Most Missed Questions for VNSG 1230
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| What position is recommended for a woman to lie in when she has heart disease? | Do not lie flat on your back, use pillows or wedges while semi recumbent.
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| What are the symptoms of trichomoniasis and can it be treated? | Large amounts of foamy green-yellow vaginal discharge, itching, unusual odor, painful sex, disuria, Treatment: metronidazole.
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| What are sympoms of chlamydia and can it be treated? | yerllow green discharge, sometimes no symptoms, burning urination. Easily treated with antibiotics.
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| What are symptoms of gonorrhea and can it be treated? | Symptoms include painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Yes, it can successfully be treated.
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| Is prednisone safe to be given to an asthmatic pregnant woman? | Yes, but only as a last resort.
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| Which trimester is the most dangerous time for the pt with heart disease? | 2nd trimester.
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| What is expected to happen if a pt has uncontrolled diabetes and has reached 37 weeks gestation? | amniocentesis to check for lung maturity.
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| When is transvaginal ultrasound preferred to an abdominal ultrasound? | ectopic and placenta previa
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| What do you monitor for when a patient presents with bleeding? | Placenta previa, or abruptio, and s/s of shock.
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| When is RhoGam given | when the mother has negative antigen.
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| What do you do when the monitor is showing that the fetus is in distress? | assess position and move if possible. Give mom 02.
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| What is the symptoms for abruptio placentae? | Sharp pain and bleeding.
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| Why do we give RhoGam? | To protect antigen differential of blood in mom and baby.
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| What do you anticipate happening when a patient has ectopic pregnancy? | Death of the fetus and surgery.
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| What increases the incidence of ectopic pregnancy? | abortions, more than one pregnancy.
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| What is a priority symptom in preeclampsia? | extreme high BP proteinurea
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| What are other symptoms with preeclampsia? | high BP 140/90 or above
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| What is done if mom is Rh negative after baby is born. | Rhogam is given.
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| What is priority intervention with hyperemesis gravidarium? | correcting fluid electrolye and acid balance. HPo for 24?
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| What is the symptoms of placenta previa? | Bleeding with no pain.
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| What are the symptoms of severe preeclampsia? | extremely high BP, CNS irritabilities.
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| what are the symptoms of an incomplete abortion? | particles still inside upon ultrasound
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| What are the signs of an inevitable abortion? | No heartbeat, ectopic pregnancy.
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| What are the first signs of fluid retention suggestive of PIH? | swollen ankles, swollen face and hands.
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| When assessing labor contractions, the nurse notes that the contracting uterus can be easily indented with the fingertips when contractions are at their peak. Contraction intensity should be recorded as: | mild.
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| Explain the cardinal movements of labor. | Engagement, descent, flexion, internal rotation, extension, expulsion.
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| Explain the behavior of a woman during the trasition phase of labor | Express irritability and restless, will feel out of control. She may tremble, vomit, or cry.
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| What are variable decels a sign of? | Acute umbilical cord compression.
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| What could happen when the membranes rupture suddenly? | Premature labor infections, precipitous birth, umbilical cord prolapse, caught in an awkward position.
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| What is augmentation of labor? | speeding up labor or speeding up contractions
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| Mechanisms of labor: Engagement | initial descent of fetal head may result in engagement. when presenting part descends to the level of ischial spins. May occor 2 weeks b4 labor or even not initial after onset of labor. More likely to occur earlier in primigravida and later in multig.
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| Mechanisms of labor: Descent | May begin when fetus "drops" measured by station. Continues throughout labor thru varying degrees.
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| Mechanisms of labor: Flexion | as head descends into labor the fetus encounters resistance from the soft tissue and muscles of pelvic floor. The resistance coaxes the fetus into flexion. Flexion is the attitude
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| Mechanisms of Labor: Internal rotation | the fetal head rotates 45 degrees from a traverse position to an anterior position so the head can a accomodate the pelvic outlet. If rotation does not occur labor can be prolonged.
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| Mechanisms of labor: extension | fetal head is well flexed chin on chest the fetus travels through the birth canal when fetus reaches pubic arch it must extend under symphsis pubis.
