Midwifery Bullets
Midwifery Bullets
Midwifery Bullets
Topics
Labor, Delivery
Pregnancy
Breastfeeding
Abortion
Bullets
1. Unlike false labor, true labor produces regular rhythmic contractions,
abdominal discomfort, progressive descent of the fetus, bloody show, and
progressive effacement and dilation of the cervix.
2. To help a mother break the suction of her breast-feeding infant, the nurse
should teach her to insert a finger at the corner of the infants mouth.
3. Administering high levels of oxygen to a premature neonate can cause
blindness as a result of retrolental fibroplasia.
4. Amniotomy is artificial rupture of the amniotic membranes.
5. During pregnancy, weight gain averages 25 to 30 lb (11 to 13.5 kg).
6. Rubella has a teratogenic effect on the fetus during the first trimester. It
produces abnormalities in up to 40% of cases without interrupting the
pregnancy.
7. Immunity to rubella can be measured by a hemagglutination inhibition test
(rubella titer). This test identifies exposure to rubella infection and determines
susceptibility in pregnant women. In a woman, a titer greater than 1:8
indicates immunity.
8. When used to describe the degree of fetal descent during labor, floating
means the presenting part isnt engaged in the pelvic inlet, but is freely
movable (ballotable) above the pelvic inlet.
9. When used to describe the degree of fetal descent, engagement means when
the largest diameter of the presenting part has passed through the pelvic
inlet.
10.Fetal station indicates the location of the presenting part in relation to the
ischial spine. Its described as 1, 2, 3, 4, or 5 to indicate the number of
centimeters above the level of the ischial spine; station 5 is at the pelvic
inlet.
11.Fetal station also is described as +1, +2, +3, +4, or +5 to indicate the
number of centimeters it is below the level of the ischial spine; station 0 is at
the level of the ischial spine.
12.During the first stage of labor, the side-lying position usually provides the
greatest degree of comfort, although the patient may assume any
comfortable position.
13.During delivery, if the umbilical cord cant be loosened and slipped from
around the neonates neck, it should be clamped with two clamps and cut
between the clamps.
14.An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates
moderate distress, and 0 to 3 indicates severe distress.
15.To elicit Moros reflex, the nurse holds the neonate in both hands and
suddenly, but gently, drops the neonates head backward. Normally, the
neonate abducts and extends all extremities bilaterally and symmetrically,
forms a C shape with the thumb and forefinger, and first adducts and then
flexes the extremities.
16.Pregnancy-induced hypertension (preeclampsia) is an increase in blood
pressure of 30/15 mm Hg over baseline or blood pressure of 140/95 mm Hg
on two occasions at least 6 hours apart accompanied by edema and
albuminuria after 20 weeks gestation.
17.Positive signs of pregnancy include ultrasound evidence, fetal heart tones, and
fetal movement felt by the examiner (not usually present until 4 months
gestation
18.Goodells sign is softening of the cervix.
19.Quickening, a presumptive sign of pregnancy, occurs between 16 and 19
weeks gestation.
20.Ovulation ceases during pregnancy.
21.Any vaginal bleeding during pregnancy should be considered a complication
until proven otherwise.
To estimate the date of delivery using Ngeles rule, the nurse counts
backward 3 months from the first day of the last menstrual period and then
adds 7 days to this date.
22.At 12 weeks gestation, the fundus should be at the top of the symphysis
pubis.
23.Cows milk shouldnt be given to infants younger than age 1 because it has a
low linoleic acid content and its protein is difficult for infants to digest.
24.If jaundice is suspected in a neonate, the nurse should examine the infant
under natural window light. If natural light is unavailable, the nurse should
examine the infant under a white light.
25.The three phases of a uterine contraction are increment, acme, and
decrement.
26.The intensity of a labor contraction can be assessed by the indentability of the
uterine wall at the contractions peak. Intensity is graded as mild (uterine
muscle is somewhat tense), moderate (uterine muscle is moderately tense),
or strong (uterine muscle is boardlike).
27.Chloasma, the mask of pregnancy, is pigmentation of a circumscribed area of
skin (usually over the bridge of the nose and cheeks) that occurs in some
pregnant women.
28.The gynecoid pelvis is most ideal for delivery. Other types include platypelloid
(flat), anthropoid (apelike), and android (malelike).
29.Pregnant women should be advised that there is no safe level of alcohol
intake.
30.The frequency of uterine contractions, which is measured in minutes, is the
time from the beginning of one contraction to the beginning of the next.
