RNC Inpatient Obstetrics Practice Exam III

An intravenous (IV) fluid bolus is given before epidural anesthesia to prevent hypotension. This is because epidural anesthesia can cause a drop in blood pressure, and the IV fluid bolus helps maintain blood volume and prevent hypotension.

The appropriate response is to honor the woman's request because it is important to respect her autonomy and preferences during the birthing process. Every woman has the right to decide who she wants to have present during labor and birth, and it is the nurse's responsibility to support her choices. It is possible that the woman has personal reasons for wanting her husband to stay in the waiting area, and it is important to ensure that she feels comfortable and in control during this vulnerable time.

During pregnancy, hormonal changes cause an increase in melanin production, resulting in darkening of the skin. The pigmented line that runs vertically from the sternum to the symphysis pubis is known as linea nigra. This line is a common occurrence in pregnant women and usually fades after childbirth. Spider nevus refers to a small, dilated blood vessel on the skin's surface, while striae gravidarum refers to stretch marks that develop on the abdomen during pregnancy.

During pregnancy, the optimum position for maternal cardiac output is lateral. This position allows for better blood flow and circulation to the placenta, which is essential for providing oxygen and nutrients to the developing fetus. Lying on the side also helps to minimize pressure on major blood vessels, such as the inferior vena cava, which can become compressed in the supine position and impede blood flow. Therefore, the lateral position is recommended to ensure adequate cardiac output and promote a healthy pregnancy.

Following national professional standards is important for successful defense of malpractice claims because these standards set the expectations and guidelines for professional conduct in a specific field. By adhering to these standards, professionals can demonstrate that they have met the established criteria for their practice, which can help in defending against claims of malpractice. National professional standards also provide a benchmark against which the professional's actions can be evaluated, helping to establish whether the alleged malpractice occurred or not. By aligning with these standards, professionals can strengthen their defense and demonstrate that they have acted in accordance with accepted norms and practices in their field.

The purpose of the root-cause analysis process is to review potentially contributing systems. This means that the process aims to identify and analyze the underlying factors or systems that may have contributed to a particular incident or problem. It is not focused on determining fault or assigning blame to healthcare providers or hospitals, nor is it primarily concerned with examining institutional liability. Instead, it seeks to understand the broader systems and processes in place that may have played a role in the occurrence of the issue at hand.

When a sentinel event occurs, the Joint Commission (TJC) recommends conducting a root-cause analysis. This analysis helps to identify the underlying causes and contributing factors of the event, allowing for appropriate corrective actions to be implemented. It is an essential step in understanding what went wrong and how to prevent similar events in the future. The analysis involves gathering data, examining processes, and identifying system weaknesses or breakdowns that may have led to the event. It is a proactive approach to improving patient safety and quality of care.

After 20 weeks' gestation, the measurement of fundal height in centimeters should correlate with gestational age. This is because after 20 weeks, the fundal height measurement becomes a reliable indicator of the growth and development of the fetus. Before 20 weeks, the fundal height may not accurately reflect gestational age as there can be variations in the position of the uterus and the size of the fetus. Near term, the fundal height may not be as reliable as the baby's position and engagement in the pelvis can affect the measurement.

An incident-management program is designed to identify and address potential risks and adverse outcomes in order to prevent them from occurring in the future. By including "near misses" with potential for adverse outcomes, the program can identify areas where mistakes or errors almost occurred and take proactive measures to prevent them from happening again. This approach focuses on learning from mistakes and improving systems rather than solely identifying and disciplining individuals at fault. It helps to create a culture of safety and continuous improvement within the institution and reduces liability by preventing adverse outcomes.

ACOG (American College of Obstetricians and Gynecologists) recommends electronic fetal monitoring as the preferred method of fetal assessment during labor for women with high-risk conditions. This method involves continuously monitoring the baby's heart rate and the mother's contractions using electronic devices. It provides a more accurate and continuous assessment of the baby's well-being and allows for early detection of any signs of distress or complications. Doppler FHTs every 30 minutes during early labor and fetal scalp electrode are alternative methods that may be used in certain situations but are not the preferred method according to ACOG.

