Shared Flashcard Set

Details

Midwifery
NARM Exam Study Questions
146
Health Care
Not Applicable
06/24/2011

Additional Health Care Flashcards

 


 

Cards

Term
Normal blood glucose levels for a newborn
Definition
50-60 mg/ml
Term
Newborn blood glucose levels below ______ require immediate intervention
Definition
30 mg/ml
Term
Infants at risk for hypoglycemia (5)
Definition

LGA/SGA

Premature

Postmature

Born of diabetic mothers

Hypoxic or depressed at birth

Term
S/Stx of newborn with hypoglycemia (5)
Definition

Apathy

Irregular respiration

Hypothermia

Refusal to nurse

High pitched cry

Term
Tx for hypoglycemic newborns with levels 45 mg/ml or above (2)
Definition

Nursed as often as possible

Water with molasses every few hours (1 tsp/cup)

Term
The coroner must be notified of any stillborn weighing _____mg or more
Definition
500 mg
Term
Protocols for midwife regarding stillbirth and neonatal death (6)
Definition

Notify coroner if >500mg

Spend time with parent first few weeks

Encourage parents to prepare memorial

Discuss basic phases of grieving with parents

Give referrals to support groups

Give written materials on speaking to children

Term
Condition in which infant has not been hypoxic for long but is already attempting to breathe more rapidly in utero
Definition
Primary apnea
Term
Condition in an infant who has been hypoxic in utero and making second attempt to breathe more rapidly without succeeding in restoring oxygen levels
Definition
Secondary apnea
Term
What is management for primary apnea?
Definition
Stimulation, blow-by oxygen, or a few breaths of mouth to mouth should revive this infant
Term
Management for secondary apnea
Definition

Immediate ventilation via mouth-to-mouth or bag-mask to reverse acidosis caused by hypoxia

 

Baby suctioned, then warmed and stimulated by massaging from base of spine up the back

Term
What 3 things guide the choice of resuscitation technique for secondary apnea?
Definition
Baby's color, muscle tone and respiratory effort
Term

Temporary condition in which the newborn has abnormally rapid breathing

 

Other names for this (2)

Definition

Transient tachypnea of the newborn (TTN)

 

wet lungs

type 2 RDS

Term
Occurrence of TTN in newborns
Definition
1-2%
Term
Normal newborn breathing rates
Definition
40-60 breaths per minute
Term

What is TTN caused by?

 

When does it resolve?

Definition

Delayed absorption of fetal lung fluid

 

Usually within 24-72 hours

Term
Infants who are at higher risk for TTN (3)
Definition

Infants born to mothers who smoked during pregnancy

Infants born to mothers who had diabetes

SGA

Term
Infants with TTN can have RR up to ____ bpm?
Definition
120
Term
When should a baby with TTN be transported?
Definition
If TTN accompanied by any additional respiratory problems, RDS, meconium aspiration, sepsis
Term
How would you support parents after birth of an infant with fetal anomalies?
Definition

Remain present until anomaly is noted

Point it out if not noticed without extended discussion

Encourage bonding by seeing perfect features

Refer to resources for info and support

Term

What is most common unknown fetal anomaly?

 

What two anomalies require immediate transport?

Definition

Heart defect (presenting as cyanosis and respiratory distress)

 

Heart defects, spina bifida

Term
What should you do if baby born with severe anomalies incompatible with life and parents don't desire transport?
Definition
Follow parents' lead unless baby seems viable (obligated to give life support)
Term
What action done by the midwife can help to rule out a concealed partial separation?
Definition
Guard uterus with hand resting on fundus as soon as birth occurs and leave there until placental delivery
Term

What sign can indicate that the placenta has separated in the center with outer margins still attached?

 

What is danger of this?

