ob evolve test 4

8/15/2019 OB Evolve Test 4

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1.A 40-year-old woman with a high body mass index (BMI) is 10 weeksregnant. !hi"h diagnosti" tool is aroriate to s#ggest to her at this time$Biohysi"al ro%leAmnio"entesisMaternal ser#m alha-'etorotein (MA*),ransaginal #ltraso#nd Correct

An #ltraso#nd is the method o' biohysi"al assessment o' the in'ant that iser'ormed at this gestational age. ,ransaginal #ltraso#nd is ese"ially #se'#l 'orobese women whose thi"k abdominal layers "annot be enetrated ade/#ately withthe abdominal aroa"h. A biohysi"al ro%le is a method o' biohysi"alassessment o' 'etal well-being in the third trimester. An amnio"entesis is er'ormeda'ter the 'o#rteenth week o' regnan"y. A MA* test is er'ormed 'rom week 1 toweek o' the gestation (weeks 12 to 13 are ideal).Awarded 0.0 oints o#t o' 1.0ossible oints.

.A n#rse roiding "are 'or the anteart#m woman sho#ld #nderstand thatthe "ontra"tion stress test (&,)ometimes #ses ibroa"o#sti" stim#lation.Is an inasie test5 howeer "ontra"tions are stim#lated.

Is "onsidered to hae a negatie res#lt i' no late de"elerations are obsered withthe "ontra"tions. &orre"tIs more e6e"tie than nonstress test (7,) i' the membranes hae already beenr#t#red.

7o late de"elerations indi"ate a ositie &, res#lt. 8ibroa"o#sti" stim#lationis sometimes #sed with 7,. &, is inasie i' stim#lation is er'ormed by I8oxyto"in b#t not i' by nile stim#lation. &, is "ontraindi"ated i' the membraneshae r#t#red.Awarded 0.0 oints o#t o' 1.0 ossible oints.

9.In the ast 'a"tors to determine whether a woman was likely to hae a highrisk regnan"y were eal#ated rimarily 'rom a medi"al oint o' iew. A broadermore "omrehensie aroa"h to high risk regnan"y has been adoted. ,here arenow 'o#r "ategories based on threats to the health o' the woman and the o#t"omeo' regnan"y. !hi"h o' the otions listed here is not in"l#ded as a "ategory$Biohysi"al*sy"hoso"ial:eograhi" Correct;nironmental

,he 'o#rth "ategory is "orre"tly re'erred to as the sociodemographic risk"ategory. ,he 'a"tors stem 'rom the mother and her 'amily. ;thni"ity may be one o'the risks to regnan"y5 howeer it is not the only 'a"tor in this "ategory. =I sho#ld hae my h#sband drie me home a'ter the test be"a#se I may be


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na#seated.>=,his test will hel to determine whether the baby has +own syndrome or a ne#ralt#be de'e"t.>=,his test obseres 'or 'etal a"tiity and an a""eleration o' the 'etal heart rate todetermine the well-being o' the baby.> Correct

,he nonstress test is one o' the most widely #sed te"hni/#es to determine

'etal well-being and is a""omlished by monitoring 'etal heart rate in "on?#n"tionwith 'etal a"tiity and moements. An #ltraso#nd re/#ires a '#ll bladder. Anamnio"entesis is the test a'ter whi"h a regnant woman sho#ld be drien home. Amaternal ser#m alha-'etorotein test is #sed in "on?#n"tion with #n"on?#gatedestriol leels and h#man "horioni" gonadotroin hels to dete"t +own syndrome.Awarded 0.0 oints o#t o' 1.0 ossible oints.

.!hat is an aroriate indi"ator 'or er'orming a "ontra"tion stress test$In"reased 'etal moement and small 'or gestational ageMaternal diabetes mellit#s and ostmat#rity CorrectAdoles"ent regnan"y and oor renatal "are@istory o' reterm labor and intra#terine growth restri"tion

+e"reased 'etal moement is an indi"ator 'or er'orming a "ontra"tion stress

test5 the sie (small 'or gestational age) is not an indi"ator. Altho#gh adoles"entregnan"y and oor renatal "are are risk 'a"tors 'or oor 'etal o#t"omes they arenot indi"ators 'or er'orming a "ontra"tion stress test. Intra#terine growthrestri"tion is an indi"ator5 history o' a reio#s stillbirth not reterm labor isanother indi"ator.Awarded 0.0 oints o#t o' 1.0 ossible oints.

2.,he n#rse sees a woman 'or the %rst time when she is 90 weeks regnant. ,he woman has smoked thro#gho#t the regnan"y and '#ndal heightmeas#rements now are s#ggestie o' growth restri"tion in the 'et#s. In addition to#ltraso#nd to meas#re 'etal sie what wo#ld be another tool #se'#l in "on%rmingthe diagnosis$+oler blood ow analysis Correct&ontra"tion stress test (&,)

Amnio"entesis+aily 'etal moement "o#nts

+oler blood ow analysis allows the examiner to st#dy the blood ownoninasiely in the 'et#s and the la"enta. It is a hel'#l tool in the management o' high risk regnan"y d#e to intra#terine growth restri"tion (IC:D) diabetes mellit#sm#ltile 'et#ses or reterm labor. Be"a#se o' the otential risk o' ind#"ing laborand "a#sing 'etal distress a &, is not er'ormed in a woman whose 'et#s isreterm. Indi"ations 'or an amnio"entesis in"l#de diagnosis o' geneti" disorders or"ongenital anomalies assessment o' #lmonary mat#rity and the diagnosis o' 'etalhemolyti" disease not IC:D. etal ki"k "o#nt monitoring is er'ormed to monitorthe 'et#s in regnan"ies "omli"ated by "onditions that may a6e"t 'etaloxygenation. Altho#gh it may be a #se'#l tool at some oint later in this womanEsregnan"y it is not #sed to diagnose IC:D.Awarded 0.0 oints o#t o' 1.0 ossibleoints.

F.7#rses sho#ld be aware o' the strengths and limitations o' ario#sbio"hemi"al assessments d#ring regnan"y in"l#ding that&horioni" ill#s samling (&8) is be"oming more o#lar be"a#se it roides earlydiagnosis."reening 'or maternal ser#m alha-'etorotein (MA*) leels is re"ommendedonly 'or women at risk 'or ne#ral t#be de'e"ts.


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*er"#taneo#s #mbili"al blood samling (*CB) is one o' the /#ad-s"reen tests 'or+own syndrome.MA* is a s"reening tool only5 it identi%es "andidates 'or more de%nitiero"ed#res. Correct

&8 does roide a raid res#lt b#t it is de"lining in o#larity be"a#se o'adan"es in noninasie s"reening te"hni/#es. MA* s"reening is re"ommended

'or all regnant women. MA* not *CB is art o' the /#ad-s"reen tests 'or +ownsyndrome. MA* is a s"reening tool not a diagnosti" tool. #rther diagnosti"testing is indi"ated a'ter an abnormal res#lt.Awarded 0.0 oints o#t o' 1.0 ossibleoints.

3.!hen wo#ld the best time'rame be to establish gestational age based on#ltraso#nd$At term3 weeksBetween 14 and weeks Correct92 weeks

Cltraso#nd determination o' gestational age dating is best done between 14and weeks. It is less reliable a'ter that eriod be"a#se o' ariability in 'etal sie.

tandard sets o' meas#rements relatie to gestational age are noted aro#nd 10 toa'ter 1 weeks and in"l#de "rown-r#m length (a'ter 10) biarietal diameter (a'ter1) 'em#r length and head and abdominal "ir"#m'eren"es.Awarded 0.0 oints o#to' 1.0 ossible oints.

G.A n#rse is roiding instr#"tion 'or an obstetri"al atient to er'orm a daily'etal moement "o#nt (+M&). !hi"h instr#"tions "o#ld be in"l#ded in the lan o'"are$ (Select all that apply.),he 'etal alarm signal is rea"hed when there are no 'etal moements noted 'or ho#rs.,he atient "an monitor 'etal a"tiity on"e daily 'or a 20-min#te eriod and notea"tiity. CorrectMonitor 'etal a"tiity two times a day either a'ter meals or be'ore bed 'or a eriod o'

ho#rs or #ntil 10 'etal moements are noted. Correct&o#nt all 'etal moements in a 1-ho#r eriod daily #ntil 10 'etal moements arenoted. Correct

,he 'etal alarm signal is rea"hed when no 'etal moements are noted 'or aeriod o' 1 ho#rs.Awarded 0.0 oints o#t o' 1.0 ossible oints.

