hey everyone it's nurse Sarah and in this video I'm going to go over maternity nursing questions and answers for inlex so let's get started this question says your patient is 24 weeks pregnant and you're measuring the fundal height which finding below is a normal measurement for this patient a 16 cm b 28 CM C 26 CM or D 12 CM to answer this question you have to remember that with fundle height after 20 weeks the number of weeks that person is pregnant is going to match their funel he plus or minus 2 cm so try to commit that to memory so our patient is 24 weeks so plus or minus 2 cm should be their measurement so on the low end the minus cenm they should be measuring the lowest 22 cm at the highest the plus part they could be measuring 26 CM so 22 to 26 is our measurement therefore since we know that information this question is relatively easy the answer is C this question says you're collecting the one minute appar on a newborn you note the heart rate to be 140 beats per minute the baby's cry is strong and regular the body is pink with slightly blue hands there is some flexion of arms and legs while assessing the newborn it moves and cries what is the newborn's appar score is it A5 B9 C6 or d8 to answer this question you got to be familiar with the appar scoring so this is a quick assessment tool that a nurse can use whenever a baby is born to let you know how that baby's doing so it's developed by Virginia apgar and her last name is spelled a p g a r and we use it as an acronym to help us go through this checklist of things while we're assessing that newborn afterbirth so you're looking at the appearance hence baby skin color you're looking at Pulse what's their heart rate G is for grimace their reflex irritability then we have their activity hence their muscle tone and then R is for respiration their respiratory effort now the avar scoring is performed at 1 minute and 5 minutes after birth and if that score is like six or less it'll be reassessed at 10 minutes now each of those little categories I went over you can score them from0 to two so you add those up and the highest score you can get is a 10 now it's rare for a baby to have a perfect 10 at one minute after birth because a lot of newborns are going to have some cyanosis in their feet and in their hands so help us answer this question we got to go through that acronym and score each part 0 to two and then add it up and we have our appar score so first is appearance how does our baby look the question tells us that the body is pink with slightly blue hands so that is that Acro sinosis we're going to give them a one for that then pulse we're told the pulse is 140 beats per minute we're going to give them a two for that so now we're at three then for grimace we're looking at the reflex irritability so we're told that the newborn while assessing the newborn it moves and cries so they're going to get a two for that which puts them at five then activity we're told that the baby has some flexion of arms and legs so we'll give them a one for for that which puts us at six and then the respiratory effort in the question it says that the baby's cry is strong and regular so they get a two for that when you add all of that up you get an appar score of eight so so D is our answer this question says early decelerations are noted on the fetal heart monitor the nurse knows that blank is the cause of this finding in maternity nursing there are three types of decelerations that you want to be familiar with for exams we have early variable and late so you want to be familiar with what they look like and what causes them because this question specifically wants to know the cause of early decelerations so with early decelerations we are not concerned about this we expect this happen because what's happening is that while the baby's inside of the uterus the uterus is Contracting to help push the baby out and as it contracts it's going to put compression on the baby's head when it does that we're going to stimulate the vagus nerve because we're compressing it and that's going to drop the heart rate so that's an expected thing to happen now with variable decelerations this is not a good thing so if you see this bad sign because what's happening is that every time mom is having a contraction it's causing that baby heart rate to just Plum it and a normal fetal heart rate is anywhere between about 110 to 160 so what usually causes this is that the umbilical cord is being compressed so we know that that's not an option so we can go ahead and roll out C for that but how I like to remember that on whenever you're looking at it is that it looks like a V so you have Mom's contraction and then from where the heart rate just drops so low it looks like a V that's how I remember it and then with BL decelerations which is also a bad sign is that what's going to happen is that baby's heart rate is going to plummet long after the beginning of Mom's contraction and then recover way after mom's contraction is over and this is usually caused by utero placental insufficiency so we can go ahead and mark off a so D is just like a distractor prolapse uterus where you can mark that off as well so our answer is B baby head compression from uterine contractions is what's going to to cause those early decelerations here we're told during an assessment of a laboring woman it is noted the fetal station is plus two you interpret this to mean what so let's talk about fetal station what is this well this tells us where the baby's presenting part is located in the pelvis so when we're talking about presenting part we're usually talking about the head because most babies are head down and that's how they're going to come out but sometimes babies like to throw this off and it could be their hand their foot or so forth so in other words this fetal station is giving us an idea of how far that baby has descended down in the pelvis so we can be prepared for delivery so how is fetal station measured well you want to remember an important Landmark known as the isial spine so this question tried to trick you in its options by throwing in iliac spine that is not the landmark we use it's isial spine so go ahead and eliminate A and B so you have a right and a left isal spine if we drew an inary line it would look something similar to what this picture is on the screen where this