31.Vitamin K is administered to neonates to prevent hemorrhagic disorders
because a neonates intestine cant synthesize vitamin K.
Before internal fetal monitoring can be performed, a pregnant patients cervix
must be dilated at least 2 cm, the amniotic membranes must be ruptured,
and the fetuss presenting part (scalp or buttocks) must be at station 1 or
lower, so that a small electrode can be attached.
32.Fetal alcohol syndrome presents in the first 24 hours after birth and produces
lethargy, seizures, poor sucking reflex, abdominal distention, and respiratory
difficulty.
33.Variability is any change in the fetal heart rate (FHR) from its normal rate of
120 to 160 beats/minute. Acceleration is increased FHR; deceleration is
decreased FHR.
34.In a neonate, the symptoms of heroin withdrawal may begin several hours to
4 days after birth.
35.In a neonate, the symptoms of methadone withdrawal may begin 7 days to
several weeks after birth.
36.In a neonate, the cardinal signs of narcotic withdrawal include coarse, flapping
tremors; sleepiness; restlessness; prolonged, persistent, high-pitched cry;
and irritability.
37.The nurse should count a neonates respirations for 1 full minute.
38.Chlorpromazine (Thorazine) is used to treat neonates who are addicted to
narcotics.
39.The nurse should provide a dark, quiet environment for a neonate who is
experiencing narcotic withdrawal.
40.In a premature neonate, signs of respiratory distress include nostril flaring,
substernal retractions, and inspiratory grunting.
41.Respiratory distress syndrome (hyaline membrane disease) develops in
premature infants because their pulmonary alveoli lack surfactant.
Whenever an infant is being put down to sleep, the parent or caregiver should
position the infant on the back. (Remember back to sleep.)
42.The male sperm contributes an X or a Y chromosome; the female ovum
contributes an X chromosome.
43.Fertilization produces a total of 46 chromosomes, including an XY combination
(male) or an XX combination (female).
44.The percentage of water in a neonates body is about 78% to 80%.
45.To perform nasotracheal suctioning in an infant, the nurse positions the infant
with his neck slightly hyperextended in a sniffing position, with his chin up
and his head tilted back slightly.
46.Organogenesis occurs during the first trimester of pregnancy, specifically,
days 14 to 56 of gestation.
47.After birth, the neonates umbilical cord is tied 1 (2.5 cm) from the
abdominal wall with a cotton cord, plastic clamp, or rubber band.
48.Gravida is the number of pregnancies a woman has had, regardless of
outcome.
65.A nonstress test is considered reactive (negative) if two or more fetal heart
rate accelerations of 15 beats/minute above baseline occur in 20 minutes.
66.A nonstress test is usually performed to assess fetal well-being in a pregnant
patient with a prolonged pregnancy (42 weeks or more), diabetes, a history of
poor pregnancy outcomes, or pregnancy-induced hypertension.
67.A pregnant woman should drink at least eight 8-oz glasses (about 2,000 ml)
of water daily.
68.When both breasts are used for breast-feeding, the infant usually doesnt
empty the second breast. Therefore, the second breast should be used first at
the next feeding.
69.A low-birth-weight neonate weighs 2,500 g (5 lb 8 oz) or less at birth.
70.A very-low-birth-weight neonate weighs 1,500 g (3 lb 5 oz) or less at birth.
71.When teaching parents to provide umbilical cord care, the nurse should teach
them to clean the umbilical area with a cotton ball saturated with alcohol after
every diaper change to prevent infection and promote drying.
72.Teenage mothers are more likely to have low-birth-weight neonates because
they seek prenatal care late in pregnancy (as a result of denial) and are more
likely than older mothers to have nutritional deficiencies.
73.Linea nigra, a dark line that extends from the umbilicus to the mons pubis,
commonly appears during pregnancy and disappears after pregnancy.
74.Implantation in the uterus occurs 6 to 10 days after ovum fertilization.
75.Placenta previa is abnormally low implantation of the placenta so that it
encroaches on or covers the cervical os.
76.In complete (total) placenta previa, the placenta completely covers the
cervical os.
77.In partial (incomplete or marginal) placenta previa, the placenta covers only a
portion of the cervical os.
78.Abruptio placentae is premature separation of a normally implanted placenta.
It may be partial or complete, and usually causes abdominal pain, vaginal
bleeding, and a boardlike abdomen.
