NCM 107 Finals Reviewer PDF

NCM 107 REVIEWER FOR FINALS EXPECT BOARD TYPE QUESTIONS FOR YOUR 200 ITEMS MULTIPLE CHOICE TEST ON FINALS. READ AND UNDERSTAND, YOU MAY CONTACT ME IF YOUR HAVING DIFFICULTY UNDERSTANDING THOSE BULLETED CONCEPTS. PM IS THE KEY!!! LABOR AND DELIVERY ⚫ During labor, to relieve supine hypotension mani...

NCM 107 REVIEWER FOR FINALS EXPECT BOARD TYPE QUESTIONS FOR YOUR 200 ITEMS MULTIPLE CHOICE TEST ON FINALS. READ AND UNDERSTAND, YOU MAY CONTACT ME IF YOUR HAVING DIFFICULTY UNDERSTANDING THOSE BULLETED CONCEPTS. PM IS THE KEY!!! LABOR AND DELIVERY ⚫ During labor, to relieve supine hypotension manifested by nausea and vomiting and paleness, turn the patient on her left side. ⚫ During the transition phase of the first stage of labor, the cervix is dilated 8 to 10 cm and contractions usually occur 2 to 3 minutes apart and last for 60 seconds. ⚫ The first stage of labor begins with the onset of labor and ends with full cervical dilation at 10 cm. ⚫ The second stage of labor begins with full cervical dilation and ends with the neonate’s birth. ⚫ The third stage of labor begins after the neonate’s birth and ends with expulsion of the placenta. ⚫ The fourth stage of labor (postpartum stabilization) lasts up to 4 hours after the placenta is delivered. This time is needed to stabilize the mother’s physical and emotional state after the stress of childbirth. ⚫ Unlike false labor, true labor produces regular rhythmic contractions, abdominal discomfort, progressive descent of the fetus, bloody show, and progressive effacement and dilation of the cervix. ⚫ When used to describe the degree of fetal descent during labor, floating means the presenting part is not engaged in the pelvic inlet, but is freely movable (ballotable) above the pelvic inlet. ⚫ When used to describe the degree of fetal descent, engagement means when the largest diameter of the presenting part has passed through the pelvic inlet. ⚫ Fetal stations indicate the location of the presenting part in relation to the ischial spine. It’s described as –1, –2, –3, –4, or –5 to indicate the number of centimeters above the level of the ischial spine; station –5 is at the pelvic inlet. ⚫ Fetal stations are also described as +1, +2, +3, +4, or +5 to indicate the number of centimeters it is below the level of the ischial spine; station 0 is at the level of the ischial spine. ⚫ Any vaginal bleeding during pregnancy should be considered a complication until proven otherwise. ⚫ During delivery, if the umbilical cord can’t be loosened and slipped from around the neonate’s neck, it should be clamped with two clamps and cut between the clamps. ⚫ During the first stage of labor, the side-lying position usually provides the greatest degree of comfort, although the patient may assume any comfortable position. ⚫ Fetal stations are also described as +1, +2, +3, +4, or +5 to indicate the number of centimeters it is below the level of the ischial spine; station 0 is at the level of the ischial spine. ⚫ Fetal stations indicate the location of the presenting part in relation to the ischial spine. It’s described as –1, –2, –3, –4, or –5 to indicate the number of centimeters above the level of the ischial spine; station –5 is at the pelvic inlet. ⚫ When used to describe the degree of fetal descent, engagement means when the largest diameter of the presenting part has passed through the pelvic inlet. ⚫ Amniotomy is artificial rupture of the amniotic membranes. ⚫ The three phases of a uterine contraction are increment, acme, and decrement. ⚫ The intensity of a labor contraction can be assessed by the indentability of the uterine wall at the contraction’s peak. Intensity is graded as mild (uterine muscle is somewhat tense), moderate (uterine muscle is moderately tense), or strong (uterine muscle is boardlike). ⚫ The frequency of uterine contractions, which is measured in minutes, is the time from the  beginning of one contraction to the beginning of the next. ⚫ Before internal fetal monitoring can be performed, a pregnant patient’s cervix must be dilated at least 2 cm, the amniotic membranes must be ruptured, and the presenting part of the fetus (scalp or buttocks) must be at station –1 or lower, so that a small electrode can be attached. ⚫ Teenage mothers are more likely to have low-birth-weight neonates because they seek prenatal care late in pregnancy (as a result of denial) and are more likely than older mothers to have nutritional deficiencies. ⚫ The narrowest diameter of the pelvic inlet is the anteroposterior (diagonal