10.A atient has #ndergone an amnio"entesis 'or eal#ation o' 'etal well-being. !hi"h interention wo#ld be in"l#ded in the n#rseEs lan o' "are a'ter thero"ed#re$ (Select all that apply.)*er'orm #ltraso#nd to determine 'etal ositioning.Hbsere the atient 'or ossible #terine "ontra"tions. CorrectAdminister Dho:AM to the atient i' she is Dh negatie. Correct*er'orm a mini"atheteriation to obtain a #rine se"imen to assess 'or bleeding.

Cltraso#nd is #sed rior to the ro"ed#re as a is#aliation aid to assistwith insertion o' transabdominal needle. ,here is no need to assess the #rine 'orbleeding as this is not "onsidered to be a tyi"al resentation or "omli"ation.Awarded 0.0 oints o#t o' 1.0 ossible oints.

&hater F

1.A woman with seere ree"lamsia is re"eiing a magnesi#m s#l'ate


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in'#sion. ,he n#rse be"omes "on"erned a'ter assessment when the woman exhibitsA sleey sedated a6e"t.A resiratory rate o' 10 breathsmin. Correct+ee tendon reexes o' J.Absen"e o' ankle "lon#s.

A resiratory rate o' 10 breathsmin indi"ates that the "lient is exerien"ing

resiratory deression (bradynea) 'rom magnesi#m toxi"ity. Be"a#se magnesi#ms#l'ate is a "entral nero#s system (&7) deressant the "lient will most likelybe"ome sedated when the in'#sion is initiated. +ee tendon reexes o' J are anormal %nding as is absen"e o' ankle "lon#s.Awarded 0.0 oints o#t o' 1.0 ossibleoints.

.A n#rse "aring 'or regnant women m#st be aware that the most "ommonmedi"al "omli"ation o' regnan"y is@yertension. Correct@yeremesis graidar#m.@emorrhagi" "omli"ations.In'e"tions.

*ree"lamsia and e"lamsia are two noted deadly 'orms o' hyertension

whi"h is the most "ommon medi"al "omli"ation o' regnan"y. A large er"entageo' regnant women hae na#sea and omiting b#t a relatie 'ew hae the seere'orm "alled hyeremesis graidar#m. @emorrhagi" "omli"ations are the se"ondmost "ommon medi"al "omli"ation o' regnan"y.Awarded 0.0 oints o#t o' 1.0ossible oints.

9.!ith regard to ree"lamsia and e"lamsia n#rses sho#ld be aware that*ree"lamsia is a "ondition o' the %rst trimester5 e"lamsia is a "ondition o' these"ond and third trimesters.*ree"lamsia res#lts in de"reased '#n"tion in s#"h organs as the la"enta kidneyslier and brain. Correct,he "a#ses o' ree"lamsia and e"lamsia are well do"#mented.eere ree"lamsia is de%ned as ree"lamsia l#s rotein#ria.

8asosasms diminish the diameter o' blood essels whi"h imedes bloodow to all organs. *ree"lamsia o""#rs a'ter week 0 o' gestation and "an r#n thed#ration o' the regnan"y. ,he "a#ses o' ree"lamsia and e"lamsia are #nknownaltho#gh seeral hae been s#ggested. *ree"lamsia in"l#des rotein#ria5 seere"ases are "hara"teried by greater rotein#ria or any o' nine other "onditions.Awarded 0.0 oints o#t o' 1.0 ossible oints.

4.A woman with seere ree"lamsia is being treated with an I8 in'#sion o'magnesi#m s#l'ate. ,his treatment is "onsidered s#""ess'#l i'Blood ress#re is red#"ed to reregnant baseline.ei#res do not o""#r. Correct+ee tendon reexes be"ome hyotoni".+i#resis red#"es #id retention.

Magnesi#m s#l'ate is a "entral nero#s system (&7) deressant gienrimarily to reent sei#res. A temorary de"rease in blood ress#re "an o""#r b#tis not the #rose o' administering this medi"ation. @yotonia is a sign o' anex"essie ser#m leel o' magnesi#m. It is "riti"al that "al"i#m gl#"onate be on handto "o#ntera"t the deressant e6e"ts o' magnesi#m toxi"ity. +i#resis is not anexe"ted o#t"ome o' magnesi#m s#l'ate administration.Awarded 0.0 oints o#t o'1.0 ossible oints.

.A woman with seere ree"lamsia has been re"eiing magnesi#m s#l'ate


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by I8 in'#sion 'or 3 ho#rs. ,he n#rse assesses the woman and do"#ments the'ollowing %ndings temerat#re 9F.1K & #lse rate G2 beatsmin resiratory rate 4breathsmin blood ress#re 111 mm @g 9J dee tendon reexes and noankle "lon#s. ,he n#rse "alls the hysi"ian anti"iating an order 'or@ydralaine. CorrectMagnesi#m s#l'ate bol#s.

+iaeam.&al"i#m gl#"onate.

@ydralaine is an antihyertensie "ommonly #sed to treat hyertension inseere ree"lamsia. An additional bol#s o' magnesi#m s#l'ate may be ordered 'orin"reasing signs o' "entral nero#s system irritability related to seere ree"lamsia(e.g. "lon#s) or i' e"lamsia deelos. +iaeam sometimes is #sed to sto orshorten e"lamti" sei#res. &al"i#m gl#"onate is #sed as the antidote 'ormagnesi#m s#l'ate toxi"ity. ,he "lient is not "#rrently dislaying any signs orsymtoms o' magnesi#m toxi"ity.Awarded 0.0 oints o#t o' 1.0 ossible oints.

2.7#rses sho#ld be aware that @;


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*ositie "lon#s resonse eli"ited #nilaterally is a "a#se 'or "on"ern as its#ggests a hyera"tie resonse. ,yi"ally there is no ain asso"iated withdetermination o' +,Ds so this %nding wo#ld be "onsidered to be normal as wo#ldbilateral +,Ds noted at J.

;en tho#gh +,Ds at 1J indi"ate a sl#ggish or de"reased resonse this%nding is #n"hanged sin"e the initiation o' theray. ,he n#rse wo#ld "ontin#e to

monitor.Awarded 0.0 oints o#t o' 1.0 ossible oints. G.!hi"h o' the 'ollowing antihyertensie medi"ations wo#ld "a#se a

regnant woman to hae a ositie &oombs test res#lt$7i'ediine (*ro"ardia)Methyldoa (Aldomet) Correct


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&raming. *ain is absent with la"enta reia and may be agoniing with abr#tio

la"entae. Bleeding #terine a"tiity and "raming may be resent in aryingdegrees 'or both la"ental "onditions.Awarded 0.0 oints o#t o' 1.0 ossible oints.

9.A woman at 9G weeks o' gestation with a history o' ree"lamsia isadmitted to the labor and birth #nit. he s#ddenly exerien"es in"reased

"ontra"tion 're/#en"y to eery 1 to min#tes5 dark red aginal bleeding5 and atense ain'#l abdomen. ,he n#rse s#se"ts the onset o';"lamti" sei#re.D#t#re o' the #ter#s.*la"enta reia.*la"ental abr#tion. Correct

Cterine tenderness in the resen"e o' in"reasing tone may be the earliest%nding o' remat#re searation o' the la"enta (abr#tio la"entae or la"entalabr#tion). !omen with hyertension are at in"reased risk 'or an abr#tion.;"lamti" sei#res are eiden"ed by the resen"e o' generalied toni"-"loni""on#lsions. Cterine r#t#re mani'ests with hyotoni" #terine a"tiity signs o'hyoolemia and in many "ases the absen"e o' ain and la"enta reia with

bright red ainless aginal bleeding.Awarded 0.0 oints o#t o' 1.0 ossible oints. 4.In "aring 'or the woman with disseminated intraas"#lar "oag#lation (+I&)

what order sho#ld the n#rse anti"iate$Administration o' blood Correct*rearation o' the woman 'or inasie hemodynami" monitoringDestri"tion o' intraas"#lar #idsAdministration o' steroids

*rimary medi"al management in all "ases o' +I& inoles "orre"tion o' the#nderlying "a#se ol#me rela"ement (not ol#me restri"tion) blood "omonenttheray otimiation o' oxygenation and er'#sion stat#s and "ontin#edreassessment o' laboratory arameters. &entral monitoring wo#ld not be orderedinitially in a woman with +I& be"a#se it "o#ld "ontrib#te to more areas o' bleeding.

teroids are not indi"ated 'or the management o' +I&.Awarded 0.0 oints o#t o' 1.0ossible oints.

