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Maternity HESI

Study set of cards for HESI
STUDY
PLAY
1 gram equals
1 mL
How do you prepare a woman for an amniocentesis?
explain the risks and benefits, lay flat, a full bladder is preferred
Diabetes and pregnancy
mother will have protein and glucose in the urine; macrosomic baby - always use INSULIN b/c it doesn't cross the placenta
Blood loss during a vaginal delivery
Blood loss during a c-section
approx: 200-300 mL
approx: 500+ mL
Fetal heart rate
110-160 bpm
Gravida
the # of times a woman has been pregnant; a pregnant woman (if pregnant - the count includes current pregnancy)
Para
a woman who has borne offspring who reached the age of viability (20-24 weeks) - no matter if the baby is lived or not
TPALM
Term, Preterm, Abortions, Living, Multiples
Quickening
felt around 16-20 weeks
Hegars sign
softening of the lower part of the uterus
McDonalds sign
being able to flex the body of the uterus against the cervix
Chadwick's sign
purple or bluish discoloration of the cervix
Goodell's sign
softening of the cervix
Venous stasis
stagnancy of the veins - in pregos there is extra pressure on the uterus and lower extermities - increased risk for blood clots
Intrapartum discomfort
change positions, no high heels, don't stand in the same place for too long, take prenatal supplements
How are contractions timed?
From the beginning of the one to the beginning of the other
Directly prior to delivery, how far apart do we want to see contractions
approx 2 minutes - any less distresses the mom and the fetus - can cause hypoxia
Why do we ambulate as soon as possible after delivery?
to regain peristalisis, and to prevent blood clots and atelectasis
Why do we massage the fundus?
to help it contract/shrink
What is the fear with an atonic or boggy fundus?
it increases risk for bleeding
Why are you at increased risk for bleeding with a multiple birth or more than on birth
the uterus loses elasticity
Perineal discomfort
ice first 24 hours; sitz bath after that
What should you if a child vomits up medications
call the physician
Hospitalization with toddlers
let them know right before - so they don't get anxiety waiting for it to happen
Mylomenigocele (tail thing by the butt)
sterile wet dressings; avoid using diapers (infection)
What to watch with a kid on lasix
potassium levels, I&Os
What should you do if you even suspect child abuse?
notify the authorities
Hypospadius
urethra on posterior part of the penis (do not circumsize!)
Leukemia
cancer of the WBCs (bone marrow) - tx includes chemo, radiation, surgery, transfusions, stem cell therapy
*Tx of skin conditions
desinex, etc - don't clean off roughly (can use oil to help get it off)
With pre-eclampsia why do we watch urine output and blood pressure?
b/c the kidneys are involved (can lead to proteinuria)
*S/S of diabetes in babies
high pitched cry, blood glucose <40 (<30 in premies), irritability, tremors (respiratory distress??)
Early signs of CHF in infants that should be reported:
tachycardia at rest, fatigue during feedings, sweating around scalp and forehead, dyspnea, sudden weight gain. Other s/s: pallor, cyanosis, rapid respirations, rapid pulse, weak cry, edema, frequent respiratory infections
What med(s) may be given to an infant with CHF?
digoxin (don't give if heart rate <100) (in older children don't give if <70bpm - adults <60bpm)
First stage of labor (longest phase)
Latent: dialation 1-4 cm, cooperative alert
Active: dilation 4-7 cm - apprehensive, anxious
Transition : 7-10 cm - irritable, rejects support
Second stage of labor (approx 30min - 2hr)
expulsion of the fetus
Third stage of labor (5-30 mins)
expulsion of the placenta
Fourth stage
recovery
*Changes in the breast during pregnancy
increases levels of estrogen and progesterone prepare the breast for lactation - areolae become deeply pigmented, sebaceous glands become prominant, later colstrum may be expressed (pre-milk) - breasts engorge
How to bulb suction
-compress bulb
-insert into mouth (mouth b4 nose)
-release pressure on the bulb
-emply contents
Breast feeding
(colostrum, transitional, mature milk) - essential teaching: latching on the entire nipple; proper body alignment of the infant, wide open mouth for grasp, infant moves in rythmic motion the express milk, audible swallow is heard, mom relaxed, room warm and private, infant satiated, mom's boobicles are soft and non-engorged at the end of feeding
Post partum complications
hemmorhage, infection, thrombosis - massage fundus - watch for fever >100.4 (38C), bright red bleeding, pain or redness of calf (homanns sign) - report to dr - watch for lasting signs of depression
Mrs. Puente is visiting the clinic for a prenatal assessment. This is the client's fourth pregnancy. She lost one pregnancy during the ninth week of gestation. One pregnancy resulted in birth of a stillborn infant at full term, and she has one living child who was born the 35th week of gestation. Which of the following best describes the client?
A. G5P2111
B. G4P1111
C. G4P1211
D. G5P1112
Ativan 0.5 mg IM every 1 hour as needed is prescribed for a client experiencing delirium tremens. The medication vial reads 2mg/mL of solution. How many mL should the LPN draw into the syringe for single dose administration?
0.25mL
A client is pregnant with her third child. Medical history of the client indicates a previous precipitate labor and birth. Which of the following interventions would NOT be expected during labor of the present pregnancy?
A. Use of magnesium sulfate
B. Close monitoring of the fetus for hypoxia
C. The nurse stays at the bedside constantly or as much as possible
D. amnioinfusion will be performed
Answer: D


