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NUR 221 Exam 2 Questions and
Answers 100% Solved
What is the normal range for AST?
10 - 30 u/L
What is the normal range for ALT?
10 - 40 u/L
What is the normal range for Creatinine?
0.6 - 1.2 mg/dL
What is the normal range of hematocrit for women?
37 - 47%
What is the normal range for hemoglobin?
12 - 18 g/dL
What is the normal range for platelets?
150,000 - 400 ,000 cells/mcL
What is the normal FHR (fetal heart rate) range?
110 to 160 beats/min
How is fetal tachycardia defined?
As a baseline FHR greater than 160 beats/min for 10 minutes or longer.
How is fetal bradycardia defined?
As a baseline FHR less than 110 beats/min for 10 minutes or longer.
What three important questions does Leopold Maneuvers help to answer?
1.) Which fetal part is in the uterine fundus? 2.) Where is the fetal back located? 3.) What is the presenting fetal part?
How is category I defined in the fetal heart rate classification system?
1.) Baseline rate 110 to 160 beats/min 2.) Baseline FHR variability: Moderate 3.) Late or variable decelerations: Absent 4.) Early decelerations: Either present or absent 5.) Accelerations: Either present or absent:
How is category II defined in the fetal heart rate classification system?
1.) Bradycardia not accompanied by absent baseline variability, tachycardia 2.) Minimal baseline variability, absent baseline variability not accompanied by recurrent decelerations, marked baseline variability 3.) No accelerations produced in response to fetal stimulation 4.) Recurrent variable decelerations accompanied by minimal or moderate baseline variability,
What are the causes of Accelerations?
1.) Spontaneous fetal movement 2.) Vaginal examination 3.) Electrode application 4.) Fetal scalp application 5.) Fetal reaction to external sounds 6.) Breech presention 7.) Occiput posterior position 8.) Uterine contractions 9.) Fundal pressure 10.) Abdominal palpation
What are the nursing interventions for Accelerations?
None required.
What are Early Decelerations of the FHR?
A visually apparent, gradual decrease in and return to baseline FHR associated with uterine contractions.
What are the causes of Early Decelerations?
Head compression resulting from the following: 1.) Uterine contractions 2.) Vaginal examination 3.) Fundal pressure 4.) Placement of internal mode of monitoring
What are the nursing interventions for Early Decelerations?
None required.
What are Late Decelerations of the FHR?
A visually apparent, decrease in and return to baseline FHR associated with uterine contractions.
What are the causes of Late Decelerations?
Disruption of oxygen transfer from environment to fetus, resulting in transient fetal hypoxemia. Late decelerations are caused by the following: 1.) Uterine tachysystole
As a visually abrupt (onset to lowest point <30 seconds) and apparent decrease in FHR below the baseline. The decrease is at least 15 beats/min or more below the baseline, lasts at least 15 seconds, and returns to baseline in less than 2 minutes from the time of onset.
What are causes of Variable Decelerations?
Umbilical cord compression caused by the following: 1.) Maternal position with cord between fetus and maternal pelvis 2.) Cord around fetal neck, arm, leg, or other body part 3.) Short cord 4.) Knot in cord 5.) Prolapsed cord
What are the nursing interventions of Variable Decelerations?
1.) Discontinue oxytocin if infusing 2.) Change maternal position (side to side, knee chest) 3.) Administer oxygen at 10 L/min by nonrebreather face mask 4.) Notify physician or nurse-midwife 5.) Assist with vaginal or speculum examination to assess for cord prolapse 6.) Assist with amnioinfusion if ordered 7.) Assist with birth (vaginal or cesarean) if pattern cannot be corrected
What are Prolonged Decelerations of the FHR?
A visually apparent decrease in FHR of at least 15 beats/min below the baseline and lasting more than 2 minutes but less than 10 minutes.
NURSING ALERT (pg. 372):
Nurses should notify the physician or nurse-midwife immediately and initiate appropriate treatment of abnormal patterns when they see a prolonged deceleration.
What is Amnioinfusion?
Infusion of room temperature isotonic fluid (usually normal saline or Lactated Ringer's solution) into the uterine cavity if the volume of amniotic fluid is low.
What is the purpose of Amnioinfusion?
To relieve intermittent umbilical cord compression that results in variable decelerations and transient fetal hypoxemia by restoring the amniotic fluid volume to a normal or near normal level.
What is the criteria for a reactive Nonstress Test (NST)?