 

 

Definition

Uterus grows larger (filling with blood)

 

Mom goes into shock (concealed hemorrhage)

Term
What action can cause partial separation of placenta and hemorrhage?
Definition
Prodding or massage of fundus
Term
Signs of placental separation in 3rd stage of labor
Definition

Cord lengthening

Gush of blood

Term
Signs of Respiratory Distress Syndrome (4)
Definition

Nasal flaring

Grunting upon exhalation

Retractions of the chest and abdomen

Cyanosis

Term
Management for baby with signs of RDS 
Definition

Blow-by oxygen administered

Baby immediately transported to hospital with notification of pediatric support

Term
Management of baby with difficulty in respirating (lung obstruction or rapid respirations) with no signs of RDS
Definition

Use steam to loosen any congestion

Apply percussion in each lung quadrant with baby on lap head down

Term
Issues with IUD as contraception for postpartum parents (2)
Definition
Can cause chronic bleeding and low grade infection
Term
Issues with Basal Body Temp/cervical mucus as contraception for postpartum parents
Definition
May not stabilize for some time after birth and during nursing
Term

Issues with Estrogen/progesterone birth control pills as contraception for postpartum parents

 

Progesterone-only mini-pills?

Definition

Can cause milk production to slow or stop 

 

Not as effective for birth control

Term
Issues with Norplant and Depo-Provera as contraception for postpartum parents
Definition
Can cause heavy bleeding and may delay start of menstruation when stopped
Term
Best contraception method for nursing mother
Definition
Barrier methods (condoms, diaphragms, cervical caps)
Term
Three elements to avoiding postpartum hemorrhage
Definition

Good nutrition and supplements

Familiarity with the mother

Delivery of placenta without urgency

Term
Supplements good for preventing PPH and maintaining hemostasis more readily
Definition

Liquid chlorophyll

Red Raspberry and nettles

Tincture of nettles, yellowdock, alfalfa and red rasp

Multivitamins

Term
Things to remember for a mom recovering from birth (6)
Definition

Requires 10 full days of absolute rest

Sleep and eat well

Not become stressed (interferes with involution)

Walk several times daily

Jug of water at hand at all times

Room comfortably warm with baby/personal needs close

Term

Where should the uterus be at Day 1 postpartum and how should it feel?

 

What should bleeding look like?

 

Definition

Below mother's umbilicus, firm not tender

 

Lochia rubra, appears like heavy period, odor fleshy

Term

Management for perineum that is still swollen at Day 1 postpartum (2)

 

What would you suspect if swelling had increased?

Definition

Alternate warm and cool compresses

Rinse 2x/day with warm water and betadine

 

 

Hematoma

Term
What is inflammation of a leg vein?  Who is at higher risk?
Definition

Thrombophlebitis

 

Those with varicose veins

Term
How do you differentiate between superficial and deep thrombophlebitis?
Definition

Superficial presents with leg pain, heat, tenderness and redness at inflamed area... (confirmed by Homan's sign)

 

Deep indicated if high fever, severe pain, edema and tenderness along entire leg

Term
Treatment for thrombophlebitis
Definition

Mother on bed rest with leg elevated

Leg should NOT be manipulated in ANY way

Term
What can you do to confirm thrombophlebitis?
Definition
Check for positive Homan's sign (pain in mother's calf when knee bent 90deg and foot dorsiflexed at ankle)
Term

One in ____ mothers develop depression or anxiety up to a year after birth of baby

 

 

___ % should at least ___ signs of clinical depression

Definition

Five

 

50, 2

Term
Reasons for post partum depression 
Definition

Hormonal shifts

Maternal emotions regarding baby, birth experience and/or maternal role

Term
Why is it important to know details about a previous abortion when working with a client? (2)
Definition

D&C involves scraping of endometrium which may cause scarring and create risk of interference with placental implantation (suction less damaging to endometrial lining)

 

Emotional reasons

Term
What is Meconium Aspiration Syndrome?
Definition
Irritation and blockage of the lungs caused by the inhalation of meconium and amniotic fluid at birth.  Meconium aspiration syndrome includes airway obstruction, chemical pneumonitis, and surfactant dysfunction.
Term
Cardinal Movements of Birth
Definition

 

  1. Engagement
  2. Descent
  3. Flexion
  4. Internal Rotation
  5. Extension
  6. Restitution
  7. Expulsion

Mnemonic device: Even Dumb Fools Instinctively EvadeRectal Exams

Term
What is a Biophysical Profile
Definition

Similar rating system to APGAR

(0-2 for each of 5 criteria)

  • Fetal Muscle Tone
  • Breathing movements
  • NST
  • Fetal Movement counts
  • Amniotic fluid volume
Mnemonic device: The Baby Needs More Attention
Term
When is physiological jaundice seen?
Definition
2nd or 3rd day of life
Term
What are 3 types of physiological jaundice?
Definition

