 15
Stages of cervical cancer
Leopold’s maneuver

Assessment of fetal well-being 16
Cardiff count to 10 method
Nonstress test
Recommended nutrient requirement
that increases curing pregnancy 17

Sexual activity 18
Exercise

Childbirth preparation 19
Bradley method
Grandly Dick Read Method
Different methods of delivery
Intrapartal notes

Theories of the onset of labor 20
The 4 P’s of labor
Passenger
Passageway

Important measurements 21
Power
Psyche/person
Pre-eminent signs of labor
Premature rupture of membrane
Cord prolapse

Difference between true labor & false labor 22
Duration of labor
First stage: onset of true contractions
Effacement
Dilation
Nsg interventions in each stage of labor
Latent phase
Active phase
Transitional phase

Pelvic exam 23
Station
Presentation
Two types
Monitoring the contractions and fetal heart tone
Parts of contractions

Health teachings 24
Second stage: fetal stage
Modified Ritgens maneuver
Mechanism of labor
Three parts of pelvis
Two major division of pelvis

Linea terminals 25
Third stage: birth to expulsion of placenta
Signs of placental separation
Types of placental delivery
Brandt Andrews Maneuver
Fourth stage: after delivery of placenta

Complications of labor 26
Precipitate labor
Uterine rupture
Amniotic fluid embolism
Trial labor

Pre-term labor 27
Postpartal period
Principles underlying puerperium
Physiologic changes

Lochia 28
Psychological response
Preventing complications
DIC

Late postpartum hemorrhage 29
Infection
General signs of inflammation
Motivate the use of family planning
Natural method
LAM
Symptothermal
Social method

Ovulation 30
Origoknause formula
Pills
Alerts on oral contraceptives
Signs of hypertension
Mechanism and chemical barriers

IUD 31
Condom
Diaphragm
Cervical cap
Foams, jellies, creams
Surgical method
High risk pregnancy
Hemorrhagic disorders

First trimester bleeding 32
Abortions
Classifications of abortions
Ectopic pregnancy
Second trimester bleeding
Hydatidiform mole

Third trimester bleeding 33
Placenta previa
Abruptio placenta

Hypersensitive disorders 34
Pregnancy induce hypertension
Transitional hypertension
Mild preeclampsia
Severe preeclampsia
Eclampsia

Diabetes Mellitus 35
Maternal effect
Fetal effect
Newborn defect
Heart disease

Intrapartal complications 36
Cesarean delivery
Infertility
2 types of infertility
Anovulation
Tubal occlusion

Maternal Review Notes -

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OB Nursing Bullets

v Unlike false labor, true labor produces regular rhythmic contractions, abdominal discomfort, progressive descent of the fetus, bloody show, and progressive effacement and dilation of the cervix.

v To help a mother break the suction of her breast-feeding infant, the nurse should teach her to insert a finger at the corner of the infant’s mouth.

v Administering high levels of oxygen to a premature neonate can cause blindness as a result of retrolental fibroplasia.

v Amniotomy is artificial rupture of the amniotic membranes.

v During pregnancy, weight gain averages 25 to 30 lb (11 to 13.5 kg).

v Rubella has a teratogenic effect on the fetus during the first trimester. It produces abnormalities in up to 40% of cases without interrupting the pregnancy.

v Immunity to rubella can be measured by a hemagglutination inhibition test (rubella titer). This test identifies exposure to rubella infection and determines susceptibility in pregnant women. In a woman, a titer greater than 1:8 indicates immunity.

v When used to describe the degree of fetal descent during labor, floating means the presenting part isn’t engaged in the pelvic inlet, but is freely movable (ballotable) above the pelvic inlet.

v When used to describe the degree of fetal descent, engagement means when the largest diameter of the presenting part has passed through the pelvic inlet.

v Fetal station indicates the location of the presenting part in relation to the ischial spine. It’s described as –1, –2, –3, –4, or –5 to indicate the number of centimeters above the level of the ischial spine; station –5 is at the pelvic inlet.

v Fetal station also is described as +1, +2, +3, +4, or +5 to indicate the number of centimeters it is below the level of the ischial spine; station 0 is at the level of the ischial spine.

v During the first stage of labor, the side-lying position usually provides the greatest degree of comfort, although the patient may assume any comfortable position.

v During delivery, if the umbilical cord can’t be loosened and slipped from around the neonate’s neck, it should be clamped with two clamps and cut between the clamps.

v An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate distress, and 0 to 3 indicates severe distress.

v To elicit Moro’s reflex, the nurse holds the neonate in both hands and suddenly, but gently, drops the neonate’s head backward. Normally, the neonate abducts and extends all extremities bilaterally and symmetrically, forms a C shape with the thumb and forefinger, and first adducts and then flexes the extremities.

v Pregnancy-induced hypertension (preeclampsia) is an increase in blood pressure of 30/15 mm Hg over baseline or blood pressure of 140/95 mm Hg on two occasions at least 6 hours apart accompanied by edema and albuminuria after 20 weeks’ gestation.

v Positive signs of pregnancy include ultrasound evidence, fetal heart tones, and fetal movement felt by the examiner (not usually present until 4 months’ gestation

v Goodell’s sign is softening of the cervix.

v Quickening, a presumptive sign of pregnancy, occurs between 16 and 19 weeks’ gestation.

v Ovulation ceases during pregnancy.

v Any vaginal bleeding during pregnancy should be considered a complication until proven otherwise.

v To estimate the date of delivery using Nägele’s rule, the nurse counts backward 3 months from the first day of the last menstrual period and then adds 7 days to this date.

v At 12 weeks’ gestation, the fundus should be at the top of the symphysis pubis.

v Cow’s milk shouldn’t be given to infants younger than age 1 because it has a low linoleic acid content and its protein is difficult for infants to digest.

