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Answers

HESI Review
March 10, 2009

Obstetric Questions

Please state whether the following statements are TRUE or FALSE

1. False.
Remember: When an NST (nonstress test) is “reactive” (favorable), this means there are
(2) accelerations of the fetal heart rate in 20 minutes. An acceleration is defined as 15
beats above baseline, lasting 15 seconds.

2. True.
When a CST (contraction stress test ) is “negative” (favorable) this is reassuring because
it means there are no late decelerations of the fetal heart rate in response to contractions.
Remember: Late decelerations of the fetal heart rate are associated with uteroplacental
insufficiency (compromised blood flow to the placenta). Repetitive late decelerations
are a sign of fetal distress and nursing intervention is required.
A CST can also be referred to as an “OCT” (oxytocin challenge test). Remember, there
must be 3 contractions in 10 minutes when conducting a CST (OCT).

3. False.
Bluish discoloration of a newborn’s hands and feet after delivery is normal. It is called
“acrocyanosis” and it is NOT associated with respiratory distress. It may be caused by
“sluggish” peripheral circulation and it generally resolves within several hours after
birth.

4. True.
RhoGAM is a form of immune globulin (passive immunity). It is given as an IM
injection to pregnant women who are Rh negative (and the partner is Rh positive).
Rh negative women are given rhoGAM at 28 weeks gestation. This protects the current
pregnancy. Sometimes, rhoGAM is given sooner if the Rh negative woman experiences
significant bleeding or placental abruption or pregnancy loss before 28 weeks.
RhoGAM is given to PREVENT SENSITIZATION (prevent antibody formation) to
the Rh antigen. Rh negative women who become sensitized (develop antibodies) to the
Rh antigen can lose the current pregnancy or subsequent pregnancies because these
antibodies will cross the placenta and destroy the red blood cells of an Rh positive
fetus (erythroblastosus fetalis). This is life-threatening to the fetus.
Remember, after delivery, if the newborn is Rh positive, the Rh negative woman will
need a second injection of Rhogam (within 72 hours of delivery) to prevent
sensitization (antibody formation) which may have occurred at the time of delivery. This
injection of RhoGAM protects the next pregnancy.

5. False.
Remember: A BPP (biophysical profile) is done to establish fetal well-being, NOT to
check for birth defects. A reassuring score on a BPP is 8 or 10. A score of 4 or less
means impending fetal demise unless intervention occurs. There are (5) components to
the BPP (Amniotic fluid volume, Fetal heart rate (NST), Fetal movement, Fetal tone, and
Fetal breathing movements). A BPP can only be done in the 3rd trimester (28 weeks to
delivery) because reactivity of the fetal heart rate (NST) only occurs after this time.

6. True.
A primigravida (G1) is a woman in her first pregnancy. She is likely to experience
quickening at 20 weeks. A multigravida (G2 or more) will likely experience
quickening at 16 weeks. Quickening is the pregnant woman’s perception of fetal
movement. It is a subjective (presumptive) sign of pregnancy.

7. False.
A positive pregnancy test is an objective (probable) sign of pregnancy. Remember:
There are only (3) positive (diagnostic) signs of pregnancy (Auscultation of fetal heart
tones, Visualization of the fetus, and Palpation of fetal movement or the fetal outline
by a trained examiner). This means the fetus must be “seen, heard, or felt” (by a trained
examiner) to make a positive diagnosis of pregnancy.

8. True.
Amenorrhea (absence of menses) is a subjective (presumptive) sign of pregnancy.
Presumptive (subjective) signs of pregnancy are symptoms the woman reports (ex:
urinary frequency, amenorrhea, breast tenderness, nausea).

9. True.
Chadwick’s sign (bluish discoloration of the cervix and vaginal mucous membranes) is
an objective (probable) sign of pregnancy. Objective (probable) signs of pregnancy are
signs that can be verified by a third party (ex: positive pregnancy test, Chadwick’s
signs, Goodell’s sign).