.igns o' a threatened abortion (mis"arriage) are noted in a woman at 3weeks o' gestation. !hat is an aroriate management aroa"h 'or this tye o'abortion$*reare the woman 'or a dilation and "#rettage (+N&).*#t the woman on bed rest 'or at least 1 week and reeal#ate.*reare the woman 'or an #ltraso#nd and blood work. Correct&om'ort the woman by telling her that i' she loses this baby she may attemt toget regnant again in 1 month.

Deetitie transaginal #ltraso#nds and meas#rement o' h#man "horioni"gonadotroin (h&:) and rogesterone leels may be er'ormed to determinewhether the 'et#s is alie and within the #ter#s. Bed rest is re"ommended 'or 43ho#rs initially. +N& is not "onsidered #ntil signs o' the rogress to ineitableabortion are noted or the "ontents are exelled and in"omlete. I' the regnan"y islost the woman sho#ld be g#ided thro#gh the grieing ro"ess. ,elling the "lientthat she "an get regnant again soon is not a therae#ti" resonse be"a#se itdis"o#nts the imortan"e o' this regnan"y.Awarded 0.0 oints o#t o' 1.0 ossibleoints.

2.I+ 9FG0FG320GA woman diagnosed with marginal la"enta reia gae


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birth aginally 1 min#tes ago. At resent she is at the greatest risk 'or@emorrhage. CorrectIn'e"tion.Crinary retention.,hrombohlebitis.

@emorrhage is the most immediate risk be"a#se the lower #terine segment

has limited ability to "ontra"t to red#"e blood loss. In'e"tion is a risk be"a#se o' thelo"ation o' the la"ental atta"hment site5 howeer it is not a riority "on"ern at thistime. *la"enta reia oses no greater risk 'or #rinary retention or thrombohlebitisthan does a normally imlanted la"enta.Awarded 0.0 oints o#t o' 1.0 ossibleoints.

F.A n#rse is eal#ating seeral obstetri" atients 'or their risk 'or "eri"alins#L"ien"y. !hi"h atient wo#ld be "onsidered to be most at risk$*rimiara:randm#lti who has reio#sly had all aginal delieries witho#t a roblem*rimi who #ndergoes a "eri"al "one biosy 'or "eri"al dyslasia rior to theregnan"y CorrectM#lti who had her reio#s deliery ia & se"tion d#e to "ehaloeli"

disroortion (&*+) Any atient who has had reio#s s#rgi"al interentions ("one biosy) is at

greater risk 'or "eri"al ins#L"ien"y. ,here is no indi"ation that a rimi is at risk'or "eri"al ins#L"ien"y. A grandm#lti who has reio#sly had aginal delierieswitho#t in"iden"e is not ne"essarily at an in"reased risk 'or "eri"al ins#L"ien"y. Am#lti who has deliered ia & se"tion as a res#lt o' &*+ wo#ld not ne"essarily beat an in"reased risk as the iss#e inoles eli" ade/#a"y as determined by eli"meas#rements in relationshi to the 'et#s.Awarded 0.0 oints o#t o' 1.0 ossibleoints.

3.,he ma?ority o' e"toi" regnan"ies are lo"ated in theCterine '#nd#s.&eri"al os.

Am#lla. Correctimbriae.

A regnan"y within the #ter#s wo#ld be "onsidered a normal regnan"y.Imlantation o' the regnan"y at the "eri"al os wo#ld be a signi%"ant abnormality.

,he ma?ority o' e"toi" regnan"ies aroximately 30 are lo"ated in the am#llaor largest ortion o' the t#be.Awarded 0.0 oints o#t o' 1.0 ossible oints.

G.A n#rse is examining a atient who has been admitted 'or ossible e"toi"regnan"y who is aroximately 3 weeks regnant. !hi"h %nding wo#ld be ariority "on"ern$7o @, heard ia +oler"ant aginal bleeding noted on eri ad;""hymosis noted aro#nd #mbili"#s CorrectBlood ress#re 10030

Be"a#se this atient is most likely in the early stages o' regnan"y @,wo#ld not be able to be a#s"#ltated at this time. "ant aginal bleeding wo#ld notbe a riority "on"ern b#t sho#ld still be monitored by the n#rse. ;""hymosis aro#ndthe #mbili"#s indi"ates llen sign whi"h indi"ates hematoeritone#m and mayalso deelo in an #ndiagnosed r#t#red intraabdominal e"toi" regnan"y.Awarded 0.0 oints o#t o' 1.0 ossible oints.

10.!hi"h o' the 'ollowing resentations is asso"iated with early regnan"y


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loss o""#rring in less than 1 weeks gestation$ (Select all that apply.)&hromosomal abnormalities CorrectIn'e"tion&ystitisAntihosholiid syndrome Correct@yothyroidism Correct

&a6eine #se0 o' early regnan"y loss res#lts 'rom geneti" abnormalities.

@yothyroidism and antihosholiid syndrome are asso"iated with early regnan"yloss. &a6eine #se is asso"iated with se"ond-trimester losses as a res#lt o' maternalbehaior. In'e"tion is not a likely so#r"e o' early regnan"y loss. &ystitis in notasso"iated with early regnan"y loss.Awarded 0.0 oints o#t o' 1.0 ossible oints.

&hater G

1.In lanning 'or the "are o' a 90-year-old woman with regestationaldiabetes the n#rse re"ognies that the most imortant 'a"tor a6e"ting regnan"yo#t"ome is the

MotherEs age.7#mber o' years sin"e diabetes was diagnosed.Amo#nt o' ins#lin re/#ired renatally.+egree o' gly"emi" "ontrol d#ring regnan"y. Correct

!omen with ex"ellent gl#"ose "ontrol and no blood essel disease sho#ldhae good regnan"y o#t"omes. Altho#gh adan"ed maternal age may ose somehealth risks the most imortant 'a"tor 'or the woman with regestational diabetesremains the degree o' gly"emi" "ontrol d#ring regnan"y. ,he n#mber o' yearssin"e diagnosis and the amo#nt o' ins#lin re/#ired are not as releant to o#t"omesas the degree o' gly"emi" "ontrol.Awarded 0.0 oints o#t o' 1.0 ossible oints.

.+iabetes in regnan"y #ts the 'et#s at risk in seeral ways. 7#rses sho#ldbe aware that

!ith good "ontrol o' maternal gl#"ose leels s#dden and #nexlained stillbirth is nolonger a ma?or "on"ern.,he most imortant "a#se o' erinatal loss in diabeti" regnan"y is "ongenitalmal'ormations. CorrectIn'ants o' mothers with diabetes hae the same risks 'or resiratory distresssyndrome be"a#se o' the "are'#l monitoring.At birth the neonate o' a diabeti" mother is no longer in any greater risk.

&ongenital mal'ormations a""o#nt 'or 90 to 0 o' erinatal deaths indiabeti" regnan"ies. ;en with good "ontrol s#dden and #nexlained stillbirthremains a ma?or "on"ern. In'ants o' diabeti" mothers are at in"reased risk 'orresiratory distress syndrome and the transition to extra#terine li'e is o'ten markedby hyogly"emia and other metaboli" abnormalities.Awarded 0.0 oints o#t o' 1.0ossible oints.

9.A regnant woman at 3 weeks o' gestation has been diagnosed withgestational diabetes. ,he n#rse "aring 'or this "lient #nderstands thatHral hyogly"emi" agents "an be #sed i' the woman is rel#"tant to gie hersel'ins#lin.+ietary modi%"ations and ins#lin are both re/#ired 'or ade/#ate treatment.:l#"ose leels are monitored by testing #rine 'o#r times a day and at bedtime.+ietary management inoles distrib#ting n#trient re/#irements oer three meals


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and two or three sna"ks. Correct mall 're/#ent meals oer a 4-ho#r eriod hel de"rease the risk 'or

hyogly"emia and ketoa"idosis. In some women gestational diabetes "an be"ontrolled with dietary modi%"ations alone. Blood not #rine gl#"ose leels aremonitored seeral times a day. Crine is tested 'or ketone "ontent5 res#lts sho#ld benegatie.

Hral hyogly"emi" agents "an be harm'#l to the 'et#s and less e6e"tie thanins#lin in a"hieing tight gl#"ose "ontrol.Awarded 0.0 oints o#t o' 1.0 ossibleoints.