v If jaundice is suspected in a neonate, the nurse should examine the infant under natural window light. If natural light is unavailable, the nurse should examine the infant under a white light.

v The three phases of a uterine contraction are increment, acme, and decrement.

v The intensity of a labor contraction can be assessed by the indentability of the uterine wall at the contraction’s peak. Intensity is graded as mild (uterine muscle is somewhat tense), moderate (uterine muscle is moderately tense), or strong (uterine muscle is boardlike).

v Chloasma, the mask of pregnancy, is pigmentation of a circumscribed area of skin (usually over the bridge of the nose and cheeks) that occurs in some pregnant women.

v The gynecoid pelvis is most ideal for delivery. Other types include platypelloid (flat), anthropoid (apelike), and android (malelike).

v Pregnant women should be advised that there is no safe level of alcohol intake.

v The frequency of uterine contractions, which is measured in minutes, is the time from the beginning of one contraction to the beginning of the next.

v Vitamin K is administered to neonates to prevent hemorrhagic disorders because a neonate’s intestine can’t synthesize vitamin K.

v Before internal fetal monitoring can be performed, a pregnant patient’s cervix must be dilated at least 2 cm, the amniotic membranes must be ruptured, and the fetus’s presenting part (scalp or buttocks) must be at station –1 or lower, so that a small electrode can be attached.

v Fetal alcohol syndrome presents in the first 24 hours after birth and produces lethargy, seizures, poor sucking reflex, abdominal distention, and respiratory difficulty.

v Variability is any change in the fetal heart rate (FHR) from its normal rate of 120 to 160 beats/minute. Acceleration is increased FHR; deceleration is decreased FHR.

v In a neonate, the symptoms of heroin withdrawal may begin several hours to 4 days after birth.

v In a neonate, the symptoms of methadone withdrawal may begin 7 days to several weeks after birth.

v In a neonate, the cardinal signs of narcotic withdrawal include coarse, flapping tremors; sleepiness; restlessness; prolonged, persistent, high-pitched cry; and irritability.

v The nurse should count a neonate’s respirations for 1 full minute.

v Chlorpromazine (Thorazine) is used to treat neonates who are addicted to narcotics.

v The nurse should provide a dark, quiet environment for a neonate who is experiencing narcotic withdrawal.

v In a premature neonate, signs of respiratory distress include nostril flaring, substernal retractions, and inspiratory grunting.

v Respiratory distress syndrome (hyaline membrane disease) develops in premature infants because their pulmonary alveoli lack surfactant.

v Whenever an infant is being put down to sleep, the parent or caregiver should position the infant on the back. (Remember back to sleep.)

v The male sperm contributes an X or a Y chromosome; the female ovum contributes an X chromosome.

v Fertilization produces a total of 46 chromosomes, including an XY combination (male) or an XX combination (female).

v The percentage of water in a neonate’s body is about 78% to 80%.

v To perform nasotracheal suctioning in an infant, the nurse positions the infant with his neck slightly hyperextended in a “sniffing” position, with his chin up and his head tilted back slightly.

v Organogenesis occurs during the first trimester of pregnancy, specifically, days 14 to 56 of gestation.

v After birth, the neonate’s umbilical cord is tied 1" (2.5 cm) from the abdominal wall with a cotton cord, plastic clamp, or rubber band.

v Gravida is the number of pregnancies a woman has had, regardless of outcome.

v Para is the number of pregnancies that reached viability, regardless of whether the fetus was delivered alive or stillborn. A fetus is considered viable at 20 weeks’ gestation.

v An ectopic pregnancy is one that implants abnormally, outside the uterus.

v The first stage of labor begins with the onset of labor and ends with full cervical dilation at 10 cm.

v The second stage of labor begins with full cervical dilation and ends with the neonate’s birth.

v The third stage of labor begins after the neonate’s birth and ends with expulsion of the placenta.

v In a full-term neonate, skin creases appear over two-thirds of the neonate’s feet. Preterm neonates have heel creases that cover less than two-thirds of the feet.

v The fourth stage of labor (postpartum stabilization) lasts up to 4 hours after the placenta is delivered. This time is needed to stabilize the mother’s physical and emotional state after the stress of childbirth.

v At 20 weeks’ gestation, the fundus is at the level of the umbilicus.

v At 36 weeks’ gestation, the fundus is at the lower border of the rib cage.

v A premature neonate is one born before the end of the 37th week of gestation.

v Pregnancy-induced hypertension is a leading cause of maternal death in the United States.

v A habitual aborter is a woman who has had three or more consecutive spontaneous abortions.

v Threatened abortion occurs when bleeding is present without cervical dilation.

v A complete abortion occurs when all products of conception are expelled.

v Hydramnios (polyhydramnios) is excessive amniotic fluid (more than 2,000 ml in the third trimester).

v Stress, dehydration, and fatigue may reduce a breast-feeding mother’s milk supply.

v During the transition phase of the first stage of labor, the cervix is dilated 8 to 10 cm and contractions usually occur 2 to 3 minutes apart and last for 60 seconds.

v A nonstress test is considered nonreactive (positive) if fewer than two fetal heart rate accelerations of at least 15 beats/minute occur in 20 minutes.

v A nonstress test is considered reactive (negative) if two or more fetal heart rate accelerations of 15 beats/minute above baseline occur in 20 minutes.

v A nonstress test is usually performed to assess fetal well-being in a pregnant patient with a prolonged pregnancy (42 weeks or more), diabetes, a history of poor pregnancy outcomes, or pregnancy-induced hypertension.

v A pregnant woman should drink at least eight 8-oz glasses (about 2,000 ml) of water daily.

v When both breasts are used for breast-feeding, the infant usually doesn’t empty the second breast. Therefore, the second breast should be used first at the next feeding.