Misoprostol is not recommended for women attempting VBAC (vaginal birth after cesarean). This is because misoprostol can increase the risk of uterine rupture in women who have had a previous cesarean section. Uterine rupture is a serious complication that can be life-threatening for both the mother and the baby. Therefore, it is important to avoid using misoprostol in women attempting VBAC and consider alternative methods for induction of labor.

Immediate intervention is the best approach for addressing disruptive clinician behavior because it allows for prompt action to be taken in order to address and rectify the disruptive behavior. By intervening immediately, the negative impact of the behavior can be minimized and potential harm to patients or colleagues can be prevented. It also sends a clear message that such behavior is not tolerated and helps to maintain a positive and respectful work environment. Monitoring trends and peer review can be effective in identifying patterns and providing feedback, but immediate intervention is necessary to address the behavior in the moment.

The correct answer is keeping the placenta in a leak proof container. This is because it is important to keep the placenta in a leak proof container to prevent any potential contamination or spread of infection. It is not necessary to require disposal of the placenta by internment (burial) or keeping it frozen until burial.

Prolactin is the hormone released from the anterior pituitary that is responsible for initiating lactation. This hormone stimulates the mammary glands in the breasts to produce milk. Oxytocin, on the other hand, plays a role in the ejection of milk from the breasts during breastfeeding. Progesterone is involved in the preparation of the breasts for lactation, but it is not responsible for initiating lactation itself.

Encouraging a woman to stop smoking before pregnancy is the ideal time because it allows her to quit smoking and eliminate any potential harm to her and her baby's health. Smoking during pregnancy can lead to various complications such as premature birth, low birth weight, and developmental issues. By quitting smoking before pregnancy, the woman can ensure a healthier start for her baby and reduce the risk of these complications.

The recommended weight for an obese woman to gain during pregnancy is 15lbs. This is because excessive weight gain during pregnancy can increase the risk of complications for both the mother and the baby. By aiming for a moderate weight gain, obese women can minimize the potential risks and promote a healthier pregnancy. It is important for obese women to consult with their healthcare provider to determine the appropriate weight gain goal based on their individual circumstances.

By 28 to 34 weeks' gestation in a normal pregnancy, the blood volume increases by approximately 30%-50%. This is because during pregnancy, the body produces more blood to support the growing fetus and provide oxygen and nutrients. The increase in blood volume helps to ensure an adequate blood supply to the placenta and the developing baby. It also helps to compensate for the increase in blood flow to the uterus and other organs. Therefore, it is expected for blood volume to increase by 30%-50% during this stage of pregnancy.

The average blood loss during vaginal birth is generally less than 500ml. This is because the body naturally constricts blood vessels and forms blood clots to minimize bleeding after childbirth. However, it is important to note that every birth is different, and some women may experience more or less blood loss depending on various factors such as the duration of labor, the presence of complications, and individual differences in physiology.

During pregnancy, the body undergoes numerous physiological changes to support the growing fetus. One of these changes is an increase in cardiac output, which refers to the volume of blood pumped by the heart per minute. The correct answer is 30%-50% because during pregnancy, the cardiac output typically increases by this range. This increase is necessary to meet the increased demands of the mother and the developing baby, ensuring an adequate supply of oxygen and nutrients.

The correct answer is "Unanticipated death of a full-term infant." According to TJC criteria, a sentinel event is an unexpected occurrence involving death or serious physical or psychological injury. In this case, the unanticipated death of a full-term infant qualifies as a sentinel event because it involves an unexpected death. The other options, such as any unexplained adverse occurrence or the birth of a baby with previously undiagnosed congenital abnormalities, may be concerning but do not meet the criteria for a sentinel event.