4.!hi"h o' the 'ollowing %ndings is not likely to be seen in a regnant atientwho has hyothyroidism$Mis"arriageMa"rosomia Correct:estational hyertension*la"ental abr#tion

In'ants born to mothers with hyothyroidism are more likely to be o' low birthweight or reterm5 these o#t"omes "an be imroed with early diagnosis andtreatment. @yothyroidism is o'ten asso"iated with both in'ertility and an in"reased

risk o' mis"arriage. *regnant women with hyothyroidism are more likely toexerien"e both ree"lamsia and gestational hyertension. *la"ental abr#tionand stillbirth are risks asso"iated with hyothyroidism.Awarded 0.0 oints o#t o' 1.0ossible oints.

.A regnant woman at 14 weeks o' gestation is admitted to the hosital witha diagnosis o' hyeremesis graidar#m. ,he rimary goal o' her treatment at thistime is toDest the gastrointestinal (:I) tra"t by restri"ting all oral intake 'or 43 ho#rs.Ded#"e emotional distress by en"o#raging the woman to dis"#ss her 'eelings.Deerse #id ele"trolyte and a"id-base imbalan"es. CorrectDestore the womanEs ability to take and retain oral #id and 'oods.

l#id ele"trolyte and a"id-base imbalan"es resent the greatest immediate

danger to the well-being o' the mother and 'et#s and sho#ld be "orre"ted as soonas ossible. Desting the :I tra"t and dis"#ssing her 'eelings are "omonents o'treatment b#t are not immediate goals 'or this "lient. ,he ability to retain oral #idand 'oods is a longer-term goal o' treatment 'or this "ondition.Awarded 0.0 ointso#t o' 1.0 ossible oints.

2.A atient who is regnant already has ,ye diabetes with a hemoglobinA1" al#e o' F. ,he n#rse wo#ld "ategorie this atient as haing:estational diabetes.Ins#lin-deendent diabetes "omli"ated by regnan"y.*regestational diabetes mellit#s. Correct7onOins#lin-deendent diabetes with "omli"ations.

Pregestational diabetes mellitus is a term #sed to des"ribe atients with tye1 or tye diabetes in whom diabetes existed rior to regnan"y. :estationaldiabetes o""#rs when a woman be"omes diabeti" d#ring the regnan"y state. ,ye diabetes is nonOins#lin-deendent. 7one o' the in'ormation resented indi"ates"omli"ations at this oint be"a#se the hemoglobin A1" is within normal rangesigni'ying ade/#ate gly"emi" "ontrol.Awarded 0.0 oints o#t o' 1.0 ossible oints.

F.,he priority assessment in eal#ating a regnant woman with seerena#sea and omiting isasting blood gl#"ose leel.


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Peton#ria. CorrectBilir#bin.!hite blood "ell "o#nt.

+etermination o' keton#ria wo#ld be a "riti"al assessment that wo#ld leadtowards determination o' hyeremesis. A regnant atient with seere na#sea andomiting may hae hyeremesis graidar#m and as s#"h re/#ires "riti"al

monitoring to determine the nat#re o' the roblem. An B meas#rement altho#ghin'ormatie wo#ld not be the riority assessment at this time nor wo#ld a bilir#binmeas#rement. A !B& "o#nt wo#ld indi"ate the ossibility o' an in'e"tio#s so#r"eb#t it wo#ld not be a riority assessment in terms o' the atientEs resentation.Awarded 0.0 oints o#t o' 1.0 ossible oints.

3.A regnant woman has maternal henylketon#ria (*PC) and is interested inwhether or not she will be able to breast'eed her baby. !hi"h rea"tion by the n#rseindi"ates a""#rate in'ormation$,he atient "an breast'eed the baby as long as she "ontin#es to maintain a *PC-restri"ted diet.,he atient sho#ld alternate breast'eeding with bottle 'eeding in order to red#"e*PC leels roided to the baby.

,he atient sho#ld be adised to not breast'eed the in'ant be"a#se her breast milkwill "ontain large amo#nts o' henylalanine. Correct,he atient "an breast'eed 'or the %rst 9 months witho#t any #ntoward e6e"ts onthe in'ant.

Breast'eeding is not adised 'or a atient who has maternal *PC be"a#sehenylalanine leels are high in s#"h a atientEs breast milk. +ietary restri"tion willnot limit the amo#nt o' this s#bstan"e in breast milk. Alternating 'eeding so#r"es isnot adised either.Awarded 0.0 oints o#t o' 1.0 ossible oints.

G.A n#rse is working with a diabeti" atient who re"ently 'o#nd o#t she isregnant. In "oordinating an interdis"ilinary team to hel manage the atientthro#gho#t the regnan"y the n#rse wo#ld in"l#de (Select all that apply.)amily ra"ti"e hysi"ian

+ieti"ian Correct*erinatologist CorrectH""#ational theraist7ehrologist Correctee"h theraist

An internal medi"ine ra"titioner rather than 'amily ra"ti"e hysi"ian wo#ldbe in"l#ded on the interdis"ilinary "are team. A dieti"ian wo#ld be in"l#ded to helthe atient with dietary lanning a erinatologist to take "are o' the maternal-'etal#nit and a nehrologist to monitor renal '#n"tion. ,here is no need 'or ano""#ational theraist or a see"h theraist #nless other iss#es arise.Awarded 0.0oints o#t o' 1.0 ossible oints.

10.A regnant atient exerien"es thyroid storm 'ollowing deliery o' herin'ant. !hat interentions wo#ld the n#rse anti"iate to be ordered by thehysi"ian$ (Select all that apply.)Destri"tion o' intraeno#s #ids to reent #id oerloadAdministration o' oxygen CorrectAntiyreti"s Correctynthroid*,C Correct


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Hxygen wo#ld be roided antiyreti"s wo#ld be gien to red#"e'eer and *,C wo#ld be administered. I8 #ids wo#ld be administered to theatient in order to reerse the hyotension that the atient wo#ld be exerien"ing.ynthroid wo#ld not be gien be"a#se it is #sed to treat hyothyroidism and withthyroid storm the atient is s#6ering 'rom hyerthyroidism.Awarded 0.0 oints o#to' 1.0 ossible oints.

&hater 90

1.Aendi"itis is more diL"#lt to diagnose d#ring regnan"y be"a#se theaendix is&oered by the #ter#s.+isla"ed to the le't.


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14/30

@yeremesis graidar#mMagnesi#m s#l'ate Correct

,he #se o' to"olyti"s s#"h as magnesi#m s#l'ate "an be asso"iated with thedeeloment o' AD+. *ito"in ind#"tion "hole"ystitis and hyeremesis graidar#mare not asso"iated with AD+.Awarded 0.0 oints o#t o' 1.0 ossible oints.

G.A atient who is regnant also has a history o' soriasis. !hat in'ormation

"an the n#rse roide to the atient relatie to this disease ro"ess$*regnan"y has no e6e"t on soriasis.As long as the atient stays o#t o' dire"t s#nlight there will be no rogression o'disease.*soriasis tyi"ally worsens d#ring regnan"y in aroximately 0 o' atients.*atients who hae soriasis d#ring regnan"y exerien"e a aried resonse.Correct

*soriasis resonds ariably to regnan"y5 in some women there is no "hangein some the disease gets better and in abo#t 0 o' women it gets worse. ,here isno dire"t "orrelation between s#nlight and soriasis.Awarded 0.0 oints o#t o' 1.0ossible oints.

10.A regnant woman with "ysti" %brosis (&) wants to breast'eed her in'ant.

!hi"h assessments wo#ld hae to be er'ormed in order to make s#re that thebreast'eedings were sa'e and e6e"tie$ (Select all that apply.)Monitor maternal weightMonitor maternal #rine 'or ketonesMonitor sodi#m leels in breast milk CorrectMonitor total 'at leels in breast milk CorrectMonitor in'ant growth attern Correct

Breast milk sho#ld be monitored 'or sodi#m total 'at and "hlorideleels in order to establish its sa'ety. Monitoring o' the in'antEs growth attern wo#ldroide eiden"e that breast'eeding is ade/#ate. Maternal weight monitoring and#rinalysis wo#ld not be indi"ated with regard to the sa'ety o' breast'eeding in this"ase.Awarded 0.0 oints o#t o' 1.0 ossible oints.

