Obstetric Nursing Practice Test

Toxemia or Pregnancy induced hypertension has the following manifestations: Edema of the face, hands, ankle and feet, proteinuria, visual disturbances, sudden weight gain, headache, fever. Edema of lower extremity alone is not a sign of toxemia as it is a normal adaptation to pregnancy that is the result of the poor circulation in the lower extremities due to the pressure from the gravid uterus. It is managed by raising the legs above the hip level. Edema of the Lower Extremities plus the upper extremities is a sign of toxemia.

Bradley childbirth method was the first technique to include the father as a support person during delivery. This method embraces the belief that childbirth is a natural event and with the right preparation most women can have spontaneous and unmedicated vaginal births. Lamaze method is a prepared labor and delivery technique. It is often called psychoprophylactic method as it uses the mind (psyche) to prevent labor pains (prophylaxis). Leboyer childbirth method sometimes termed as “birth without violence,” views birth as a stressful experience for the newborn. The focus of this method is to primarily improve the quality of the birth experience for the baby. Grantly Dick-read Method is a psychophysiological preparation for childbirth. This technique alleviates pain during childbirth by blocking feelings of fear and tension.

Dr. Grantly Dick-Read is an English obstetrician who was practicing medicine in 1900’s. On 1933 his book, “Childbirth without Fear,” was published. He explained in this publication that no physiological function in a person’s body can give rise to pain under the condition that it is of normal course of health. Unless a disease process is taking place, pain or agony would associate delivery Bradley Method was named after an American obstetrician Dr. Robert Bradley. “Husband Coached Childbirth,” was written by Dr. Bradley and his principles and theories paved the way for fathers to be present in the delivery room. This changed the face of childbirth around the globe. Lamaze childbirth method is an alternative to the use of medical intervention during childbirth. The method was originally developed in Russia (based on Pavlov’s conditioning studies) but was popularized by a French obstetrician Dr. Ferdinand Lamaze. After watching a woman gave birth in Russia Dr. Lamaze developed his own system of painless childbirth. Leboyer childbirth method was introduced by Frederick Leboyer. He is a French obstetrician who believed that the traditional hospital births of the time (1975) were traumatic for the infant. In 1975, he published a book entitled “Birth without Violence,” where depth of a newborn’s sensitivity and the importance of how the baby is handled by the people around him were emphasized. He pointed out that babies born in a less stressful environment were more content.

Leboyer childbirth method sometimes termed as “birth without violence,” views birth as a stressful experience for the newborn. The focus of this method is to primarily improve the quality of the birth experience for the baby.

Normal weight a. Underweight – under 18.5 BMI b. Normal weight – 18.5-24.9 BMI c. Overweight – 25-29.9 BMI d. Obese – above 30.0

Graafian follicles are structures containing high amounts of estrogen. Graafian follicle are derived from primordial follicles. Corpus Luteum is the structure containing high amounts of progesterone and is yellow in color. If no fertilization occurs corpus luteum turns white and is now called Corpus Albicans.

Hegar’s sign is the softening of the uterus. Goodell’s sign is the change in cervix consistency resembling to that of an earlobe. Chadwick’s sign is the increased vascularity of the vagina changing its color from light pink to deep purple or violet. There is no known vaginal sign in pregnancy.

Leboyer childbirth method was introduced by Frederick Leboyer. He is a French obstetrician who believed that the traditional hospital births of the time (1975) were traumatic for the infant. In 1975, he published a book entitled “Birth without Violence,” where depth of a newborn’s sensitivity and the importance of how the baby is handled by the people around him were emphasized. He pointed out that babies born in a less stressful environment were more content.

Chadwick’s sign is the increased vascularity of the vagina changing its color from light pink to deep purple or violet. Hegar’s sign is the softening of the uterus. Goodell’s sign is the change in cervix consistency resembling to that of an earlobe. There is no known vaginal sign in pregnancy.

Grantly Dick-read Method is a psychophysiological preparation for childbirth. This technique alleviates pain during childbirth by blocking feelings of fear and tension. Dr. Dick-Read postulated that this fear felt by women during delivery causes the blood to be carried away from the uterus to be used by the muscles needing it due to perceived pain. This results to an unoxygenated uterus which would be unable to perform its function well leading to pain, a phenomenon called “the fear-tension-pain syndrome.” Dick-Read believed that presence of fear and tension result to labor pains. Thus, eliminating fear would increase blood supply to the uterus and alleviating labor pains. He also identified that laboring women needed constant emotional support to help them cope.

Encouraging a woman on labor to change position during labor is a concept of Lamaze method to stimulate cutaneous stimulation. The following concepts are taught in Bradley Classes: • Natural birth process • Active involvement of the husband as a coach • Proper nutrition during pregnancy • Avoidance of drugs throughout the pregnancy • Natural breathing methods (without patterns) • Coaching techniques • Natural pain coping methods • Maternal-newborn bonding • Breastfeeding • Education on emergent situations throughout pregnancy and delivery (CS) • Postpartum and newborn care • Responsible parenthood

The priority treatment for Hyperemesis gravidarum is giving 3 L of D5NSS for 24 hours. CBR is also important but the main treatment is D5NSS to replace the lost fluids. Eating dry crackers before arising in the morning is the management for morning sickness not Hyperemesis gravidarum. Milk of magnesia is an antacid used to manage heartburn in pregnant woman.

