Maternal Newborn Proctored Exam 2023

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Questions and Answers

What should be avoided in a patient with bleeding from placenta previa?

Vaginal exam (correct)

IV fluids

Blood test

Ultrasound

When should an acoustic stim be used on the abdomen during a nonstress test?

When FHR is 130 without accelerations.

What should be given to a mom who is rubella non-immune?

Rubella immunization after delivery.

A client with polyhydramnios might have GI anomalies.

True Signup and view all the answers

What is an adverse effect of magnesium sulfate?

Feeling of warmth throughout the body. Signup and view all the answers

What should be applied to manage low back pain during the latent phase of labor?

Counter pressure to the lower back during contractions. Signup and view all the answers

What is the first trimester sign that should be reported to a provider?

Swelling of the face. Signup and view all the answers

What is necessary for a first trimester sonogram?

A full bladder. Signup and view all the answers

What should clients on magnesium sulfate report to their provider?

Absent deep tendon reflexes. Signup and view all the answers

What medication is used for herpes simplex virus type two?

Acyclovir. Signup and view all the answers

What is a possible complication following amniocentesis?

Hemorrhage. Signup and view all the answers

How often should the oxytocin IV rate be increased during normal labor?

Every 30-60 minutes. Signup and view all the answers

What should be done if a client on oxytocin experiences late decelerations?

Move the client to a lateral position. Signup and view all the answers

What is the best care approach for an HIV client regarding their baby?

Bathe the baby before skin-to-skin contact. Signup and view all the answers

What to do for a client with a boggy uterus and BP of 142/92?

Withhold methylergnovine 0.2 mg orally. Signup and view all the answers

What lab values are expected to increase during pregnancy?

RBC counts. Signup and view all the answers

What is the indicator for a client to auscultate fetal heart rate?

Feeling quickening for the first time. Signup and view all the answers

What are the signs and symptoms of placenta previa?

Painless vaginal bleeding. Signup and view all the answers

What actions should be taken before starting phototherapy for jaundice?

Close the newborn's eyes under eye shields. Signup and view all the answers

What is an adverse effect of combined oral contraceptives?

Depression. Signup and view all the answers

What are the uses of cytotec/misoprostol?

Ripening/softening/opening cervix. Signup and view all the answers

How can pain be minimized during heel sticks on newborns?

Place the baby skin to skin on mother. Signup and view all the answers

What does the Kleihauer-Betke test detect?

Fetal blood in maternal circulation. Signup and view all the answers

What is a possible cause of abruptio placenta?

Recent cocaine use. Signup and view all the answers

What are signs and symptoms of severe pre-eclampsia?

Blurred vision. Signup and view all the answers

What condition can cause increased urinary output during pregnancy?

Gestational diabetes with hyperglycemia. Signup and view all the answers

What are some complications of amniocentesis?

Leakage of amniotic fluid or preterm labor. Signup and view all the answers

What are signs of hypoglycemia in a newborn?

All of the above Signup and view all the answers

What are Hispanic cultural practices for clients postpartum?

Protect feet and head from cold air. Signup and view all the answers

What is the first action to take after delivery?

ID band before vitamin K, eye ointment, and weight. Signup and view all the answers

What should a postpartum client with hypovolemic shock be watched for?

Cool and clammy skin. Signup and view all the answers

What should be done for a client after an epidural who has hypotension?

Turn the client to her side. Signup and view all the answers

Match the following terms with their definitions:

Babinski reflex = Run your finger from heel to toe and baby's toes will fan out. Postpartum rubella immunization teachings = Avoid getting pregnant for at least one month after immunization. Amniocentesis complications = Leakage of amniotic fluid / preterm labor. Preciptus labor = Less than 3 hours of labor can cause postpartum hemorrhage. Signup and view all the answers