&hater 91 1.!hi"h oiate "a#ses e#horia relaxation drowsiness and deta"hment

'rom reality and has ossible e6e"ts on the regnan"y in"l#ding ree"lamsiaintra#terine growth restri"tion and remat#re r#t#re o' membranes$@eroin CorrectAl"ohol*hen"y"lidine almitate (*&*)&o"aine

,he oiates in"l#de oi#m heroin meeridine morhine "odeine andmethadone. ,he signs and symtoms o' heroin #se are e#horia relaxation relie''rom ain deta"hment 'rom reality imaired ?#dgment drowsiness "onstri"ted#ils na#sea "onstiation sl#rred see"h and resiratory deression. *ossiblee6e"ts on regnan"y in"l#de ree"lamsia intra#terine growth restri"tionmis"arriage remat#re r#t#re o' membranes in'e"tions bree"h resentation andreterm labor. Al"ohol *&* and "o"aine are not oiates.Awarded 0.0 oints o#t o'1.0 ossible oints.

.+#ring regnan"y al"ohol withdrawal may be treated #sing+is#l%ram (Antab#se).&orti"osteroids.


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Benodiaeines. CorrectAminohylline.

ymtoms that o""#r d#ring al"ohol withdrawal "an be managed with short-a"ting barbit#rates or benodiaeines. +is#l%ram is "ontraindi"ated in regnan"ybe"a#se it is teratogeni". &orti"osteroids and aminohylline are not #sed to treatal"ohol withdrawal.Awarded 0.0 oints o#t o' 1.0 ossible oints.

9.,o roide ade/#ate ostart#m "are the n#rse sho#ld be aware thatostart#m deression (**+) with sy"hoti" 'eat#resIs more likely to o""#r in women with more than two "hildren.Is rarely del#sional and is #s#ally abo#t someone trying to harm her (the mother).Altho#gh serio#s is not likely to need sy"hiatri" hositaliation.Is tyi%ed by a#ditory or is#al hall#"inations. Correct

@all#"inations are resent in o' women with this disorder5 aranoid orgrandiose del#sions (resent in 0) elements o' deliri#m or disorientation andextreme de%"its in ?#dgment a""omanied by high leels o' im#lsiity may"ontrib#te to risks o' s#i"ide or in'anti"ide. **+ is more likely to o""#r in %rst-timemothers. **+ with sy"hosis is a sy"hiatri" emergen"y that re/#ireshositaliation.Awarded 0.0 oints o#t o' 1.0 ossible oints.

4.7#rses m#st be "ogniant o' the growing roblem o' methamhetamine#se d#ring regnan"y. !hen "aring 'or a woman who #ses methamhetamines it isimortant 'or the n#rse to be aware o' whi"h 'a"tor related to the ab#se o' thiss#bstan"e$Methamhetamine is a deressant.All methamhetamines are asodilators.Methamhetamine #sers are extremely sy"hologi"ally addi"ted. CorrectDehabilitation is #s#ally s#""ess'#l.

=Meth> #sers are extremely sy"hologi"ally addi"ted. ,yi"ally these womendislay oor "ontrol oer their behaior and a low threshold 'or ain. ,his s#bstan"eis relatiely inexensie and easy to obtain. Methamhetamine is a stim#lant and aaso"onstri"tor. ,he rate o' relase 'or methamhetamine #sers is ery high.

Awarded 0.0 oints o#t o' 1.0 ossible oints. ."reening /#estions 'or al"ohol and dr#g ab#se sho#ld be in"l#ded in the

oerall assessment d#ring the %rst renatal isit 'or all women. ,he 4 *s-*l#s is as"reening tool designed se"i%"ally to identi'y when there is a need 'or a more in-deth assessment. !hi"h o' the 'ollowing is not in"l#ded in the 4 *s-*l#s s"reeningtool$*resent Correct*artner*ast*regnan"y

,he %rst * is Parents ,he woman sho#ld be asked =+id either o' yo#r arentshae a roblem with al"ohol or dr#gs$> ,he se"ond * is Partner =+oes yo#r artnerhae a roblem with al"ohol or dr#gs$> ,he third * is Past =@ae yo# eer had anybeer wine or li/#or$> ,he 'o#rth * is Pregnancy =In the month be'ore yo# knewyo# were regnant how many "igarettes did yo# smoke$ @ow m#"h beer wine orli/#or did yo# drink$>Awarded 0.0 oints o#t o' 1.0 ossible oints.

2.,he As s"reening interention tool is #sed to imlement smoking"essation strategies on the basis o' atient resonse. !hat do the As stand 'or$Ask adise administer aroe and admitAsk assess adise assist and arrange 'ollow-# Correct


16/30

Assess assist adise aly and arrangeAssess aly adise ask and arrange 'ollow-#

,he As stand 'or ask assess adise assist and arrange 'ollow-#.Awarded0.0 oints o#t o' 1.0 ossible oints.

F.!hi"h o' these medi"ations wo#ld be "lassi%ed as a &ategory Q s#bstan"ethat is not to be #sed d#ring regnan"y$


17/30

roblems. CorrectA higher in"iden"e o' ostart#m deression (**+) is 'o#nd in abo#t 0 o' theo#lation.Between 90 and 0 billion dollars a""o#nts 'or rod#"tiity and dire"t medi"al "ostsrelated to deression in women. Correct

,he !@H re"ognies deression as the leading "a#se o' disability in

women. Between 14 and 9 o' women will exerien"e some ase"t o'deression d#ring their regnan"ies. Correct=Be"a#se this is yo#r se"ond "esarean birth yo# will re"oer 'aster.>=So# will not need reoeratie tea"hing be"a#se this is yo#r se"ond "esareanbirth.>

,he statement in B is most aroriate. ,he statements in A & and + are nota""#rate. Maternal and 'etal risks are asso"iated with eery "esarean se"tion.*hysiologi" and sy"hologi" re"oery 'rom a "esarean se"tion is m#lti'a"torial andindiid#al to ea"h "lient ea"h time. *reoeratie tea"hing sho#ld always beer'ormed regardless o' whether the "lient has already had this ro"ed#re. Awarded0.0 oints o#t o' 1.0 ossible oints.

9.or a woman at 4 weeks o' gestation whi"h %nding re/#ires moreassessment by the n#rse$etal heart rate o' 112 beatsmin&erix dilated "m and 0 e6a"ed


18/30

"ore o' 3 on the biohysi"al ro%leHne 'etal moement noted in 1 ho#r o' assessment by the mother Correct

el'-"are in a ostterm regnan"y sho#ld in"l#de er'orming daily 'etal ki"k"o#nts three times er day. ,he mother sho#ld 'eel 'o#r 'etal moements er ho#r.I' she 'eels 'ewer than 'o#r moements she sho#ld "o#nt 'or 1 more ho#r. ewerthan 'o#r moements in that ho#r warrants eal#ation. ,he %ndings des"ribed in the

other "hoi"es are normal at 4 weeks o' gestation.Awarded 0.0 oints o#t o' 1.0ossible oints.

4.A regnant womanEs amnioti" membranes r#t#re. *rolased "ord iss#se"ted. !hi"h interention is the n#rseEs to riority$*la"e the woman in the knee-"hest osition. Correct&oer the "ord in a sterile towel sat#rated with warm normal saline.*reare the woman 'or a "esarean birth.tart oxygen by 'a"e mask.

,he woman is assisted into a osition (e.g. modi%ed ims osition ,rendelenb#rg osition or knee-"hest osition) in whi"h graity kees the ress#reo' the resenting art o6 the "ord. Delieing ress#re on the "ord is the n#rsingriority. ,he n#rse may also #se her gloed hand or two %ngers to li't the resenting

art o6 the "ord. I' the "ord is rotr#ding 'rom the agina it may be "oered with asterile towel soaked in saline. ,he n#rse sho#ld administer H by 'a"ial mask at 3 to10


19/30

imortant maternal "ontraindi"ations to to"olyti" theray. ,o"olyti"-ind#"ed edema"an be "a#sed by I8 #ids.Awarded 0.0 oints o#t o' 1.0 ossible oints.

F.!ith regard to dys'#n"tional labor n#rses sho#ld be aware that!omen who are #nderweight are more at risk.!omen exerien"ing re"iito#s labor are abo#t the only women exerien"ingdys'#n"tional labor who are not exha#sted. Correct

@yertoni" #terine dys'#n"tion is more "ommon than hyotoni" dys'#n"tion.Abnormal labor atterns are most "ommon in older women.

