Module 1 Prenatal Flashcards
(231 cards)
1
Q
What are some of the risk factors related to infertility in women?
A
Women over 35 years of age, endometriosis, ovulation disorders, tubal occlusions, hormonal and adrenal disorders, past pelvic and abdominal procedures, spontaneous abortions, intercourse frequency, number of sexual partners across the lifespan, history of STI’s nutrition status (obesity, anorexia, malnourished), abdominal uterine contours, substance use (alcohol, tobacco, heroin, methadone)
2
Q
What are some risk factors related to infertility in men?
A
mumps (especially after adolescence), endocrine disorders, genetic disorders, abnormalities in the reproductive system, intercourse frequency, number of sexual partners across the lifespan, history of STI’s
3
Q
A nurse is caring for a couple who is being evaluated for infertility. Which of the following statements by the nurse indicates understanding of the infertility assessment process?
A. “You will need to see a genetic counselor as part of the assessment.”
B. “It is usually the female who is having trouble, so the male doesn’t have to be involved.”
C. “The male is the easiest to assess, and the provider will usually begin there.”
D. “Think about adopting first because there are many babies that need good homes.”
A
C. “The male is the easiest to assess, and the provider will usually begin there.”
4
Q
What are some things that are NON-PHARMECUTICAL that can be done to help with infertility?
A
nutritional and dietary changes, exercise, yoga, and stress management, herbal medications (only if prescribed), acupuncture, avoiding high scrotal temperatures
5
Q
What are some MEDICATIONS to help with infertility?
A
Clomiphene, Letrozole, and metformin.
6
Q
Which medications that help with infertility cause ovarian stimulation?
A. Clomiphene
B. Letrozole
C. Metformin
A
A. Clomiphene
B. Letrozole
7
Q
Which medication that helps with infertility helps to support ovulation?
A. Clomiphene
B. Letrozole
C. Metformin
A
C. Metformin
8
Q
What are some side effects when taking Clomiphene?
A
hot flashes, nausea and vomiting, bloating, breast tenderness/pain, headache, break through bleeding or spotting, diarrhea, blurred vision/ visual disturbances
9
Q
This is an infertility procedure that places prepared sperm in the uterus at the time of ovulation.
A. In vitro fertilization- embryo transfer (IVF-ET)
B. Donor oocyte
C. Surrogate mother
D. Intrauterine insemination
A
D. Intrauterine insemination
10
Q
In this procedure for infertility, it starts with the collecting of the patient’s eggs from the ovaries, fertilizing the eggs in the laboratory with sperm, and transferring the embryo to the uterus.
A. Therapeutic donor insemination
B. Gestational carrier (embryo host)
C. In vitro fertilization- embryo transfer (IVF-ET)
D. Gamete intrafallopian transfer
A
C. In vitro fertilization- embryo transfer (IVF-ET)
11
Q
This infertility proceudre consists of retrieving oocytes and immediately placing them with motile sperm. Both are placed together into a thin flexible tube. The gametes are then injected into the fallopian tubes using a surgical procedure called laparoscopy. A. Gamete intrafallopian transfer B. Surrogate mother C. Intrauterine insemination D. Donor oocyte
A
A. Gamete intrafallopian transfer
12
Q
In this infertility procedure donated eggs are collected from a donor by an IVF procedure. The eggs are inseminated. The embryos are placed in a recipents uterus. Prior to implantation, the recipient undergoes hormonal therapy to prepare the uterus. A. Surrogate mother B. Donor oocyte C. Therapeutic donor insemination D. Gamete intrafillopian transfer
A
B. Donor oocyte
13
Q
During this infertility procedure, a donated embryo is placed in the recipient's uterus, which is hormonally prepared. A. Surrogate mother B. Donor embryo C. Donor oocyte D. Gestational carrier (embryo host)
A
B. Donor embryo
14
Q
In this infertility procedure, a couple completes the process of IVF with the embryo placed in another person, who will carry the pregnancy. This is a contract agreement with the carrier having no genetic investment with the embryo. A. Donor embryo B. Surrogate mother C. Gestational carrier (embryo host) D. Donor oocyte
A
C. Gestational carrier (embryo host)
15
Q
This infertility process is when a person is inseminated with semen and carries the fetus until birth. A. Donor embryo B. Therapeutic donor insemination C. Surrogate mother D. Gestational carrier (embryo host)
A
C. Surrogate mother
16
Q
During this infertility procedure, donor sperm is used to inseminate a person. A. Donor oocyte B. Donor embryo C. Gestational carrier (embryo host) D. Therapetuic donor insemination
A
D. Therapeutic donor insemination
17
Q
This type of sign of pregnancy are changes the patient experiences that make them think they might be pregnant. These changes may be subjective manifestations or objective findings.
