Download AWHONN PEOP Perinatal Final Review 2024 Questions with Complete Solutions | 100% pass Swis and more Exams Nursing in PDF only on Docsity!
AWHONN PEOP Perinatal Final Review 2024
Questions with Complete Solutions | 100% pass
Swiss cheese is often used as the paradigm for explaining medical error. In this model, the holes in the cheese represent - ✔✔latent weaknesses You are assigned to a patient who is at 38 weeks and 6 days gestation. She is being admitted for an elective induction of labor because her husband is going on an extended business trip in 2 days and he wants to be present for the delivery. The hospital has no policy regarding elective induction, but you know that the AWHONN "Go the Full 40" campaign doesn't support early elective induction. You approach the physician with your concerns. He responds that he's been doing this for 30 years and has never had a bad outcome from an elective induction at this gestation. This scenario is an example of - ✔✔normalization of deviance Which of the following has been noted among the top three root causes of sentinel events for over 10 years? - ✔✔Communication A shared understanding of what is going on and what is likely to happen next is known as - ✔✔situational awareness A patient safety event, unrelated to the natural course of the underlying illness, that reaches a patient and results in death, permanent harm, or severe temporary harm with intervention required to sustain life is an example of - ✔✔a sentinel event
Which tool is used when an adverse event has occurred to identify variations in performance that led to the outcome? - ✔✔Root cause analysis Yearly objectives developed by The Joint Commission that focus on problems in healthcare safety are known as - ✔✔National Patient Safety Goals The Perinatal Care Core Measures include all of the following EXCEPT - ✔✔use of the NICHD nomenclature for electronic fetal monitoring. Authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty are expected to perform competently are defined - ✔✔Standards of Care Position statements are recommendations for - ✔✔a pathway of action regarding a particular issue In health care, an unplanned event that did NOT result in injury, illness, or damage but had the potential to do so is referred to as a - ✔✔near miss All of the following are elements of good documentation EXCEPT - ✔✔inclusion of nursing opinion as to causes of error Mrs. Johnson is a primipara at 34 weeks gestation who has been admitted to your unit with increasing blood pressures. You have a discussion with the physician about her reports of headache and blurred vision. What actions should surround the documentation of this conversation in the medical record? - ✔✔Document the date, time, person spoken to, and objective details of what was said in the medical record.
During the proliferative phase of the menstrual cycle, which is NOT true? - ✔✔Menstruation occurs The corpus luteum produces ___________ to prepare the uterus to nurture the fertilized egg. - ✔✔progesterone In the early menstrual cycle phase, which gland sends a signal telling the ovaries to prepare to release an egg? - ✔✔Pituitary After ovulation, the ovarian follicle produces - ✔✔progesterone Implantation of a fertilized ovum occurs ______ days after ovulation. - ✔✔ 7 - 10 Average viability for male sperm within the female reproductive tract is - ✔✔ 2 - 3 days For a healthy, 3 0 - year-old woman, the chance of conception is approximately __ per cycle. - ✔✔20% The best way for a woman with a regular menstrual cycle to predict ovulation is to record the first day of the LMP and - ✔✔count backward 14 days Which is NOT a characteristic of ovulation in the female? - ✔✔Decreased basal body temperature Infertility evaluation is recommended for women less than 35 years old who have not conceived after ___ months. - ✔✔6 (but I think question is incorrectly worded should be 12 months; >35 y/o is 6 months)
Starting at what age does female fertility decline? - ✔✔ 32 Which is NOT a symptom of polycystic ovarian syndrome? - ✔✔Painful periods What is the best way to confirm the diagnosis of endometriosis? - ✔✔Laparoscopy At ovulation, the cervical mucus becomes clear and stretchy. This facilitates - ✔✔sperm to pass through the cervical canal Which of the following uterine abnormalities may be surgically corrected to improve fertility? - ✔✔All the above (Endometrial polyps, Myomas, Uterine septum) Which test is the best predictor of a woman's ovarian reserve? - ✔✔Antral follicle count When is the best time of the menstrual cycle to perform hysterosalpingography? - ✔✔Day 7- 12 Standards for semen analysis have been designated to maintain consistency and quality control by - ✔✔World Health Organization Pregnancy outcomes associated with ART include - ✔✔all the above (early pregnancy loss, multiple gestation pregnancy, preterm birth)
