Nursing Medical Surgical Care Exam 2 Study Guide

Questions and Answers

What does full dilation of the cervix signify in labor?

The onset of contractions

The start of active labor

The end of the first stage of labor (correct)

The beginning of the second stage of labor

How is effacement defined during the first stage of labor?

The shortening and thinning of the cervix (correct)

The opening of the birth canal

The descent of the fetal head

The widening of the cervical canal

In relation to ischial spines, what does a station of +4 or +5 cm indicate?

Labor has stalled

The fetus is in a transverse lie

Labor is progressing normally

Birth is imminent (correct)

Which of the following factors is NOT one of the 5 P's affecting the labor process?

Preparation Signup and view all the answers

What is the primary significance of the fetal head during labor?

It impacts the labor process due to its size and rigidity Signup and view all the answers

How typically does effacement progress in first pregnancies compared to subsequent pregnancies?

Faster than dilation in first pregnancies Signup and view all the answers

What is the primary purpose of external cephalic version (ECV)?

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

What is the estimated success rate of ECV at 36-37 weeks gestation?

65% Signup and view all the answers

Which of the following is a risk factor for spontaneous preterm labor?

Genetics Signup and view all the answers

At what gestational weeks does preterm birth occur?

20 0/7 to 36 6/7 weeks Signup and view all the answers

What is the role of the Fetal Fibronectin (fFN) Test in diagnosing preterm labor?

It predicts the likelihood of preterm labor Signup and view all the answers

Which of the following accurately describes the definition of preterm labor?

Cervical dilation of at least 2 cm occurring before 37 weeks Signup and view all the answers

Which of the following statements is true regarding cervical lengths and preterm birth?

Cervical lengths cannot predict imminent preterm birth Signup and view all the answers

What is a primary contraindication for performing an external cephalic version (ECV)?

History of cesarean birth Signup and view all the answers

What may necessitate an emergency C-section during labor?

Uterine rupture 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

During labor, what blood glucose level should be maintained?

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

What can Leopold's maneuvers help to determine?

Fetal presentation, position, and lie Signup and view all the answers

What condition is considered a variant of preeclampsia?

HELLP syndrome Signup and view all the answers

What should be done for women with a history of gestational diabetes post-delivery?

Carbohydrate intolerance assessment Signup and view all the answers

What is an important aspect of intrapartum care for women requiring insulin?

Hourly monitoring of blood glucose levels Signup and view all the answers

What is a common follow-up for women who had gestational diabetes?

Lifelong repeat screening every three years Signup and view all the answers

What is considered the normal range for blood pressure during pregnancy?

SBP < 140 / DBP < 90 Signup and view all the answers

What is the diagnosis criteria for gestational hypertension?

HTN without proteinuria after week 20 Signup and view all the answers

When recording blood pressure to confirm hypertension in a previously normal patient, how many readings must be taken?

Two readings at least 4 hours apart Signup and view all the answers

Chronic hypertension is defined as hypertension present:

Before any pregnancy Signup and view all the answers

How long does it typically take for gestational hypertension to resolve after giving birth?

6-12 months Signup and view all the answers

Women with chronic hypertension are at risk of developing which conditions during pregnancy?

Pre-eclampsia or eclampsia Signup and view all the answers

What defines a fourth-degree perineal laceration?

Extends completely through the anal sphincters and rectal mucosa Signup and view all the answers

Which condition is characterized by the cord lying below the presenting part of the fetus?

Prolapsed cord Signup and view all the answers

What is a common intervention to reduce the risk of perineal lacerations during childbirth?

Gentle perineal massage and warm compresses Signup and view all the answers

What risk does the mother face when shoulder dystocia occurs during delivery?

Excessive blood loss from uterine atony Signup and view all the answers

Which maneuver is indicated for managing shoulder dystocia?

McRoberts maneuver Signup and view all the answers

How can cultural perceptions influence labor experience?

They affect behavior and coping mechanisms during labor. Signup and view all the answers

What is an immediate management step for tachysystole?

Stop or lower the dose of labor-enhancing drugs Signup and view all the answers

What does meconium-stained amniotic fluid indicate?

The fetus is likely in distress. Signup and view all the answers

What factor is NOT associated with a higher risk of fetal shoulder dystocia?

Maternal obesity Signup and view all the answers

What can lead to early decelerations in fetal heart rate?

Fetal head compression Signup and view all the answers

What is defined as fetal tachycardia?

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

Which condition is NOT a recognized cause of fetal tachycardia?