10. True.
Auscultation of the fetal heart beat is a diagnostic (positive) sign of pregnancy.
Auscultation by Doppler usually occurs at 10 – 12 weeks gestation.
11. False.
Early decelerations of the fetal heart rate are NORMAL. They occur as a result of fetal
head compression which occurs as the fetus descends in the pelvis. The only nursing
responsibility is to document their presence. No interventions are needed because early
decelerations of the fetal heart rate are a sign that labor is progressing.

12. False.
Variable decelerations of the fetal heart rate are caused by umbilical cord
compression. Variable decelerations can be mild, moderate, or severe. If moderate or
severe, the nurse must FIRST change the woman’s position to try and alleviate cord
compression. If that is not successful, an amnioinfusion may be ordered (instillation of
warm saline into the uterus) in order to relieve cord compression.

13. False.
PIH (pregnancy induced hypertension or preeclampsia) will compromise blood flow to
the placenta. Therefore, infants born to women who have PIH will likely be SGA (small
for gestational age). The terms SGA and IUGR (intrauterine growth restriction) are
similar in meaning.

14. False.
Women with PIH are at increased risk for placental ABRUPTION (premature
separation of the placenta before delivery). Remember: the number one risk factor for
placental abruption is maternal hypertension (PIH or chronic hypertension). All women
with PIH are at risk for placental abruption. Placental abruption is characterized by
painful, dark red bleeding.

15. True.
Magnesium Sulfate is a CNS depressant which reduces the risk of seizures in women
who have PIH (preeclampsia). Magnesium Sulfate is not considered an antihypertensive
agent. Therefore, a woman receiving magnesium sulfate for PIH may also need
Apresoline (Hydralazine) to lower her blood pressure.

16. True.
Magnesium Sulfate can also be used to treat preterm labor because it is a tocolytic.
Tocolytics relax the uterus. Remember: women who receive magnesium sulfate during
labor are at higher risk for postpartum hemorrhage due to uterine relaxation.

17. False.
18. True.
Terbutaline (Brethine) is a tocolytic. It is used to treat preterm labor. It is a beta-2
agonist. One side effect is increased maternal glucose. This puts newborns at risk for
neonatal hypoglycemia. Remember: Terbutaline also increases maternal pulse. A
woman’s pulse must be checked before she can safely receive Terbutaline (most sources
say hold the Terbulatine if maternal pulse is greater than 115 or 120 bpm).

19. True.

20. True.
Placental previa is caused by abnormal implantation of the placenta over the cervical
os. At term (38 weeks or more), complete placenta previa requires that a woman
deliver by cesarean section in order to prevent hemorrhage. Remember: Never
perform a bimanual (vaginal) examination of a woman with 3rd-trimester bleeding
unless an ultrasound has been done to rule out placenta previa.

21. True.
Remember: maternal glucose crosses the placenta (not maternal insulin). High levels of
maternal glucose cross the placenta and stimulate insulin release from the fetal
pancreas. Fetal insulin stimulates the growth of the fetus.

22. True.

23. True.
Amniocentesis can be done at 38 weeks if a woman has GDM to check fetal lung
maturity. If the L/S ratio is 2: 1 (or greater) and PG (phosphatidylglycerol) is present,
the fetal lungs are mature and it is safe to induce labor.

24. True.
Women with elevated glucose (or elevated Hgb A1C) early in pregnancy are at high risk
to have an infant with birth defects. It is essential that women with pregestational
diabetes achieve “euglycemia” (normal glucose) prior to conception and early in
pregnancy in order to prevent birth defects.

25. False.
This patient is a G3P1. “G” means the number of times a woman has been pregnant.
Don’t forget to count the current pregnancy. “P” means the number of completed
pregnancies that delivered after 20 weeks. Twins counts as (1) pregnancy.
26. True.
Nagele’s rule is applied using the FIRST day of the woman’s LMP. Add (7) days and
subtract (3) months. Don’t forget to change the year if this applies.