conjugate). ⚫ During labor, the resting phase between contractions is at least 30 seconds. ⚫ The length of the uterus increases from 2½” (6.3 cm) before pregnancy to 12½” (32 cm) at term. ⚫ To estimate the true conjugate (the smallest inlet measurement of the pelvis), deduct 1.5 cm from the diagonal conjugate (usually 12 cm). A true conjugate of 10.5 cm enables the fetal head (usually 10 cm) to pass. ⚫ The smallest outlet measurement of the pelvis is the intertuberous diameter, which is the transverse diameter between the ischial tuberosities. ⚫ Electronic fetal monitoring is used to assess fetal well-being during labor. If compromised fetal status is suspected, fetal blood pH may be evaluated by obtaining a scalp sample. ⚫ In an emergency delivery, enough pressure should be applied to the emerging fetus’s head to guide the descent and prevent a rapid change in pressure within the molded fetal skull. ⚫ Massaging the uterus helps to stimulate contractions after the placenta is delivered. ⚫ When a patient is admitted to the unit in active labor, the nurse’s first action is to listen for fetal heart tones. ⚫ Nitrazine paper is used to test the pH of vaginal discharge to determine the presence of amniotic fluid. ⚫ A pregnant patient normally gains 2 to 5 lb (1 to 2.5 kg) during the first trimester and slightly less than 1 lb (0.5 kg) per week during the last two trimesters. ⚫ Precipitate labor lasts for approximately 3 hours and ends with delivery of the neonate. ⚫ As emergency treatment for excessive uterine bleeding, 0.2 mg of methylergonovine (Methergine) is injected I.V. over 1 minute while the patient’s blood pressure and uterine contractions are monitored. ⚫ Braxton Hicks contractions are usually felt in the abdomen and don’t cause cervical change. True labor contractions are felt in the front of the abdomen and back and lead to progressive cervical dilation and effacement. ⚫ If a fetus has late decelerations (a sign of fetal hypoxia), the nurse should instruct the mother to lie on her left side and then administer 8 to 10 L of oxygen per minute by mask or cannula. The nurse should notify the physician. The side-lying position removes pressure on the inferior vena cava. ⚫ Oxytocin (Pitocin) promotes lactation and uterine contractions. ⚫ Because oxytocin (Pitocin) stimulates powerful uterine contractions during labor, it must be administered under close observation to help prevent maternal and fetal distress. ⚫ Molding is the process by which the fetal head changes shape to facilitate movement through the birth canal. ⚫ If a woman suddenly becomes hypotensive during labor, the nurse should increase the infusion rate of I.V. fluids as prescribed. ⚫ During fetal heart monitoring, early deceleration is caused by compression of the head during labor. ⚫ After the placenta is delivered, the nurse may add oxytocin (Pitocin) to the patient’s I.V. solution, as prescribed, to promote postpartum involution of the uterus and stimulate lactation. ⚫ If needed, cervical suturing is usually done between 14 and 18 weeks gestation to reinforce an  incompetent cervix and maintain pregnancy. The suturing is typically removed by 35 weeks gestation. ⚫ The Food and Drug Administration has established the following five categories of drugs based on their potential for causing birth defects: A, no evidence of risk; B, no risk found in animals, but no studies have been done in women; C, animal studies have shown an adverse effect, but the drug may be beneficial to women despite the potential risk; D, evidence of risk, but its benefits may outweigh its risks; and X, fetal anomalies noted, and the risks clearly outweigh the potential benefits. ⚫ The mechanics of delivery are engagement, descent and flexion, internal rotation, extension, external rotation, restitution, and expulsion. ⚫ The duration of a contraction is timed from the moment that the uterine muscle begins to tense to the moment that it reaches full relaxation. It’s measured in seconds. ⚫ Fetal demise is death of the fetus after viability. ⚫ The most common method of inducing labor after artificial rupture of the membranes is oxytocin (Pitocin) infusion. ⚫ After the amniotic membranes rupture, the initial nursing action is to assess the fetal heart rate. ⚫ The most common reasons for cesarean birth are malpresentation, fetal distress, cephalopelvic disproportion, pregnancy-induced hypertension, previous cesarean birth, and inadequate progress in labor. ⚫ Amniocentesis increases the risk of spontaneous abortion, trauma to the fetus or