Study Notes

Maternal Newborn Proctored Exam Key Points

Placenta Previa Management: Avoid vaginal examinations for patients experiencing bleeding.
Nonstress Test Protocol: If fetal heart rate (FHR) is 130 without accelerations, use an acoustic stimulator on the abdomen for 3 seconds.
Rubella Immunization: Administer rubella vaccine to non-immune mothers after delivery, especially if beta-hemolytic streptococcus is present and blood type is O negative.
Polyhydramnios Concerns: Be alert for potential gastrointestinal anomalies in the baby.
Magnesium Sulfate Side Effects: Patients may report warmth throughout the body as a common adverse effect.
Latent Labor Pain Relief: Apply counter pressure to the lower back during contractions for relief from low back pain.
Early Signs in Pregnancy: Report facial swelling as a concerning sign during the first trimester.
Ultrasound Preparation: A full bladder is necessary for optimal imaging during the first trimester ultrasound.
Magnesium Sulfate Monitoring: Clients should notify the provider of absent deep tendon reflexes, indicating potential issues.
Herpes Medication: Acyclovir is the medication used to manage herpes simplex virus type two infections.
Amniocentesis Risks: Potential complications include hemorrhage, leakage of amniotic fluid, and preterm labor.
Oxytocin Administration: The rate should be increased every 30 to 60 minutes during normal labor.
Late Decelerations Action: Move the patient to a lateral position if late decelerations occur while on oxytocin.
HIV Client Care: Bathe the newborn before initiating skin-to-skin contact to reduce infection risk.
Postpartum Nursing Action: For a boggy uterus and elevated BP, withhold methylergnovine (can increase blood pressure).
Pregnancy Lab Changes: Expect an increase in RBC count during pregnancy.
Fetal Heart Rate Detection: First-time quickening indicates the client should be able to auscultate fetal heart rate.
Placenta Previa Indicators: Recognize painless vaginal bleeding as a sign of placenta previa.
Phototherapy Preparations: Always shield the newborn's eyes under eye shields prior to jaundice phototherapy.
Contraceptives Side Effects: Depression is a possible adverse effect of combined oral contraceptives.
Cytotec/Misoprostol Uses: It is effective for cervical ripening and facilitating softening and opening of the cervix.
Minimizing Pain in Newborns: Skin-to-skin contact with the mother can help reduce pain during heel sticks.
Kleihauer-Betke Test: Used to detect fetal blood in maternal circulation, which may indicate placental abruption.
Abruptio Placenta Causes: Recent cocaine use is a potential cause of placental separation.
Severe Pre-eclampsia Symptoms: Blurred vision is a significant indicator of severe pre-eclampsia.
Increased Urinary Output Causes: Gestational diabetes with hyperglycemia can lead to increased urinary output.
Postpartum Hemorrhage Risks: One cause includes retained placental fragments.
Newborn Hypoglycemia Signs: Look for weak high-pitched cry, lethargy, tremors, BG of 40 or less, irregular respiratory effort, and seizures.
Cultural Practices in Postpartum Care: Hispanic clients may prefer to protect their feet and head from cold air postpartum.
Seizure Management in Pregnancy: Turn the client's head to the side and administer oxygen during a seizure.
Hypovolemic Shock Intervention: Massage the uterus to expel clots and promote uterine contractions after delivery.
C-Section Postoperative Care: Monitor the amount of lochia due to the increased risk of postpartum hemorrhage.
Nonstress Test Instructions: Clients should press a button each time fetal movement is detected during monitoring.
Rubella Immunization Aftercare: Advise clients to avoid pregnancy for at least one month post-immunization.
Sources of Vitamin B12: Fortified soy milk is an excellent source of vitamin B12.
Expected Findings in Newborns: Petechiae may appear as a result of nuchal cord complications.
Cytomegalovirus Transmission: The virus is transmitted via droplet and through saliva and urine of newborns.
Nutritional Guidance for Maternal Cholelithiasis: Recommend baked chicken over fried foods.
Fundal Height at 32 Weeks: Fundal height should measure within +/- 2 cm of 32 weeks (30-34 cm).
Magnesium Sulfate Output Monitoring: Urine output of less than 30 ml/hour is a concern, indicating a potential adverse reaction.
Breastfeeding Instruction: Advise mothers to feed for 15-20 minutes per breast at least every 3 hours.
Postpartum Infection Risk: An episiotomy increases the risk for infection.
Epidural Postcare for Hypotension: Turn the patient to her side to manage hypotension after an epidural.
Fundal Massage Procedure: Clients should lie on their back with knees flexed during fundal massage.
Amniocentesis Objectives: It’s performed to detect genetic or congenital disorders, not simply to determine the baby’s sex.
Medroxyprogesterone Guidance: Encourage increased calcium intake for those taking this medication.
Cytomegalovirus Effects: Can lead to hearing loss in newborns.
Babinski Reflex Assessment: Stroke from heel to toe to elicit the reflex where the baby's toes fan out.
Immediate Postpartum Action: Identification band must be placed on the newborn before administering vitamin K, eye ointment, or weight checks.
Postpartum Hypovolemic Shock Signs: Look for cool and clammy skin as a symptom.
Nausea Management in First Trimester: Suggest consuming cooler temperature foods to alleviate nausea.
Precipitous Labor Risks: Labor lasting less than 3 hours increases the risk of postpartum hemorrhage.
Dinoprostone Overview: Used for cervical ripening and stimulating contractions; ensure informed consent is obtained before administration.
Visual Disturbances in Pregnancy: Clients seeing floating spots should be prioritized for assessment.
Magnesium Sulfate Usage: It is generally used to prevent seizures in patients at risk.

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Prepare for your Maternal Newborn proctored exam with these flashcards covering critical concepts. Each card addresses essential topics such as patient bleeding, nonstress tests, and immunization protocols. Enhance your understanding and readiness for this important assessment.