*re"iito#s labor lasts less than 9 ho#rs. hort women more than 90 o#ndsoerweight are more at risk 'or dys'#n"tional labor. @yotoni" #terine dys'#n"tionin whi"h the "ontra"tions be"ome weaker is more "ommon. Abnormal laboratterns are more "ommon in women yo#nger than 0 years.Awarded 0.0 ointso#t o' 1.0 ossible oints.

3.A n#rse roiding "are to a woman in labor sho#ld be aware that "esareanbirthIs de"lining in 're/#en"y in the Cnited tates.Is more likely to be er'ormed in the oor in #bli" hositals who do not re"eie then#rse "o#nseling that wealthier "lients do.

Is er'ormed rimarily 'or the bene%t o' the 'et#s. Correct&an be either ele"ted or re'#sed by women as their absol#te legal right.

,he most "ommon indi"ations 'or "esarean birth are danger to the 'et#srelated to labor and birth "omli"ations. &esarean births are in"reasing in theCnited tates. !ealthier women who hae health ins#ran"e and who gie birth in ariate hosital are more likely to exerien"e "esarean birth. A womanEs right toele"t "esarean s#rgery is in dis#te as is her right to re'#se it i' in doing so sheendangers the 'et#s.


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m#ltiara who has deliered all her in'ants aginally.Awarded 0.0 oints o#t o' 1.0ossible oints.

&hater 99 1.,he %rst and most imortant n#rsing interention when a n#rse obseres

ro'#se ostart#m bleeding is to

&all the womanEs rimary health "are roider.Administer the standing order 'or an oxyto"i".*alate the #ter#s and massage it i' it is boggy. CorrectAssess maternal blood ress#re and #lse 'or signs o' hyoolemi" sho"k.

,he initial management o' ex"essie ostart#m bleeding is %rm massage o'the #terine '#nd#s to sto the bleeding. ,his is the most imortant n#rsinginterention. ,hen the rimary health "are roider sho#ld be noti%ed or the n#rse"an delegate this task to another sta6 member. Administering an oxyto"i" andas"ertaining ital signs are aroriate a'ter assessment has been made andimmediate stes hae been taken to "ontrol the bleeding.Awarded 0.0 oints o#t o'1.0 ossible oints.

.!hi"h **@ "onditions are "onsidered medi"al emergen"ies that re/#ire

immediate treatment$Inersion o' the #ter#s and hyoolemi" sho"k Correct@yotoni" #ter#s and "oag#loathies#binol#tion o' the #ter#s and idioathi" thrombo"ytoeni" #r#ra (I,*)Cterine atony and disseminated intraas"#lar "oag#lation (+I&).

Inersion o' the #ter#s and hyoolemi" sho"k are "onsidered medi"alemergen"ies. A hyotoni" #ter#s "an be managed with massage and oxyto"in5"oag#loathies sho#ld hae been identi%ed rior to deliery and treateda""ordingly. Altho#gh s#binol#tion o' the #ter#s and I,* are serio#s "onditionsthey do not always re/#ire immediate treatment5 I,* "an be sa'ely managed with"orti"osteroids or I8 imm#noglob#lin. +I& and #terine atony are ery serio#sobstetri" "omli"ations b#t are not medi"al emergen"ies re/#iring immediate

interention.Awarded 0.0 oints o#t o' 1.0 ossible oints. 9.!hi"h ostart#m in'e"tion is most o'ten "ontra"ted by %rst-time mothers

who are breast'eeding$;ndometritis!o#nd in'e"tionsMastitis CorrectCrinary tra"t in'e"tions (C,Is)

Mastitis is in'e"tion in a breast #s#ally "on%ned to a milk d#"t. Most womenwho get it are %rst-timers who are breast'eeding. ;ndometritis is the most "ommonostart#m in'e"tion. Its in"iden"e is higher a'ter a "esarean birth not in %rst-timemothers. !o#nd in'e"tions are also a "ommon ostart#m "omli"ation. ites o'in'e"tion in"l#de both a "esarean in"ision and the eisiotomy or reaired la"eration.

,he graidity o' the mother and her 'eeding "hoi"e are not 'a"tors in thedeeloment o' a wo#nd in'e"tion. C,Is o""#r in to 4 o' all ostart#mwomen. Disk 'a"tors in"l#de "atheteriations 're/#ent aginal exams and eid#ralanesthesia.Awarded 0.0 oints o#t o' 1.0 ossible oints.

4.+esite o#lar belie' there is a rare tye o' hemohilia that a6e"tswomen o' "hildbearing age. 8on !illebrand disease is the most "ommon o' thehereditary bleeding disorders and "an a6e"t males and 'emales alike. It res#lts 'roma 'a"tor 8III de%"ien"y and latelet dys'#n"tion. Altho#gh 'a"tor 8III leels rise


21/30

nat#rally d#ring regnan"y there is an in"reased risk 'or ostart#m hemorrhage'rom birth #ntil 4 weeks ostart#m as leels o' on !illebrand 'a"tor (!') and'a"tor 8III 'all. ,he treatment that sho#ld be "onsidered %rst 'or the "lient with on!illebrand disease who exerien"es a ostart#m hemorrhage is&ryore"iitatea"tor 8III and !'

+esmoressin Correct@emabate

+esmoressin is the rimary treatment o' "hoi"e. ,his hormone whi"h "anbe administered orally nasally and intraeno#sly romotes the release o' 'a"tor8III and !' 'rom storage. ,reatment with "ryore"iitate or with lasma rod#"tss#"h as 'a"tor 8III and !' is a""etable b#t be"a#se o' the asso"iated risk o'ossible ir#ses 'rom donor blood rod#"ts other modalities are "onsidered sa'er.Altho#gh the administration o' the syntheti" rostaglandin in @emabate is known toromote "ontra"tion o' the #ter#s d#ring ostart#m hemorrhage it is not e6e"tie'or the "lient who resents with a bleeding disorder.Awarded 0.0 oints o#t o' 1.0ossible oints.

.+#ring ro#nds a n#rse s#se"ts that a atient who has re"ently deliered

ia aginal ro#te is haing ex"essie ostart#m bleeding. !hi"h interentionwo#ld be the priority a"tion taken by the n#rse at this time$&all the hysi"ian.Massage the #terine '#nd#s. CorrectIn"rease the rate o' intraeno#s #ids.Monitor ad "o#nt and er'orm "atheteriation.

Massaging o' the #terine '#nd#s wo#ld be a riority a"tion to hel exel "lotsand stim#late #terine "ontra"tions to "onstri"t blood ow. ,he other a"tionsdes"ribed as well as "atheteriation (i' bladder distention is noted) and lo"hia owmonitoring may be needed b#t none o' them is the riority a"tion re/#ired at thistime.Awarded 0.0 oints o#t o' 1.0 ossible oints.

2.A thrombosis res#lts 'rom the 'ormation o' a blood "lot or "lots inside a

blood essel and is "a#sed by inammation or artial obstr#"tion o' the essel. ,hree thromboemboli" "onditions are o' "on"ern d#ring the ostart#m eriod5whi"h o' the 'ollowing is not$Amnioti" #id embolism (A;) Correct#er%"ial eno#s thrombosis+ee ein thrombosis*#lmonary embolism

An A; o""#rs d#ring the intraart#m eriod when amnioti" #id "ontainingarti"les o' debris enters the maternal "ir"#lation. Altho#gh A; is rare themortality rate is as high as 30. A s#er%"ial eno#s thrombosis in"l#desinolement o' the s#er%"ial saheno#s eno#s system. !ith dee einthrombosis the inolement aries b#t "an extend 'rom the 'oot to the ilio'emoralregion. A #lmonary embolism is a "omli"ation o' dee ein thrombosis o""#rringwhen art o' a blood "lot dislodges and is "arried to the #lmonary artery where ito""l#des the essel and obstr#"ts blood ow to the l#ngs.Awarded 0.0 oints o#t o'1.0 ossible oints.

F.!hi"h o' the 'ollowing is the most "ommon kind o' la"ental adheren"eseen in regnant women$A""reta Correct*la"enta reia


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*er"retaIn"reta

*la"enta a""reta is the most "ommon kind o' la"ental adheren"e seen inregnant women and is "hara"teried by slight enetration o' myometri#m. Inla"enta reia the la"enta does not embed "orre"tly and res#lts in what is knownas a low-lying la"enta. It "an be marginal artial or "omlete in how it "oers the

"eri"al os and it in"reases the atientEs risk 'or ainless aginal bleeding d#ringthe regnan"y andor deliery ro"ess. *la"enta er"reta leads to er'oration o' the#ter#s and is the most serio#s and inasie o' all tyes o' a""rete. *la"enta in"retaleads to dee enetration o' the myometri#m.Awarded 0.0 oints o#t o' 1.0 ossibleoints.