1)Breakdown of excess RBC and release of bilirubin

2)Breast milk jaundice (hormone in milk interferes with newborn's ability to eliminate bilirubin)

3)ABO Incompatibility (Maternal Type O transfers to baby with Type A or B)

Term
What can pathological jaundice be caused by (4)
Definition

Liver disease

Obstructed bile duct

Infection

Rh hemolytic disease

Term
Pathological jaundice usually presents within the first ___ of life, __________ levels are much higher, and if not decreased quickly, ____________ can result.
Definition

24 hours

bilirubin

kernicterus

Term
When should the birth family have items gathered for a home birth by?
Definition
36 weeks
Term
What three things should be done in advance in case of transport during labor?
Definition

Have car fueled

Test route to the hospital

Complete and chart hospital admission forms

Term
What does HIPAA stand for?
Definition
Health Insurance Portability and Accountability Act
Term
What 3 legal things summarize HIPAA for the midwife?
Definition

- Maintain privacy of client's healthcare information

- Provide clients with written notice about privacy policies

- May use info for tx, payment, healthcare, inform others in emergency tx, when required by law and if suspicion of abuse or neglect

Term
What should be included in the informed consent document (7)?
Definition

- Advantages/disadvantages or decision to be w/ midwife

- Qualifications of the midwife

- Consent to examination and treatment

- Summary of complications risked in childbirth

- Definition of common terms used during pregnancy/CB

-Details of emergency equipment provided by midwife

- Agreement to transfer recommended by midwife

Term
What are the 4 waking states of a newborn?
Definition

1) Crying

2) Much motor activity

3) Alert

4) Drowsy

Term
Newborns spend ___% of daytime hours in the alert state.  Crying communicates a need to be fed, held, suck or sleep; rarely, it is for _____.
Definition

15%

pain

Term
There are two sleep states for the newborn.  In _____ sleep, respiratory rates vary, there are frequent _____ movements, and the infant can startle easily.  In ______ sleep, there are few ______ movements and respiration is deep and regular.
Definition

Light

motor

Deep

motor

Term
Healthy newborns spend up to ____% of their time sleeping, mostly in short naps.  Over the first ____, the infant begins to spend more time in ______ sleep as opposed to _____ sleep, and in the waking state there is an increase in the ______ state.
Definition

60%

month

deep

light

alert

Term
All women should be offered HIV testing and alpha-feto protein or triple screen testing at ___ to ___ weeks
Definition
15 to 18 weeks
Term

Of the following, which lab is not routinely performed during pregnancy:  

 

Pap smear, Gonococcal and Chlamydia, HIV, Sickle cell, TB (in high risk groups), VDRL, Varicella antibody

Definition
HIV (should be offered at 15-18 weeks but not routinely performed)
Term
What is recommended daily protein intake for a pregnancy diet?
Definition
80-100 grams
Term

Mother should take in daily:

 

___ servings of meat, fish, nuts, legumes, tofu 

___ servings of dairy

___ servings of green veggies

___ serving of yellow veggies

___ servings of fruit

___ servings of whole grains

Definition

2-3

2-3

2

1

3

3

Term
Preeclampsia can be prevented by eating at least ___ grams of protein a day.
Definition
75 grams
Term
Toxoplasmosis is a ________ infection.  If contracted after the ___ wk of gestation it can cause congenital anomalies, most severe of which are (4 things)
Definition

protozoan

10th

anencephaly, hydrocephalus, microcephaly, intracranial calcifications 

Term
How is Toxoplasmosis contracted? (2)
Definition

Raw or undercooked meat (esp pork)

Cat feces or contaminated soil

Term
True or False:  toxoplasmosis infected babies usually show signs at time of birth.
Definition
False- many babies do not show symptoms at time of birth
Term
What two complications should be discussed early in pregnancy since there is no time to explain during such emergencies?  The explanations should include what 4 things?
Definition

Hemorrhage and fetal distress

Possible causes, procedures for handling, your training, tools and techniques for stopping bleeding and resuscitating baby

Term

Lidocaine spray or gel is administered directly to _______, and then ______ injections of ___ or ___% are administered into the _____ of the laceration.  