Elective labor induction should not occur prior to 39 weeks of gestation. This is because babies born before 39 weeks may have an increased risk of complications, such as respiratory distress syndrome, jaundice, and low blood sugar. Waiting until 39 weeks allows the baby's lungs and other organs to fully mature, reducing the risk of these complications. Inducing labor before 39 weeks should only be done for medical reasons, as determined by a healthcare provider.

During pregnancy, the body undergoes various changes to accommodate the growing fetus. One of these changes is an increase in blood volume, which can lead to fluid retention and swelling in the lower extremities, known as dependent edema. This occurs due to the pressure on the veins and the decreased return of blood flow from the legs to the heart. Therefore, dependent edema is a normal physical finding that can occur during pregnancy.

During labor, maternal cardiac output increases progressively. This is because the body needs to supply more oxygen and nutrients to the growing fetus. As the uterus contracts and the intensity of contractions increases, it leads to an increase in maternal heart rate and stroke volume, resulting in a higher cardiac output. This helps to ensure an adequate blood supply to the placenta and meet the increased metabolic demands of both the mother and the baby during labor.

According to the hot/cold theory, pregnancy is believed to be a "hot" condition. This theory suggests that certain conditions or states of the body can be classified as either hot or cold, and pregnancy is considered to fall under the hot category. This classification is based on traditional beliefs and practices in some cultures, where hot conditions are associated with increased energy, activity, and warmth, while cold conditions are associated with decreased energy and activity.

The correct answer is the American Nurses Association 'Code of Ethics for Nurses'. This code provides guidance for ethical nursing care, outlining the principles and values that nurses should uphold in their practice. It addresses various ethical considerations such as patient autonomy, confidentiality, advocating for patients' rights, and maintaining professional boundaries. It serves as a resource for nurses to navigate ethical dilemmas and ensure that they provide safe, compassionate, and patient-centered care. The other options, the American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG) 'Guidelines for Perinatal Care' and the American Medical Association 'Code of Medical Ethics', may provide guidance specific to their respective fields but do not encompass the broader scope of nursing ethics.

The average blood loss during cesarean birth is less than 1000ml. This means that on average, women who undergo a cesarean birth do not lose more than 1000ml of blood during the procedure. It is important to note that this is an average and individual cases may vary.

During pregnancy, the body undergoes several changes to accommodate the growing fetus. One of these changes is the decrease in systemic vascular resistance. This is because the body needs to increase blood flow to the placenta and uterus to provide oxygen and nutrients to the developing baby. By reducing systemic vascular resistance, blood vessels dilate, allowing for easier blood flow and ensuring an adequate blood supply to the fetus. This decrease in resistance also helps to lower blood pressure, which is beneficial for both the mother and the baby.

The nurse appropriately assesses the significance of Maria's mother's advice because it is important to understand the reasoning behind her mother's suggestion to take only herbal medication during pregnancy. By assessing the significance, the nurse can determine if there are any cultural beliefs or concerns that need to be addressed and can provide appropriate education and guidance to Maria based on her individual needs and preferences.

During pregnancy, the oxygen consumption of the body increases. This is because the growing fetus requires more oxygen to support its development and growth. The mother's body responds to this increased demand by increasing the rate at which oxygen is consumed. This is necessary to ensure that both the mother and the fetus receive an adequate supply of oxygen for their metabolic needs. Therefore, the correct answer is that oxygen consumption increases during pregnancy.

Unit protocols are a measure of patient safety because they provide standardized guidelines and procedures for healthcare providers to follow. These protocols ensure that all members of the healthcare team are on the same page and are following evidence-based practices, which can help prevent errors and improve patient outcomes. By implementing unit protocols, healthcare facilities can enhance patient safety by reducing variations in care, promoting effective communication, and ensuring that best practices are consistently followed.