Baby's descended down in the pelvis and so what we're looking at are 5 cm above that line and 5 cm below that line and when we report fetal station we don't say the baby's at 2 cm above the line or 2 cm below the line we refer to it in negative or positive numbers so here's our line everything above the line from up to 5 cm are negative numbers and everything below that in the line are positive numbers so how I like to remember that is that okay if we're in the negative unfortunately that means our baby is still in that pelvis it's not ready to be delivered yet so on the negative side mom is still in labor but if we're in the positive side okay things are going baby's almost here this is a positive for Mom they get to meet baby and labors going to be over so our question tells us that the fetal station is plus two so get your line out and just think these are negative numbers these are positive numbers we're at positive2 that means baby's almost here and labor is almost over that is a positive thing So based on our options is it C the baby's presenting part is 2 cm above the issal spine remember above were those negative numbers so nope and then D which is our answer the baby's presenting part is 2 cm below the line and that is our answer this question says your patient is 48 Hours postpartum while assessing fundle height you would expect the fundle height to be what so during the postpartum period we are paying close attention to that fundus of the uterus we want to make sure that it is firm and midline it's not soft and boggy and that that uterus is starting to shrink down where eventually it will go back to pre pregnancy size so we're going to be looking at that fundle height so there is a general rule that you just want to commit to your memory so you can get questions like this right so during that postpartum period the fundle height should decrease by 1 cm per day below that belly button so if your patient is 48 Hours like they are here they're 2 days so according to that rule they should be at 2 cm below the belly button so our answer is B here we're told we have a patient who is 27 weeks pregnant and they have had a 3-hour glucose tolerance test performed below are the patient results so we need to interpret the results as either normal or abnormal so again we have one of those alternate format questions we have where it's the patients report of what those results were and then we need to click the drop- down box and tell if it's normal or abnormal typically a 3-hour or oral glucose tolerance test is performed because a patient did not pass their 1eh hour oral glucose tolerance test so they need further investigation because we're trying to rule out gestational diabetes so for this what's going to happen is the patient's going to have to come back to the office they're going to be there for a little while and um before they come they have to make sure that they've been fasting and then immediately they're going to get a blood draw and then after they get a blood draw they're going to have to drink about 100 gram solution of glucose and then at the one hour mark they get more blood drawn then two hours they get more blood drawn and then three hours they get more blood drawn so with this we are looking at how those glucose readings are trending and what we're looking for with those measurements are two or more abnormal results during those hour intervals when we measure the glucose and that would point us to gestational diabetes and on your screen you're going to see what those abnormal results would be be during those intervals so the initial blood draw or fasting one where the patient shouldn't have anything in their system an abnormal result would be that their sugar was greater than 95 milligram per deciliter then they take in that oral solution and we expect their glucose to go up because they're taking in some so at 1 hour we would not want it greater than 180 Mig per deciliter then as the next hour goes we want the glucose to be trending downward so so an abnormal result at 2 hours would be greater than 155 and then at 3 hours which should be a lot lower than the first and the second hour an abnormal result would be greater than 140 so now that we have that information we just have to plug it into this table with this drop- down box so with the fasting the patients is 94 milligram per deciliter so they're sort of on the edge a little bit but it is less than 95 so we're going to put that it's normal then the next one the 1 hour was 210 we know that it is going to Trend upward because they took in some glucose about an hour ago however we don't want it that high so because anything greater than 180 would be abnormal so that's abnormal and then we have 2 hours it was 180 we wanted that's high so that is going to be abnormal because anything greater than 155 was abnormal and then let's see what our 3-h hour one was was it was 130 so they're actually normal for that so we're going to put normal because anything greater than 140 was abnormal So based on this they have two or more abnormal results so they definitely are looking at gestational diabetes this question says a 28-year-old patient gives birth to twins at 38 weeks gestation this is the patient's first pregnancy which option below best describes the patient's gravidity and Par is it a grabit a one pair of one B gravita one pair of two c grabit a two PA of two or d gravita a one para zero to answer this question we have to review gravidity and parity so gravidity is the number of times a person has been pregnant regardless of the outcome and in this question we're told this is the patient's first pregnancy and that they just gave birth to twins so we know they've been pregnant once but they've had twins now a lot of people get confused on this but don't let this confuse you with gravidity multiples it doesn't matter if they're having triplets quadruplets a million of them I don't know it only counts as one pregnancy so it would be gravita one okay we have that now let's talk about parity parity is the number of birth so hence completed pregnancies after 20 weeks of gation so we're told that this pregnancy ended at 38 weeks gestation so again just like with gravidity multiples hence twins onward they count as one so don't let yourself think it's two but it's one so we have a gravit of one a pair of one so our