79.Cutis marmorata is mottling or purple discoloration of the skin. Its a transient
vasomotor response that occurs primarily in the arms and legs of infants who
are exposed to cold.
80.The classic triad of symptoms of preeclampsia are hypertension, edema, and
proteinuria. Additional symptoms of severe preeclampsia include
hyperreflexia, cerebral and vision disturbances, and epigastric pain.
81.Ortolanis sign (an audible click or palpable jerk that occurs with thigh
abduction) confirms congenital hip dislocation in a neonate.
82.The first immunization for a neonate is the hepatitis B vaccine, which is
administered in the nursery shortly after birth.
83.If a patient misses a menstrual period while taking an oral contraceptive
exactly as prescribed, she should continue taking the contraceptive.
84.If a patient misses two consecutive menstrual periods while taking an oral
contraceptive, she should discontinue the contraceptive and take a pregnancy
test.
85.If a patient who is taking an oral contraceptive misses a dose, she should take
the pill as soon as she remembers or take two at the next scheduled interval
and continue with the normal schedule.
86.If a patient who is taking an oral contraceptive misses two consecutive doses,
she should double the dose for 2 days and then resume her normal schedule.
She also should use an additional birth control method for 1 week.
87.Eclampsia is the occurrence of seizures that arent caused by a cerebral
disorder in a patient who has pregnancy-induced hypertension.
88.In placenta previa, bleeding is painless and seldom fatal on the first occasion,
but it becomes heavier with each subsequent episode.
89.Treatment for abruptio placentae is usually immediate cesarean delivery.
90.Drugs used to treat withdrawal symptoms in neonates include phenobarbital
(Luminal), camphorated opium tincture (paregoric), and diazepam (Valium).
91.Infants with Down syndrome typically have marked hypotonia, floppiness,
slanted eyes, excess skin on the back of the neck, flattened bridge of the
nose, flat facial features, spadelike hands, short and broad feet, small male
genitalia, absence of Moros reflex, and a simian crease on the hands.
92.The failure rate of a contraceptive is determined by the experience of 100
women for 1 year. Its expressed as pregnancies per 100 woman-years.
93.The narrowest diameter of the pelvic inlet is the anteroposterior (diagonal
conjugate).
94.The chorion is the outermost extraembryonic membrane that gives rise to the
placenta.
95.The corpus luteum secretes large quantities of progesterone.
96.From the 8th week of gestation through delivery, the developing cells are
known as a fetus.
97.In an incomplete abortion, the fetus is expelled, but parts of the placenta and
membrane remain in the uterus.
98.The circumference of a neonates head is normally 2 to 3 cm greater than the
circumference of the chest.
99.After administering magnesium sulfate to a pregnant patient for hypertension
or preterm labor, the nurse should monitor the respiratory rate and deep
tendon reflexes.
100.
During the first hour after birth (the period of reactivity), the neonate is
After delivery, the first nursing action is to establish the neonates airway.
103.
the patient on her left side for maximum fetal perfusion, monitoring fetal
heart tones, and administering I.V. fluids and oxygen, as ordered.
104.
The neonatal period extends from birth to day 28. Its also called the first
few drops of breast milk (or colostrum) on the nipples after each feeding. She
should let the breasts air-dry to prevent them from cracking.
107.
After feeding an infant with a cleft lip or palate, the nurse should rinse the
seconds.
114.
Lochia rubra is the vaginal discharge of almost pure blood that occurs
Lochia serosa is the serous vaginal discharge that occurs 4 to 7 days after
childbirth.
116.
Colostrum, the precursor of milk, is the first secretion from the breasts
after delivery.
118.
The length of the uterus increases from 2 (6.3 cm) before pregnancy to
pelvis), deduct 1.5 cm from the diagonal conjugate (usually 12 cm). A true
conjugate of 10.5 cm enables the fetal head (usually 10 cm) to pass.
120.
emerging fetuss head to guide the descent and prevent a rapid change in
pressure within the molded fetal skull.
123.
delivered.
127.
When a patient is admitted to the unit in active labor, the nurses first
134.
135.
trimester and slightly less than 1 lb (0.5 kg) per week during the last two
trimesters.
138.
condition that interrupts normal blood flow to or from the placenta increases
fetal partial pressure of arterial carbon dioxide and decreases fetal pH.
141.
Precipitate labor lasts for approximately 3 hours and ends with delivery of
the neonate.
142.
143.
Braxton Hicks contractions are usually felt in the abdomen and dont
cause cervical change. True labor contractions are felt in the front of the
abdomen and back and lead to progressive cervical dilation and effacement.