During pregnancy, the relaxation of the lower esophageal sphincter is the primary reason for heartburn. The lower esophageal sphincter normally acts as a barrier to prevent stomach acid from flowing back into the esophagus. However, hormonal changes during pregnancy can cause this sphincter to relax, allowing stomach acid to reflux into the esophagus. This reflux leads to the burning sensation known as heartburn. Decreased gastric motility and increased secretion of hydrochloric acid may contribute to heartburn, but the relaxation of the lower esophageal sphincter is the main cause.

Tay-Sachs disease is a recessive disorder that is more common in families of Jewish ancestry. This is because the gene mutation that causes Tay-Sachs disease is more prevalent in the Ashkenazi Jewish population. Ashkenazi Jews have a higher carrier frequency for the disease compared to other populations. Therefore, individuals with Jewish ancestry have a higher risk of inheriting and passing on the gene mutation, making them more susceptible to Tay-Sachs disease.

The correct answer is Haiti. In Haitian culture, there is a belief that swallowing saliva during pregnancy can harm the baby. This belief is rooted in the traditional practice of avoiding certain foods and behaviors to ensure a healthy pregnancy. Carrying a spit cup to avoid swallowing saliva is a common practice among some Haitian women during pregnancy. It is important to note that this belief may not be representative of all Haitian women, as cultural practices can vary within a community.

The correct answer is 36 weeks because it is recommended to repeat the serology and gonorrhea culture tests at this stage of pregnancy. This timing allows for the detection and treatment of any potential infections before delivery. It is important to monitor for any changes in the woman's health status and ensure the well-being of both the mother and the baby.

Rates of maternal morbidity and mortality are considered outcome measures of patient safety because they reflect the effectiveness of healthcare in preventing harm and ensuring the well-being of pregnant women. These rates provide important information about the quality of care provided during pregnancy, delivery, and postpartum periods. Monitoring and reducing maternal morbidity and mortality rates are crucial in identifying areas for improvement in healthcare systems and implementing interventions to enhance patient safety and outcomes.

During the first half of pregnancy, the weight gain experienced by the mother is primarily due to changes in her own body weight. This includes an increase in blood volume, the growth of the uterus, and the development of breast tissue. The baby's weight gain during this period is relatively minimal compared to the mother's. Amniotic fluid, although it does contribute to the overall weight gain during pregnancy, is not the primary factor in the weight gain during the first half of pregnancy.

During pregnancy, the glomerular filtration rate (GFR) increases. This is because the increased blood volume and cardiac output during pregnancy lead to increased renal blood flow. As a result, more blood is filtered through the glomerulus, leading to an increased GFR. This is a normal physiological adaptation to support the increased metabolic demands of the mother and the growing fetus.

Professional nursing liability is most commonly increased by the absence of adequate medical record documentation. This is because thorough and accurate documentation is essential for providing evidence of the care provided to patients. It helps in communication among healthcare professionals, ensures continuity of care, and serves as legal protection in case of any legal disputes or claims. Inadequate documentation can lead to errors, miscommunication, and misunderstandings, increasing the risk of adverse events and potential liability for nurses.

During pregnancy, the maternal PaO2 (partial pressure of oxygen) levels increase while the PaCO2 (partial pressure of carbon dioxide) levels decrease. This is due to the increased oxygen demand by the growing fetus, which leads to a higher oxygen intake and improved oxygenation of the blood. Additionally, the increased respiratory rate and tidal volume during pregnancy help to eliminate carbon dioxide more efficiently, resulting in a decrease in PaCO2 levels.

Wang Din Wah's refusal to bring the newborn back to the clinic for a phenylketonuria test is most likely based on the cultural belief that the first month after birth is a time for confinement and rest. In some cultures, it is believed that the mother and baby should stay at home and avoid going out or engaging in activities outside of the house during this time. Wang may be adhering to this cultural practice and therefore refusing to bring the baby to the clinic.

