AWHONN PEOP Perinatal Final Review 2022

AWHONN PEOP Perinatal Final Review 2022 Swiss cheese is often used as the paradigm for explaining medical error. In this model, the holes in the cheese represent latent weaknesses You are assigned to a patient who is at 38 weeks and 6 days gestation. She is being admitted for an elective induction of labor because her husband is going on an extended business trip in 2 days and he wants to be present for the delivery. The hospital has no policy regarding elective induction, but you know that the AWHONN "Go the Full 40" campaign doesn't support early elective induction. You approach the physician with your concerns. He responds that he's been doing this for 30 years and has never had a bad outcome from an elective induction at this gestation. This scenario is an example of normalization of deviance Which of the following has been noted among the top three root causes of sentinel events for over 10 years? Communication A shared understanding of what is going on and what is likely to happen next is known as situational awareness A patient safety event, unrelated to the natural course of the underlying illness, that reaches a patient and results in death, permanent harm, or severe temporary harm with intervention required to sustain life is an example of a sentinel event Which tool is used when an adverse event has occurred to identify variations in performance that led to the outcome? Root cause analysis Yearly objectives developed by The Joint Commission that focus on problems in healthcare safety are known as National Patient Safety Goals The Perinatal Care Core Measures include all of the following EXCEPT use of the NICHD nomenclature for electronic fetal monitoring. Authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty are expected to perform competently are defined Standards of Care Position statements are recommendations for a pathway of action regarding a particular issue In health care, an unplanned event that did NOT result in injury, illness, or damage but had the potential to do so is referred to as a near miss All of the following are elements of good documentation EXCEPT inclusion of nursing opinion as to causes of error Mrs. Johnson is a primipara at 34 weeks gestation who has been admitted to your unit with increasing blood pressures. You have a discussion with the physician about her reports of headache and blurred vision. What actions should surround the documentation of this conversation in the medical record? Document the date, time, person spoken to, and objective details of what was said in the medical record. Which of the following is NOT a component of the risk reduction strategy known as closed loop communication? Is only used in emergency patient care situations You are a nurse on the mother/baby unit caring for a woman who is 12 hours postpartum from an operative vaginal delivery with midline episiotomy. The woman has severe rectal pain and reports inability to urinate. You suspect a vaginal hematoma and call her physician to request an evaluation. The physician does not respond. Under these circumstances it is appropriate to institute the chain of communication Team training is an effective risk management strategy because it outlines effective communication tools and techniques One of the leading causes of obstetric liability is oxytocin administration leading to tachysystole Which two medications frequently used in the perinatal setting are identified as high-risk medications by the Institute for Safe Medication Practices (ISMP)? Magnesium sulfate and oxytocin Successful defense against malpractice claims is enhanced by which of the following? Following national professional standards The innermost layer of the uterus is called the endometrium Fertilization occurs in the fallopian tube During the proliferative phase of the menstrual cycle, which is NOT true? Menstruation occurs The corpus luteum produces ___________ to prepare the uterus to nurture the fertilized egg. progesterone In the early menstrual cycle phase, which gland sends a signal telling the ovaries to prepare to release an egg? Pituitary After ovulation, the ovarian follicle produces progesterone Implantation of a fertilized ovum occurs ______ days after ovulation. 7-10 Average viability for male sperm within the female reproductive tract is 2-3 days For a healthy, 30-year-old woman, the chance of conception is approximately __ per cycle. 20% The best way for a woman with a regular menstrual cycle to predict ovulation is to record the first day of the LMP and count backward 14 days Which is NOT a characteristic of ovulation in the female? Decreased basal body temperature Infertility evaluation is recommended for women less than 35 years old who have not conceived after ___ months. 6 (but I think question is incorrectly worded should be 12 months; 35 y/o is 6 months) Starting at what age does female fertility decline? 