Lamaze childbirth method is an alternative to the use of medical intervention during childbirth. The method was originally developed in Russia (based on Pavlov’s conditioning studies) but was popularized by a French obstetrician Dr. Ferdinand Lamaze. After watching a woman gave birth in Russia Dr. Lamaze developed his own system of painless childbirth.

Normal weight gain pattern in pregnancy is 1 lb (0.45 kg) per month in the first trimester and 1 lb per week in the second and third trimesters. Meaning to say, in the second and third trimester the pregnant woman should be gaining 4 lbs (1.82 kg) per month. To easily remember the pattern of weight gain in pregnancy is 3-12-12. 3 lbs in the first trimester and 12 lbs each in the second and third trimester.

Frothy, cream-colored vaginal discharges, vulvar edema and hyperemia are hallmark signs of Trichomoniasis or vaginitis. Moniliasis or Candidiasis is caused by a fungus Candida Albicans (Monilia). Symptoms include: white patchy and cheese like particles that adheres to the vaginal wall, irritatingly itchy and foul smelling vaginal discharges. Chancres on vulva and non-itchy rash covering the whole body or appearing in patches are manifestations of syphilis.

Because of the word “least likely” the correct option is B. The method employed in promoting a sensitive and unobtrusive technique of care while respecting the natural process and promoting a peaceful atmosphere at birth to help the baby be born with a minimum stress is LeBoyer Childbirth Method. To decrease the trauma at birth this technique is an advocate of the following: • The birthing room is darkened or dimmed. Doing so prevents sudden contrast of light that might distress the newborn. Leboyer thought that this is less shocking for the neonate’s eyes that have been in semi-darkness for several months. • A soft music is played or at least harsh noises are kept to a minimum. All the talking inside the delivery room is done by whispering. • The room is kept pleasantly warm, not chilled, to help the newborn be comfortable with the new environment and adapt to extrauterine life more easily. • Newborns are handled gently and carefully. Leboyer recommends not pulling the baby’s head to completely allow a natural childbirth. • The umbilical cord is cut late (It is cut after it has stopped pulsating). According to Leboyer, this allows the newborn to continue receiving the maternal hormones and oxygen carrying red blood cells. This is also done to allow the baby to breathe when he is ready and not have to be rushed. • The infant receives a warm bath immediately after birth for relaxation. • Before maternal and newborn bonding is done, the infant is massage to ease crying. Nowadays, mothers do this massaging to encourage immediate bonding. • Placing the infant in the mother’s abdomen is done for maternal-neonate bonding.

For women who have twins or multiple fetuses the weight gain should be 1 lb/week for a total of 40-45 lbs. (Adelle Pillitteri, 5th Ed p.302). 25-35 lbs is the average and recommended weight gain for pregnant woman with one fetus only.

Moniliasis or Candidiasis is caused by a fungus Candida Albicans (Monilia). Symptoms include: white patchy and cheese like particles that adheres to the vaginal wall, irritatingly itchy and foul smelling vaginal discharges. Chancres on vulva and non-itchy rash covering the whole body or appearing in patches are manifestations of syphilis. Frothy, cream-colored vaginal discharges, vulvar edema and hyperemia are hallmark signs of Trichomoniasis or vaginitis.

Infant massage, a warm bath and immediate bonding with the mother are all hallmarks of the Leboyer method. Bradley childbirth method was the first technique to include the father as a support person during delivery.

The easiest method for determining if a woman’s caloric intake is adequate is assessing the weight she is gaining. (Pillitteri, 5th Ed). A typical day history or a 24 hour nutrition recall is the best method for assessing overall nutritional intake.

In Lamaze method one technique of alleviating pain is by cutaneous stimulation. It is done by effleurage, sacral pressure, thermal stimulation (offering ice chips) and positioning. Preventing impulses to reach the brain is employing the distraction or imagery technique. Reducing a woman’s anxiety is done by a continuous support system. Allowing more blood to pool in the uterus to alleviate pain is a principle in Dick-Read method.

Heartburn not morning sickness is the result of increased progesterone level which in return decreases gastric motility thus causing reverse peristaltic waves.

Lamaze method is a prepared labor and delivery technique. It is often called psychoprophylactic method as it uses the mind (psyche) to prevent labor pains (prophylaxis). The Lamaze method of prepared childbirth is based on the gating control theory of pain relief. It involves concentration and conditioning to help the woman respond to contractions with relaxation from techniques thereby alleviating pain. This is based on the theory that through stimulus-response conditioning, women can learn to use controlled breathing to reduce the pain in the labor. Lamaze method is the most popular approach used to today.

22 BMI To compute for BMI 1. Convert weight into kilograms: 130 lbs / 2.2= 59.09 kg (1 kg=2.2 lbs) 2. Convert height into cm: 5’4” ( 5 feet 4 inches) 1 foot=12 inches; 1 inch = 2.54 cm CONVERT TO INCH FIRST: 5 x 12 = 60 inches + 4 inches = 64 inches INCN TO CM: 64 x 2.54 = 162.56 cm 3. Square the height in meters (1 m = 100 cm) CONVERT CM TO METER: 162.56 / 100 = 1.6256 m or 1.63 m SQUARE THE HEIGHT IN METER: 1.63 x 1.63 = 2.6569 or 2.66 4. Divide weight (kg) by meter squared 59.09 / 2.66 = 22 BMI

a. Underweight – under 18.5 BMI b. Normal weight – 18.5-24.9 BMI c. Overweight – 25-29.9 BMI d. Obese – above 30.0