Nursing Medical Surgical Care Exam 2 Study Guide

Questions and Answers

What is the main management approach for Premature Rupture of Membranes (PPROM) at less than 32 weeks?

Begin labor induction immediately

Administer high-dose antibiotics only

Immediate delivery of the baby

Expectant and conservative management (correct)

What is a key intervention for fetal neuroprotection during preterm premature rupture of membranes?

Magnesium sulfate administration (correct)

Antenatal glucocorticoids only

Immediate cesarean delivery

Continuous fetal monitoring

What characterizes the Active Phase of the First Stage of Labor?

Fetal monitoring becomes less important

Cervical dilation from 6 to 10 cm (correct)

Cervix is fully dilated and pushing begins

Cervical dilation from 0 to 6 cm

Which stage of labor follows the birth of the baby?

Third Stage of Labor Signup and view all the answers

Which statement about the Fourth Stage of Labor is true?

It starts after the delivery of the placenta Signup and view all the answers

What is recommended for all women with preterm PROM between 24 0/7 and 34 0/7 weeks of gestation?

Corticosteroid therapy Signup and view all the answers

What is the purpose of an External Cephalic Version (ECV)?

To turn the fetus to a vertex presentation for birth Signup and view all the answers

At what gestational age is the success rate for ECV approximately 65%?

36-37 weeks Signup and view all the answers

Which of the following is NOT a characteristic of preterm labor (PTL)?

Always results in a low birth weight Signup and view all the answers

What is the diagnostic test used for determining preterm labor?

Fetal Fibronectin (fFN) Test Signup and view all the answers

Which factor is NOT considered a risk factor for spontaneous preterm birth?

Advanced maternal age Signup and view all the answers

What is the primary purpose of ultrasound scanning during an ECV?

To visualize the fetal position Signup and view all the answers

Which of the following statements about cervical length is true concerning preterm birth?

A cervical length > 30 mm decreases risk for preterm birth Signup and view all the answers

Which of the following best describes indicated preterm birth?

Occurs due to maternal health issues Signup and view all the answers

What is considered fetal tachycardia?

A fetal heart rate exceeding 160 bpm for 10 minutes or longer Signup and view all the answers

Which of the following can be a cause of fetal tachycardia?

Maternal fever or fetal infection Signup and view all the answers

Which medication is associated with causing fetal tachycardia?

Terbutaline Signup and view all the answers

Which measure is NOT part of intrauterine resuscitation?

Rapid intravenous infusion of glucose Signup and view all the answers

Fetal cardiac arrhythmias can lead to which condition?

Fetal tachycardia Signup and view all the answers

What is the primary aim of intrauterine resuscitation?

To increase oxygen delivery to the placenta Signup and view all the answers

What marks the end of the first stage of labor?

Full dilation of the cervix Signup and view all the answers

How is effacement expressed during labor?

As a percentage from 0 to 100% Signup and view all the answers

Which of the following represents the degree of descent of the presenting fetal part?

Station Signup and view all the answers

What is the typical range for cervical dilation during labor?

0 to 10 cm Signup and view all the answers

Which factor is NOT considered one of the 5 P's affecting the labor process?

Contraction strength Signup and view all the answers

What usually happens to effacement and dilation in a first pregnancy?

Effacement typically progresses faster than dilation. Signup and view all the answers

What is a critical reason for performing an emergency C-section?

To prevent permanent harm to the fetus Signup and view all the answers

Which procedure helps to estimate fetal size and assess fetal position, presentation, and lie?

Leopold's maneuver Signup and view all the answers

What is the target blood glucose level to maintain during labor?

80 to 110 mg/dl Signup and view all the answers

What should be assessed at 6 to 12 weeks postpartum for women who had gestational diabetes?

Carbohydrate intolerance Signup and view all the answers

What is the primary goal of antepartum care for women requiring insulin during pregnancy?

Strict blood glucose control Signup and view all the answers

Which of the following is NOT a component of postpartum care after gestational diabetes?

Insulin therapy continuation Signup and view all the answers

What should be done if tachysystole occurs when using labor-enhancing drugs?

Promptly respond and monitor the fetus Signup and view all the answers

Which element is NOT part of the DM counseling for pregnant women?

Assessing for thyroid dysfunction Signup and view all the answers

Study Notes

Labor and Delivery Overview

Dilation: Widening of cervical opening; measured from 0-10 cm. Full dilation signifies end of first labor stage.
Effacement: Thinning and shortening of the cervix; expressed as 0-100%. Typically progresses faster during first pregnancies.
Station: Measures descent of fetal part in relation to ischial spines; +4 or +5 cm indicates imminent birth.

Fetal Monitoring

Tachycardia: Defined as fetal heart rate > 160 bpm for over 10 minutes. Common causes include fetal hypoxemia, maternal fever, medications (e.g., atropine, terbutaline), and arrangements like fetal cardiac arrhythmias.
Intrauterine Resuscitation: Methods to enhance oxygen flow to placenta; includes proper positioning, IV fluid administration, and maternal oxygen supply.

Stages of Labor

First Stage: Begins with contractions, ends at full dilation; consists of Latent (0-6 cm) and Active phases (6-10 cm).
Second Stage: Full dilation to baby’s birth; includes both passive fetal descent and active pushing phases.
Third Stage: Delivery of placenta following birth.
Fourth Stage: Observational period lasting two hours post-delivery to monitor for complications.

Labor Induction Techniques

External Cephalic Version (ECV): Procedure to turn a fetus from a breech or shoulder position to vertex, usually performed at 36-37 weeks with a success rate around 65%.
Internal Version: Rarely used; safety is uncertain.

Preterm Labor (PTL)

Diagnosis relies on regular contractions and cervical changes before 37 weeks. Preterm birth occurs between 20 0/7 and 36 6/7 weeks.
Spontaneous PTB: Accounts for 75% of cases. Risk factors include infections, multifetal gestation, and socioeconomic status.
Fetal Fibronectin (fFN) Test: Glycoprotein test with high predictive accuracy for assessing the risk of imminent preterm labor.

HELLP Syndrome

Variant of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets.

Pregnancy Insulin Management

Antepartum Care: Strict glucose control through dietary modifications, monitoring, and pharmacologic therapy. Regular fetal surveillance needed.
Intrapartum Care: Hourly glucose monitoring during labor, maintaining levels between 80-110 mg/dl.
Postpartum Care: Normal glucose levels typically return, but women are at a higher risk for gestational diabetes in future pregnancies.

Fetal Assessment Techniques

Leopold's Maneuvers: Abdominal palpation to determine fetal position, presentation, and engagement.
Continuous Lumbar Epidural (CLE): Common pain relief method during labor, with specific contraindications and side effects.

Monitoring and Interventions

Continuous vigilance for signs of infection in cases of Preterm Premature Rupture of Membranes (PPROM) especially under 32 weeks.
Use of antenatal glucocorticoids and antibiotics to manage conditions associated with preterm labor.

Summary of Care Goals

Maintain optimal maternal and fetal health through monitoring, adequate medical interventions, and careful tracking of labor progression and complications.

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Description

Prepare for your N330 Exam 2 with this comprehensive study guide focused on Nursing Medical Surgical Care of Adults at California State University San Marcos. Review key concepts, essential nursing practices, and critical patient care skills to excel in your exam.