 

___ to ____ cc's should be in syringe, but only ___ cc is administered in each location, with the injection starting at the ___ of the tear.

Definition

laceration

subcutaneous

1 or 2%

edges

 

5-10cc

1cc

top

Term
In childbirth, shock is most often caused by _________?  What is this also known as?  What is another possibility?  
Definition

blood loss

hypovolemic shock

septic shock

Term
What are 6 symptoms of shock?
Definition

- cool, clammy skin

- weak and rapid pulse

- dull eyes

- faintness

- weakness

-confusion

Term
Any delay in treating shock can result in what two things?
Definition

Multisystem organ failure

Death

Term

When dealing with shock what three things should you do?  (Hint: DCS)

 

 

Definition

Determine cause of blood loss

Contain it

Stabilize mother

Term
What are steps (in order) for treating shock?
Definition

1) Mom positioned flat on her back with feet elevated

2) Kept warm without overheating

3) Oxygen and fluids should be administered

4) Encouraged to breathe deeply and calmly

5) EMS notified and mother prepped for transport

Term
What situations or procedures prompt the injection of Rhogam?
Definition

Rh negative woman carrying an Rh positive child

Rh negative woman miscarries or has an abortion

CVS

Amniocentesis

Csection

*Any other procedure that could cause fetal-maternal transplacental hemorrhage (TPH)

Term
What disease can affect an Rh+ fetus in a sensitized Rh- mom?
Definition
Hemolytic disease of the newborn
Term
Methergine is an ______ derivative used to control uterine bleeding after delivery.  It is offered as an ______  _____ or _____ ______ and can be given when bleeding occurs or as a __________.  It promotes _______ _________.
Definition

Ergot

oral medication

intramuscular injection

preventative

uterine contraction

Term
Both methergine and pitocin are used when the placenta must be _____________ or when ____________________
Definition

manually removed

it separates but maternal bleeding doesn't cease

Term
Vitamin K is administered routinely to newborns to prevent ________.  It activates precursor proteins that in turn make _____ _______ proteins.  Injected vitamin k stimulates _________.  It can also be found in _______ tablets which an expectant mother can take regularly in the last weeks of pregnancy to facilitate clotting after giving birth.
Definition

hemorrhaging

blood clotting 

clotting

alfalfa

Term
Vitamin A is a teratogen in large doses which can cause ______ ______.  It can also affect the _______ _______.
Definition

birth defects

maternal liver

Term
Vitamin C can cause increased absorption of _____ which in turn can cause problems when taken in excess
Definition
iron
Term
Calcium (when taken in excessive quantities) can affect ________ function and cause ________ _______ as well as decrease absorption of _______, _______, and ___________
Definition

kidney

kidney stones

iron

magnesium

zinc

Term
Iron (when taken in excessive quantities) can decrease absorption of _______, ______ and _______
Definition

zinc

copper

calcium

Term
Before administering additional vitamin or mineral supplementation, what should you first take into consideration?  
Definition
The mother's diet, including any herbs or other supplements being ingested.  
Term
Pregnancy multivitamin contains appropriate levels of the vitamins most needed in pregnancy including increased _______ ____ and ______
Definition

folic acid

iron

Term
Vitamin C functions as a ___________ __________, often given to ____________?
Definition

preventative antioxidant

ward off infection

Term
Vitamin E functions as a non-specific chain breaking _________. Also used occasionally to relieve ______ _______
Definition

antioxidant

varicose veins

Term
Folic acid prevents ________ anemia in adults and _____ _____ ______ in the fetus
Definition

megaloblastic 

neural tube defects

Term
Vitamin B6 functions as a coenzyme in the metabolism of amino acids and glycogen.  It may also reduce ________ __________
Definition
morning sickness
Term
Vitamin B12 reduces the occurrence of ____ _____ ______ damage in the newborn from a deficiency of _____
Definition

central nervous system

B12

Term
Iron is a component of hemoglobin which is used for _____ transport in the red blood cell
Definition
oxygen
Term
Calcium functions in blood _______, ______ contraction, ______ transmission and _____ and ______ formation.  It may also relieve pregnancy-based _________
Definition

clotting

muscle

nerve

bone 

tooth

hypertension

Term
Magnesium helps prevent ________ ______ and stops it if it occurs
Definition
preterm labor
Term

