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level: Level 1

Questions and Answers List

level questions: Level 1

QuestionAnswer
An incomplete separation of the embryonic disk results in _______ _______.Conjoined twins
What is the infant mortality rate in the US?5.6 per 1000 live births
What percentage of babies are born prematurely?10%
What does morbidity mean?State of having disease
Thiamine deficiency can cause which condition in the fetus?Encephalopathy
Although the cause of hyperemesis gravidarum is unknown, what is thought to be a factor?Elevated levels of HCG
Which women are at higher risk of developing hyperemesis gravidarum?Experienced disorder in the past Primigravidas
What should be obtained of the woman with hyperemesis gravidarum to determine the impact of the vomiting?Electrolyte profile
What is the only medication approved by the FDA to treat vomiting during pregnancy?Pyridoxine (Diclegis)
Monozygotic twins are known as ______ twinsIdentical
What is the medical term for fraternal twins?Dizygotic
Monozygotic twins begin with how many fertilized ovums?1
Dizygotic twins almost always have separate _________.Placentas
Two separate ova being fertilized at the same time results in _______ twinsDizygotic
Which condition are more common in women with twins?Spontaneous abortion Maternal anemia Gestational hypertension Hydramnios Bleeding from placenta previa Abruptio placentae
An incomplete separation of the embryonic disk results in _______ _______.Conjoined twins
What are the two types of hydatidiform mole?Complete or partial
How often does a pregnancy involving twins occur in the US?33.4 in 1000 live births
A higher incidence of hydatidiform mole is reported in women of which descent?Asian
What does a complete mole result from?Fertilization of an egg whose nucleus has been lost or inactivated
Any symptoms of GH (gestational hypertention) before 20 weeks can indicate which condition?Hydatidiform mole
20% of cases of complete mole progress toward which condition?Choriocarcinoma
A woman who has experienced a molar pregnancy must avoid becoming pregnant for how long?One year
Cells of a molar pregnancy may be left behind and mey develop into _________Malignancy
Where does implantation most commonly occur in an ectopic pregnancy?Fallopian tube
What kind of ectopic pregnancy may be salvageable?Abdominal
What are some risk factors for the development of an ectopic pregnancy?Pelvic inflammatory disease Endometriosis Tubal structure defects Surgery to reproductive organs Smoking Low progesterone
What do HCG levels look like in an ectopic pregnancy?Lower than normal for gestational age
What kind of medication is a folic acid antagonist?Methotrexate
What does methotrexate do?Destroys rapidly dividing cells
What kind of medication may be prescribed to a woman with unruptured ectopic pregnancy?Methotrexate
What percentage of women have a normal pregnancy after an ectopic pregnancy?50%
What are the 8 classifications of abortion?Threatened Spontaneous Inevitable Complete Incomplete Missed Septic Habitual
What length cervix is indicative of incompetent cervix?Less than 20 mm long
The use of a suture to constrict the internal os of the cervix is called:Cerclage
A prophylactic cerclage is done at what week of gestation?10 to 14 weeks
Cerclage is rarely done after what week gestation?26 weeks
When the placenta implants in the lower uterine segment, this is called:Placenta previa
What is the main presenting symptom of placenta previa?Painless, bright red, vaginal bleeding that occurs after 20 weeks of gestation
What is the common birthing practice of a woman with placenta previa?Cesarean birth is scheduled at 36 weeks gestation
________ ________ is not allowed in the woman with placenta previaSexual intercourse
The premature separation of the placenta from the uterine wall is called:Abruptio placentae
When does abruptio placentae usually occur?Late in pregnancy
List the predisposing factors of abruptio placentaeTrauma Chronic hypertension GH
The use of which drug increases the risk of abruptio placentae?Cocaine
Abruptio placentae is 3 times more likely to occur in women of gravidity of more than ____Five
What are the major symptoms of abruptio placentae?Sudden severe pain accompanied by uterine rigidity
Which factors should be assessed when any bleeding occurs during pregnancy?Duration, amount, color, characteristic Vital signs Pain FHR Emotional response
Which laboratory tests determine the amount of blood loss?Hemoglobin and hematocrit
What is the leading cause of maternal death?Abruptio placentae
What does DIC result from?Alterations in normal clotting mechanism
DIC is usually a secondary diagnosis, and seen in which conditions?Abruptio placentae Incomplete abortion Hypertensive disease Infectious process
What is the body attempting to do in DIC?Prevent excessive blood loss
What are the clinical manifestations of DIC?Chest pain Restless and cyanotic Frothy blood-tinged mucus
DIC therapy includes continuous IV infusion of what medication?Heparin