placenta, premature labor, infection, and Rh sensitization of the fetus. ⚫ After amniocentesis, abdominal cramping or spontaneous vaginal bleeding may indicate complications. ⚫ To prevent her from developing Rh antibodies, an Rh-negative primigravida should receive Rho(D) immune globulin (RhoGAM) after delivering an Rh-positive neonate. ⚫ When informed that a patient’s amniotic membrane has broken, the nurse should check fetal heart tones and then maternal vital signs. ⚫ Crowning is the appearance of the fetus’s head when its largest diameter is encircled by the vulvovaginal ring. ⚫ Subinvolution may occur if the bladder is distended after delivery. ⚫ For an extramural delivery (one that takes place outside of a normal delivery center), the priorities for care of the neonate include maintaining a patent airway, supporting efforts to breathe, monitoring vital signs, and maintaining adequate body temperature. ⚫ The administration of oxytocin (Pitocin) is stopped if the contractions are 90 seconds or longer. ⚫ If a pregnant patient’s rubella titer is less than 1:8, she should be immunized after delivery. ⚫ During the transition phase of labor, the woman usually is irritable and restless. ⚫ Maternal hypotension is a complication of spinal block. ⚫ The mother’s Rh factor should be determined before an amniocentesis is performed. ⚫ With early maternal age, cephalopelvic disproportion commonly occurs. ⚫ Spontaneous rupture of the membranes increases the risk of a prolapsed umbilical cord. POSTPARTUM CARE ⚫ Lochia rubra is the vaginal discharge of almost pure blood that occurs during the first few days after childbirth. ⚫ Lochia serosa is the serous vaginal discharge that occurs 4 to 7 days after childbirth. ⚫ Lochia alba is the vaginal discharge of decreased blood and increased leukocytes that’s the final stage of lochia. It occurs 7 to 10 days after childbirth. ⚫ After delivery, a multiparous woman is more susceptible to bleeding than a primiparous woman because her uterine muscles may be overstretched and may not contract efficiently. ⚫ The nurse should suggest ambulation to a postpartum patient who has gas pain and flatulence. ⚫ Methylergonovine (Methergine) is an oxytocic agent used to prevent and treat postpartum hemorrhage caused by uterine atony or subinvolution. ⚫ After a stillbirth, the mother should be allowed to hold the neonate to help her come to terms with the death. ⚫ If a woman receives a spinal block before delivery, the nurse should monitor the patient’s blood pressure closely. ⚫ A postpartum patient may resume sexual intercourse after the perineal or uterine wounds heal (usually within 4 weeks after delivery). ⚫ If a pregnant patient’s test results are negative for glucose but positive for acetone, the nurse should assess the patient’s diet for inadequate caloric intake. ⚫ Direct antiglobulin (direct Coombs’) test is used to detect maternal antibodies attached to red blood cells in the neonate. ⚫ Before discharging a patient who has had an abortion, the nurse should instruct her to report bright red clots, bleeding that lasts longer than 7 days, or signs of infection, such as a temperature of greater than 100° F (37.8° C), foul-smelling vaginal discharge, severe uterine cramping, nausea, or vomiting. ⚫ The fundus of a postpartum patient is massaged to stimulate contraction of the uterus and prevent hemorrhage. ⚫ Laceration of the vagina, cervix, or perineum produces bright red bleeding that often comes in spurts. The bleeding is continuous, even when the fundus is firm. ⚫ To avoid puncturing the placenta, a vaginal examination should not be performed on a pregnant patient who is bleeding. ⚫ A patient who has postpartum hemorrhage caused by uterine atony should be given oxytocin as prescribed. ⚫ After delivery, if the fundus is boggy and deviated to the right side, the patient should empty her bladder. ⚫ In the early postpartum period, the fundus should be midline at the umbilicus. Pregnancy Complications ⚫ An ectopic pregnancy is one that implants abnormally, outside the uterus. ⚫ A habitual aborter is a woman who has had three or more consecutive spontaneous abortions. ⚫ Threatened abortion occurs when bleeding is present without cervical dilation. ⚫ A complete abortion occurs when all products of conception are expelled. ⚫ Hydramnios (polyhydramnios) is excessive amniotic fluid of more than 2,000 ml in the third trimester. ⚫ In an incomplete abortion, the fetus is expelled, but parts of the placenta and membrane remain in the uterus. ⚫ When a pregnant patient has