answer would be a here we're told we have a patient with preeclampsia and they're started on magnesium sulfate the nurse knows to have what medication on standby while the patient is receiving this medication preclampsia is a hypertensive disorder that can occur during pregnancy it typically happens around 20 weeks gestation and unfortunately what it can lead to are seizures so we don't want a pregnant person to have seizures because it can lead to death and death of the baby so whenever a patient's receiving magnesium sulfate what it's going to do is it's going to slow things down and decrease the risk of the person having a seizure however whenever they're on magnesium sulfate we got to make sure we're not giving them too much magnesium sulfate signs and symptoms of toxicity with this is that they have decreased deep tendon reflexes so that's why we're always checking those and if that happens we need to give them the antidote and just need to remember the antidote for magnesium sulfate and it is calcium gluconate So based on this we know that our answer is D this question says during a prenatal visit a patient tells you her last menstrual period was August 15 2016 based on the nagles rule what is the estimated due date of her baby nagles rule is used to estimate a baby's due date based on the patient's last menstrual period And it calculation is based on that the patient's going to have a 28-day cycle and that the gestation period is going to last for 280 days which is 40 weeks and we know that that's not always the case a lot of patients don't have 28 day cycles and a lot of pregnancies go on a little bit longer than 40 weeks especially for first time moms so this is just really an estimation for a due date so whenever you're calcul in this you want to take into account some things because some months are a little bit trickier than others first of all the month of February some years there's a leap year so we're not even going to add the leap year with the 29 days because we know February has 28 just always give February 28 days also know which months have 30 days versus 31 days so again September April June and November all have 30 days so we're told our patients last menstrual period was August 15th 2016 so first what we're going to do is we're going to subtract 3 months from that last menstrual period when we subtract 3 months from August we get May then second we are going to add seven days to that last menstrual period date it was the 15th so when we add seven to that that gives us 22 and then we're going to add a year do not forget to add that year because that would be an easy mistake to do so we know the patient can't have it in 2016 so out a year so it's going to be 2017 so our estimated due date is May 22nd 2017 now the way that you calculate that it is best used whenever the patient's last menstrual period Falls between the months of April and December however if it fell between January to March just so you don't get confused it may be a little bit easier to do the following add 7 days to the last menstrual period and then just add n months so just keep that in mind whenever you're doing this rule this question says a 36-year-old patient who is 38 weeks pregnant reports having dark red bleeding the patient experienced abruptio placente with her last pregnancy at 29 weeks what other signs and symptoms are likely to present with abruptio placent select all that apply abruptio placent also known as placental abruption is where that placenta detaches from the uterine wall this could be partial Detachment or complete Detachment whatever it is it is not good for the baby or the mother because we have learned that the placenta is really what provides the baby with nutrients so if we're detaching that from the uterine wall we're going to limit the nutrients and oxygen that baby can get and instead it's going to keep its waste and deoxygenated blood which eventually can lead to fetal death in addition the mother can Hemorrhage and develop DIC which is disseminated intravascular coagulation so with this you want to remember how the patient is going to present and remember this pneumonic I created called detached so D is for dark red bleeding e is for extended fundle height this is going to be for concealed bleeding T is for tender uterus a abdominal pain/ contractions C concealed bleeding that can stay inside the uterus and then back flow into the fian tubes the patient can enter shock without even seeing the amount of blood loss H is for hard abdomen e for experiences DIC this is a super event of clotting in the body followed by a depletion of clotting factors that leads to uncontrolled bleeding and possibly death and then lastly D for distress baby you're going to see heart rate tone abnormalities So based on that information all we have to do now is just check our boxes so decrease in fundel height no we know from that pneumonic we're going to have an increase in fundle hey because we can have some concealed bleeding so we're not going to check that hard abdomen yes check that fetal distress absolutely they're being deprived of oxygen and nutrients so check that one abnormal Al position this is actually going to present with placental preia where we have a lowline placenta sometimes it can be over the cervix because it's not positioned where it's supposed to be that alters baby's position in the womb so that would be more with that condition and then te tender uterus absolutely from where we've had the Detachment of it so we're going to check that here we have a 25-year-old patient who is 18 weeks pregnant that reports feeling fluttering in the lower abdomen the patient states it feels like the baby is moving this is known as what in maternity nursing there's a lot of specialized terms that are used and anytime you see those terms you want to make sure you commit those to memory because chances are they're probably going to be on a test so let's take each of these options and eliminate them okay so the patient is reporting fluttering it's like the baby's moving what is a fancy term that they're going to use in maternity nursing for that so let's look at a blotman what is this well this this is a probable sign of pregnancy and this is where there's the returning of the fetus hence the fetus is just like bouncing up against the examiner examiner's fingers whenever the