How should the mother position herself to maximize blood flow to the fetus?Side-lying tilt
Early post partum hemorrhage is blood loss greater than ____mL after vaginal birth, or ___ mL after C-section500 mL, 1000mL
What are the most common causes of early hemorrhage?Atony Retained placental fragments Perineal lacerations
What are the causes of uterine atony?Excessive distention of uterus (from multiple pregnancies) Hydramnios Large infant
What percentage of women experience postpartum hemorrhage?5%
What is the most common cause oflate postpartum hemorrhage?Retained placental fragments
Which pharmacologic therapies are linked to postpartum hemorrhage?Magnesium sulfate Nifedipine
Tachycardia and hypotension are reflective of excessive ________ ________.Blood loss
How should the uterus feel for the first 24 hours after childbirth?Firmly contracted ball, the size of a grapefruit
Where should the uterus be easily located in the first 24 hours after birth?Level of the umbilicus
What is considered a large amount of lochia?Soaking more than one peripad per hour
What is considered an excessive amount of lochia?Soaking more than one peripad in 15 minutes
Which position is not advised for the woman with postpartum hemorrhage?Trendelenburg
Blood pressure levels are normally _______ during the first trimesterReduced
When do blood pressure levels return to pre pregnancy baseline?20 weeks gestation
What is the likelihood of a woman with chronic hypertension to develop preeclampsia?1:4
When does the condition of gestational hypertension begin?After 20 weeks gestation
Unlike preeclampsia, gestational hypertension is not accompanied by _____________Proteinuria
The hypertension of preeclampsia and eclampsia are accompanied by which symptoms?Albuminuria Edema Headache Visual disturbances Epigastric pain
List some risk factors for preeclampsia and eclampsiaFirst pregnancy African American race Chronic or gestational hypertension Obesity Family history Diabetes Gestational trophoblastic disease
Which ages are at higher risk for preeclampsia and eclampsia?Under 18, and over 30
What kind of blood pressure reading indicates a problem (mild preeclampisa?Increase of 30 mmHg systolic, and 15mmHg diastolic Or a reading of 140/90
What does urine testing show in a woman with mild preeclampsia?1+ to 2+ albumin readings
What is the urinary output of a woman with mild preeclampisa?At least 500 mL/24 h
What are the blood pressure findings of a woman with severe preeclampsia?160/110 mm Hg or higher on two separate readings 6 hours apart
What will urine testing for albumin show in the woman with severe pre eclampisa?3+ to 4+
What is the urinary output of a woman with severe pre eclampsia?Less than 500mL/24hr
What can epigastric or upset stomach in a patient with preeclampsia or eclampsia be indicative of?Distention of hepatic capsule; can warn that a convulsion is approaching
What position of bed rest is recommended for a patient with preeclampsia?Left lateral recumbent
When are antihypertensive medications prescribed to the woman with preeclampsia?When blood pressure exceeds 160/100
Fetal kicks of less than ___ per hour must be reported3 kicks
Fetal activity decreases in the presence of __________Hypoxia
List the nurse's responsibilities to protect the woman and fetus during convulsionRemain with the woman, call for help Turn woman to left side Note time and sequence Insert and airway after convulsion Observe fetal monitor patterns Notify physician
List 5 eclamptic seizure precautions & interventions1. Keep environment quiet 2. Keep call button nearby 3. Have calcium gluconate ready 4. Move carefully and calmly 5. Emergency birth pack accessible
Bed rest for the preeclamptic woman is vital because it slows ______ and relieves _______Metabolism, edema
What is the only cure for preeclampsia and GH?Delivery of the baby
What does HELLP syndrome stand for?Hemolysis, Elevated liver enzymes, Low platelet count
In order to be diagnosed with HELLP syndrome, what must the platelet count be?Less than 100,000/mm3
What is the prominent symptom of HELLP syndrome?Pain in right upper quadrant, lower chest, or epigastric area
What kind of birth is preferable if the woman has a hypertensive condition during pregnancy?Vaginal
HELLP syndrome necessitates what kind of birth?Cesarean
In addition to HELLP syndrome, what blood glucose level is associated with a high maternal mortality rate?Less than 40 mg/dL
Pregnancy is regarded as what kind of condition?Immunosuppressive
Mastitis is often caused by which bacteria?Staphylococcus aureus
When should breast feeding from a breast infected with mastitis be discontinued?If an abscess forms and ruptures into the milk ducts
How often should the mother with mastitis breast feed or pump the affected side to prevent stasis?Every 1.5 to 2 hours
Which side should the mother begin breastfeeding on when infected with mastitis?Unaffected side
Weaning during an episode of mastitis may increase _________ and __________. Encourage the mother to keep breast feeding.Engorgement and stasis