Risks of ultrasound:

- can give a false sense of _______ to the fetus

- can give a false positive indications of ________ conditions

- ubiquitous use can cause an over-reliance on _______ and increase ________ costs

Definition

wellness

abnormal

technology

health care

Term
Ultrasound is best used in cases where the mother has _____ _______ that may decrease the chances of an optimal pregnancy outcome
Definition
risk factors
Term
Some studies of ultrasound show that _____ and _____ decrease when ultrasound is performed
Definition

alcohol 

tobacco

Term
As the biophysical profile score ________ the risk of complications ________.  A score of 4/10 means that _______ ______ has likely occurred and indicates a need for delivery.
Definition

decreases

increases

perinatal asphyxia

Term

What is indicated when following are known or suspected:

IUGR

oligohydraminos

insulin-dependent diabetes

multiple pregnancy

pre-eclampsia

postdatism

 

Which 2 require twice weekly testing while rest only require once weekly?

 

Definition

Biophysical profile

 

Insulin dependent diabetics, postdate pregnancies

Term
During a BPP, amniotic fluid volume is considered to be a measure of _____ ______ function
Definition
fetal renal
Term
What does a BPP consist of? What equipment is used?
Definition

NST, amniotic fluid volume, fetal muscle tone, gross fetal movement, respiratory activity

 

Electronic fetal monitoring (NST), Ultrasound (rest)

Term
Decreased blood flow to the kidneys reduces volume of ________ _______.  This presents as ____________ in the uterus
Definition

amniotic fluid

oligohydraminos

Term
Fetuses with anomalies, especially of the ______, _________, or _________ system may have decreased BPP scores characteristic of their specific anomalies.
Definition
CNS, respiratory, genitourinary
Term
PPV using a bag and mask is indicated when the newborn does not exhibit _______, ______ respirations or if the color is ______ after positioned on its back with the neck slightly extended and _______ stimulation has been ineffective
Definition

spontaneous, regular

dusky

tactile

Term
What test describes and categorizes abnormal epithelial cells?
Definition
Pap smear
Term
When should pap smears be performed in pregnancy?  Why?  When should a second smear be taken?
Definition

Early

Hormonal changes may precipitate abnormal cell growth

6wks postpartum (check for any differences from early pregnancy)

Term
Actinomyces israelii has been found to cause ________?
Definition
pelvic inflammatory disease
Term

Basic suture kit should contain:

___ needle holders

____ tissue forceps

____ mosquito hemostats

____ sharp scissors

Gauze pads

Betadine

Suture material

Definition

2

1

2-3

1

Term
What instrument should be used to control small bleeding vessels and never used for anything else?
Definition
Mosquito hemostats
Term
Vaginal fluid is very acidic or alkaline?
Definition
Acidic
Term
Hemoglobin should be ___g/dl or greater and hematocrit ___% or greater
Definition
11, 33
Term
CBC includes the _________ and ________.  It also reports the number of _____ with their indices, the number of _____ with their type differential, and the number of _______.  
Definition

hemoglobin

hematocrit

RBC

WBC

platelets

Term
A higher than normal white count may indicate the presence of ________.  Lower than normal platelet counts can result in ______ or extended ______.
Definition

infection

bruising

bleeding

Term
Normal fasting glucose level is less than ____ mg/dl.  A higher reading indicates the possibility of __________ _______
Definition

99

gestational diabetes

Term

Consider the following before doing a urinary catheter:

- Whether the bladder is _________

- Whether the mother has urinated in the past ___ hours

- Whether the risk of ______ _______ is greater than the need to empty the bladder