fingers are pushed onto the uterus this is like external blotman this is not what the patient's reporting so we can x that out B quickening this is a presumptive sign of pregnancy and what's happening is that the person is feeling the baby move in the abdomen a lot of times it's described as fluttering like here in this question in the lower abdomen or some people even say it feels like gas and it can happen as early as 16 weeks this is usually for second time moms who've had babies before so um that's looking good for our answer but let's look at the other ones and just go over it just for your knowledge so a c hegar sign this is where the lower uterin segment is softening so this happens anywhere between 6 to 12 weeks of gestation that's not the case here and then D good El sign this is where you have softening of the cervix and this happens about 6 to 8 weeks gestation so that's not it our answer is B this question says a patient presents with a possible pregnancy during examination it is noted that the patient has softening of the cervix H I wonder where we've heard about that before this is known as what profitable sign of pregnancy so many of you may already know the answer to this question because we s of talked about it already but it's still a good question to go over because it has some of those specialized terms in it that you want to be familiar with because you may see it on an exam so we've already talked about Goodell sign and Hagar sign but what about Chadwick and Palmer sign okay first Palmer I like to think of the palm of your hand and um with this what sign it is is that the patient starts to get uterine contractions during a b manual exam ation so think about Hand by manual examination is causing uterine contraction it's the palm of the hand that's how I remember that and then Chadwick sign is where we have bluish coloring to the vulva the cervix and the vagina due to increased blood flow and this typically happens around four weeks of gestation and how I remember that is I just remember someone named Chadwick and they're sort of bluish colored so again uh the the question wants to know about softening of the cervix so we know know that that's a Goodell sign here we're told you're performing a routine assessment on a mother after delivery the uterus is soft and displaced to the left of the umbilicus what is your next nursing action here we have a scenario where we are doing our fundal checks and typically whatever based on your hospitals protocol but typically after birth you're going to be checking that fundus every 15 minutes for 1 hour and then 30 minutes for 2 hours and so forth and so you're looking at how it's presenting is how does it feel hard soft is it boggy what's its position so here we're told that it's soft and displaced to the left of the umbilicus the belly button so that is an abnormal finding and whenever you see that that should be sending off little bells uhoh that's not good so as a nurse I need to do something to help that out and what have I been taught that I do that will help that out so what you're going to do is that you want to make make sure that you are providing fundle massage those are not fun for the patient and I can tell you firsthand because I've had it done to me twice from having two kids they're not fun but they're necessary but anyways that was a side note so you want to do fundle massage and um have the patient go to the bathroom because many times why why it's presenting like that soft and displaced is because there is a full bladder so that's one easy step that can be taken to do that so that should be the next nursing action therefore a is our answer so why are the other ones not the answer will B continue to monitor the mother this is a normal finding no it's not so that's not the answer C notify the healthc care provider that maybe would be a little bit later on if you've done the funel massage they've went to the bathroom you're doing those funel checks and it's still soft and displaced then we would do that but that's not the next nursing action and then D administer PRN dose of pin as ordered by the healthc care provider no that's not what we're going to do so a is the answer this question says a patient who is 39 weeks pregnant arrives to labor triage the patient's pratal history includes gravidity 3 parody 2 what signs and symptoms below indicate the patient is experiencing true labor select all that apply this question is going to have multiple answers and it's really wanting you to be able to identify true labor versus false labor so it's really just the process of elimination and we'll check the boxes of the ones that indicate true labor because there's some defining characteristics now I created a pneumonic to help you remember the signs and symptoms of true versus false and it's really easy to remember so for True labor you're going to remember the word true and then for false labor you're going to remember the word fake so true labor we're going to have timing of contractions regular radiating contraction pain unable to relieve contraction pain with activity exam changes present and then for false labor we have fakes so fails to cause changes to cervix and baby's position activity diminishes contractions keep feeling contractions above the belly button they don't radiate from back to abdomen and then erratic timing of contractions so now we're just going to take that information from the pneumonic particularly the true labor pneumonic which was true and um we're just going to eliminate what we don't need okay first up the patient states the contractions are located above the umbilicus that is with false labor so we can delete that off um changing positions and walking does not decrease discomfort that's with true because the U part of our pneumonic was unable to relieve contraction pain with activity person's trying to do other activities to make the pain go away it's not helping so check that one the contractions are regular yep that was the te part check that and then the cervix is 90% of face and dilated to 4 cm so that was the E part exam changes present so we're going to go ahead and check that okay so that wraps up this video over maternity nursing questions and answers for the inlex exam and don't forget to access the other videos in this series by clicking the link in the description below