Kaplan Maternity Integrated Exam questions and answers| GRADED A
Lab screening Correct answerAFP: 16-18 wk for neural tube defects
Glucose between 24-28
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Rh antibody titers for Rh negative women at 24,28,32,36,40.
Culdoscopy Correct answer- Visualization of the ovaries, fallopian tubes, uterus via lighted tube inserted into vagina and through cul-de-sac.
- Local anesthetic, light sedation
- Knee to chest position. Post procedure position on abdomen with pillow under. Observe for vaginal bleeding, avoid douching and sex for 2 weeks.
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BPH Correct answerCompression of urethra and urinary retention.
Men over 50.
Dysuria, frequency, urgency, decreased urinary stream, hesitancy and nocturia.
Later symptoms: cystitis, hydronephrosis, urinary calculi.
"Taking in" phase Correct answerDependency.
1-2 day after delivery
Preoccupied with self and own needs. Talkative and hesitant about making decisions. Retells perceptions of birth experience.
3 hr glucose test Correct answerFBS: <92
1 hr: <180
2 hr: <153
3 hr: < 140
If 2 or more abnormal findings, then they have diabetes.
Abruptio placentae Correct answerAbdominal pain, uterine rigidity and tenderness, rapid s&s of maternal shock and fetal distress.
Prepare for delivery usually c section.
Post op: monitor for infection, renal failure and DIC- no IM injections.
Absent variability Correct answerfetal sleep, prematurity, reaction to meds, congenital anomalies, hypoxia, acidosis.
Accelerations Correct answerHR more tha 15 bpm above baseline lasting more than 15 seconds and less than 2 min.
Amniocentesis Correct answer14-17 weeks- to detect inborn errors of metabolism, chromosomal abnormalities, open NTD,
After 28 wks- determine sex of fetus and sex linked disorders.
after 30 wks- determine lung maturity.
Void before procedure and Rh immunoglobulin for Rh- mothers.
Anemia Correct answerHgb < 10
Hct <35%
Atrophic vaginitis Correct answerAssessment: Occurs after menopause. Pale, thin, dry mucosa, itching, dyspareunia
Nursing: topical estrogen cream, water soluble lubricants, antibiotic vaginal suppositories and ointments.
Babinski's sign Correct answerstroking sole of foot causes toes to fan out. Usual adult response by 12 months.
"Letting go" phase Correct answerIndependence.
Evident by weeks 5-6
Assuming new role responsibilities. May grief for prior roles. Adjustment to accommodate for infant in family.
"Taking hold" phase Correct answerDependency-independence
By day 3
Performing self care. Concern for self and baby. Open to instructions
Biophysical profile Correct answerassessments of fetal breathing movements, body movements, muscle tone, amniotic fluid volume by US, FHR reactivity by NST
score of 0-2 for each.
8-10 is normal
Post op: 3 way f/c CBI. Monitor drainage- should be reddish pink that progresses to clear. Don't try to void around cath. Control/treat bladder spasms.
Avoid heavy lifting, straining w BM, prolonged travel
Breast milk Correct answerRefrigerated for no more than 48 hr or frozen in plastic bottles in freezer for 2 wk and deep freezer for 2 months.
Candida albicans- vaginal yeast Correct answerAssessment: Odorless, cheesy white discharge, itching, inflamed vagina and perineum.
Nursing: Topical clotrimazole, diflucan, nystatin.
Colposcopy Correct answer- Visualization of cervix and vaginal tissues for color, shape, by a lighted scope.
- Performed between periods and takes 20 min.
- Lithotomy. Cervix is washed with dilute acetic acid.
contraction/stress test Correct answerevaluates FHR using pit or nipple stimulation.
After 28 wks.
Negative (GOOD) no late decels.
Positive (BAD) late decels.
CVS Correct answer8-12 wks diagnosing of genetic disorders.
Should be a full bladder.
Similar to amniocentesis.
Diaphragm Correct answer- Must be fitted by HCP.
- Risk of UTI and TSS
- Teaching: Should not be inserted more than 6 hours prior to sex.
- Use in conjunction w spermicidal gel.
Diazepam Correct answerFetal resp. depression if given within 24 hr of delivery.
Sedative, anticonvulsant. Monitor fetal neonatal status and FHT
Early decelerations Correct answerhead compression, common in second stage with pushing
Eclampsia Correct answerBP >160/110
Marked proteinuria
Seizures
Same as severe preeclampsia, severe HA, renal failure and cerebral hemorrhage.
Patent airway, O2
Manage DIC,
delivery of fetus
If sever HTN, seizures can occur 24-48 hr PP
Fibrocystic changes Correct answerAssessment: Multiple cysts. Free moving, tender, enlarged 1 wk before and during period.
Nursing: SBE, Aspiration, biopsy, surgery. Diet changes and vitamin supplements. Benign but increased risk of breast cancer.
First stage of labor Correct answer- Latent phase (0-3cm)
- Active phase (4-7cm) descent of presenting part.
- Transition phase (8-10cm) Contractions every 2-3 min and last 60-90 seconds.
Decrease their desire to push before full dilation
Hormone injections- methoxyprogesterone
estradiol Correct answer- Progestin prevents ovulation for 12 weeks. No action at time of intercourse. Injections given q12wks. Don't massage injection site.
- Menstrual irregularity, spotting and breakthrough bleeding are common.
- Return to fertility is 6-12 months.
- Monthly injection
- Periods less painful with less blood
- Return to fertility is 2-4 months.
hydralyzine- vasodilator. Correct answerAE: tachycardia, palpitations, HA, N/V, orthostatic hypotension
Nursing: maintain diastolic bp
monitor fetus
IUD Correct answer- Inserted by HCP during period when cervix is dilated.
- AE: Cramping, excessive flow for 2-3 months, infection
- Teaching: Check for IUD string routinely. Report unusual cramping, late period, abnormal spotting/bleeding, abd pain, pain with sex, exposure to STD, infection.
Laparoscopy Correct answerVisualization of pelvic cavity through an incision beneath the umbilicus to view structures.
- CO2 introduced. General anesthesia. F/C for bladder decompression
- Out of bed after procedure and regular diet.
Late decelerations Correct answerfetal hypoxia bc of deficient placental perfusion
Manage: LION
Mag sulfate Correct answerAE: flushing, sweating
Toxic: sudden drop in bp. RR <12, UOP < 25-30 ml/hr. Decreased DTR's, toxic serum levels.
Nursing: Monitor bp, P, RR, FHR q15min.
reflex hammer and calcium gluconate at bedside.
Marked variability Correct answerGreater than 25 BPM
cord prolapse or compression, maternal hypotension, uterine hyperstimulation, abruptio placentae.
Mastitis Correct answerAssessment: Reddened, inflamed breast, exudate from nipple, fever, fatigue, pain, leukocytosis.
Nursing: Antibiotics, warm packs to promote drainage, rest, breast support.
Measurement of fundal height Correct answer- Level of symphysis between 12 and 14 wk
- At umbilicus about 20 wk (measures 20 cm)
- Rises 1cm/wk until 36 wks
Methyldopa Correct answerused for chronic HTN, monitor all VS and mental status
Mild preeclampsia Correct answerBP > 140/90 after 20 wks.
Proteinuria- 300 per 24hr. 1+
Mild facial edema, wgt gain >4.5 pound/wk
Bed rest in left side lying position. [Show Less]