- Whether a ________ is expected

Definition

distended

2

bladder infection

complication

Term
Rh factor is an ______ that resides on the blood cell of Rh ___ individuals
Definition

antigen

+

Term
ABO incompatibility can also cause some _______ in the baby if a type ___ mother receives A or B cells from the fetus due to a fetal/maternal cross bleed
Definition

jaundice

O

Term
A history of fibroids can cause what two problems?
Definition

Disrupt placental implantation

Increase chance of postpartum hemorrhage

Term
Cone biopsies can cause scarring that reduces _______
Definition
dilation
Term
Cervical cauterization and cryosurgery may cause ______
Definition
scarring
Term
LEEP laser surgery may be implicated in cases of ____________ and ____________
Definition

incompetent cervix

premature labor

Term
A contraceptive history of _____ use may cause anemia due to excess menstruation
Definition
IUD
Term
__________ and ____ use can cause scarring of the uterine lining and result in ectopic pregnancy, irregular implantation of the placenta and third stage hemorrhage
Definition

Pelvic inflammatory disease

IUD

Term
Oral contraceptive use can cause a _______ deficiency
Definition
folic acid
Term
Breast exams should be performed every _____ , ____ to _____ hours after the end of a menstrual period
Definition

month

24-48

Term
Key words to remember for remedying sleep difficulties
Definition
exercise during day, eye pillow with flax and lavender, skullcap, valerian, hops (last trimester), aconite 30c for anxiety, lemon balm, oats/oat straw
Term
What is the easiest way to get B12 into a vegan mother?
Definition
Supplemental B12 in the active form of cyanocobalamin or hydroxocobalamin
Term
True or False:  Fermented soy products, shiitake mushrooms, seaweed and spirulina are the best sources of B12
Definition
False- contain an analog of B12 that can block actual B12
Term
Good sources of B12 (3)
Definition

Fortified soy products

Fresh juices

Sublingual tablets

Term
Why can yeast overgrow during pregnancy?
Definition
Due to higher alkalinity of vaginal secretions during pregnancy and associated increase in progesterone levels
Term
Treatment for yeast overgrowth
Definition
Insertion of vaginal sponges (boiled to reduce mineral deposits) or cotton tampons soaked in acidophilus culture solution (changed every 3 hours)
Term
Gardnerella or hemophilus is another name for _______ ________
Definition
Bacterial vaginosis
Term
Bacterial vaginosis can cause what 3 things when it presents during pregnancy
Definition

Chorioamnionitis

PROM

preterm labor

Term
S/stx of Bacterial Vaginosis include a ______ odor to vaginal secretions, a thin _____/______ discharge that adheres to the vaginal walls, and typically no vaginal ________
Definition

fishy

gray/white

itching

Term
What test is used to diagnose BV?  What solution is used for this test?  What indicates a positive test?
Definition

Whiff test

KOH solution

Potent fish odor

Term
What is the treatment for BV? What should woman abstain from until BV treated?
Definition

Unnicked garlic clove inserted into vagina 3x/day followed by 5 days of acidolphilus treatment.  

 

Sexual intimacy

Term

Where should the fundus be at:

 

10 weeks

12 weeks

16 weeks

20 weeks

Definition

Slightly above pubic bone

Few cm above pubis

Halfway between the pubic bone and the umbilicus

Exactly at umbilicus

Term
What is Naegele's rule for calculating EDD?
Definition
LMP-3 months + 1 week  (10 lunar months or 40 weeks)
Term
Mittendorf's study showed the average length of gestation to be ?
Definition
41 weeks and 1 day
Term

What is Nichol's Rule for 1st time moms?  2nd?  >28 day cycles? <28 day cycles?

 

What should also be recorded in addition to LMP?

Definition

1st time:  LMP +12 months- 2 months, 14 days= EDD

2nd time:  LMP +12 months- 2 months, 18 days= EDD

>28 days:  EDD + (days in cycle -28) = EDD

<28 days:  EDD - (28 dyas - days in cycle)= EDD

 

PMP (Previous menstrual period)

Term
Remedies for heartburn during pregnancy
Definition

Frequent small meals and digestive aids *most effective

Limiting fat intake

Avoid lying down immediately after eating

Digestive aids (ie dandelion leaf, RR leaf)

Slippery Elm lozenges

Raw almonds

Raw papaya/papaya enzymes

Term
If mother's pre-pregnancy weight was appropriate for frame and height, she should gain an average of ___ pound a week
Definition
1
Term

Underweight women should gain ___ to ___ pounds

Normal weight women should gain ___ to ___ pounds

Overweight women should gain ___ to ___ pounds

Obese women should gain less than ___ pounds

Definition

27 to 40

25-35

15-25

15

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