Which of the following birth outcomes may be improved by preconception and interconception care? - ✔✔All of the above (Infant mortality, Preterm birth, Birth defects) Cultural sensitivity means that the healthcare provider is - ✔✔alert and considerate of others' views Increasing maternal and paternal age have been shown to influence the risk of - ✔✔genetic abnormalities Women over the age of 35 have an increased risk of - ✔✔all of the above (cesarean birth, miscarriage and stillbirth, pregnancy-related complications) Access to care may be limited by all factors except lack of - ✔✔contraception A tool used to screen for IPV is - ✔✔RADAR The first "a" in RADAR stands for - ✔✔ask directly, in a kind, nonjudgmental way Nadia has arrived for a routine annual physical examination. She does not maintain eye contact and provides only brief responses to questions during the physical assessment systems review. Upon physical examination, you notice bruises on her breasts, upper thighs, and genitals. Nadia begins to cry and states that her husband beats her. Your first action should be to - ✔✔assess Nadia's safety and ask if she has a safety plan Folic acid supplementation prior to and during pregnancy has been shown to reduce the risk of neural tube defects by at least - ✔✔85%
Some foods are considered unsafe during pregnancy, and women may choose to avoid them during the preconception period. Undercooked meat and unwashed fruits and vegetables may expose women to which organism? - ✔✔Toxoplasma gondii Methylmercury may be found in certain fishes and can adversely affect which fetal system? - ✔✔Neurologic In nonpregnant women, obesity is defined as a body mass index (BMI) over - ✔✔ 30 Obese women (BMI ≥30) should gain how many pounds during pregnancy? - ✔✔ 11 - 20 Women who are underweight may have difficulty conceiving due to which of the following conditions? - ✔✔Oligo-ovulation Obesity can result in - ✔✔all of the above (ovulatory dysfunction, altered oocyte and endometrial functions, lower birth rates) Smoking increases the risk of - ✔✔increase in spontaneous abortion No amount of alcohol is safe during pregnancy. Fetal alcohol spectrum disorders include - ✔✔central nervous system abnormalities
Mrs. Mavis is 38 weeks pregnant and presents to the outpatient testing unit for a nonstress test. A reactive nonstress test for a fetus at this gestational age includes two fetal heart rate increases of 15 beats per minute above the baseline lasting for 15 seconds or longer in a timeframe of - ✔✔20 minutes. If a mother is Rh-negative and her fetus is Rh-positive, the mother will create antibodies against the fetal cells anytime they cross the placenta. To prevent Rh isoimmunization, Rh-negative mothers are screened with a D (Rh) antibody screen and given D immune globulin (RhIG) as prophylaxis at which gestational age? - ✔✔28 weeks Sofia has arrived to your unit for a labor evaluation. She is 37 weeks pregnant and has been complaining of excessive fatigue. Which of the following is a normal physiologic response to the expanding blood volume during pregnancy? - ✔✔Red blood cell (RBC) production increases to accommodate the expanding blood volume and White blood cell (WBC) production increases due to the changes in estrogen and cortisol. Match the developmental task with the correct description. - ✔✔Acceptance of the pregnancy ----- The woman's adaptation to and her sense of gratification about being pregnant. Identifying with the role of mother-----The woman's ability to identify with the role of mother. Evaluating and reordering the relationships-----How well the woman adapts to her pregnancy and her view of motherhood. Establishing a relationship with the fetus and preparing for childbirth-----The woman reconciles her fantasies and concerns about who this new baby will be.
Prenatal fear of loss of control and self-esteem in labor----- The woman's sense of how well she thinks she can cope with the events of labor can influence her performance in labor. Caroline G1P0 at 34 weeks gestation presents to the OB triage per the recommendation of her provider. Caroline has complaints of pain and frequency with urination. Caroline states that she has never had a UTI before and asks you why she would get one now. Your best response would be - ✔✔As the uterus grows, pressure displaces the ureters and bladder. Pressure on the renal system can impede urine flow thus increasing the risk for UTIs. An essential component of prenatal health assessment is the determination of the pregnant woman's vital signs. Which of the following is an expected change in vital signs during pregnancy? - ✔✔A decrease in diastolic blood pressure by 10-15 mm Hg or more in the sitting and standing positions and An increase in the respiratory rate and a heighted awareness to breathe as pregnancy progresses. Johanna was recently diagnosed with gestational hypertension. She arrives to the outpatient clinic for an ultrasound examination at 26 weeks gestation to monitor fetal status. Ultrasound examination of the umbilical cord should show - ✔✔two arteries carrying deoxygenated blood from the fetus to the placenta and one vein returning oxygenated blood from the placenta to the fetus. Mrs. McKenzie has arrived for a routine prenatal visit. She is 34 weeks pregnant and is complaining of heartburn and constipation. Her vital signs, fetal heart rate, and deep tendon reflexes are normal. You recognize that her complaints may be due to a/an - ✔✔decrease in gastric smooth muscle tone and motility caused by increasing maternal hormones.
