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NURS 331 - Final exam
Terms in this set (187)
What is postmenopausal bleeding often associated with?
fibroids, polyps, cancer
How often should a woman get a mammogram and at what age?
age 40 - 50
every 1 - 2 years
How often should a woman get a PAP and at what age does it start?
starts at age 21 - 65
every 3 years until 30 and if it always negative you can go every 5 years
What is the number one cause of cervical cancer
__________ is the phase during which ovarian function and hormone production
How long does perimenopause last?
Why are there symptoms in perimenopause?
there are symptoms because of a decrease in estrogen
Menopause is defined as?
period stops for 1 year
List 3 types of things a woman can do in menopause to help with comfort
dress in layers, use a fan, avoid alcohol
What are some risk factors for breast cancer? (6)
1) family history/gene
2) didn't breastfed
3) early menarche/late menopause
5) never had a child
How is breast cancer determined?
mammogram and needle biopsy
List 3 warning signs of breast cancer
1) lump that is immobile and more fixed
2) breast drainage
3) dimpling of skin - orange peel appearance
When is the best time to do a BSE
1 week after period
_______ generalized pressure in the vagina, irriated
______rectum into the vagina, constipation, severe rectal pressure
_____ bladder prolapsed in the vagina, more urinary frequency, downward displacement of bladder
treatment for cystocele
kegel exercise, estrogen, physical therapy
______ occurs 1 week before period and improves 1 - 2 days into your cycle
In fibrocystic disease the nodular cysts are _____ and ______.
dense and irregular
In fibrocystic disease, a woman may experience _______ and ________
pain and tenderness
How can you tell if a lump in your breast may be cancer?
it is fixed, painless with retraction noticed
In polycystic ovarian disease a woman may have ______ and _____
hirsutism and irregular/no periods
How can you treat polycystic ovarian disease? (3)
birth control, lose weight, metformin
What vitals should a nurse monitor after a hysterectomy?
pulse, BP, O2
What are some classic signs and symptoms of ovarian cancer? (3)
bloating, general malaise/discomfort and cannot eat as much
___________ is when the lining of the uterine wall gets out in other places and causes pain and discomfort especially during periods
woman with endometriosis may also experience __________ an _________
debilitating pain and painful sex
How is endometriosis treated?
birth control where they do not get a period - Depo Provera, Hormonal IUD
How is endometriosis diagnosed?
List the cycle of abuse
tension building, abusive incident, honeymoon period
________ is the most frequently reported STI that is difficult to diagnose and can lead to PID, infertility and ectopic pregnancy*
What medications can you use to treat chlamydia?
1) Doxycycline 100mg PO BID 7 days
***Cannot give during pregnancy
2) Azithromycin 1g PO
In chlamdia a patient will have _______ discharge, ______ changes, burning/frequency of _____ and ________ pain
what is the oldest communicable disease?
How is gonorrhea treated?
antibiotics - cefixime or ceftriazone 250mg IM single dose PLUS azithromycin 1g PO
When you treat gonorrhea you also treat for?
_______ STI can cause PROM, neonatal sepsis, chorioamnionitis, IUGR and Preterm birth
In gonorrhea, the discharge is _____ & _____, there is _____ pain, and inflammation/swelling of the ______
greenish/yellow and foul
In the 1st trimester of pregnancy, the woman is tested for _____ sti
_______ Transmission by entry into the subcutaneous tissue through microscopic abrasions that can occur during sex
________ has chancre, fever, weight loss and malaise
Syphilis in pregnant woman can cause ____, _____, ____
PTL, IUGR, still birth
How can you treat syphilis?
T or F: you CAN cure herpes
FALSE - you can give them acyclovir for maintenance
it can be passed to fetus in utero or in birthing canal
what STI is more common in pregnant women?
HPV (genital warts)
in HPV there may be painless or irritating ______
vaginal discharge with itching
The best way to diagnose HPV is?
Can you get a shot to try and prevent HPV?
Yes, 3 shots over 6 months
________ is blister-like vesicles, that are painful. Patients have flu-like symptoms, genital pruritus and difficulty urinating
HSV - herpes simplex virus
Is there treatment for HSV
NO = palliative care only such as oral acyclovir because this is a recurrent lifelong infection
with HSV there is an increased risk of?
miscarriage in the first trimester
______ Itching, painful sex, bleeding with sex, foul odor, vaginal discharge, irritation
_______ is thin, watery white-gray discharge, with a fishy odor that can be treated with FLAGYL (metronidazole)
______ is itching, thick chunky "cottage cheese" discharge with a red rash and swollen labia
How can you treat candidiasis?