v A low-birth-weight neonate weighs 2,500 g (5 lb 8 oz) or less at birth.

v A very-low-birth-weight neonate weighs 1,500 g (3 lb 5 oz) or less at birth.

v When teaching parents to provide umbilical cord care, the nurse should teach them to clean the umbilical area with a cotton ball saturated with alcohol after every diaper change to prevent infection and promote drying.

v Teenage mothers are more likely to have low-birth-weight neonates because they seek prenatal care late in pregnancy (as a result of denial) and are more likely than older mothers to have nutritional deficiencies.

v Linea nigra, a dark line that extends from the umbilicus to the mons pubis, commonly appears during pregnancy and disappears after pregnancy.

v Implantation in the uterus occurs 6 to 10 days after ovum fertilization.

v Placenta previa is abnormally low implantation of the placenta so that it encroaches on or covers the cervical os.

v In complete (total) placenta previa, the placenta completely covers the cervical os.

v In partial (incomplete or marginal) placenta previa, the placenta covers only a portion of the cervical os.

v Abruptio placentae is premature separation of a normally implanted placenta. It may be partial or complete, and usually causes abdominal pain, vaginal bleeding, and a boardlike abdomen.

v Cutis marmorata is mottling or purple discoloration of the skin. It’s a transient vasomotor response that occurs primarily in the arms and legs of infants who are exposed to cold.

v The classic triad of symptoms of preeclampsia are hypertension, edema, and proteinuria. Additional symptoms of severe preeclampsia include hyperreflexia, cerebral and vision disturbances, and epigastric pain.

v Ortolani’s sign (an audible click or palpable jerk that occurs with thigh abduction) confirms congenital hip dislocation in a neonate.

v The first immunization for a neonate is the hepatitis B vaccine, which is administered in the nursery shortly after birth.

v If a patient misses a menstrual period while taking an oral contraceptive exactly as prescribed, she should continue taking the contraceptive.

v If a patient misses two consecutive menstrual periods while taking an oral contraceptive, she should discontinue the contraceptive and take a pregnancy test.

v If a patient who is taking an oral contraceptive misses a dose, she should take the pill as soon as she remembers or take two at the next scheduled interval and continue with the normal schedule.

v If a patient who is taking an oral contraceptive misses two consecutive doses, she should double the dose for 2 days and then resume her normal schedule. She also should use an additional birth control method for 1 week.

v Eclampsia is the occurrence of seizures that aren’t caused by a cerebral disorder in a patient who has pregnancy-induced hypertension.

v In placenta previa, bleeding is painless and seldom fatal on the first occasion, but it becomes heavier with each subsequent episode.

v Treatment for abruptio placentae is usually immediate cesarean delivery.

v Drugs used to treat withdrawal symptoms in neonates include phenobarbital (Luminal), camphorated opium tincture (paregoric), and diazepam (Valium).

v Infants with Down syndrome typically have marked hypotonia, floppiness, slanted eyes, excess skin on the back of the neck, flattened bridge of the nose, flat facial features, spadelike hands, short and broad feet, small male genitalia, absence of Moro’s reflex, and a simian crease on the hands.

v The failure rate of a contraceptive is determined by the experience of 100 women for 1 year. It’s expressed as pregnancies per 100 woman-years.

v The narrowest diameter of the pelvic inlet is the anteroposterior (diagonal conjugate).

v The chorion is the outermost extraembryonic membrane that gives rise to the placenta.

v The corpus luteum secretes large quantities of progesterone.

v From the 8th week of gestation through delivery, the developing cells are known as a fetus.

v In an incomplete abortion, the fetus is expelled, but parts of the placenta and membrane remain in the uterus.

v The circumference of a neonate’s head is normally 2 to 3 cm greater than the circumference of the chest.

v After administering magnesium sulfate to a pregnant patient for hypertension or preterm labor, the nurse should monitor the respiratory rate and deep tendon reflexes.

v During the first hour after birth (the period of reactivity), the neonate is alert and awake.

v When a pregnant patient has undiagnosed vaginal bleeding, vaginal examination should be avoided until ultrasonography rules out placenta previa.

v After delivery, the first nursing action is to establish the neonate’s airway.

v Nursing interventions for a patient with placenta previa include positioning the patient on her left side for maximum fetal perfusion, monitoring fetal heart tones, and administering I.V. fluids and oxygen, as ordered.

v The specific gravity of a neonate’s urine is 1.003 to 1.030. A lower specific gravity suggests overhydration; a higher one suggests dehydration.

v The neonatal period extends from birth to day 28. It’s also called the first 4 weeks or first month of life.

v A woman who is breast-feeding should rub a mild emollient cream or a few drops of breast milk (or colostrum) on the nipples after each feeding. She should let the breasts air-dry to prevent them from cracking.

v Breast-feeding mothers should increase their fluid intake to 2½ to 3 qt (2,500 to 3,000 ml) daily.

v After feeding an infant with a cleft lip or palate, the nurse should rinse the infant’s mouth with sterile water.

v The nurse instills erythromycin in a neonate’s eyes primarily to prevent blindness caused by gonorrhea or chlamydia.

v Human immunodeficiency virus (HIV) has been cultured in breast milk and can be transmitted by an HIV-positive mother who breast-feeds her infant.

v A fever in the first 24 hours postpartum is most likely caused by dehydration rather than infection.

v Preterm neonates or neonates who can’t maintain a skin temperature of at least 97.6° F (36.4° C) should receive care in an incubator (Isolette) or a radiant warmer. In a radiant warmer, a heat-sensitive probe taped to the neonate’s skin activates the heater unit automatically to maintain the desired temperature.

v During labor, the resting phase between contractions is at least 30 seconds.

v Lochia rubra is the vaginal discharge of almost pure blood that occurs during the first few days after childbirth.