3.!hi"h ratio wo#ld be #sed to restore e6e"tie "ir"#lating ol#me in aostart#m atient who is exerien"ing hyoolemi" sho"k$4111191 Correct

A 91 ratio o' 9 ml #id in'#sed 'or eery 1 ml o' estimated blood loss is

re"ommended to restore "ir"#lating ol#me.Awarded 0.0 oints o#t o' 1.0 ossibleoints.

G.!hi"h indi"ator wo#ld lead the n#rse to s#se"t that a ostart#m atientexerien"ing hemorrhagi" sho"k is getting worse$Destoration o' blood ress#re leels to normal range&aillary re%ll brisk*atient "omlaint o' heada"he and in"reased rea"tion time to /#estioning Correct*atient statement that she sees =stars>

*atient "omlaint o' a heada"he a""omanied by an in"reased rea"tion(resonse) time indi"ates that "erebral hyoxia is getting worse. Det#rn o' bloodress#re to normal range wo#ld indi"ate resoling symtoms. Brisk "aillary re%ll isa normal %nding. ,he atient may see =stars> early on in de"reased blood ow

states.Awarded 0.0 oints o#t o' 1.0 ossible oints. 10.In whi"h sit#ations wo#ld the #se o' Methergine or rostaglandin be

"ontraindi"ated een i' the atient was exerien"ing a ostart#m signi%"antbleed$ (Select all that apply.)*atient has deliered twin regnan"ies.*atientEs blood ress#re ostart#m is 130G0. Correct*atient has a history o' asthma. Correct*atient has a mitral ale rolase. Correct*atient is a grand m#lti.

,win regnan"ies s#""ess'#lly deliered and grand m#ltiarity are not"ontraindi"ations to the #se o' these medi"ations. I' a atient is hyertensie or has"ardioas"#lar disease these medi"ations wo#ld not be #sed. I' a atient has ahistory o' asthma rostaglandin medi"ation wo#ld not be #sed.Awarded 0.0 ointso#t o' 1.0 ossible oints

&hater 94 1.!hen roiding an in'ant with a gaage 'eeding what sho#ld the n#rse

do"#ment ea"h time$,he in'antEs abdominal "ir"#m'eren"e a'ter the 'eeding,he in'antEs heart rate and resirations


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,he in'antEs s#"k and swallow "oordination,he in'antEs resonse to the 'eeding Correct

+o"#mentation o' a gaage 'eeding sho#ld in"l#de the sie o' the 'eedingt#be the amo#nt and /#ality o' the resid#al 'rom the reio#s 'eeding the tye and/#antity o' the #id instilled and the in'antEs resonse to the ro"ed#re. omeolder in'ants may be learning to s#"k b#t the imortant 'a"tor to do"#ment is the

in'antEs resonse to the 'eeding (in"l#ding attemts to s#"k). Abdominal"ir"#m'eren"e is not meas#red a'ter a gaage 'eeding. 8ital signs may be obtainedrior to 'eeding b#t the in'antEs resonse is more imortant.Awarded 0.0 oints o#to' 1.0 ossible oints.

.A male in'ant at 2 weeks o' gestation arries 'rom the deliery roomint#bated. ,he n#rse weighs the in'ant la"es him #nder the radiant warmer andatta"hes him to the entilator at the res"ribed settings. A #lse oximeter and"ardioresiratory monitor are la"ed. ,he #lse oximeter is re"ording oxygensat#ration al#es o' 30. ,he res"ribed sat#ration al#e is G. ,he n#rseEs mostaroriate a"tion is to


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designation 'or ery low birth rate (8


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De"orded intake and o#t#t ;stablishing intraeno#s a""ess 'or the administration o' antibioti"s wo#ld be

a riority interention. ,he other a"tions des"ribed might be re/#ired b#t are notthe riority interention.Awarded 0.0 oints o#t o' 1.0 ossible oints.

G.!hi"h 'a"tor wo#ld "ontrib#te to deletion o' weight and metaboli" storesin the high risk newborn$

re/#ent breast 'eedings&ore temerat#re within normal range*hototheray CorrectBathing

,he #se o' hototheray "o#ld lead to insensible heat loss and as a res#ltlead to de"reased weight and metaboli" stores in the high risk newborn. re/#entbreast'eedings and bathing wo#ld not hae these e6e"ts. Maintaining a "oretemerat#re wo#ld hel maintain weight and metaboli" stores in the high risknewborn.Awarded 0.0 oints o#t o' 1.0 ossible oints.

10.!hi"h o' the 'ollowing ro"esses or %ndings in"rease the risk o' retermin'ants in whi"h hematologi" roblems are deeloing$ (Select all that apply.)+e"rease in sie o' red blood "ells

+e"reased "aillary 'ragility*rolonged *, time Correct+e"reased red blood "ell s#rial time Correct+e"rease in erythrooiesis Correct

*rolonged *, ree"ts an in"reased tenden"y to bleed in retermin'ants. +e"rease in red blood "ell s#rial time is seen in s#"h in'ants. o isde"reased '#n"tional ability o' erythrooietin whi"h limits red blood "ell synthesis.Hne sees an in"rease in the sie o' red blood "ells in reterm in'ants whi"h a6e"tstheir s#rial time. In"reased "aillary 'ragility also o""#rs in reterm in'ants.Awarded 0.0 oints o#t o' 1.0 ossible oints.

&hater 9

1.!ith regard to in?#ries to the in'antEs lex#s d#ring labor and birth n#rsessho#ld be aware thatI' the neres are stret"hed with no a#lsion they sho#ld re"oer "omletely in 9 to2 months. Correct;rb alsy is damage to the lower lex#s.*arents o' "hildren with bra"hial alsy are ta#ght to i"k # the "hild 'rom #nder theaxillae.Breast'eeding is not re"ommended 'or in'ants with 'a"ial nere aralysis #ntil the"ondition resoles.

I' the ganglia are dis"onne"ted "omletely 'rom the sinal "ord the damageis ermanent. Erb palsy is damage to the #er lex#s and is less serio#s thanbra"hial alsy. *arents o' "hildren with bra"hial alsy are ta#ght to aoid i"king #the "hild #nder the axillae or by #lling on the arms. Breast'eeding is not"ontraindi"ated in 'a"ial nere aralysis b#t both mother and in'ant will need hel'rom the n#rse at the start.Awarded 0.0 oints o#t o' 1.0 ossible oints.

.!ith regard to the "lassi%"ation o' neonatal ba"terial in'e"tion n#rsessho#ld be aware that&ongenital in'e"tion rogresses slower than health "areOasso"iated in'e"tion.@ealth "areOasso"iated in'e"tion "an be reented by e6e"tie handwashing5 early-onset in'e"tion "annot. Correct


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In'e"tions o""#r with abo#t the same 're/#en"y in boy and girl in'ants altho#gh'emale mortality is higher.,he "lini"al sign o' a raid high 'eer makes in'e"tion easier to diagnose.

@andwashing is an e6e"tie reentie meas#re 'or late-onset (health "areOasso"iated) in'e"tions be"a#se these in'e"tions "ome 'rom the enironment aro#ndthe in'ant. ;arly-onset ("ongenital) in'e"tions are "a#sed by the normal ora at the

maternal aginal tra"t. &ongenital (early-onset) in'e"tions rogress more raidlythan health "areOasso"iated (late-onset) in'e"tions. In'e"tion o""#rs abo#t twi"e aso'ten in boys and res#lts in higher mortality. &lini"al signs o' neonatal in'e"tion arenonse"i%" and similar to nonin'e"tio#s roblems making diagnosis diL"#lt.Awarded 0.0 oints o#t o' 1.0 ossible oints.

9.!hi"h ,HD&@ in'e"tion "o#ld be "ontra"ted by the in'ant be"a#se themother owned a "at$,oxolasmosis Correct8ari"ella-oster*aroir#s B1GD#bella

&ats that eat birds in'e"ted with the #oxoplasma gondii rotooan ex"rete

in'e"tie oo"ysts. @#mans (in"l#ding regnant women) "an be"ome in'e"ted i' they'ail to wash their hands a'ter "leaning a "atEs litter box. ,he in'e"tion is assedthro#gh the la"enta. ,he ari"ella-oster ir#s is resonsible 'or "hi"kenox andshingles. Aroximately G0 o' "hildbearing women are imm#ne. +#ringregnan"y in'e"tion with aroir#s "an res#lt in abortion 'etal anemia hydrosintra#terine growth restri"tion (IC:D) and stillbirth5 this ir#s is sread by erti"altransmission not by 'elines. in"e a""ination 'or r#bella was beg#n in 1G2G "aseso' "ongenital r#bella in'e"tion hae been red#"ed signi%"antly. 8a""ination 'ail#resla"k o' "omlian"e and the migration o' nonimm#nied ersons res#lt in eriodi"o#tbreaks o' r#bella (:erman measles).Awarded 0.0 oints o#t o' 1.0 ossibleoints.

