1. Late in pregnancy, a patient often develops supine hypotension because ofa. partial occlusion of the vena cava and aorta. b. decreased peripheral collateral circulation.c. increased blood flow to the placenta. - A because of partial occlusion of the vena cava and aorta from the weight of the uterus. This impedes venous return from the lower extremities although increased collateral circulation during pregnancy helps to compensate. Remaining in the supine position forlong periods of time could decrease fetal oxygenation as well. The lateral recumbent position relieves the pressure on the vena cava and aorta, allowing the blood pressure to increase and symptoms to decrease. The nurse must educate the new mother that a contraindication to breast feeding isa. fetal macrosomia. b. type II diabetes. c. infection with HIV/AIDS. - C Some maternal contraindications to breastfeeding include: -Infection with HIV/AIDS -Use of antiretroviral medications -Active TB not treated -Infection with human T-cell lymphotropic virus -Illicit drug use -Use of chemotherapeutic agents -Radiation therapy (may require only interruption during treatment) -Use of other medications that pass into the breast milk and may harm the child -Presence of herpes on the breast -Presence of varicella lesions on the breast (may resume after lesions crust) The initial postpartal intervention indicated for a soft boggy uterus is toa. apply an ice compress. b. massage the fundus until firm.c. apply a warm compress. - B ...with the dominant hand while supporting the inferior uterus with the non-dominanthand to prevent trauma. If the fundus does not contract with massage, then further evaluation is indicated to determine if placental fragments remain. After the fundus becomes contracted, the nurse should push firmly downward on the fundus to expelclots that may have pooled. With the vibroacoustic stimulation test, stimulus with an artificial larynx or other device isapplied to the maternal abdomen for a. 1 to 3 seconds. b. 5 to 10 seconds. c. 1 to 2 minutes. - A Usually, stimulus is applied for 1-2 seconds and repeated up to 3 times with time extending to 3 seconds in order to stimulate fetal movement. A positive or reactive finding is an increased fetal heart rate of 15 bpm or more for at least 15 seconds; however, a nonreactive result does not always indicate fetal abnormality but indicatesthe need for further testing. Absence of the Moro reflex on one side only in a neonate may indicatea. fractured scapula. b. cerebral palsy. c. fractured clavicle. - C a fractured clavicle or brachial plexus injury. Damage to the central nervous system, such as may occur with cerebral palsy, often results in bilateral absence of the reflex. The Moro reflex is elicited by allowing the infant's head and trunk to fall slightly backward when the infant is raised. A positive Moro reflex includes immediate extensionand abduction of the arms(and sometimes the legs) with fingers fanning and forming a C-shape with a return of the limbs to the flexed states In a multiparous woman, what is the lowest Bishop score that predicts labor inductionwill be successful? a. 5 b. 7 c. 9 - A In a multiparous woman, the Bishop score that predicts that labor induction will be successful is 5 or more while it is a 9 or more for a nulliparous woman. The Bishop score is a rating system to determine readiness for induction based on scores of 0-3 infour different measures: dilation (cm), effacement (percentage), station (cm), and cervical consistency (firm, medium, soft), and cervical position (posterior, mid position,anterior). The fifth measure, cervical position, is scored only 0-2. When cervical laceration occur during delivery, they are most common at what position?a. 3 and 9 o'clock b. 12 and 6 o'clock c. 10 and 4 o'clock - A Cervical lacerations are most often identified with vaginal retractors when bleeding is persistent after delivery. The lacerations are sutured with absorbable sutures, so no further treatment is usually indicated. Minor lacerations often occur during delivery, butthey usually require no treatment. Tears are more common after forceps assisted and vacuum assisted deliveries than normal vaginal births If using fetal pulse oximetry, what is normal oxygen saturation?a. 30% to 65% b. 65% to 90% c. 90% to 100% - A because of the fetus's high hemoglobin and hematocrit. A value below 30% may be associated with hypoxia and metabolic acidosis. For fetal pulse oximetry, which may beused to determine whether immediate intervention is needed for non-reassuring fetal heart rate, a special single-use sensor is placed internally along the fetal cheek, temple,or forehead. However, fetal pulse oximetry has not been found to reduce overall rates ofCaesarean. A decrease of fetal heart rate of at least 15 bpm for at least 10 minutes is classified asa. recurrent deceleration. b. prolonged