Two accelerations in a 20 minute period, each lasting at least 15 seconds and peaking at least 15 beats/min above the baseline. (Before 32 weeks of gestation, an acceleration is defined as a rise of at least 10 beats/min lasting at least 10 seconds from onset to offset.)
Prenatal diagnosis of genetic disorders or congenital anomalies (neural tube defects [NTDs] in particular), assessment of pulmonary maturity, and (rarely) diagnosis of fetal hemolytic disease.
What instructions should you give the pregnant woman who is at risk for cardiac decompensation?
1.) Watch for and immediately report signs of cardiac decompensation or congestive heart failure: generalized edema; distention of neck veins; dyspnea, frequent, moist cough; or palpitations. 2.) Watch for and immediately report signs of thromboembolism; pain, redness, tenderness, or swelling in extremities or chest pain. 3.) Avoid constipation and thus straining with bowel movements (Valsalva maneuver) by taking in adequate fluids and fiber. A stool softener may also be helpful.
What should you teach the pregnant woman who is at risk for cardiac decompensation the importance of?
1.) Daily weighing: Sudden weight gain indicates fluid retention. 2.) Keeping all prenatal visit appointments, although they will be scheduled more frequently than for "normal" pregnant women. 3.) Limiting activity (depending on classification of her heart disease). Patients with class I or II cardiac disease need 10 hours of sleep every night and 30 minutes of rest after meals. Patients with class III or IV cardiac disease usually need bed rest for most of each day.
What is Preeclampsia?
Development of hypertension and proteinuria in a previously normotensive woman after 20 weeks of gestation or in the early postpartum period. In the absence of proteinuria, the
development of new onset hypertension with the new onset of any of the following: thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms.
What are the risk factors for Preeclampsia?
1.) Nulliparity 2.) Age >40 years 3.) Pregnancy with assisted reproduction techniques 4.) Interpregnancy interval >7 years 5.) Family history of preeclampsia 6.) Woman born small for gestational age 7.) Obesity/gestational diabetes mellitus 8.) Multifetal gestation 9.) Preeclampsia in previous pregnancy 10.) Poor outcome in previous pregnancy 11.) Preexisting medical/genetic conditions 12.) Chronic hypertension 13.) Renal disease 14.) Type 1 (insulin dependent) diabetes mellitus
3.) Mental confusion 4.) Right upper quadrant abdominal or epigastric pain 5.) Nausea or vomiting 6.) Shortness of breath 7.) Decreased urinary output
What should you teach the patient about assessing and reporting clinical signs of Preeclampsia?
1.) Take your blood pressure as directed. Always sit to take your blood pressure, and use your right arm each time for consistent and accurate readings. Support your arm on a table with a horizontal position at heart level. 2.) Report any increase in your blood pressure to your health care provider immediately. 3.) Dipstick test your clean catch urine sample as directed to assess proteinuria. 4.) Report to your health care provider if proteinuria is 1+ or more or if you have a decrease in urine output. 5.) Assess your baby's activity daily. Decreased activity (four or fewer movements per hour) may indicate fetal compromise and should be reported. 6.) Be sure to keep your scheduled prenatal appointments so that any changes in your or your baby's condition can be detected. 7.) Keep a daily log or diary of your assessments for your home health care nurse, or take it with you to your next prenatal visit. 8.) Report any headache, dizziness, or blurred vision to your health care provider immediately.
If the woman develops severe Gestational Hypertension/Preeclampsia with severe features after 34 weeks gestation, what is the recommended treatment?
It is recommended that she gives birth promptly, because severe preeclampsia has been associated with increased rated of maternal morbidity and mortality and with significant fetal risks.
What is the medication of choice for preventing and treating seizure activity (Eclampsia)?
Magnesium Sulfate
How is Magnesium Sulfate administered?
Intravenously (piggyback) with an initial loading dose of 4 to 6 g infused over 15 to 30 minutes. This dose is followed by a maintenance dose that is diluted in an IV solution (e.g., 40 g in 1000 mL of Lactated Ringer's solution) and administered by an infusion pump at 2 to 3 g/hr. This dose should maintain a therapeutic serum magnesium level of 4 to 7 mEq/L.
What are the symptoms of Magnesium toxicity?
1.) Absent deep tendon reflexes 2.) Respiratory depression 3.) Blurred vision 4.) Slurred speech 5.) Severe muscle weakness 6.) Cardiac arrest
What are the hospital precautionary measures for women with Preeclampsia?