145.
vaginal fornix.
147.
patients.
150.
If a fetus has late decelerations (a sign of fetal hypoxia), the nurse should
instruct the mother to lie on her left side and then administer 8 to 10 L of
oxygen per minute by mask or cannula. The nurse should notify the physician.
The side-lying position removes pressure on the inferior vena cava.
152.
153.
Lanugo covers the fetuss body until about 20 weeks gestation. Then it
begins to disappear from the face, trunk, arms, and legs, in that order.
154.
weight daily.
156.
158.
159.
hyperinsulinism.
162.
After a stillbirth, the mother should be allowed to hold the neonate to help
Molding is the process by which the fetal head changes shape to facilitate
The best technique for assessing jaundice in a neonate is to blanch the tip
After the placenta is delivered, the nurse may add oxytocin (Pitocin) to
Pica is a craving to eat nonfood items, such as dirt, crayons, chalk, glue,
starch, or hair. It may occur during pregnancy and can endanger the fetus.
171.
A pregnant patient should take folic acid because this nutrient is required
During the first trimester, a pregnant woman should avoid all drugs unless
doing so would adversely affect her health.
174.
175.
The Food and Drug Administration has established the following five
the lower abdomen, with spotting and cramping. She may have abdominal
rigidity; rapid, shallow respirations; tachycardia; and shock.
177.
the lower abdomen, with spotting and cramping. She may have abdominal
rigidity; rapid, shallow respirations; tachycardia; and shock.
178.
181.
A pregnant womans partner should avoid introducing air into the vagina
185.
The duration of a contraction is timed from the moment that the uterine
muscle begins to tense to the moment that it reaches full relaxation. Its
measured in seconds.
186.
187.
(infertile).
188.
Spermatozoa (or their fragments) remain in the vagina for 72 hours after
sexual intercourse.
189.
190.
191.
194.
The most common method of inducing labor after artificial rupture of the
The most common reasons for cesarean birth are malpresentation, fetal
If a pregnant patients test results are negative for glucose but positive for
acetone, the nurse should assess the patients diet for inadequate caloric
intake.
202.
If a pregnant patients test results are negative for glucose but positive for
acetone, the nurse should assess the patients diet for inadequate caloric
intake.
203.
anemia.
205.
Nausea and vomiting during the first trimester of pregnancy are caused
Before discharging a patient who has had an abortion, the nurse should
instruct her to report bright red clots, bleeding that lasts longer than 7 days,
or signs of infection, such as a temperature of greater than 100 F (37.8 C),
foul-smelling vaginal discharge, severe uterine cramping, nausea, or vomiting.
208.
When informed that a patients amniotic membrane has broken, the nurse
should check fetal heart tones and then maternal vital signs.
209.
The initial weight loss for a healthy neonate is 5% to 10% of birth weight.
211.
212.
Crowning is the appearance of the fetuss head when its largest diameter
The Apgar score is used to assess the neonates vital functions. Its
abdominal circumference, fetal femur length, and fetal head size. These
measurements are most accurate between 12 and 18 weeks gestation.
218.
Skeletal system abnormalities and ventricular septal defects are the most
common disorders of infants who are born to diabetic women. The incidence
Skeletal system abnormalities and ventricular septal defects are the most
common disorders of infants who are born to diabetic women. The incidence
of congenital malformation is three times higher in these infants than in those
born to nondiabetic women.
220.
The patient with preeclampsia usually has puffiness around the eyes or
edema in the hands (for example, I cant put my wedding ring on.).
221.
These exercises help strengthen pelvic muscles and improve urine control in
postpartum patients.
222.
The nurse may suction the neonates nose and mouth as needed with a
To prevent heat loss, the nurse should place the neonate under a radiant
warmer during suctioning and initial delivery-room care, and then wrap the
neonate in a warmed blanket for transport to the nursery.
229.
The umbilical cord normally has two arteries and one vein.
230.
When providing care, the nurse should expose only one part of an infants
body at a time.
231.
Lightening is settling of the fetal head into the brim of the pelvis.
232.
37.2 C), apical pulse rate averages 120 to 160 beats/minute, and
respirations are 40 to 60 breaths/minute.
235.
In the neonate, a straight spine is normal. A tuft of hair over the spine is
an abnormal finding.
237.
appear along a line that runs from each axilla, through the normal nipple
area, and to the groin.
239.