What does "TORCH" infection stand for?Toxoplasmosis, Others such as Rubella, Cytomegalovirus, and Herpes
What are common presenting problems of HIV infection in women?Chronic vaginitis, and candidiasis
What are HIV infected women at risk for during pregnancy?Preterm labor/birth Premature rupture of membranes IUGR Perinatal mortality Postpartum endometriosis
Giving birth within ___ hours of membrane rupture greatly reduces the transmission of HIV to the neonate4 hours
What are the risk factors in the development of gestational diabetes mellitus?Older than 25 Family history of diabetes History of gestational diabetes Nonwhite race Obesity Hypertension
When is a 1-hour, 50-g diabetes screening or glucose tolerance test performed?24 to 28 weeks gestation
Which test for diabetes is not reliable during pregnancy?Glycosylated hemoglobin (A1c)
What is prescribed for women with type 2 diabetes while pregnant?Insulin
Why are hypoglycemic medications contraindicated during pregnancy?Possible teratogenic agents
Why is insulin safe during pregnancy?It does not cross the placental barrier
What are the potential complications of the mother with diabetes during pregnancy?Risk for operative birth Tissue trauma from large for gestational age infant
What are the fetal complications of a diabetic pregnancy?Preterm delivery Macrosomia
The symptoms of cardiomyopathy are similar to those of _______ ______ ________.Congestive heart failure
When is cardiomyopathy usually seen?Last month of pregnancy or postpartum period
What are the most common cardiac problems of maternity patients?Rheumatic heart disease Congenital heart defects Mitral valve prolapse
Rheumatic heart disease is the result of what kind of infection?Streptococcal infection
During labor which position of the mother enhances respiratory effort and improves circulation?Semi-Fowler's or side-lying
What kind of birth is recommended for the woman with heart disease?Vaginal
What is used to minimize the mother's use of valsalva's maneuver during labor?Vacuum extraction Outlet forceps
What is the mother with heart disease at risk for during the first 48 hours after birth?Cardiac decompression
What kind of fluids are used for amnioinfusion?Lactated Ringer's solution Saline
What are the physiologic concerns associated with adolescent pregnancy?GH Cephalopelvic disproportion Abruptio placentae Low birth weight IUGR Anemia Infection Preterm delivery Perinatal death
Why are oral contraceptives not usually recommended immediately after birth?Woman is at risk for thromboembolic disease in the immediate postpartum period (first 4 weeks)
Which oral contraceptives are recommended for adolescents?medroxyprogesterone (Depo-Provera) levonorgestrel (Norplant(
Each year after the age of 35 years increases the risk of conceiving a child with _____ _________.Down syndrome
The incidence of which conditions increases as the woman agesEctopic pregnancy Placenta previa Diabetes Hypertension
What are the three types of thrombus that the postpartum period may be affected by?Superficial venous thrombus Deep vein thrombosis Pulmonary embolism
What kind of respiratory changes signal pulmonary embolsim?Tachycardia and dyspnea
A positive Homan's sign is not considered a definitive test of ______ _________ _______Deep vein thrombosis
Oral anticoagulation therapy for deep vein thrombosis should be continued for how long during the acute phase?3 months
What kind of IV therapy is used in managing pulmonary embolism?IV heparin therapy
What kind of blood thinner is contraindicated in pregnany?Warfarin
How long will the patient anticipate to take oral anticoagulants or subcutaneous heparin therapy after the acute phase of pulmonary embolism?6 months
What weeks of gestation is considered a preterm birth?20-37 weeks
38 to 41 weeks gestation birth is considered:Term
What week gestation is considered a post term birth?42 weeks
What is the preterm infants greatest potential problem?Respiratory distress syndrome
What is the post term infant at risk for?Asphyxia Respiratory distress Hypoglycemia
When does Rh incompatibility occur?When the mother is negative, and the fetus is positive
A hemolytic anemia that occurs in newborns due to maternal-fetal blood incompatibility is called ________ _________.Erythroblastosis fetalis
The destruction of fetal RBC's results in _______ ________.Pathological jaundice
What is kernicterus?Toxic accumulation of bilirubin in central nervous system tissues
Kernicterus may result in _______ damage or _________.Neurologic damage or death
What does an indirect coombs test meaure?Number of maternal antibodies
When should an amniocentesis be performed after an indirect coombs test?If the titer exceeds 1:16
Phototherapy is begun when bilirubin levels reach __ to ___ mg/dL12 to 15 mg/dL
When is RhoGAM administered to the mother?At 28 weeks, and 72 hours after birth
Positioning the newborn on the ______ side reduces the risk of aspirationRight side