v Lochia serosa is the serous vaginal discharge that occurs 4 to 7 days after childbirth.

v Lochia alba is the vaginal discharge of decreased blood and increased leukocytes that’s the final stage of lochia. It occurs 7 to 10 days after childbirth.

v Colostrum, the precursor of milk, is the first secretion from the breasts after delivery.

v The length of the uterus increases from 2½" (6.3 cm) before pregnancy to 12½" (32 cm) at term.

v To estimate the true conjugate (the smallest inlet measurement of the pelvis), deduct 1.5 cm from the diagonal conjugate (usually 12 cm). A true conjugate of 10.5 cm enables the fetal head (usually 10 cm) to pass.

v The smallest outlet measurement of the pelvis is the intertuberous diameter, which is the transverse diameter between the ischial tuberosities.

v Electronic fetal monitoring is used to assess fetal well-being during labor. If compromised fetal status is suspected, fetal blood pH may be evaluated by obtaining a scalp sample.

v In an emergency delivery, enough pressure should be applied to the emerging fetus’s head to guide the descent and prevent a rapid change in pressure within the molded fetal skull.

v After delivery, a multiparous woman is more susceptible to bleeding than a primiparous woman because her uterine muscles may be overstretched and may not contract efficiently.

v Neonates who are delivered by cesarean birth have a higher incidence of respiratory distress syndrome.

v The nurse should suggest ambulation to a postpartum patient who has gas pain and flatulence.

v Massaging the uterus helps to stimulate contractions after the placenta is delivered.

v When providing phototherapy to a neonate, the nurse should cover the neonate’s eyes and genital area.

v The narcotic antagonist naloxone (Narcan) may be given to a neonate to correct respiratory depression caused by narcotic administration to the mother during labor.

v In a neonate, symptoms of respiratory distress syndrome include expiratory grunting or whining, sandpaper breath sounds, and seesaw retractions.

v Cerebral palsy presents as asymmetrical movement, irritability, and excessive, feeble crying in a long, thin infant.

v The nurse should assess a breech-birth neonate for hydrocephalus, hematomas, fractures, and other anomalies caused by birth trauma.

v When a patient is admitted to the unit in active labor, the nurse’s first action is to listen for fetal heart tones.

v In a neonate, long, brittle fingernails are a sign of postmaturity.

v Desquamation (skin peeling) is common in postmature neonates.

v A mother should allow her infant to breast-feed until the infant is satisfied. The time may vary from 5 to 20 minutes.

v Nitrazine paper is used to test the pH of vaginal discharge to determine the presence of amniotic fluid.

v A pregnant patient normally gains 2 to 5 lb (1 to 2.5 kg) during the first trimester and slightly less than 1 lb (0.5 kg) per week during the last two trimesters.

v Neonatal jaundice in the first 24 hours after birth is known as pathological jaundice and is a sign of erythroblastosis fetalis.

v A classic difference between abruptio placentae and placenta previa is the degree of pain. Abruptio placentae causes pain, whereas placenta previa causes painless bleeding.

v Because a major role of the placenta is to function as a fetal lung, any condition that interrupts normal blood flow to or from the placenta increases fetal partial pressure of arterial carbon dioxide and decreases fetal pH.

v Precipitate labor lasts for approximately 3 hours and ends with delivery of the neonate.

v Methylergonovine (Methergine) is an oxytocic agent used to prevent and treat postpartum hemorrhage caused by uterine atony or subinvolution.

v As emergency treatment for excessive uterine bleeding, 0.2 mg of methylergonovine (Methergine) is injected I.V. over 1 minute while the patient’s blood pressure and uterine contractions are monitored.

v Braxton Hicks contractions are usually felt in the abdomen and don’t cause cervical change. True labor contractions are felt in the front of the abdomen and back and lead to progressive cervical dilation and effacement.

v The average birth weight of neonates born to mothers who smoke is 6 oz (170 g) less than that of neonates born to nonsmoking mothers.

v Culdoscopy is visualization of the pelvic organs through the posterior vaginal fornix.

v The nurse should teach a pregnant vegetarian to obtain protein from alternative sources, such as nuts, soybeans, and legumes.

v The nurse should instruct a pregnant patient to take only prescribed prenatal vitamins because over-the-counter high-potency vitamins may harm the fetus.

v High-sodium foods can cause fluid retention, especially in pregnant patients.

v A pregnant patient can avoid constipation and hemorrhoids by adding fiber to her diet.

v If a fetus has late decelerations (a sign of fetal hypoxia), the nurse should instruct the mother to lie on her left side and then administer 8 to 10 L of oxygen per minute by mask or cannula. The nurse should notify the physician. The side-lying position removes pressure on the inferior vena cava.

v Oxytocin (Pitocin) promotes lactation and uterine contractions.

v Lanugo covers the fetus’s body until about 20 weeks’ gestation. Then it begins to disappear from the face, trunk, arms, and legs, in that order.

v In a neonate, hypoglycemia causes temperature instability, hypotonia, jitteriness, and seizures. Premature, postmature, small-for-gestational-age, and large-for-gestational-age neonates are susceptible to this disorder.

v Neonates typically need to consume 50 to 55 cal per pound of body weight daily.

v Because oxytocin (Pitocin) stimulates powerful uterine contractions during labor, it must be administered under close observation to help prevent maternal and fetal distress.

v During fetal heart rate monitoring, variable decelerations indicate compression or prolapse of the umbilical cord.

v Cytomegalovirus is the leading cause of congenital viral infection.

v Tocolytic therapy is indicated in premature labor, but contraindicated in fetal death, fetal distress, or severe hemorrhage.

v Through ultrasonography, the biophysical profile assesses fetal well-being by measuring fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate (nonstress test), and qualitative amniotic fluid volume.

v A neonate whose mother has diabetes should be assessed for hyperinsulinism.