Maternal anemia. Signup and view all the answers

What is an initial intervention in intrauterine resuscitation to improve fetal oxygen delivery?

Apply left lateral positioning. Signup and view all the answers

Which of the following drugs is a known cause of fetal tachycardia when administered to the mother?

Caffeine. Signup and view all the answers

What is one specific goal of intrauterine resuscitation?

To reverse hypoxia and acidosis. Signup and view all the answers

Which physiological response is associated with early signs of fetal hypoxemia?

Decreased fetal heart variability. Signup and view all the answers

What methods are commonly used to monitor fetal heart rate during labor?

Internal fetal monitoring and electronic fetal monitoring Signup and view all the answers

What is the primary purpose of using external fetal monitoring during labor?

To evaluate fetal heart rate and uterine activity Signup and view all the answers

Which statement about assessing fetal heart rate (FHR) is accurate?

FHR can be assessed using both intermittent auscultation and electronic fetal monitoring. Signup and view all the answers

What does EFM stand for in the context of fetal monitoring?

External Fetal Monitoring Signup and view all the answers

Which of the following accurately describes the method of indirect fetal heart rate monitoring?

Using an external belt to detect fetal heart activity Signup and view all the answers

Which condition could justify the use of internal fetal monitoring during labor?

Certain high-risk situations requiring continuous monitoring Signup and view all the answers

What aspect of fetal monitoring can impact decisions regarding labor interventions?

Fetal heart rate patterns and variability Signup and view all the answers

What is a potential limitation of external fetal monitoring?

It may not provide accurate readings in obese patients. Signup and view all the answers

What is a critical action to take when tachysystole is detected during labor enhancement?

Monitor the fetal heart rate for any signs of distress Signup and view all the answers

During intrapartum care for women with diabetes, what is the target blood glucose range that should be maintained?

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

What type of monitoring is recommended for women who require insulin during pregnancy starting at 32 weeks gestation?

Twice-weekly Non-Stress Tests (NST) Signup and view all the answers

What does a Non-Stress Test (NST) primarily assess in pregnant women?

Fetal heart rate patterns and responsiveness Signup and view all the answers

What indicates the need for an emergency C-section during labor enhancement?

Uterine rupture leading to fetal distress Signup and view all the answers

What is an expected outcome for women who had gestational diabetes after delivery?

They are at high risk for recurrence in future pregnancies Signup and view all the answers

Which condition can be inferred when a Non-Stress Test indicates a non-reassuring fetal heart rate pattern?

The fetus is likely experiencing hypoxia Signup and view all the answers

What assessment does Leopold's maneuvers primarily assist with?

Estimating fetal size and position Signup and view all the answers

Study Notes

Labor and Delivery Terms

Dilation: Enlargement of the cervical opening and canal, measured from 0 to 10 cm; full dilation marks the end of the first stage of labor.
Effacement: Shortening and thinning of the cervix during the first stage, expressed as a percentage from 0% to 100%.
Station: Degree of descent of the fetal part through the birth canal in relation to ischial spines; birth is imminent when the presenting part is +4 or +5 cm.

Continuous Lumbar Epidural (CLE)

Side Effects: Various potential complications associated with the use of CLE.
Contraindications: Specific conditions that may prevent the use of CLE during labor.

Factors Affecting Labor: The 5 P’s

Five Major Factors: Include passenger (fetal head), passageway, powers, position of the mother, and psyche.

Fetal Position Assessment

External Cephalic Version (ECV): A procedure to turn the fetus to a vertex position around 36-37 weeks, with a 65% success rate; ultrasound guidance is used.
Internal Version: Rare, with questionable safety.

Preterm Labor (PTL)

Diagnosis: Regular contractions with cervical changes or contractions and cervical dilation of at least 2 cm before 37 weeks.
Preterm Birth: Occurs between 20-36 weeks of gestation, distinct from low birth weight (<2500 g).
Spontaneous vs. Indicated Preterm Birth: Spontaneous (75% of cases) occurs without maternal or fetal illness; risk factors include infections, multifetal gestation, and low socioeconomic status.
Fetal Fibronectin (fFN) Test: High predictive value for ruling out imminent preterm labor.

Lacerations During Birth

Types of Perineal Lacerations:
- First Degree: Skin and superficial structures.
- Second Degree: Fascia and muscles of perineal body.
- Third Degree: Extends to anal sphincter.
- Fourth Degree: Continues through anal sphincters and rectal mucosa.
Prevention: Interventions like warm compresses and perineal massage may reduce lacerations.