32 Which is NOT a symptom of polycystic ovarian syndrome? Painful periods What is the best way to confirm the diagnosis of endometriosis? Laparoscopy At ovulation, the cervical mucus becomes clear and stretchy. This facilitates sperm to pass through the cervical canal Which of the following uterine abnormalities may be surgically corrected to improve fertility? All the above (Endometrial polyps, Myomas, Uterine septum) Which test is the best predictor of a woman's ovarian reserve? Antral follicle count When is the best time of the menstrual cycle to perform hysterosalpingography? Day 7-12 Standards for semen analysis have been designated to maintain consistency and quality control by World Health Organization Pregnancy outcomes associated with ART include all the above (early pregnancy loss, multiple gestation pregnancy, preterm birth) Which is NOT true about ovarian hyperstimulation syndrome? Not an assisted reproductive technologies (ART) risk The MOST common form of ART for a woman with cervical factor infertility is intrauterine insemination (IUI) Which of the following is TRUE about IVF? Involves ovarian stimulation Which of the following is TRUE about GIFT? Requires laparoscopy Preconception care includes maximizing health all of the above (between pregnancies, during pregnancies, and throughout life) Anticipatory guidance is an important part of preconception and interconception care because the following percentage of all pregnancies in the United States are unintended. 45% Healthcare providers should strive to provide preconception and interconception care to all women of childbearing age, which is generally considered to be 15-44 years of age Interconception care should be provided to a woman postpartum until she can no longer become pregnant Which of the following birth outcomes may be improved by preconception and interconception care? All of the above (Infant mortality, Preterm birth, Birth defects) Cultural sensitivity means that the healthcare provider is alert and considerate of others' views Increasing maternal and paternal age have been shown to influence the risk of genetic abnormalities Women over the age of 35 have an increased risk of all of the above (cesarean birth, miscarriage and stillbirth, pregnancy-related complications) Access to care may be limited by all factors except lack of contraception A tool used to screen for IPV is RADAR The first "a" in RADAR stands for ask directly, in a kind, nonjudgmental way Nadia has arrived for a routine annual physical examination. She does not maintain eye contact and provides only brief responses to questions during the physical assessment systems review. Upon physical examination, you notice bruises on her breasts, upper thighs, and genitals. Nadia begins to cry and states that her husband beats her. Your first action should be to assess Nadia's safety and ask if she has a safety plan Folic acid supplementation prior to and during pregnancy has been shown to reduce the risk of neural tube defects by at least 85% Some foods are considered unsafe during pregnancy, and women may choose to avoid them during the preconception period. Undercooked meat and unwashed fruits and vegetables may expose women to which organism? Toxoplasma gondii Methylmercury may be found in certain fishes and can adversely affect which fetal system? Neurologic In nonpregnant women, obesity is defined as a body mass index (BMI) over 30 Obese women (BMI ≥30) should gain how many pounds during pregnancy? 11-20 Women who are underweight may have difficulty conceiving due to which of the following conditions? Oligo-ovulation Obesity can result in all of the above (ovulatory dysfunction, altered oocyte and endometrial functions, lower birth rates) Smoking increases the risk of increase in spontaneous abortion No amount of alcohol is safe during pregnancy. Fetal alcohol spectrum disorders include central nervous system abnormalities Which statement is most accurate about asthma during pregnancy? It is safer for a pregnant woman to be treated with asthma medications than to have associated symptoms and exacerbated asthma. Depression, fatigue, weight gain, and difficulty concentrating may all be signs of which condition? Hypothyroidism Women with chronic diseases who want to plan a pregnancy should not stop medications immediately All women of childbearing age should take which of the following per day to reduce the risk of neural tube defects? Folic acid Profound reproductive and endocrine changes occur throughout pregnancy. Which of the following statements is true about progesterone? Progesterone supports and maintains implantation of the developing embryo in early pregnancy. You are reviewing Jamie's prenatal record prior to her arrival for induction of labor. You notice that she had an ultrasound last week and her maximum vertical pocket was 1.75 and her AFI was 4.5. Given these results, you assume she is being induced for oligohydramnios During pregnancy, maternal hepatic glucose and pancreatic insulin production increase to meet the metabolic demands of both the mother and fetus. Therefore, pregnancy is generally characterized by postprandial hyperglycemia and hyperinsulinemia. Mrs. Mavis is 38 weeks pregnant and presents to the outpatient testing unit for a nonstress test. A reactive nonstress test for a fetus at this gestational age includes two fetal heart rate increases of 15 beats per minute above the baseline lasting for 15 seconds or longer in a timeframe of 20 minutes. If a mother is Rh-negative and her fetus is Rh-positive, the mother will create antibodies against the fetal cells anytime they cross the placenta. To prevent Rh isoimmunization, Rh-negative mothers are screened with a D (Rh) antibody screen and given D immune globulin (RhIG) as prophylaxis at which gestational age? 28 weeks Sofia has arrived to your unit for a labor evaluation. She is 37 weeks pregnant and has been complaining of excessive fatigue. Which of the following is a normal physiologic response to the expanding blood volume during pregnancy? Red blood cell (RBC) production increases to accommodate the expanding blood volume and White blood cell (WBC) production increases due to the changes in estrogen and cortisol.