v In a patient with preeclampsia, epigastric pain is a late symptom and requires immediate medical intervention.

v After a stillbirth, the mother should be allowed to hold the neonate to help her come to terms with the death.

v Molding is the process by which the fetal head changes shape to facilitate movement through the birth canal.

v If a woman receives a spinal block before delivery, the nurse should monitor the patient’s blood pressure closely.

v If a woman suddenly becomes hypotensive during labor, the nurse should increase the infusion rate of I.V. fluids as prescribed.

v The best technique for assessing jaundice in a neonate is to blanch the tip of the nose or the area just above the umbilicus.

v During fetal heart monitoring, early deceleration is caused by compression of the head during labor.

v After the placenta is delivered, the nurse may add oxytocin (Pitocin) to the patient’s I.V. solution, as prescribed, to promote postpartum involution of the uterus and stimulate lactation.

v Pica is a craving to eat nonfood items, such as dirt, crayons, chalk, glue, starch, or hair. It may occur during pregnancy and can endanger the fetus.

v A pregnant patient should take folic acid because this nutrient is required for rapid cell division.

v A woman who is taking clomiphene (Clomid) to induce ovulation should be informed of the possibility of multiple births with this drug.

v If needed, cervical suturing is usually done between 14 and 18 weeks’ gestation to reinforce an incompetent cervix and maintain pregnancy. The suturing is typically removed by 35 weeks’ gestation.

v During the first trimester, a pregnant woman should avoid all drugs unless doing so would adversely affect her health.

v Most drugs that a breast-feeding mother takes appear in breast milk.

v The Food and Drug Administration has established the following five categories of drugs based on their potential for causing birth defects: A, no evidence of risk; B, no risk found in animals, but no studies have been done in women; C, animal studies have shown an adverse effect, but the drug may be beneficial to women despite the potential risk; D, evidence of risk, but its benefits may outweigh its risks; and X, fetal anomalies noted, and the risks clearly outweigh the potential benefits.

v A patient with a ruptured ectopic pregnancy commonly has sharp pain in the lower abdomen, with spotting and cramping. She may have abdominal rigidity; rapid, shallow respirations; tachycardia; and shock.

v A patient with a ruptured ectopic pregnancy commonly has sharp pain in the lower abdomen, with spotting and cramping. She may have abdominal rigidity; rapid, shallow respirations; tachycardia; and shock.

v The mechanics of delivery are engagement, descent and flexion, internal rotation, extension, external rotation, restitution, and expulsion.

v A probable sign of pregnancy, McDonald’s sign is characterized by an ease in flexing the body of the uterus against the cervix.

v Amenorrhea is a probable sign of pregnancy.

v A pregnant woman’s partner should avoid introducing air into the vagina during oral sex because of the possibility of air embolism.

v The presence of human chorionic gonadotropin in the blood or urine is a probable sign of pregnancy.

v Radiography isn’t usually used in a pregnant woman because it may harm the developing fetus. If radiography is essential, it should be performed only after 36 weeks’ gestation.

v A pregnant patient who has had rupture of the membranes or who is experiencing vaginal bleeding shouldn’t engage in sexual intercourse.

v Milia may occur as pinpoint spots over a neonate’s nose.

v The duration of a contraction is timed from the moment that the uterine muscle begins to tense to the moment that it reaches full relaxation. It’s measured in seconds.

v The union of a male and a female gamete produces a zygote, which divides into the fertilized ovum.

v The first menstrual flow is called menarche and may be anovulatory (infertile).

v Spermatozoa (or their fragments) remain in the vagina for 72 hours after sexual intercourse.

v Prolactin stimulates and sustains milk production.

v Strabismus is a normal finding in a neonate.

v A postpartum patient may resume sexual intercourse after the perineal or uterine wounds heal (usually within 4 weeks after delivery).

v A pregnant staff member shouldn’t be assigned to work with a patient who has cytomegalovirus infection because the virus can be transmitted to the fetus.

v Fetal demise is death of the fetus after viability.

v Respiratory distress syndrome develops in premature neonates because their alveoli lack surfactant.

v The most common method of inducing labor after artificial rupture of the membranes is oxytocin (Pitocin) infusion.

v After the amniotic membranes rupture, the initial nursing action is to assess the fetal heart rate.

v The most common reasons for cesarean birth are malpresentation, fetal distress, cephalopelvic disproportion, pregnancy-induced hypertension, previous cesarean birth, and inadequate progress in labor.

v Amniocentesis increases the risk of spontaneous abortion, trauma to the fetus or placenta, premature labor, infection, and Rh sensitization of the fetus.

v After amniocentesis, abdominal cramping or spontaneous vaginal bleeding may indicate complications.

v To prevent her from developing Rh antibodies, an Rh-negative primigravida should receive Rho(D) immune globulin (RhoGAM) after delivering an Rh-positive neonate.

v If a pregnant patient’s test results are negative for glucose but positive for acetone, the nurse should assess the patient’s diet for inadequate caloric intake.

v If a pregnant patient’s test results are negative for glucose but positive for acetone, the nurse should assess the patient’s diet for inadequate caloric intake.

v Rubella infection in a pregnant patient, especially during the first trimester, can lead to spontaneous abortion or stillbirth as well as fetal cardiac and other birth defects.

v A pregnant patient should take an iron supplement to help prevent anemia.

v Direct antiglobulin (direct Coombs’) test is used to detect maternal antibodies attached to red blood cells in the neonate.

v Nausea and vomiting during the first trimester of pregnancy are caused by rising levels of the hormone human chorionic gonadotropin.

v Before discharging a patient who has had an abortion, the nurse should instruct her to report bright red clots, bleeding that lasts longer than 7 days, or signs of infection, such as a temperature of greater than 100° F (37.8° C), foul-smelling vaginal discharge, severe uterine cramping, nausea, or vomiting.