deceleration.c. baseline change. - C If it persists more than 2 minutes but less than 10 minutes, it is classified as a prolonged deceleration. Recurrent decelerations are classified as occurring with half or more of uterine contractions in a 20 minute period. Intermittent decelerations occur with fewer than half of uterine contractions in a 20 minute period. With suspected fetal hypoxia, a cord blood gas specimen is obtained during delivery bya. withdrawing blood from the vein/artery before the cord is clamped or cut and before placental expulsion. b. placing one clamp and withdrawing blood above the clamp before cutting the cord.c. double clamping a 10 to 20 cm segment, cutting it out, and then withdrawing bloodfrom the segment. - C The segment can be placed on ice temporarily as cord blood gas can be accurately assessed for 60 minutes. An arterial sample is preferred over venous, but paired sampling is recommended. A pH of 7.24 or less is associated with neurological compromise. A base excess of 12 mmol/L or more is predictive of motor or cognitiveimpairment. When eliciting the scarf sign in a neonate, the infant's elbow crosses the midline of thechest, probably indicating a a. preterm infant.b. term infant. c. postterm infant. - A At fullterm, the elbow should not cross the midline. For the scarf test, the neonate should be placed supine. One arm is grasped and the hand pulled toward the oppositeshoulder and then the position of the elbow is assessed in relation to the midline of thechest. Following birth, which hormone stimulates the alveolar cells of the breast, promotingproduction of milk? a. Estrogen b. Prolactin c. Progesterone - B which increases in response to the neonate's suckling. Suckling also promotes releaseof oxytocin, which promotes the letdown reflex by increasing contractibility of the muscles of the mammary ducts. After milk production is well established, prolactin levels decrease, and most milk production is then facilitated by oxytocin. During pregnancy, estrogen promotes proliferation of breast ducts and progesterone the development of lobules and alveoli Which anesthetic technique provides the best relief of pain during labor and delivery? a. Epidural b. Spinal c. Pudendal block - A The epidural can provide continuous relief during both labor and delivery and does notpose the risk of spinal headache and provides less motor blockade. Additionally, thereis a deceased risk of hypotension because of reduced risk of sympathetic blockade. Spinal is now usually reserved for Cesareans. The pudendal block provides reliefprimarily during delivery. A patient with lupus erythematosus places the fetus at risk if she takes which medication during pregnancy? a. Prednisone b. Methotrexate c. Plaquenil® (hydroxychloroquine) - B ...methotrexate or cyclophosphamide. Both of these medications should be discontinuedat least 30 days prior to the patient becoming pregnant. Plaquenil and prednisone may be continued during pregnancy. A patient with lupus should be stabilized for at least 6 months before attempting to become pregnant because pregnancy may exacerbate symptoms, and the patient may have antibodies that increase risk of miscarriage or stillbirth in late pregnancy. A series of ultrasound scans after the 20th week show that the fetal head is growing normally but the abdominal circumference is lower than expected. This may indicatedwhich of the following? a. Down syndrome b. Neural tube defect c. Placental insufficiency - C ...common in patients who are diabetic, hypertensive, or anemic. With placental insufficiency, the supply of oxygen and nutrients to the fetus is impaired, so the fetusresponds by sending the nutrients to the most critical organs (heart, brain, lungs) andthe other abdominal organs receive less, so they develop more slowly Idiopathic cardiomyopathy of pregnancy is a condition that a. precedes pregnancy and exacerbates due to the stress of pregnancy. b. develops in the last month of pregnancy or soon after birth without preexisting cardiacdisease. c. develops in the first trimester of pregnancy and must be monitored throughout the pregnancy and delivery. - B Develops in the last month of pregnancy or the first 5-6 postpartal months and is not associated with pre-existing myocarditis, endocarditis, or cardiac disease. It is characterized by left ventricular systolic dysfunction. Typical symptoms are similar to heart failure and include dyspnea (the most common symptom), orthopnea, cough, palpitations, and chest pain. The heart is markedly enlarged, and the ejection fraction isless than 45%. It increases risk of thromboembolia, so the woman is often treated with heparin. Treatment is similar to that for heart failure although if it occurs prior to delivery,ACE inhibitors are withheld because of adverse effects to the fetus. Management includes bedrest, diuretics, and digoxin.