_______ is Yellow-green, frothy, odorous discharge, strawberry cervix and vulvar itcing
How can you treat trichomoniasis?
When do you do GBS screening?
35 - 37 weeks
What 3 things are you at risk for if you have Pelvic Inflammatory disease (PID)?
infertility, ectopic pregnancy and chronic pelvic pain
What is a common bacteria found in PID and where is it commonly found?
gonorrhea and chlamydia
uterus and uterine tubes
In PID, a woman may have _______ sharp cramping pain in lower quadrants, fever greater than ______, irregular _______
*may also have N/V, tenderness during sex, malaise
A patient may be at risk for PID if they have ______
How can you get toxic shock syndrome?
leaving a tampon/diaphragm in to long
In Toxic shock syndrome, a patient may have a rash that looks like _____, ______ fever, foul ______
What is the only contraceptive practice acceptable by the Roman Catholic Church?
fertility awareness based methods (FABs)
________ birth control method tracks menses for 6 months and identify shortest and longest cycles
What is the basal temp method?
take temperature every morning before getting up
temperature rises and remains elevated for several days following ovulation
_____ stops ovulation, thins uterine lining and thickens cervical mucosa
combined oral contraceptive (COC)
Who should not take OCP?
history of diabetes, risk for breast cancer, risk for blood clots, heavy smoker
What does ACHES stand for in regards to contraception?
Swelling and aching in extremities
what are 2 benefits of OCP
prevents ovarian and uterine cancer and decreases incidence of ovarian cysts
How fast do you need to take emergency contraceptive pills?
72 - 120 hours
What medications do you give to a newborn and why?
Vitamin K - clotting
Hep B -
Erythromycin - for gonorrhea and chlamydia
Hypothermia in newborns can be a sign of?
When is jaundice normal and when it is not normal
NORMAL = physiologic jaundice that occurs 24 hours after birth
NOT NORMAL = pathologic jaundice that occurs in the first 24 hours
Pathologic jaundice may be a sign of _____, _____
sepsis, ABO compatibility
What can occur if jaundice is severe enough?
How can a baby get rid of bilirubin?
When does Rh incompatibility occur?
When the mother is Rh- and the fetus is Rh+
what is a sign of a hemolytic disorder in newborns?
early onset jaundice
How should you resuscitate a baby? (5)
1) Dry and stimulate
2) Still not breathing or crying - PPV For 30 - 60 seconds and reevaluate
3) If HR less than 60
Chest compression with thumb and prepare for possible intubation
4) Medications - Epinephrine and volume expanders
5) IV access - Umbilical vein
What might you see in a baby born from a mother with substance abuse? (5)
2) high pitch cry
4) CNS dysfunction
5) delay in oral feeding
How can you help a baby born with neonatal abstinence syndrome?
cuddle them, swaddle them, decrease stimulus
Group B strep and Chorioamonitis may cause _______ in a baby
______ in the first 24 hours of life is a good sign of sepsis
Tachycardia, respiratory distress, temperature instability and poor feeding may be signs of _______
sepsis in baby
In preterm babies why do they have problems with temperature regulation?
lack of brown fat stores
In a preterm baby, why do you want to feed a baby slowly?
to prevent NEC
What are the parameters for anemia in a baby?
If less than 11 in term babies or 7 - 9 in preterm
How do you treat a pneumothorax in baby?
chest tube because they had sudden RDS presenting with color changes and diminished lung sounds
You observe a baby that has enlarged/distended abdomen and lack of bowel movements, difficult feeding and worsening RDS. You suspect this baby might have?
Best treatment for NEC
Babies of diabetic mothers or LGA are more at risk for?
excess adipose tissue
Hypoglycemia in a baby is considered ______
less than 40 - 45 - treat with D10W 6-8mg/kg/min
Circumcision is thought to prevent _______
infection and STI especially HIV
After a circumcision you notice some bleeding, what do you do?
apply gentle pressure
In fetal circulation the fetus has 2 ______ and 1 _____
arteries and veins
The ________ test is a screening tool for Rh incompatibility while the ______ tests for Rhogam needs in Rh- women
What might a postterm babies skin look like?
dry, cracked, parchment-like, no vernix and meconium staining
What can you give before birth to try and limit the possibility of RDS?