v When informed that a patient’s amniotic membrane has broken, the nurse should check fetal heart tones and then maternal vital signs.

v The duration of pregnancy averages 280 days, 40 weeks, 9 calendar months, or 10 lunar months.

v The initial weight loss for a healthy neonate is 5% to 10% of birth weight.

v The normal hemoglobin value in neonates is 17 to 20 g/dl.

v Crowning is the appearance of the fetus’s head when its largest diameter is encircled by the vulvovaginal ring.

v A multipara is a woman who has had two or more pregnancies that progressed to viability, regardless of whether the offspring were alive at birth.

v In a pregnant patient, preeclampsia may progress to eclampsia, which is characterized by seizures and may lead to coma.

v The Apgar score is used to assess the neonate’s vital functions. It’s obtained at 1 minute and 5 minutes after delivery. The score is based on respiratory effort, heart rate, muscle tone, reflex irritability, and color.

v Because of the anti-insulin effects of placental hormones, insulin requirements increase during the third trimester.

v Gestational age can be estimated by ultrasound measurement of maternal abdominal circumference, fetal femur length, and fetal head size. These measurements are most accurate between 12 and 18 weeks’ gestation.

v Skeletal system abnormalities and ventricular septal defects are the most common disorders of infants who are born to diabetic women. The incidence of congenital malformation is three times higher in these infants than in those born to nondiabetic women.

v Skeletal system abnormalities and ventricular septal defects are the most common disorders of infants who are born to diabetic women. The incidence of congenital malformation is three times higher in these infants than in those born to nondiabetic women.

v The patient with preeclampsia usually has puffiness around the eyes or edema in the hands (for example, “I can’t put my wedding ring on.”).

v Kegel exercises require contraction and relaxation of the perineal muscles. These exercises help strengthen pelvic muscles and improve urine control in postpartum patients.

v Symptoms of postpartum depression range from mild postpartum blues to intense, suicidal, depressive psychosis.

v The preterm neonate may require gavage feedings because of a weak sucking reflex, uncoordinated sucking, or respiratory distress.

v Acrocyanosis (blueness and coolness of the arms and legs) is normal in neonates because of their immature peripheral circulatory system.

v To prevent ophthalmia neonatorum (a severe eye infection caused by maternal gonorrhea), the nurse may administer one of three drugs, as prescribed, in the neonate’s eyes: tetracycline, silver nitrate, or erythromycin.

v Neonatal testing for phenylketonuria is mandatory in most states.

v The nurse should place the neonate in a 30-degree Trendelenburg position to facilitate mucus drainage.

v The nurse may suction the neonate’s nose and mouth as needed with a bulb syringe or suction trap.

v To prevent heat loss, the nurse should place the neonate under a radiant warmer during suctioning and initial delivery-room care, and then wrap the neonate in a warmed blanket for transport to the nursery.

v The umbilical cord normally has two arteries and one vein.

v When providing care, the nurse should expose only one part of an infant’s body at a time.

v Lightening is settling of the fetal head into the brim of the pelvis.

v If the neonate is stable, the mother should be allowed to breast-feed within the neonate’s first hour of life.

v The nurse should check the neonate’s temperature every 1 to 2 hours until it’s maintained within normal limits.

v At birth, a neonate normally weighs 5 to 9 lb (2 to 4 kg), measures 18" to 22" (45.5 to 56 cm) in length, has a head circumference of 13½" to 14" (34 to 35.5 cm), and has a chest circumference that’s 1" (2.5 cm) less than the head circumference.

v In the neonate, temperature normally ranges from 98° to 99° F (36.7° to 37.2° C), apical pulse rate averages 120 to 160 beats/minute, and respirations are 40 to 60 breaths/minute.

v The diamond-shaped anterior fontanel usually closes between ages 12 and 18 months. The triangular posterior fontanel usually closes by age 2 months.

v In the neonate, a straight spine is normal. A tuft of hair over the spine is an abnormal finding.

v Prostaglandin gel may be applied to the vagina or cervix to ripen an unfavorable cervix before labor induction with oxytocin (Pitocin).

v Supernumerary nipples are occasionally seen on neonates. They usually appear along a line that runs from each axilla, through the normal nipple area, and to the groin.

v Meconium is a material that collects in the fetus’s intestines and forms the neonate’s first feces, which are black and tarry.

v The presence of meconium in the amniotic fluid during labor indicates possible fetal distress and the need to evaluate the neonate for meconium aspiration.

v To assess a neonate’s rooting reflex, the nurse touches a finger to the cheek or the corner of the mouth. Normally, the neonate turns his head toward the stimulus, opens his mouth, and searches for the stimulus.

v Harlequin sign is present when a neonate who is lying on his side appears red on the dependent side and pale on the upper side.

v Mongolian spots can range from brown to blue. Their color depends on how close melanocytes are to the surface of the skin. They most commonly appear as patches across the sacrum, buttocks, and legs.

v Mongolian spots are common in non-white infants and usually disappear by age 2 to 3 years.

v Vernix caseosa is a cheeselike substance that covers and protects the fetus’s skin in utero. It may be rubbed into the neonate’s skin or washed away in one or two baths.

v Caput succedaneum is edema that develops in and under the fetal scalp during labor and delivery. It resolves spontaneously and presents no danger to the neonate. The edema doesn’t cross the suture line.

v Nevus flammeus, or port-wine stain, is a diffuse pink to dark bluish red lesion on a neonate’s face or neck.

v The Guthrie test (a screening test for phenylketonuria) is most reliable if it’s done between the second and sixth days after birth and is performed after the neonate has ingested protein.

v To assess coordination of sucking and swallowing, the nurse should observe the neonate’s first breast-feeding or sterile water bottle-feeding.