undiagnosed vaginal bleeding, vaginal examination should be avoided until ultrasonography rules out placenta previa. ⚫ A patient with a ruptured ectopic pregnancy commonly has sharp pain in the lower abdomen, with spotting and cramping. She may have abdominal rigidity; rapid, shallow respirations; tachycardia; and shock. ⚫ A 16-year-old girl who is pregnant is at risk for having a low-birth-weight neonate. ⚫ A rubella vaccine shouldn’t be given to a pregnant woman. The vaccine can be administered after delivery, but the patient should be instructed to avoid becoming pregnant for 3 months. NONSTRESS TEST ⚫ A nonstress test is considered nonreactive (positive) if fewer than two fetal heart rate accelerations of at least 15 beats/minute occur in 20 minutes. ⚫ A nonstress test is considered reactive (negative) if two or more fetal heart rate accelerations of 15 beats/minute above baseline occur in 20 minutes. ⚫ A nonstress test is usually performed to assess fetal well-being in a pregnant patient with a prolonged pregnancy (42 weeks or more), diabetes, a history of poor pregnancy outcomes, or pregnancy-induced hypertension. PLACENTAL ABNORMALITIES ⚫ Placenta previa is abnormally low implantation of the placenta so that it encroaches on or covers the cervical os. ⚫ In complete (total) placenta previa, the placenta completely covers the cervical os. ⚫ In partial (incomplete or marginal) placenta previa, the placenta covers only a portion of the cervical os. ⚫ Abruptio placentae is premature separation of a normally implanted placenta. It may be partial or complete, and usually causes abdominal pain, vaginal bleeding, and a boardlike abdomen. ⚫ In placenta previa, bleeding is painless and seldom fatal on the first occasion, but it becomes heavier with each subsequent episode. ⚫ Nursing interventions for a patient with placenta previa include positioning the patient on her left side for maximum fetal perfusion, monitoring fetal heart tones, and administering I.V. fluids and oxygen, as ordered. ⚫ Treatment for abruptio placentae is usually immediate cesarean delivery. ⚫ A classic difference between abruptio placentae and placenta previa is the degree of pain. Abruptio placentae causes pain, whereas placenta previa causes painless bleeding. ⚫ Because a major role of the placenta is to function as a fetal lung, any condition that interrupts normal blood flow to or from the placenta increases fetal partial pressure of arterial carbon dioxide and decreases fetal pH. PREECLAMPSIA ⚫ Pregnancy-induced hypertension is a leading cause of maternal death in the United States. ⚫ Pregnancy-induced hypertension (preeclampsia) is an increase in blood pressure of 30/15 mm Hg over baseline or blood pressure of 140/95 mmHg on two occasions at least 6 hours apart accompanied by edema and albuminuria after 20 weeks gestation. ⚫ The classic triad of symptoms of preeclampsia are hypertension, edema, and proteinuria. Additional symptoms of severe preeclampsia include hyperreflexia, cerebral and vision disturbances, and epigastric pain. ⚫ After administering magnesium sulfate to a pregnant patient for hypertension or preterm labor, the nurse should monitor the respiratory rate and deep tendon reflexes. ⚫ Eclampsia is the occurrence of seizures that aren’t caused by a cerebral disorder in a patient who has pregnancy-induced hypertension. ⚫ In a patient with preeclampsia, epigastric pain is a late symptom and requires immediate medical intervention. ⚫ In a pregnant patient, preeclampsia may progress to eclampsia, which is characterized by seizures and may lead to coma. ⚫ HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is an unusual variation of pregnancy-induced hypertension. CONTRACEPTIVES ⚫ The failure rate of a contraceptive is determined by the experience of 100 women for 1 year. It’s expressed as pregnancies per 100 woman-years. ⚫ Before providing a specimen for a sperm count, the patient should avoid ejaculation for 48 to 72 hours. ⚫ If a patient misses two consecutive menstrual periods while taking an oral contraceptive, she should discontinue the contraceptive and take a pregnancy test. ⚫ If a patient who is taking an oral contraceptive misses a dose, she should take the pill as soon as she remembers or take two at the next scheduled interval and continue with the normal schedule. ⚫ If a patient who is taking an oral contraceptive misses two consecutive doses, she should double the dose for 2 days and then resume her normal schedule. She also should use an additional birth control method for 1 week