Match the fetal lie with correct definition. - ✔✔Oblique-----occurs less frequently and usually converts to a different fetal lie during labor Transverse-----occurs when the long axis of the fetus is at a right angle, or perpendicular, to that of the mother Longitudinal-----occurs when the long axis of the fetus is parallel to the long axis of the mother Occiput - ✔✔What fetal Presentation? Frank - ✔✔What fetal Presentation? Complete - ✔✔What fetal Presentation? Footling - ✔✔What fetal Presentation? LOP - ✔✔What is the correct fetal position shown in the image? Abby, G2P1 at 39 3/7 weeks gestation presents to the OB triage with complaints of "her water leaking". You apply the fetal monitor. Abby's vitals are as follows: BP 158/98 mm Hg, P 82 bpm, R 22 bpm, Temp 100.4°F (38°C). Abby has a positive pH paper test indicating her membranes are ruptured and her cervical examination is 3cm dilated and 70% effaced. The FHR is 165 bpm, minimal variability, and recurrent variable decelerations are present. Abby is contracting every 3-4 minutes, 60-70 seconds in duration, the contractions palpate moderate, and her resting tone is soft. What assessment findings
indicate IMMEDIATE provider notification? - ✔✔Hypertension, elevated temperature, and indeterminant FHR pattern You are caring for Sonya, G1P0 at 40 weeks gestation who was admitted in active labor. Sonya's membranes spontaneously ruptured 30 minutes ago. You are orientating a new nurse and he asks you how often Sonya's vital signs should be taken. What is your best response? - ✔✔We should take Sonya's pulse, respirations, and blood pressure at least every 4 hours and take her temperature every hour. Match the mechanism of labor with the correct definition. - ✔✔Engagement-----occurs as the biparietal diameter of the fetal head passes through the pelvic inlet Descent-----the process of movement of the presenting part through the pelvis and depends on the intraamniotic pressure and the force exerted on the fundus by uterine contractions Flexion-----occurs when the descending fetal head meets resistance from the cervix, the pelvic wall, or the pelvic floor Internal rotation-----takes place as the fetal head continues to descend from the pelvic inlet through the midpelvis to the pelvic outlet A baseline FHR is defined as - ✔✔an approximate mean FHR rounded to increments of 5 bpm during a 10 - minute segment, excluding accelerations, and decelerations, and periods of marked variability. FHR variability is defined as - ✔✔irregular fluctuations in a 10-minute window excluding FHR accelerations and decelerations that represent the fetal sympathetic and parasympathetic nervous systems reactivity.
Jamie, a new RN on the labor and delivery unit, asks you why your patient is being induced at 39 1/ weeks gestation when there is no medical or obstetric indication. What is your BEST response? - ✔✔The ARRIVE study demonstrated the potential benefit of non-medically indicated induction of labor. Offering induction of labor after 39 0/7 weeks gestation is acceptable and may be associated with decreased maternal and perinatal risks. 4 - ✔✔Kelly, a G2P1 at 39 4/7 weeks gestation presents to the OB triage with complaints of contractions. Her cervical examination revealed 2 cm dilatated, 50 % effaced, a ballotable fetal presenting part. The cervical consistency is medium and in a mid position. Based on these findings, what is Kelly's Bishop score? You are assisting Dr. Torres with placing a cervical ripening balloon catheter for Amy, G1P0 at 40 1/ weeks gestation. Amy asks you how long the catheter has to remain in place. What is your BEST response? - ✔✔The catheter will be in place no longer than 24 hours. Brianna G1P0 at 39 6/7 weeks gestation presents to the OB triage with complaints of vaginal bleeding. You noted small amount of pink tinged discharge on the pad that Brianna was wearing. Brianna reported that she was in the doctors office earlier in that day and she did a "very rough" vaginal examination. Brianna stated "the doctor told me I may go into labor because of the examination". Given the information Brianna gave you, what may be the best explanation for the vaginal bleeding? - ✔✔Dr. Torres probably stripped Brianna's membranes. Louis is a new RN working in labor and delivery. He is curious what happens if a woman has too many contractions and no oxytocin is infusing. What is your best response? - ✔✔After a fluid bolus, if the woman is still having more than five contractions in 10 minutes, we will notify the provider and request terbutaline 0.25 mg SQ.