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| mechanisms of labor: expulsion (birth) | occurse after deliveryof anterior and posterior shoulders.
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| What deceleration is associated with cord compression? | Variable Decels
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| What should you do when a woman feels like her baby is coming? | Do an assessment on her and vaginal exam.
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| When is the scalp electrode contraindicated? | HIV infections, hepatitis, active herpes simplex virus
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| If the fetal heart rate is decreased what should you check first? | Check maternal heart rate.
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| After amniotomy what is reported immediately? | FHR is documented before and after, if there is a drastic drop in FHR report it immediately.
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| Different Breech Births: Frank | Hips flexed, knees extended
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| Different Breech Births: Complete | Hips and knees flexed
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| Different Breech Births: Single footling | one hip extended with one foot presenting
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| Different Breech Births: double footling | both feet and hips extended presenting
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| After which occurence should the primagravida come to the hospital? | Expelling the mucus plug - breaking water - ripinening and thinning of cervix
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| What is the behavior during the latent phase? | Excited and talkative although anxiety and apprehension are common responses.
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| What are symptoms of hyperventilation? | numbness and tingling , confusion, fainting, spasms/cramps in hands and feet, weakness, dizziness
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| what are treatments of hyperventilation for the laboring mother? | breathing into cupped hands or a paper bag
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| why are foods and fluids restricted prior to deliver? | to prevent mom from aspirating in the event of a c section
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| what is the intial action when a woman is receiving an oxytocin infusion and she begins to develop a hypertonic uterus? | Shut off oxytocin infusion. If FHR is affected atocolytic may be ordered.
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| What are some complications with a vacuum extractor? | Scalp trauma, subgaleal and intracranial hemorrhage or even death.
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| What is an adverse effect of Brethine? | Tachycardia, palpitations, anxiety, hypokalemia, hyperglycemia, hypotension, SOB, HA, NV, Chest pain, pulmonary edema, cardiac ischemia and insufficiency.
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| What is Brethine used for? | Relaxes the uterus to prevent premature labor and give the fetus time to mature.
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| What is an adverse effect of magnesium sulfate? | Warmth, HA,
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| What is magnesium sulfate used for? | to prevent seizures by relaxation of muscles and action on CNS and to slow down preterm labor.
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| A woman with ruptured membranes is discharged to home, what should be reported immediately? | any signs of infection: elevated maternal temps. maternal tachycardia, cloudy-foul-dmelling amnio fluid; uterine tenderness
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| What does each side of the placenta look like? | smooth, shiny, fetal side and bloody red segmented mother side.
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| What indicates labor? | progressive dilation and effacement of cervix
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| What does zero station mean? | presenting part is at ischial spine in the true pelvis.
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| what is going on to the womans body during the trasition phase (not emotions)? | cervix is dilated 8cm ending in full dilation, strong contractions every 2-3 minutes, duration of 60-90 seconds. Strong urge to push.
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| Describe ROA | Back of babys head is slightly off center with back of head towards right thigh.
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| Why do we try nonpharmocological methods of pain mgmt first before meds? | non invasive! they address: emotional and spiritual aspects of birth and promote moms sense of control over her own pain.
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| When a pt is noted to have decels of 75 bpm what should the nurse do first? | check the mothers heart rate and change positions.
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| If a pt has a classical or traditional incision, can they have a VBAC? | No. Risk of uterine rupture is higher.
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| How do you chart a vacuum assisted or forcep assisted delivery? | Document "operative vaginal delivery", maternal fetal response to procedure
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| Why do we most often perform c-sections? | Hx of previous Csections, labor dystocia, non-reassuring fetal status, fetal malpresentation.
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| What is the difference between fraternal and identical twins? | Fraternal is 2 zygotes while identical is one zygote.
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| What normally occurs at 20 weeks to the fetus? | Eyebrows and scalp hair are present. Lanugo covers body. Vernix caseosa forms. Heart sounds.
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| Where does fertilization occur? | Ampulla of the fallopian tube.