An appropriate recommendation for weight gain for an underweight pregnant woman would be 30lb. This is because underweight pregnant women typically need to gain more weight to support the growth and development of the fetus. Adequate weight gain during pregnancy is important to ensure the health of both the mother and the baby. Gaining 30lb would help provide the necessary nutrients and energy for the baby's growth, as well as support the mother's overall health during this critical period.

The greater increase in plasma volume than in red blood cell volume results in hemodilution. Hemodilution occurs when the concentration of red blood cells decreases due to an increase in plasma volume. This can lead to a decrease in the viscosity of blood, which can affect blood flow and potentially increase the risk of blood clots during pregnancy. It can also result in increased blood pressure as the volume of fluid in the blood vessels increases.

The correct answer is Korean. In Korean culture, it is common for the mother-in-law to play a significant role in caring for the mother and newborn during the postpartum period. This tradition is known as "samchilil" and is believed to provide support and assistance to the new mother as she recovers and adjusts to motherhood. The mother-in-law typically takes on responsibilities such as cooking, cleaning, and taking care of the baby, allowing the new mother to rest and recover.

In late pregnancy, there is a decrease in insulin sensitivity. This means that the body becomes less responsive to the effects of insulin, a hormone that helps regulate blood sugar levels. This decrease in insulin sensitivity is believed to be a protective mechanism to ensure an adequate supply of glucose to the growing fetus. As a result, blood glucose levels may increase, leading to gestational diabetes in some cases.

Coumadin, also known as warfarin, is a commonly used anticoagulant drug. It is known to be a teratogen, meaning it can cause harm to a developing fetus if taken during pregnancy. This is because Coumadin can cross the placenta and interfere with the normal development of the baby. Therefore, it is generally not recommended for use during pregnancy unless the benefits outweigh the potential risks. Fragmin and Heparin are also anticoagulant drugs, but they are not known to be teratogens.

The monitoring of fetal kick counts begins at 28 weeks gestation. This is because by this time, the baby's movements should be strong enough for the mother to feel them regularly. Monitoring fetal kick counts is important as it helps to ensure the baby's well-being and can indicate any potential problems or changes in the baby's activity level. Starting at 28 weeks allows for enough time to establish a pattern of movement and provides a baseline for comparison in case there are any changes in the baby's activity later on.

During pregnancy, the levels of various coagulation factors increase to prevent excessive bleeding during childbirth. Fibrin is a protein that forms blood clots, and its levels increase during pregnancy. Fibrinogen is a precursor to fibrin and also increases during pregnancy. However, platelets, which are responsible for clot formation, do not increase in number during pregnancy. This is because the increase in fibrin and fibrinogen compensates for the lack of increase in platelets, ensuring proper clotting function.

A nonreactive nonstress test at 39 weeks' gestation indicates that the baby's heart rate did not accelerate appropriately during the test. This could be a sign of fetal distress or a potential problem with the baby's oxygen supply. Further testing is necessary to evaluate the baby's well-being, such as a biophysical profile or a contraction stress test. This will help determine if there is a need for expedited birth or if reassurance about the fetal status is sufficient.

The correct answer is "how tachysystole is identified and treated." Process measures of patient safety refer to the specific steps or actions taken to ensure patient safety. In this case, tachysystole is a condition characterized by excessively frequent uterine contractions during labor. Identifying and treating tachysystole promptly is crucial to prevent complications for both the mother and the baby. Therefore, monitoring and addressing tachysystole effectively contribute to patient safety in the context of childbirth. The other options, such as the number of nurses certified in fetal monitoring and rates of cesarean birth for indeterminate fetal status, may also be relevant to patient safety but do not directly pertain to the process of identifying and treating tachysystole.

Disruptive clinician behavior is often directly linked to clinical practice issues because it can stem from factors such as stress, burnout, or dissatisfaction with patient care. These issues can manifest as disruptive behavior towards colleagues, patients, or the healthcare system itself. Addressing the underlying clinical practice issues can help mitigate disruptive behavior and improve overall patient care and workplace dynamics.