ATI Maternal Newborn Nursing Questions and Correct Solutions

Diaphragm - Spermicide must be applied with each act of sexual intercourse and should remain in place 6 hrs after. Empty bladder prior to coitus Transdermal contraceptive patch - Patch applied to dry skin overlying subQ tissue, excluding breast Depo-Provera - IM injection given every 11-13 weeks (start should be during first 5 days of clients menstrual cycle) Essure - Insertion of agent resulting in development of scar tissue in Fallopian tubes. Not reversible Female sterilization - Burning or blocking the Fallopian tubes. Not reversible Vasectomy - Ligation and severance of vas deferens. Need alternate form of birth control for 20 ejaculations RhoGAM - Administered at 28 weeks gestation to a mother who is Rh-negative and gives birth to an Rh-positive infant. Recommended following an amniocentesis Oxytocin (Pitocin) - Monitor for water intoxication (lightheaded, n/v, headache, malaise) which can lead to cerebral edema, seizures, coma, and death. Contraindicated based on late decelerations 3 hour glucose tolerance test - Screens for gestational diabetes and is done at 28 weeks of gestation Rubella titer - Obtained at initial prenatal visit (about 6 weeks gestation) Betamethasone (Celestone) - Glucocorticoid administered IM in 2 injections 24 hr apart, given to stimulate fetal lung maturity if early delivery is anticipated and to prevent respiratory distress. Can cause pulmonary edema (crackles, chest pain, SOB) Leopold Maneuver - Abdominal palpation of fetus, lie, attitude, helps nurse assess the position of the fetus to determine the optimal placement of the fetal monitoring transducer. Empty bladder beforehand, supine positioning Steps of Leopold Maneuver - Palpate client's fundus, determine location of fetal back, palpate fetal part presenting at the inlet, and palpate the cephalic prominence to identify the attitude of the head Ferning test - If positive, indicates rupture of membranes Expected newborn temp - 36.5-37.2 Expected newborn HR - 120-160 Expected newborn RR - 30-60 Expected newborn BP - 60-80 S, 40-50 D Expected newborn length - 45-55 cm Expected newborn weight - 2,500-4,000 g What is effleurage? - Client strokes abdomen using circular motion during contractions Maternal Serum Alpha-Fetoprotein - Screening tool for neural tube defects that is effective between 15 and 22 weeks. levels above indicate the need for an ultrasound Position for transvaginal ultrasound - Lithotomy position Biophysical profile assesses? - Fetal HR, breathing, body movements, fetal tone, and qualitative amniotic fluid volume What does biophysical profile indicate? - The risk of asphyxia Nonstress test - Client presses a button whenever they feel fetal movement which allows nurse to assess FHR in relationship to the fetal movement Reactive stress test - FHR has moderate variability, accelerated to 15 beats/min for at least 15 seconds and occurs two or more times during a 20 minute period Nonreactive stress test - FHR does not accelerate adequately with fetal movement. Does not meet criteria after 40 minutes. Contraction stress test or biophysical profile is indicated Contraction stress test - FHR in response to contractions which decreases placental blood flow Amniocentesis - Performed after 14 weeks gestation, empty bladder beforehand, client in supine position High levels of AFP - Alpha-Fetoprotein is measured between 16 and 18 weeks and is used to detect neural tube defects (anencephaly), spina bifida, and omphalocele Low levels AFP - Chromosomal disorders (Down syndrome) Fetal lung tests - Lecithin/sphingomyelin ratio- 2:1 indicating lung maturity or 3:1 for diabetes mellitus Percutaneous blood sampling - Obtains fetal blood from umbilical cord which evaluates isoimmune fetal hemolytic anemia and assesses need for fetal blood transfusion Chorionic Villus sampling - Alternative to amniocentesis (10-12 weeks gestation) Quad marker screening - Blood test that ascertains info about likelihood of fetal birth defects. Includes AFP, hCG, Estriol, Inhibin-A