v To establish a milk supply pattern, the mother should breast-feed her infant at least every 4 hours. During the first month, she should breast-feed 8 to 12 times daily (demand feeding).

v To avoid contact with blood and other body fluids, the nurse should wear gloves when handling the neonate until after the first bath is given.

v If a breast-fed infant is content, has good skin turgor, an adequate number of wet diapers, and normal weight gain, the mother’s milk supply is assumed to be adequate.

v In the supine position, a pregnant patient’s enlarged uterus impairs venous return from the lower half of the body to the heart, resulting in supine hypotensive syndrome, or inferior vena cava syndrome.

v Tocolytic agents used to treat preterm labor include terbutaline (Brethine), ritodrine (Yutopar), and magnesium sulfate.

v A pregnant woman who has hyperemesis gravidarum may require hospitalization to treat dehydration and starvation.

v Diaphragmatic hernia is one of the most urgent neonatal surgical emergencies. By compressing and displacing the lungs and heart, this disorder can cause respiratory distress shortly after birth.

v Common complications of early pregnancy (up to 20 weeks’ gestation) include fetal loss and serious threats to maternal health.

v Fetal embodiment is a maternal developmental task that occurs in the second trimester. During this stage, the mother may complain that she never gets to sleep because the fetus always gives her a thump when she tries.

v Visualization in pregnancy is a process in which the mother imagines what the child she’s carrying is like and becomes acquainted with it.

v Hemodilution of pregnancy is the increase in blood volume that occurs during pregnancy. The increased volume consists of plasma and causes an imbalance between the ratio of red blood cells to plasma and a resultant decrease in hematocrit.

v Mean arterial pressure of greater than 100 mm Hg after 20 weeks of pregnancy is considered hypertension.

v The treatment for supine hypotension syndrome (a condition that sometimes occurs in pregnancy) is to have the patient lie on her left side.

v A contributing factor in dependent edema in the pregnant patient is the increase of femoral venous pressure from 10 mm Hg (normal) to 18 mm Hg (high).

v Hyperpigmentation of the pregnant patient’s face, formerly called chloasma and now referred to as melasma, fades after delivery.

v The hormone relaxin, which is secreted first by the corpus luteum and later by the placenta, relaxes the connective tissue and cartilage of the symphysis pubis and the sacroiliac joint to facilitate passage of the fetus during delivery.

v Progesterone maintains the integrity of the pregnancy by inhibiting uterine motility.

v Ladin’s sign, an early indication of pregnancy, causes softening of a spot on the anterior portion of the uterus, just above the uterocervical juncture.

v During pregnancy, the abdominal line from the symphysis pubis to the umbilicus changes from linea alba to linea nigra.

v In neonates, cold stress affects the circulatory, regulatory, and respiratory systems.

v Obstetric data can be described by using the F/TPAL system:

o F/T: Full-term delivery at 38 weeks or longer

o P: Preterm delivery between 20 and 37 weeks

o A: Abortion or loss of fetus before 20 weeks

o L: Number of children living (if a child has died, further explanation is needed to clarify the discrepancy in numbers).

v Parity doesn’t refer to the number of infants delivered, only the number of deliveries.

v Women who are carrying more than one fetus should be encouraged to gain 35 to 45 lb (15.5 to 20.5 kg) during pregnancy.

v The recommended amount of iron supplement for the pregnant patient is 30 to 60 mg daily.

v Drinking six alcoholic beverages a day or a single episode of binge drinking in the first trimester can cause fetal alcohol syndrome.

v Chorionic villus sampling is performed at 8 to 12 weeks of pregnancy for early identification of genetic defects.

v In percutaneous umbilical blood sampling, a blood sample is obtained from the umbilical cord to detect anemia, genetic defects, and blood incompatibility as well as to assess the need for blood transfusions.

v The period between contractions is referred to as the interval, or resting phase. During this phase, the uterus and placenta fill with blood and allow for the exchange of oxygen, carbon dioxide, and nutrients.

v In a patient who has hypertonic contractions, the uterus doesn’t have an opportunity to relax and there is no interval between contractions. As a result, the fetus may experience hypoxia or rapid delivery may occur.

v Two qualities of the myometrium are elasticity, which allows it to stretch yet maintain its tone, and contractility, which allows it to shorten and lengthen in a synchronized pattern.

v During crowning, the presenting part of the fetus remains visible during the interval between contractions.

v Uterine atony is failure of the uterus to remain firmly contracted.

v The major cause of uterine atony is a full bladder.

v If the mother wishes to breast-feed, the neonate should be nursed as soon as possible after delivery.

v A smacking sound, milk dripping from the side of the mouth, and sucking noises all indicate improper placement of the infant’s mouth over the nipple.

v Before feeding is initiated, an infant should be burped to expel air from the stomach.

v Most authorities strongly encourage the continuation of breast-feeding on both the affected and the unaffected breast of patients with mastitis.

v Neonates are nearsighted and focus on items that are held 10" to 12" (25 to 30.5 cm) away.

v In a neonate, low-set ears are associated with chromosomal abnormalities such as Down syndrome.

v Meconium is usually passed in the first 24 hours; however, passage may take up to 72 hours.

v Boys who are born with hypospadias shouldn’t be circumcised at birth because the foreskin may be needed for constructive surgery.

v In the neonate, the normal blood glucose level is 45 to 90 mg/dl.

v Hepatitis B vaccine is usually given within 48 hours of birth.

v Hepatitis B immune globulin is usually given within 12 hours of birth.

v HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is an unusual variation of pregnancy-induced hypertension.

v Maternal serum alpha-fetoprotein is detectable at 7 weeks of gestation and peaks in the third trimester. High levels detected between the 16th and 18th weeks are associated with neural tube defects. Low levels are associated with Down syndrome.