1.) Keep airway patent, turn head to one side, place pillow under one shoulder or back if possible. 2.) Call for assistance. Do not leave bedside. 3.) Raise side rails, and pad them with a folded blanket or pillow if possible. 4.) Observe and record convulsion activity.
What are the clinical manifestations of Placenta Previa?
Placenta Previa is typically characterized by painless bright red vaginal bleeding during the second or third trimester.
What are the risk factors for Placenta Previa?
A history of previous cesarean birth, advanced maternal age (more than 35 to 40 years of age), multiparity, history of prior suction curettage, smoking and living at a higher altitude.
What does an abdominal examination reveal in regards to Placenta Previa?
A soft, relaxed, non-tender uterus with normal tone.
What are the clinical manifestations of Placental Abruption?
Vaginal bleeding, abdominal pain, uterine tenderness, and contractions.
What are the risk factors for Placental Abruption?
Maternal hypertension, whether chronic or pregnancy related, is the most consistently identified risk factor for abruption. Cocaine use is also a risk factor because it causes vascular disruption in the placental bed. Blunt external abdominal trauma, most often the result of motor vehicle accidents (MVAs) or maternal battering, is another frequent cause of placental abruption. Other risk factors include cigarette smoking, a history of abruption in a previous pregnancy, and preterm premature rupture of membranes.
What is the management of choice if a pregnant patient has Placental Abruption?
Immediate birth is the management of choice if the fetus is at term gestation or the bleeding is moderate to severe and the mother or fetus is in jeopardy.
What are some non-pharmacologic strategies to encourage relaxation and relieve pain?
Cutaneous Stimulation:
1.) Countepressure
2.) Effleurage (light massage)
3.) Therapeutic touch and massage
4.) Walking
5.) Rocking
What does Counterpressure help with?
The woman cope with the sensations of internal pressure and pain in the lower back.
What are the nursing considerations for Nubain?
May precipitate withdrawal symptoms in opioid-dependent women and their newborns. Assess maternal vital signs, degree of pain, FHR, and uterine activity before and after administration. Observe for maternal respiratory depression, notifying obstetric health care provider if maternal respirations are less than or equal to 12 breaths per minute. Encourage voiding every 2 hours, and palpate for bladder distention. If birth occurs with 1 to 4 hours of dose administration, observe newborn for respiratory depression. Implement safety measures as appropriate, including use of side rails and assistance with ambulation. Continue use of non-pharmacologic pain relief measures.
What are the side effects of Neuraxial Anesthesia?
Hypotension, lightheadedness, dizziness, tinnitus, metallic taste, numbness of the tongue and mouth, bizarre behavior, slurred speech, convulsions, loss of consciousness, fever, urinary retention, pruritus, limited movement, longer second stage labor, increased use of oxytocin, increased likelihood of forceps or vacuum assisted birth and high or total spinal anesthesia.
What is the emergency treatment for maternal hypotension with decreased placental perfusion?
1.) Turn woman to lateral position, or place pillow or wedge under hip to displace uterus. 2.) Maintain intravenous (IV) infusion at rate specified, or increase administration per hospital protocol. 3.) Administer oxygen by nonrebreather face mask at 10 to 12 L/minute or per protocol.
4.) Elevate the woman's legs. 5.) Notify primary health care provider, anesthesiologist, or nurse anesthetist. 6.) Administer IV vasopressor (e.g., ephedrine 5 to 10 mg or phenylephrine 50 to 100 mcg) per protocol if previous measures are ineffective. 7.) Remain with woman, continue to monitor maternal blood pressure and fetal heart rate (FHR) every 5 minutes until her condition is stable or per primary health care provider's order.
SAFETY ALERT (pg. 357):
After receiving a neuraxial block or opioid intravenously for pain, the woman should not be allowed to ambulate alone. She must either remain in bed or request assistance before attempting to get out of bed. The nurse assesses the woman for signs of orthostatic hypotension and return of sensation and motor function of the lower extremities prior to ambulation.
What are some of the nursing considerations for Cytotec?
1.) Avoid giving aluminum hydroxide and magnesium-containing antacids along with misoprostol. 2.) Use with caution in women with renal failure because the medication is eliminated through the kidneys. 3.) Have the woman void before insertion.
What are some of the nursing considerations for Cervidil?
1.) Avoid use in women with asthma, glaucoma, and hypotension or hypertension. 2.) Use with caution if the woman has cardiac, renal, or hepatic disease, anemia, jaundice, diabetes, epilepsy, or genitourinary (GU) infections. 3.) Have the woman void before insertion.