Explanation
Amnioinfusion is instillation of fluid into the amniotic sac within the uterus to treat oligohydraminios. This is not done to prevent precipitate labor and birth.
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 urination
Answer: B
Pressure and irritation of the bladder by the growing uterus during the first trimester is responsible for causing urinary frequency. Dysuria, incontinence, and burning are symptoms associated with urinary tract infections.
During a lecture on reproduction, a student nurse asks the instructor what determines the sex of a fetus. Accurate information in response to this question would be:
A. "The sex of the fetus is not determined until the eighth week of gestation."
B. "The fertilization of the zygote is the point at which sex is determined."
C. "Males have one less pair of chromosomes than females."
D. "Sex is determined by the chromosomes contributed by the ovum."
Answer: B
Explanation
The sex of the fetus is determined at the point that the sperm fertilizes the ovum to form the zygote. Sex is ultimately determined by the chromosome contributed by the sperm.
Fetal heart is carefully monitored throughout pregnancy and during labor to assess fetal well being. Which of the following represents an appropriate fetal heart rate?
A. 108
B. 127
C. 170
D. 185
Answer: B
The appropriate range of fetal heart rate is 120-160 beats per minute.
A client suspects that she is pregnant and visits the clinic. Of the following changes caused by pregnancy, which is the only positive sign that the client is pregnant?
A. enlarge abdomen
B. positive pregnancy test
C. detection of fetal heartbeat
D. uterine contraction
Answer: C


Explanation
Positive signs of pregnancy are detected changes that provide objective, conclusive proof of pregnancy.
1. detection of fetal heartbeat
2. fetal movement palpated by a professional
3. visualization of the fetus by sonography

The other choices are considered PROBABLE signs of pregnancy.
The physcician orders epinephrine 0.1 mg SQ x 1 now. The constitution of epinephrine according to the vial is 1;1000, or 1 g of epinephrine per 1,000 mL of solution. How much solution should be drawn into the syringe by the LPN?
A. 0.01 mL
B. 0.1 mL
C. 1.0 mL
D. 10 mL
Answer: B
Explanation
1000mg/1000mL = 0.1mg/x mL

1000x=100

x= 100/1000

x=0.1 mL
A client at 36 weeks' gestation is schedule for a routine ultrasound prior to an amniocentesis. After teaching the client about the purpose for the ultrasound, which of the following client statements would indicate to the nurse in charge that the client needs further instruction?
A. The ultrasound will help to locate the placenta
B. The ultrasound identifies blood flow through the umbilical cord

C. The test will determine where to insert the needle
D. The ultrasound locates a pool of amniotic fluid
Answer: B
Explanation
Before amniocentesis, a routine ultrasound is valuable in locating the placenta, locating a pool of amniotic fluid, and showing the physician where to insert the needle. Color Doppler imaging ultrasonography identifies blood flow through the umbilical cord. A routine ultrasound does not accomplish this.
The LPN is preparing to administer Solu-medrol 40 mg mixed in 150 mL of sodium chloride via intravenous piggyback. The medication is to be administered over 30 minutes. Using the tubing with a drop factor of 15 ggts/mL, what would the LPN calculate the rate to be in drops per minute?
A. 40
B. 50
C. 75
D. 150
Answer: C
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 brim
C. relaxation of the pelvic joints
D. excessive weight gain
Answer: C


Explanation
During pregnancy, hormonal changes cause relaxation of the pelvic joints, resulting in the typical "waddling" gait. Changes in posture are related to the growing fetus. Pressure on the surrounding muscles causing discomfort is due to the growing uterus. Weight gain has no effect on gait.
A nurse is collecting data from a client who suspects that she is pregnant. The nurse is checking the client for probable signs of pregnancy. Select all that apply.
A. Ballottement
B. Chadwick's sign
C. Uterine enlargement
D. Braxton Hicks contractions
E. Outline of fetus via radiography or ultrasound
F. Fetal heart rate detected by a non electronic device
G. Hegar's sign
H. Goodle's sign
Answer: A,B,C,D,G,H


Explanation
Ballottement or rebound of the fetus against the examiner's fingers on palpation; Chadwick's sign or the bluish coloration of the mucus membrane of the cervix, Uterine enlargement, Goodle's sign or the softening of the cervix; Braxton Hicks contraction, and Hegar's sign the softening and thinning of the lower uterine segment are ALL PROBABLE SIGNS OF PREGNANCY.
Reddish purple strech marks that usually occur on the abdomen, breasts, thighs, and upper arm. As a nurse, you would document this correctly in the client's chart by using what medical terminology?
Striae gravidarum