27. False.
A molar pregnancy (gestational trophoblastic disease) is considered a precancerous
condition. Molar pregnancies are diagnosed by ultrasound and by clinical
signs/symptoms (brownish vaginal discharge, size > dates, increased blood pressure
before 20 weeks, hyperemesis gravidarum, absence of fetal heart tones). Molar
pregnancies must be terminated by dilation and curettage. Patients are then asked to
refrain from pregnancy for (1) year. During this time, hCG levels are checked
regularly. Getting pregnant again DOES NOT increase the risk of developing
choriocarcinoma. It just makes it more difficult to interpret rising hCG levels. This is
why women are asked not to get pregnant for (1) year after termination of a molar
pregnancy.

28. True.
PID (pelvic inflammatory disease) causes scarring of the fallopian tubes. This
increases the risk of ectopic pregnancy and infertility. Remember: gonorrhea and
chlamydia are (2) organisms associated with PID.

29. False.
These symptoms suggest mastitis (infection of the breast). Breastfeeding should be
continued, even in the affected breast, because this promotes emptying of the breast.
Antibiotics are often used to treat mastitis (ex: dicloxacillin). These antibiotics are safe
for breastfeeding. The newborn will not “catch” mastitis from the mom.

Please complete the following statements:

1. Decrease.

2. Kleihauer-Betke

3. Immune Globulin

4. Hypertension (140/90) and Proteinuria (more than trace amounts)


5. Maternal Hypertension

6. hCG (human chorionic gonadotropin)

7. Progesterone and Estrogen

8. hCG (human chorionic gonadotropin)

9. Progesterone, Estrogen, hCG, hPL (human placental lactogen = human


chorionic somatomatotropin)

10. Progesterone. Progesterone PREPARES the endometrium for implantation


and PREVENTS CONTRACTIONS (keeps the uterus relaxed) during
pregnancy.

11. Folic Acid.

12. MSAFP (maternal serum alpha-fetoprotein). This screening test is done at 16 –


18 weeks gestation. Also, TSP (triple screen profile) can be used to screen for
neural tube defects (it also screens for Down Syndrome).

13. Fetal Lung Maturity. An L/S ratio of 2:1 (or more) and a positive PG
(phosphatidylglycerol) test mean that the fetal lungs are mature.

14. Surfactant.

15. Pica.

16. Iron-deficiency Anemia.


17. (5) Components of the BPP (Biophysical Profile):
Amniotic Fluid Volume
Fetal Heart Rate (NST)
Fetal Movement
Fetal Tone
Fetal Breathing Movements

Reassuring scores on a BPP are (8) or (10).

18. (5) Components of the Apgar Score:


Heart Rate
Respirations
Muscle Tone
Reflex Irritability
Skin Color

Remember: The Apgar score is assigned at (1) minute and (5) minutes after delivery for
ALL infants. It checks newborn adaptation to extrauterine life.

19. Acrocyanosis

20. Uterine Atony

21. Amenorrhea: Subjective (Presumptive)


Quickening : Subjective (Presumptive)
Auscultation of Fetal Heart Tones: Diagnostic (Positive)
Chadwick’s Sign: Objective Objective (Probable)
Goodell’s Sign: Objective (Probable)
Hegar’s Sign: Objective (Probable)
Urinary Frequency: Subjective (Presumptive)
Positive Pregnancy Test: Objective (Probable)
Ultrasound Visualization of the fetus: Diagnostic (Positive)
Palpation of fetal movement (or outline) by a trained examiner: Diagnostic (Positive)
Breast tenderness: Subjective (Presumptive)
Uterine enlargement: Objective (Probable)
Math Questions
1. Remember: 1 Unit = 1000 Milliunits
10,000 : 1000 : : 8 : X
8000 = 10,000 X
X = 0.8 mL/minute
0.8 x 60 = 48 mL/hr

2. 20,000 : 1000 : : 26 : X
26,000 = 20,000X
X = 1.3 mL/minute
1.3 x 60 = 78 mL/hr

3. 20,000 : 500 : : 10 : X
5000 = 20,000 X
X = 0.25 mL/minute
0.25 x 60 = 15 mL/hr