List some signs of infant respiratory distress
What is the difference between a midwife and an MD?
MIDWIFE = more holistic approach, no surgeries, focus more on low risk, more time with pts, more educational approach
MD = surgeries, higher risk
______ hormone comes from the posterior pituitary and helps contract the uterues
_____ comes from corpus lietum until the placenta can take over
Progesterone is important in pregnancy because ________
it maintains pregnancy
______ is initially produces by the corpus lute then the placenta takes over around the 7th weeks of pregnancy
Estrogen is important because it stimulates _____ and ____ development
uterine and breast
What is the earliest biochemical marker for pregnancy?
Describe what we should see in HcG levels
levels double every 48 hours which tells us we have a good pregnancy
if the levels are abnormally slow to rise this may indicate a miscarriage or ectopic pregnancy
How soon ca HcG be found?
it can be found 7 - 8 days before the expected period
When can you get a positive pregnancy test?
within 7 - 14 days
blood work in a few days
1) A presumptive sign of pregnancy are things that __________
2) A probable sign of pregnancy are things that ________
3) Positive signs of pregnancy are _______
1) patient reports
2) provider can evaluate
3) actual evidence/ only signs considered proof
- Urinary frequency
- Breast tenderness
- Excessive fatigue
are all _________
presumptive signs of pregnancy
Enlargement of abdomen, changes in pelvic organs, positive pregnancy tests* are all _______-
probable signs of pregnancy
Fetal movement, visualization of fetus, fetal heart beat are all ________
positive signs of pregnany
Fetal heart beat can be heard with a doppler at ________ and a fetoscope by ______
10 - 12
17 - 20
What is a zygote
What is meiosis?
When can you hear a heart beat with an ultrasound?
5 - 6 weeks
When can you feel quickening?
16 - 20 weeks
Describe the frequency of prenatal visits
every 4 weeks until 28 weeks then every 2 weeks until 36 weeks than every week until birth
When do you start giving Rhogam to an Rh negative mother?
THEN if the baby is Rh+ you give it within 72 hours to the MOM
When do you test H & H?
33% HCT and 11HGB
What is common in the 1st and 3rd trimester?
Back pain occurs in what trimester?
3rd - can do pelvic rock, counter pressure to help
Cravings, heartburn, constipation and headaches happen in what trimester?
When do you start lab work?
15 - 22 weeks
when do you test for STDs
1st and 3rd trimester
Describe the diagnosis for gestational diabetes
fails the 1 hours glucose test with a blood sugar of 140 or higher
does the 3 hours glucose test and misses 2/3 then she has GDM
If a woman has a blood glucose level of 200 she ______
automatically has GDM
What does MSAFP screen for?
NTD, down syndrome, trisomy 18
1) 16 weeks ________
2) 20 - 22 weeks ______
3) 22 - 24 weeks _____
4) 28 weeks _______
5) 36 weeks _____
1) halfway to umbilicus
2) at umbilicus
3) slight above umbilicus
4) 3 fingers above umbilicus
5) just below xiphoid process
An ultrasound at 20 weeks is for __________
What do you use an ultrasound for in pregnancy (3)
check growth, amniotic fluid, correct dating
abdominal ultrasound = _____
vaginal ultrasound = _____
Describe a reactive NST
Accelerations going up more than 15 bpm above baseline lasting 15 seconds with 2 or more accelerations in 20 minutes
*REACTIVE IS GOOD
______ decelerations are normal and usually seen with HEAD COMPRESSION or result of vagal stimulation
_______ decelerations indicate CORD COMPRESSION
Variable decelerations are ________ shape
V or W
_______ decelerations indicate UTEROPLACENTAL INSUFFICIENCY
In late decelerations, what is going to happen?
c-section, tocolytics may be used to well to stop contractions
What do late decelerations look like?
show uniform shape from contraction to contraction
Onset is late in the contraction phaes of the uterus
What do you do during Prolonged decelerations?
perform a vaginal exam to rule out prolapsed cord
What do you do if you palpate a prolapsed cord?
hand remains in pelvis, call for help, mom in knee-to-chest
1) _______ external monitor to measure contractions
2) ______ internal monitored on babies head to monitor heart tones
3) _____ assesses uterine contractions/resting tone
2) fetal scalp electrode
when does GDM testing start?