Kira, G2P1, at 39 0/7 weeks gestation is being induced for gestational diabetes. Dr. Albertson ordered Dinoprostone vaginal insert (Cervidil) for cervical ripening prior to starting oxytocin. You have just received training and demonstrated competence in insertion. Given what you learned in your training, what are the key components to care. (Select all that apply.) - ✔✔Oxytocin administration may be started 30-60 minutes after removal of the insert. The insert is usually removed after 12 hours or when active labor begins. The insert should be removed in the presence of an abnormal FHR pattern, with or without tachysystole. Women should remain recumbent for two hours after insertion Effective cervical ripening agents include (Select all that apply.) - ✔✔Cervidil, Misoprostol, Prepidil You are caring for Jenny, G2P1 at 39 4/7 weeks who is having an elective induction. Dr. Biglin ordered oxytocin to be started at 2 milliunits/minute and to increase by 1 milliunit/minute every 30 minutes until Jenny is in a good labor pattern. The pharmacy has prepared 30 units oxytocin in a 500 mL bag of IV solution. To administer 2 milliunits/minute, what rate should be set on the IV pump? - ✔✔2 mL/hour When administering oxytocin, nursing responsibilities include (Select all that apply.) - ✔✔decreasing the dose rate or discontinuing the oxytocin when contractions are too frequent. decreasing the dosage rate or discontinuing the oxytocin if an indeterminate or abnormal FHR patterns occur.
The provider asked you to perform suprapubic pressure. Which image reflects the correct method. - ✔✔ Justine, G1P0 at 39 5/7 weeks gestation is has been pushing for 50 minutes. Dr. Linton has requested to use the vacuum device. Prior to application of the vacuum, what should you suggest? - ✔✔Empty Justine's bladder. a prolonged deceleration that may be associated with uterine rupture. - ✔✔You are caring for Liesa, G2P1 at 39 weeks gestation. Liesa is attempting a TOLAC. You note the following FHR tracing. This tracing may reflect In caring for a woman who is in labor with an attempt at a vaginal birth after cesarean (VBAC), it is important to provide labor support, perform ongoing assessment of maternal and fetal status, and observe for signs of abnormal labor progress. Which intervention is usually indicated as a precaution throughout labor in TOLAC patients? - ✔✔Maintaining patent intravenous access Your patient, Kayla, calls a nurse to her bedside describing spontaneous rupture of membranes. As the sheets are pulled back, a loop of umbilical cord is noted protruding from her vagina. All of the following are appropriate interventions for umbilical cord prolapse. (Select all that apply.) - ✔✔Covering the cord with a moistened gauze Calling for immediate assistance Placing the patient in Trendelenburg position to relieve compression on the cord.
Jessica, a new RN on the labor and delivery unit, asks you when she should complete a hemorrhage risk assessment. What is your BEST response? - ✔✔Upon admission to labor, during the pre-birth period, during the post-birth period, and once per shift for the first 24 hours after birth Althea arrived at the obstetric unit for a labor evaluation at 39 weeks gestation. She reports decreased fetal movement for the past 24 hours. Her biophysical profile is 2/8. The decision is made to perform a cesarean delivery. The most common maternal reason for a cesarean birth is - ✔✔failure to progress or abnormal fetal heart patterns. Which of the following is a contraindication to the administration of regional analgesia and anesthesia? - ✔✔Local infection at the site of injection A woman is to receive general anesthesia for an unscheduled cesarean birth. The anesthesiologist asks if she or anyone in her immediate family has had problems with general anesthesia in the past. This question is asked to screen for which of the following? - ✔✔Malignant hyperthermia Which of the following is recommended thromboprophylaxis for all women having a cesarean birth? - ✔✔Placement of pneumatic compression devices A primary and routine role of the circulating registered nurse during a cesarean birth includes - ✔✔performing needle and sponge counts with the scrub person. The level of care provided when a patient is emerging from a surgical procedure requiring anesthesia or sedation is referred to as - ✔✔phase 1.
