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54 terms

PRNU 129 Exam 2

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A woman arrives at the clinic seeking confirmation that she is pregnant. The following info is obtained; 24 years old, BMI-17.5, she admits to having used cocaine several times during the past year and drinks alcohol occasionally. BP 108/70, pulse 72 bpm, resp. 16 bpm, family history diabetes mellitus and cancer. her sister recently gave birth to an infant with neural tube defect NTD Which characteristics place her at a high risk category
Family history of NTD, low BMI, and substance abuse are all high risk factors
o Polyhydramnios
Too much amniotic fluid
IUGR
Intrauterine Growth Restriction
Oligohydramonions
Not enough amniotic fluid
Kick Counts/Daily Fetal Movement Counts
Assessment of fetal activity by mother, fetal movement not present during sleep cycle
When nurses help their expectant mother assess the daily fetal movement counts, they should be aware that:
the fetal alarm signal should go off when the fetal movements stop entirely for 12 hours
Biophysical Profile
Fetal breathing movements
Gross body movements
Fetal tone
Reactive heart rate
Quantitative amniotic fluid volume
Abruptio placentae
Placenta separates from the uterus
Chorionic Villus Sampling (CVS)
Removal of small tissue specimen from fetal portion of placenta
A 39 year old primagravida thinks she is about 8 weeks pregnant although she has had irregular menstrual periods her life history of smoking approx. one pack of cigarette a day tell you she trying to cut down, lab within normal limits
Ultrasound
Percutaneous umbilical blood sampling (PUBS) or Cordocentesis
Direct access to fetal circulation, needle into fetal umbilical vessel
Coombs test
Rh incompatibility , detects other antibodies for incompatibility with maternal antigens
41 week pregnant multigravida present in labor and delivery unit after a non-stress test indicated that her fetus could be experiencing some difficulties in utero, which diagnostic tool would yield more detailed info about the fetus:
Biophysical profile
HA1C
Blood test- history of sugar management over last 3 months
Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with
congenital anomalies in the fetus
Amnio used to test for
Lung maturity
In assessing knowledge of pregestational woman with type I diabetes concerning changing insulin needs during pregnancy the nurse recognizes that further teaching is warranted when the woman states
I will need to increase my insulin dosage during the first 3 months of pregnancy
Hypoglycemia
Blood sugar is too low
Target Glucose in Pregnancy
o Postmeal or fasting
>65 but <95
o Postmeal (1h)
<130-140
o Postmeal (2h)
<120
Screening at 24 weeks of gestation reveals that a normal weight pregnant woman has gestational diabetes mellitus (GDM) in planning her care nurse and woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM the nurse identifies that the fetus is at greatest risk for
Macrosomia
A 26 year old primigravida comes to clinic for regular prenatal visit at 12 weeks appears thin nervous, reports eats well balanced diet, although her weight is 5 pounds less than it was at her last visit, lab studies confirm she has a hyperthyroid condition, based on data from the nurse formulate a plan of care, what nursing diagnosis is most appropriate for the woman at this time
Imbalanced nutrition: less than body requirements
Phenylketonuria
o Recognized causes of mental retardation caused by deficiency in enzyme phenylalanine hydrolase
In caring for a pregnant women with sickle cell crisis, the nurse understands that management of this patient includes all except
antibiotics
4 P's
In caring for a pregnant women with sickle cell crisis, the nurse understands that management of this patient includes all except
• Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women the 4 Ps plus is a screening tool designed specifically or identify when there is a need of r a more in death assessment the 4 Ps include all except:
o Present
• A primigravida is being monitored in her prenatal clinic for preeclampsia, which finding should concern her nurse
o A dipstick value of 3+ for protein in her urine
• A pregnant woman has been receiving magnesium sulfate infusion for tx. of preeclampsia for 24 hr., on assessment temp 37.3 degree c, pulse rate 88 bpm respiratory rate of 10 breaths/min blood pressure of 128/90 mm hg absent deep tendon reflexes and no ankle clonus the pt. complains I'm so thirsty and warm"
o Discontinues the magnesium sulfate infusion
• The perinatal nurse is giving instructions to a woman, stay she must take two post-suction curettage secondary to a hydatidiform mole, the woman asks why she must take oral contraceptives for 12 months the best response
o The major risk yo you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produced during pregnancy, if you were to get pregnant it would make the diagnosis of this cancer more difficult
• The most prevalent clinical manifestation of abruptio placenta as opposed to placenta previa is:
abdominal pain
• In caring for the woman with disseminated intravascular coagulation (DIC) what order should the nurse anticipate
o Administration of blood
Exlampsia
Seizure activity or coma in woman diagnosed with preeclampsia
HELLP
Associated with preeclampsia, Hemolysis (H)
Elevated liver enzymes (EL)
Low platelets (LP)
Tonic-Clonic Convulsions
Stage of invasion, contraction, convulsion
Hyperemesis Gravidarium
Excessive vomiting, weight loss, electrolyte imbalance, ketonuria
Ectopic
Fertilized ovum implanted` outside uterine cavity
Hydatidiform Mole (Molar Pregnancy)
Gestational trophoblastic disease is a spectrum of pregnancy-related trophoblastic disorders without a viable fetus
Complete/Classic
• Mole results from fertilization of egg with lost or inactivated nucleus
• No fetus, placenta, or amniotic membrane
Partial mole
2 sperm fertilizing normal ovum, embryonic parts present and an amniotic sac
• The perinatal nurse is giving instructions to a woman, stay she must take two post-suction curettage secondary to a hydatidiform mole, the woman asks why she must take oral contraceptives for 12 months the best response
o The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produced during pregnancy, if you were to get pregnant it would make the diagnosis of this cancer more difficult
Placenta Previa
Painless, placenta is attached to the cervix
The most prevalent clinical manifestation of abruptio placenta as opposed to placenta previa is
abdominal pain
DIC
Disseminated intravascular coagulation; • Pathologic form of diffuse clotting causing widespread external and internal bleeding
In caring for the woman with disseminated intravascular coagulation (DIC) what order should the nurse anticipate
Administration of blood
TORCH
Toxoplasmosis
Other infections
• Hepatitis A
• Hepatitis B
Rubella
Cytomegalovirus
Herpes simplex
Preterm
20-37 weeks
Late Preterm
34-36 weeks
Low birth weight
2500 g or less
In planning for home care of a woman with preterm labor, the nurse needs to address what concern
prolonged bed rest may cause negative physiological effects
A woman in preterm labor at 30 weeks of gestation receives 2 12 mg doses of betamethasone intramuscularly, The purpose of this pharmacologic treatment is to
antenatal glucocorticoids given as intramuscular injections to the mother to stimulates fetal lung maturation (surfactant)
Tocolytics
goal is to delay birth long enough to institute interventions that delay neonatal morbidity and mortality
5 P's of dystocia
Powers, passage, passenger, position, psychologic
A primigravida 40 weeks gestational is having uterine contractions every 1 ½ to 2 minutes and says that they are very painful, her cervix is dilated 2 cm and has not changes in 3 hours. The woman is crying and wants an epidural what is likely status of this woman's labor:
Hypertonic
A woman is having her first child. She has been in labor for 15 hours, 2 hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0, 5 mins ago her vaginal examination indicated that there had been no change what abnormal labor pattern is associated with this description
secondary arrest
• A nurse suspects that a client has been physically abused. The woman refuses to report the abuse to the police. Which statement by the client suggests to the nurse that the relationship may be in the "honeymoon phase'
o My partner said that he will never hurt me again