4.In "aring 'or a mother who has ab#sed (or is ab#sing) al"ohol and 'or her

in'ant n#rses sho#ld be aware that,he attern o' growth restri"tion o' the 'et#s beg#n in renatal li'e is halted a'terbirth and normal growth takes oer.,wo thirds o' newborns with 'etal al"ohol syndrome (A) are boys.Al"ohol-related ne#rodeelomental disorders (AD7+s) not s#L"ient to meet A"riteria (learning disabilities see"h and lang#age roblems) are o'ten not dete"ted#ntil the "hild goes to s"hool. CorrectBoth the distin"tie 'a"ial 'eat#res o' the A in'ant and the diminished mental"aa"ities tend toward normal oer time.

ome learning roblems do not be"ome eident #ntil the "hild is in s"hool. ,he attern o' growth restri"tion ersists a'ter birth. ,wo thirds o' newborns withA are girls. Altho#gh the distin"tie 'a"ial 'eat#res o' the A in'ant tend tobe"ome less eident with growth the mental "aa"ities neer be"ome normal.Awarded 0.0 oints o#t o' 1.0 ossible oints.

.Antideressant medi"ation is the mainstay treatment 'or maternalderession with sele"tie serotonin re#take inhibitors (DIs) being the %rst line o' harma"otheray. Deorts o' "ardia" de'e"ts hae been asso"iated with the #se o'whi"h DI$&italoraml#oxetine


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ertraline*aroxetine Correct

,he Ameri"an &ollege o' Hbstetri"ians and :yne"ologists (A&H:) has iss#eda re"ommendation that aroxetine be aoided both d#ring regnan"y and in women"onsidering regnan"y. ,here hae also been reorts linking aroxetine to otherabnormalities s#"h as omhalo"ele "raniosynostosis and anen"ehaly. ,he

absol#te risk o' any "ongenital abnormality asso"iated with #se o' "italoram#oxetine or sertraline is small.Awarded 0.0 oints o#t o' 1.0 ossible oints.

2.An in'ant weighing 4.1 kg was born ho#rs ago at 9F weeks o' gestation. ,he in'ant aears "h#bby with a #shed "omlexion and is ery trem#lo#s. ,hetremors are most likely the res#lt o'Birth in?#ry.@yo"al"emia.@yogly"emia. Correctei#res.

,he des"rition is indi"atie o' a ma"ro"osmi" in'ant. @yogly"emia is"ommon in the in'ant with ma"rosomia. ,he tremors are ?itteriness that isasso"iated with hyogly"emia. Hther signs o' hyogly"emia are anea ta"hynea

and "yanosis.Awarded 0.0 oints o#t o' 1.0 ossible oints. F.!hi"h 'a"tor in"reases the risk o' "omli"ations 'or in'ants o' diabeti"

mothers$:ly"emi" "ontrol@emoglobin A1" leel o' F+#ration o' maternal disease Correct@emoglobin A1" leel o' F rior to regnan"y

,he d#ration and seerity o' maternal disease are signi%"ant 'a"tors inin"reasing the risk 'or "omli"ations in in'ants o' diabeti" mothers. :ly"emi" "ontrolwo#ld be a ositie 'a"tor indi"ating that blood gl#"ose leels were maintainedwithin normal range. A hemoglobin A1" leel o' F is within normal range.Awarded0.0 oints o#t o' 1.0 ossible oints.

3.*reterm in'ants are more likely to be"ome seti" be"a#seIg: and IgA leels are ade/#ate at birth.Imm#ne '#n"tion is s#ressed be"a#se o' in"reased Ig: leels.Ig: leel is dire"tly roortional to gestational age. Correcter#m "omlement leels are ade/#ate.

Ig: leels are dire"tly roortional to gestational age being de"reased inreterm in'ants and ree"t imm#ne '#n"tion.


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M#lti between the ages o' and 908ertex resentationAli"ation o' an internal 'etal s"al ele"trode Correct8a"##m-assisted birth Correct

,he #se o' an internal 'etal s"al ele"trode "o#ld res#lt in a s"alin?#ry whi"h wo#ld be eident #on birth. ,he #se o' a"##m extra"tion "o#ld lead

to a birth in?#ry. 8ery yo#ng age (less than 12) and older age (more than 9) in arimiara are more likely to redisose an in'ant to birth in?#ries. 8ertexresentation is a normal %nding and as s#"h wo#ld not tyi"ally lead to a birthin?#ry.Awarded 0.0 oints o#t o' 1.0 ossible oints.

&hater 92 1.!hi"h %nding s#orts the diagnosis o' athologi" ?a#ndi"e$

er#m bilir#bin "on"entrations greater than mgd< in "ord blooder#m bilir#bin leels in"reasing more than 1 mgd< in 4 ho#rser#m bilir#bin leels greater than 10 mgd< in a '#ll-term newborn&lini"al ?a#ndi"e eident within 4 ho#rs o' birth Correct

&lini"al ?a#ndi"e eident within 4 ho#rs o' birth s#orts a diagnosis o'

athologi" ?a#ndi"e. ,his diagnosis is also s#orted by ser#m bilir#bin"on"entrations greater than 4 mgd< in "ord blood5 total ser#m bilir#bin leels thatin"rease by more than mgd< in 4 ho#rs5 and a ser#m bilir#bin leel in a retermnewborn that ex"eeds 10 mgd


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assessment.@ae the st#dent sto er'orming the test immediately. Correct

,he Hrtolani test sho#ld be er'ormed by an exerien"ed ra"titioner so as toaoid any ossible damage. It sho#ld not be er'ormed reetitiely. Altho#gh itwo#ld be imortant to as"ertain whether the n#rsing st#dent knew the "lini"alimli"ation 'or the test the riority sa'ety a"tion wo#ld be to interene and sto

'#rther testing.Awarded 0.0 oints o#t o' 1.0 ossible oints. 3.A n#rse is er'orming an assessment on a newborn and notes 2 digits on

ea"h 'oot. ,his %nding is an examle o'&ongenital hi dyslasia.@yosadias.*olyda"tyly. Correct&l#b'oot.

Polydactyly is a "ongenital de'ormity asso"iated with extra digits. $ongenitalhip dysplasia indi"ates a dislo"ated hi. %ypospadias indi"ates an abnormality o'the external genitalia. &l#b'oot "an be ositional or "ongenital in nat#re and is a'oot de'ormity.Awarded 0.0 oints o#t o' 1.0 ossible oints.

G.A n#rse is er'orming a #lse oximetry reading on a newborn to test 'or

*PC.&ongenital heart disease. Correcti"kle "ell disease.,halassemia.

*#lse oximetry "an be #sed to determine the resen"e o' "ongenital heartdisease in healthy newborns. Do#tine s"reening o' newborns is done ia the :#thrieheelsti"k test to look 'or "ertain metaboli" diseases s#"h as *PC si"kle "ell diseaseand thalassemia.Awarded 0.0 oints o#t o' 1.0 ossible oints.

10.In terms o' Dh in"omatibility whi"h sit#ations wo#ld "a#se a otentialroblem$ ele"t all that alyDh-negatie mom haing an Dh-ositie baby CorrectDh-negatie mom haing an Dh-negatie baby

,he in'ant o' an Dh-negatie mom with Dh-ositie 'ather who is homoygo#s 'orthe trait CorrectDh-ositie baby born to an Dh-ositie mom

An Dh-negatie mom haing an Dh-ositie baby is the "lassi"resentation 'or isoimm#niation or Dh in"omatibility. ,he in'ant o' an Dh-negatiemom with an Dh ositie 'ather who is homoygo#s 'or the trait wo#ld hae aotential roblem be"a#se the in'ant wo#ld be Dh-ositie. ,he other two sit#ationswo#ld not "a#se a roblem.Awarded 0.0 oints o#t o' 1.0 ossible oints.

ob evolve test 4

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