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| What does the baby look like at 12 weeks? | 8cm Long, 25g weight, face well formed eyes widely spread.
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| At what age can exposure to a teratogen cause deafness? | 6-8 weeks
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| What is the ductus arteriosus? | Fetal shunt that links PA and aorta.
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| What is the purpose of surfactant? | Decrease surface tension in alveoli.
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| What day after ferliziation is the embryo fully implated into the uterus wall? | 10th day.
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| When is the best time to try to have intercourse around ovulation? | 5 days before and 2 days after.
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| What is the weight gain for an underweight woman? | 28-40 lb.
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| What is the weight gain for an overweight woman? | 15-20lb.
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| What is the weight gain for a normal sized woman? | 25-35 lb.
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| A vegan needs to add what to their diet? | Protein, fortified cereal.
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| What are the probable signs for pregnancy? | Presence of HCG in blood or urine, uterine growth, Braxton hicks, ballotment of fetus.
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| What causes frequent urination? | 1st Trimester increased glomerular filtration due to CO and decreased renal vascular resistance. 3rd Trimester is due to pressure from expanding uterus.
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| What is a mucus plug? | Thickened mucus that covers cervix during pregnancy to protect
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| What happens after vaginal exam? | Bleeding is to be expected.
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| What is the increase of blood volume? | 40-50%
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| What happens if the woman does not gain enough weight during pregnancy? | Baby could be born with low birth weight and more susceptible to chromosomal abnormalities.
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| What does a high MSFAP indicate? | Spina bifida or pregnancy could be further along.
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| What does a low MSFAP indicate? | Downs Syndrome
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| What do you teach a woman who has a repetitive heartburn? | eat small meals sleep sitting up dont lay down right after eating.
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| What are some common discomforts that happen in the final trimester of pregnancy? | leg cramps, back pain, SOB, fatigue, heartburn.
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| Why is Rhogam done after an amniocentesis? | If mother is RH(-) baby may not be compatible.
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| What do you teach a woman who is suffering from leg cramps? | dorsi flexion
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| Why are amniocentesis' not done in the first trimester? | fear of fetal foot deformaties and pregnacy loss. not enough fluid.
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| What does a woman do for constipation while pregnant? | increased fluid and fiber and fruits.
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| What is special about fetal circulation? | It is different than the pattern of human circulation that is present after birth. the fetus depends on maternal circulation for oxygenation while in utero. Also, 2 arteries, 1 vein. Arteries - unoxygentated and Vein - oxygenated.
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| List two probable signs of pregnancy. | Presensce of HCg in blood may be caused by hydatoform mole. May be caused by tumors in uterine growth.
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| List two probable signs of pregnancy. | Early breast changes - could caused by oral contraceptives. Amenorrhea- could be caused by hormonal imbalance, emotions, stress, or illness.
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| List two positive signs of pregnancy. | Visualization of fetus by ultrasound. fetal heart sounds by fetoscope.
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| How much weight should the woman gain? | 25-35 lbs.
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| Significant formed structures at 8 weeks | bigger head than body due to brain development. The eheart with septum and valves is beating rhythmically. Fingers and toes are distinct and seperated. Sex differentation begins Organogenesis is complete.
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| Significant formed structures at 16 weeks | Lungs fully shaped. Fetus swallows amniotic fluid. Skeletal structure is identifiable. Downy lanug hair is present. Liver and pancreas are functioning. Sex can be determined via ultrasound.
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| Significant formed structures at 20 weeks. | Eyebrows and scalp hair are present. Lanugo covers entire body. Vernix caseosa begins to form. Heart sounds can be heard with fetoscope. Fetal movements are felt by the woman.
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| Significant formed structures at 32 weeks. | Lungs are not yet fully developed but the fetus does well if born at this time. Active mororeflex is present. Steady weight gain. Male testes descend into the scrotum. Scrotal sac has a few rugae.
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| Significant formed structures at 40 weeks. | (full term) vernix caseosa is evident on body folds. Lanugo remains on shoulders and upper back only. Creases cover at least 2/3 of the surface of the sole of the foot. Female: labia majora is fully developed.
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