Cultural Differences in Labor

Reactions to Pain: Culturally influenced; expressions may vary significantly without correlating to actual pain levels.
Impact on Labor Choices: Cultural expectations can affect decisions regarding birth companions and the role of the father.

Emergencies in Labor

Prolapsed Cord: Occurs when the umbilical cord lies below the presenting fetal part, often requiring prompt care and position changes.
Meconium-Stained Amniotic Fluid: Indicates fetal distress; requires skilled neonatal resuscitation.
Shoulder Dystocia: Complication when the shoulder cannot pass under the pubic arch, occurring in 0.2% to 3% of births.

Nursing Interventions

Tachysystole Management: Stop/lower labor-enhancing drugs, change maternal position, and provide oxygen and IV fluids as needed.
HELLP Syndrome: A variant of preeclampsia involving hemolysis, elevated liver enzymes, and low platelets.

Vitamin & Glucose Monitoring in Pregnancy

Insulin Needs: Strict blood glucose control during pregnancy with monitoring pre- and post-delivery.
Postpartum Care: Return to normal glucose levels; increased risk of recurrent gestational diabetes.

Blood Pressure and Hypertension in Pregnancy

Normal Blood Pressure: Defined as SBP < 140 and DBP < 90.
Gestational Hypertension: Elevated BP without proteinuria diagnosed after 20 weeks; resolves postpartum.
Chronic Hypertension: Present before or diagnosed before 20 weeks; risk of developing preeclampsia.

Leopold's Maneuvers

Assessment Method: Abdominal palpation to determine fetal presentation, position, and lie, aiding in the identification of fetal part and location.

Preterm Birth Prediction and Management

Presence of fetal fibronectin (fFN) alone is not a reliable predictor of preterm birth.
Preterm births may occur due to medical indications such as gestational diabetes mellitus (GDM), preeclampsia (Pre-E), previous cesarean section, seizures, or fetal disorders (25% likelihood).
Prevention strategies include addressing risk factors, early recognition, and lifestyle modifications such as activity restriction and pelvic rest.

Labor Management Techniques

Tocolytics are medications used to suppress uterine activity and delay preterm labor.
Labor augmentation is used when spontaneous labor does not progress satisfactorily, often through oxytocin infusion and amniotomy.
Active management aims for birth within 12 hours of admission, often through aggressive use of oxytocin.

Labor Terminology

Back labor occurs when the baby is in the occiput posterior (OP) position.
Station measures the baby's descent during labor, with engagement typically at station 0, indicating the largest part has passed through the pelvic brim.
Birth is imminent at a station of +4/+5 cm.

External Fetal Monitoring

Fetal heart rate (FHR) is monitored via intermittent auscultation (IA) or external fetal monitoring (EFM).
Normal FHR ranges from 110 to 160 bpm, with tachycardia defined as exceeding 160 bpm for 10 minutes or longer.

Causes of Fetal Tachycardia

Early sign of fetal hypoxemia, especially with other concerning variables like late decelerations.
Potential causes include maternal fever, infections, hyperthyroidism, anemia, and responses to various medications.

Intrauterine Resuscitation (IUR)

Aims to increase oxygen delivery to the placenta, reversing fetal hypoxia and acidosis.
Initial measures include positioning, rapid fluid infusion, maternal oxygen administration, and inhibition of contractions with terbutaline if necessary.

HELLP Syndrome

A serious condition considered a variant of preeclampsia involving hemolysis, elevated liver enzymes, and low platelet counts.

Leopold's Maneuvers

Assesses fetal presentation using abdominal palpation, answering questions about fetal position, lie, and engagement.

Insulin Management During Pregnancy

Antepartum care focuses on strict blood glucose control through diet, exercise, self-monitoring, pharmacological therapy, and fetal surveillance.
Intrapartum glucose levels should be maintained between 80 to 110 mg/dl, with hourly monitoring and insulin infusion as needed.
Postpartum, glucose levels typically normalize, but women who had GDM are at high risk for recurrence; follow-up screening is recommended at 6 to 12 weeks postpartum and every 3 years thereafter.

DM Counseling

Counseling is recommended for diabetic management during pregnancy for optimal maternal and fetal health.

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Description

Prepare for your N330 Exam 2 with this comprehensive study guide focused on Medical Surgical Care of Adults at California State University San Marcos. This guide will cover essential topics and equip you with the knowledge needed to succeed in your exam.