________ is usually painless bright red bleeding, quiet and sneaky in onset, uterus is nontender and soft
T or F: you DO NOT do a vaginal exam with placenta previa
______ burning, tearing, shearing pain. Very localized, rigid board like abdomen, sudden onset, may or may not have bleeding
what can cause placenta abruption
trauma, drug use, HTN
_____ loss of fetal station, constant abdominal pain, uterine tenderness*, change in uterine shape, sudden searing pain
in uterine rupture, the woman may display signs of?
What can cause uterine rupture?
prior uterine surgery, inductions (pitocin)
What is the earliest sign of uterine rupture?
nonreassuring fetal heart rate - variables or late decelerations followed by bradycardia
When do you take iron supplements?
empty stomach with some type of vitamin c to help absorption
Describe intrauterine resuscitation
turn on left side
How can you tell if a woman is in real labor
bloody show, lightening, ROM, dilation
back pain that radiates to abdomen
intensity increases with ambulation
How can you tell if it is false labor
pain subsides with activity, no cervical effacement or dilation, commonly in lower abdomen/groin
stages of labor
1) First stage of labor starts with ___________ and ends with ________
2) 2nd stage of labor starts with _______ and ends with _____
3) 3rd stage of labor starts with _______ and ends with _____
1) regular contractions, end with cervical dilation and effacement
2) 10cm and birth of baby
3) birth of baby until placental is expelled
In the 1st stage of labor, describe the latent, active and transition phases
1) latent = up to 3cm, no fetal descent and mom is excited
2) active = 4 - 7cm, progressive descent, mom anxious, more contractions
3) active = 8 - 10cm, intense stage, contractions every 1 - 2 minutes
In stage 2 of labor, women feel the urge to ________
bear down, it is the "pushing stage"
What are the cardinal movements a baby goes through in the 2nd stage of labor
Descent, Flexion, Internal Rotation, Extension, Restitution, External Rotation, Expulsion
Where is the uterus in the 3rd stage of labor?
midline, approximately 2cm below the level of the umbilicus
12 hours later it is 1cm above the umbilicus
In the 4th stage of labor you palpate the fundus?
every 15 minutes for 1 hour
What do you give magnesium sulfate for?
preterm labor, women with pre-eclampsia to prevent seizures
Does magnesium sulfate effect blood pressure
magnesium toxicity symptoms
decrease reflexes, respiratory problems, urine output falls
*normal = LOC, CNS changes, flushing
How can you reverse magnesium sulfate toxicity?
Nurses role in shoulder dystocia
Call for Help
Elevate Legs-McRoberts maneuver
Pubic Pressure- NEVER FUNDAL-Always SUPRAPUBIC!!!!!
Rotation maneuver's (Midwives will use all fours!! Not easily done with epidural in place!)
Classic sign of should dystocia is?
what are 2 important things to have in an emergency situation for pregnant women?
type and cross
List the components of the APGAR score
color, posture/muscle tone, heart rate, respiratory effort, reflex irritability
MMR, TDAP, flu shot,
what does a flaccid boggy uterus indicate?
uterine atony = PPH
PPH signs of infection = ______, ______, ______,
fever, tachycardia, foul discharge
lochia rubra should only occur for the first 2 - 3 days, if it continues past 2 weeks that is a sign of?
1) pitocin = ________
2) Metergine = _____
3) Hemabate = ______
4) Transimic acid = _____
5) cytotec = ______
1) 10 - 20 units IV or IM
2) 0.2mg PO or IM
3) 250mg IM
4) IM or IV
5) 600-1000 PO, vaginally, rectally
List some signs of PPH (7)
- cross cradle
- side lying
saturation of more than 1 pad per hour with bright red blood indicates______
How many wet diapers per day?
how many poopy diapers per day
3 - 4
Who shouldn't breastfeed?
HIV, drugs (cocaine/heroin), active TB, active herpes
how much should babies eat per day?
What is postpartum blues?
Transient period of depression
- Occurs first few days after delivery
-Mother may experience tearfulness, anorexia, insomnia, mood instability.
Begins in the first week and usually resolves in 2-10 days.
What is postpartum depression
Sleeping difficulties or excessive sleep, sadness, frequent crying, difficulty concentrating, appetite change, lack of interest in activities, lack of concern with appearance, feelings of worthlessness or inadequacy
What is postpartum psychosis?
syndrome characterized by depression, delusions, and thoughts of harming either infant or herself
evident in first 4 weeks
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