Meconium is a material that collects in the fetuss intestines and forms the
possible fetal distress and the need to evaluate the neonate for meconium
aspiration.
241.
cheek or the corner of the mouth. Normally, the neonate turns his head
toward the stimulus, opens his mouth, and searches for the stimulus.
242.
Harlequin sign is present when a neonate who is lying on his side appears
Mongolian spots can range from brown to blue. Their color depends on
how close melanocytes are to the surface of the skin. They most commonly
appear as patches across the sacrum, buttocks, and legs.
244.
by age 2 to 3 years.
245.
fetuss skin in utero. It may be rubbed into the neonates skin or washed away
in one or two baths.
246.
Caput succedaneum is edema that develops in and under the fetal scalp
its done between the second and sixth days after birth and is performed after
the neonate has ingested protein.
249.
infant at least every 4 hours. During the first month, she should breast-feed 8
to 12 times daily (demand feeding).
251.
To avoid contact with blood and other body fluids, the nurse should wear
gloves when handling the neonate until after the first bath is given.
252.
number of wet diapers, and normal weight gain, the mothers milk supply is
assumed to be adequate.
253.
venous return from the lower half of the body to the heart, resulting in supine
hypotensive syndrome, or inferior vena cava syndrome.
254.
second trimester. During this stage, the mother may complain that she never
gets to sleep because the fetus always gives her a thump when she tries.
259.
the child shes carrying is like and becomes acquainted with it.
260.
sometimes occurs in pregnancy) is to have the patient lie on her left side.
263.
The hormone relaxin, which is secreted first by the corpus luteum and
later by the placenta, relaxes the connective tissue and cartilage of the
symphysis pubis and the sacroiliac joint to facilitate passage of the fetus
during delivery.
266.
uterine motility.
267.
on the anterior portion of the uterus, just above the uterocervical juncture.
268.
During pregnancy, the abdominal line from the symphysis pubis to the
systems.
270.
Parity doesnt refer to the number of infants delivered, only the number of
deliveries.
272.
Women who are carrying more than one fetus should be encouraged to
273.
30 to 60 mg daily.
274.
from the umbilical cord to detect anemia, genetic defects, and blood
incompatibility as well as to assess the need for blood transfusions.
276.
phase. During this phase, the uterus and placenta fill with blood and allow for
the exchange of oxygen, carbon dioxide, and nutrients.
277.
yet maintain its tone, and contractility, which allows it to shorten and
lengthen in a synchronized pattern.
279.
During crowning, the presenting part of the fetus remains visible during
281.
282.
A smacking sound, milk dripping from the side of the mouth, and sucking
noises all indicate improper placement of the infants mouth over the nipple.
284.
the stomach.
285.
both the affected and the unaffected breast of patients with mastitis.
286.
Neonates are nearsighted and focus on items that are held 10 to 12 (25
take up to 72 hours.
289.
291.
292.
293.
and peaks in the third trimester. High levels detected between the 16th and
18th weeks are associated with neural tube defects. Low levels are associated
with Down syndrome.
295.
An arrest of descent occurs when the fetus doesnt descend through the
edema.
297.
299.
examination.
301.
In the early stages of pregnancy, the finding of glucose in the urine may
To prevent heat loss in the neonate, the nurse should bathe one part of
his body at a time and keep the rest of the body covered.
305.
A patient who has a cesarean delivery is at greater risk for infection than
307.
The nurse should keep the sac of meningomyelocele moist with normal
saline solution.
308.
312.
umbilical cord.
313.
decelerations.
314.
320.
The administration of folic acid during the early stages of gestation may
syndrome.
322.
323.
umbilicus.
324.
325.
neonate.
326.
performed.
327.
328.
After delivery, if the fundus is boggy and deviated to the right side, the
Before providing a specimen for a sperm count, the patient should avoid
331.
During the transition phase of labor, the woman usually is irritable and
restless.
333.
that often comes in spurts. The bleeding is continuous, even when the fundus
is firm.
337.
feeding.
338.
341.
accomplished if the mother expresses milk and feeds the neonate by gavage.
342.
343.
90 seconds or longer.
344.
delivery center), the priorities for care of the neonate include maintaining a
patent airway, supporting efforts to breathe, monitoring vital signs, and
maintaining adequate body temperature.
345.
346.
The nurse must place identification bands on both the mother and the
348.
pregnancy.
349.
Before performing a Leopold maneuver, the nurse should ask the patient
cord should not be clamped until pulsations have stopped (thats about 1-3
minutes).