v An arrest of descent occurs when the fetus doesn’t descend through the pelvic cavity during labor. It’s commonly associated with cephalopelvic disproportion, and cesarean delivery may be required.

v A late sign of preeclampsia is epigastric pain as a result of severe liver edema.

v In the patient with preeclampsia, blood pressure returns to normal during the puerperal period.

v To obtain an estriol level, urine is collected for 24 hours.

v An estriol level is used to assess fetal well-being and maternal renal functioning as well as to monitor a pregnancy that’s complicated by diabetes.

v A pregnant patient with vaginal bleeding shouldn’t have a pelvic examination.

v In the early stages of pregnancy, the finding of glucose in the urine may be related to the increased shunting of glucose to the developing placenta, without a corresponding increase in the reabsorption capability of the kidneys.

v A patient who has premature rupture of the membranes is at significant risk for infection if labor doesn’t begin within 24 hours.

v Infants of diabetic mothers are susceptible to macrosomia as a result of increased insulin production in the fetus.

v To prevent heat loss in the neonate, the nurse should bathe one part of his body at a time and keep the rest of the body covered.

v A patient who has a cesarean delivery is at greater risk for infection than the patient who gives birth vaginally.

v The occurrence of thrush in the neonate is probably caused by contact with the organism during delivery through the birth canal.

v The nurse should keep the sac of meningomyelocele moist with normal saline solution.

v If fundal height is at least 2 cm less than expected, the cause may be growth retardation, missed abortion, transverse lie, or false pregnancy.

v Fundal height that exceeds expectations by more than 2 cm may be caused by multiple gestation, polyhydramnios, uterine myomata, or a large baby.

v A major developmental task for a woman during the first trimester of pregnancy is accepting the pregnancy.

v Unlike formula, breast milk offers the benefit of maternal antibodies.

v Spontaneous rupture of the membranes increases the risk of a prolapsed umbilical cord.

v A clinical manifestation of a prolapsed umbilical cord is variable decelerations.

v During labor, to relieve supine hypotension manifested by nausea and vomiting and paleness, turn the patient on her left side.

v If the ovum is fertilized by a spermatozoon carrying a Y chromosome, a male zygote is formed.

v Implantation occurs when the cellular walls of the blastocyte implants itself in the endometrium, usually 7 to 9 days after fertilization.

v Implantation occurs when the cellular walls of the blastocyte implants itself in the endometrium, usually 7 to 9 days after fertilization.

v Heart development in the embryo begins at 2 to 4 weeks and is complete by the end of the embryonic stage.

v Methergine stimulates uterine contractions.

v The administration of folic acid during the early stages of gestation may prevent neural tube defects.

v With advanced maternal age, a common genetic problem is Down syndrome.

v With early maternal age, cephalopelvic disproportion commonly occurs.

v In the early postpartum period, the fundus should be midline at the umbilicus.

v A rubella vaccine shouldn’t be given to a pregnant woman. The vaccine can be administered after delivery, but the patient should be instructed to avoid becoming pregnant for 3 months.

v A 16-year-old girl who is pregnant is at risk for having a low-birth-weight neonate.

v The mother’s Rh factor should be determined before an amniocentesis is performed.

v Maternal hypotension is a complication of spinal block.

v After delivery, if the fundus is boggy and deviated to the right side, the patient should empty her bladder.

v Before providing a specimen for a sperm count, the patient should avoid ejaculation for 48 to 72 hours.

v The hormone human chorionic gonadotropin is a marker for pregnancy.

v Painless vaginal bleeding during the last trimester of pregnancy may indicate placenta previa.

v During the transition phase of labor, the woman usually is irritable and restless.

v Because women with diabetes have a higher incidence of birth anomalies than women without diabetes, an alpha-fetoprotein level may be ordered at 15 to 17 weeks’ gestation.

v To avoid puncturing the placenta, a vaginal examination shouldn’t be performed on a pregnant patient who is bleeding.

v A patient who has postpartum hemorrhage caused by uterine atony should be given oxytocin as prescribed.

v Laceration of the vagina, cervix, or perineum produces bright red bleeding that often comes in spurts. The bleeding is continuous, even when the fundus is firm.

v Hot compresses can help to relieve breast tenderness after breast-feeding.

v The fundus of a postpartum patient is massaged to stimulate contraction of the uterus and prevent hemorrhage.

v A mother who has a positive human immunodeficiency virus test result shouldn’t breast-feed her infant.

v Dinoprostone (Cervidil) is used to ripen the cervix.

v Breast-feeding of a premature neonate born at 32 weeks’ gestation can be accomplished if the mother expresses milk and feeds the neonate by gavage.

v If a pregnant patient’s rubella titer is less than 1:8, she should be immunized after delivery.

v The administration of oxytocin (Pitocin) is stopped if the contractions are 90 seconds or longer.

v For an extramural delivery (one that takes place outside of a normal delivery center), the priorities for care of the neonate include maintaining a patent airway, supporting efforts to breathe, monitoring vital signs, and maintaining adequate body

v temperature.

v Subinvolution may occur if the bladder is distended after delivery.

v The nurse must place identification bands on both the mother and the neonate before they leave the delivery room.

v Erythromycin is given at birth to prevent ophthalmia neonatorum.

v Pelvic-tilt exercises can help to prevent or relieve backache during pregnancy.

v Before performing a Leopold maneuver, the nurse should ask the patient to empty her bladder.

OBSTETRIC NURSING/ MATERNAL

I.Anatomy and Physiology of Female and Male Reproductive Organ
II.Human Sexuality
III.Preganancy and Prenatal Care
IV.Labor and Delivery
V.Complications of Labor
VI.High Risk Pregnancy
VII.Intrapartal Complication
VIII.Family Planning

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OBSTETRIC NURSING/ MATERNAL

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