A. Presumptive
B. Probable
C. Positive
A
A. Presumptive
18
Q
This type of sign of pregnancy are changes that make the examiner suspect the client is pregnant. (primarily related to physical changes of the uterus)
A. Presumptive
B. Probable
C. Positive
A
B. Probable
19
Q
Which of these choices are presumptive signs of pregnancy? Select all that apply. A. Amenorrhea B. Hegar's sign C. Positive pregnancy test D. Fatigue E. Urinary frequency F. Ballottement
A
A. Amenorrhea
D. Fatigue
E. Urinary frequency
20
Q
Which of these choices are probable signs of pregnancy? Select all that apply. A. Nausea and vomiting B. Braxton Hick's contractions C. Quickening D. Goodell's sign E. Positive pregnancy test F. Abdominal enlargement
A
B. Braxton Hick’s contractions
D. Goodell’s sign
E. Positive pregnancy test
F. Abdominal enlargement
21
Q
Which of these choices are presumptive signs of pregnancy? Select all that apply. A. Quickening B. Uterine enlargement C. Chadwick's sign D. Nausea and vomiting E. Ballottement F. Breast changes
A
A. Quickening
B. Uterine enlargement
D. Nausea and vomiting
F. Breast changes
22
Q
Which of these choices are probable signs of pregnancy? Select all that apply. A.Chadwick's sign B. Uterine enlargement C. Hegar's sign D. Ballottement E. Breast changes F. Fetal outline
A
A. Chadwick’s sign
C. Hegar’s sign
D. Ballottement
F. Fetal outline
23
Q
What are the positive signs of pregnancy?
A
Fetal heart sounds,
Visualization of the fetus by ultrasound, and
Fetal movement felt by the examiner
24
Q
Softening of the cervical tip.
A
Goodell’s sign
25
Softening and compressibility of the lower uterus.
Hegar's sign
26
Deepened violet-bluish color of cervix and vaginal mucosa.
Chadwick's sign
27
When the HCP touches the end of the cervix upward and the mother can feel the baby bounce on the cervix.
Ballottement
28
False contractions that are painless, irregular, and usually relieved by walking.
Braxton Hick's contractions
29
What is amenorrhea?
No mesntral cycle. (no period)
30
You are educating a client on how to take an at home pregnancy test. What do you teach them?
Urine samples should be first-voided morning specimens and follow directions for accuracy.
31
Which tests provide the most accurate way of confirming a pregnancy?
Blood and urine tests
32
```
What hormone do blood and urine tests detect?
A. hCG
B. FSH
C. LH
D. Progesterone (PG)
```
A. hCG
33
```
Which hormones spike BEFORE ovulation? Select all that apply.
A. FSH
B. Estrogen (E2)
C. LH
D. Progesterone (PG)
E. hCG
```
A. FSH
B. Estrogen (E2)
C. LH
34
```
Which hormone spikes AFTER ovulation?
A. FSH
B. Estrogen (E2)
C. LH
D. Progesterone (PG)
E. hCG
```
D. Progesterone (PG)
35
Where does fertilization take place?
The fillopian tube
36
What holds the egg?
Follicle
37
Explain how to calculate the due date and what is the name of the rule?
Nagele's rule; Identify the first day of the last menstrual period (LMP), subtract 3 months, and add 7 days.
38
What is a major complication of etopic pregnancy?
Internal bleeding
39
What are some signs and symptoms of internal bleeding?
Light-headed or dizziness, hypotension, excessive thirst, cyanosis, tachypnea, altered LOC, cool, moist, pale, or bluish skin
40
This term referes to the number of pregnancies.
Gravidity
41
What does it mean if a client is nulligravida?
The client has never been pregnant
42
What does it mean if a patient is primigravida?
A client is in their first pregnancy
43
What does it mean if a patient is multigravida?
A client who has had two or more pregnancies.
44
This term refers to the number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy, not the number of fetuses.
Parity
45
What does it mean if a patient is nullipara?
No pregnancy beyond the stage of viability
46
What does it mean if a patient is primipara?
Has completed one pregnancy to stage of viability
47
What does it mean if a patient is multipara?
Has completed two or more pregnancies to stage of viability.
48
This term refers to the point in time when an infant has the capacity to survive outside the uterus.
Viability
49
What does GTPAL stand for?
Gravidity
Term births (38 weeks or more)
Preterm births (from viability up to 37 weeks)
Abortions/miscarriages (prior to viability)
Living children
50
```
A nurse is caring for a client who is pregnant and states that their last menstral period was April 1st. Which of the following is the client's estimated date of delivery?
A. January 8
B. January 15
C. Februray 8
D. Februrary 15
```
A. January 8
51
If the client is pregnant, do we count that with gravidity?
Yes
52
What are some reproductive changes (adaptations) in pregnancy?
Uterus enlarges & changes shape & position, Menses stop (no period), breast increase in size, sensitivity, and areolas darken.
53
What are some cardiovascular changes (adaptations) in pregnancy?
Cardiac output INCREASES, blood volume INCREASES, change in shape & size (should return to normal shortly after delivery) Murmurs may be ausculatated.
54
Would you heart rate increase or decrease during pregnancy? If so, how much?
Increase 10-15 bpm
55
What does your blood pressure do during pregnancy? Increase? Decrease? Specific to diastolic or systolic?
A slight increase in blood pressure & diastolic might increase in the second trimester
56
What are some respiratory changes (adaptations) in pregnancy?
Oxygen needs INCREASE, chest may enlarge, total lung capacity decreases.
57
What are some musculoskeletal changes (adaptations) in pregnancy?
weight increase causes adjustment in posture (lordosis), pelvic joints relax, center of gravity changes (can affect mobility)
58
What are some GI changes (adaptations) in pregnancy?
Nausea, vomiting, and heartburn due to progesterone which relaxes the pyloric sphincter OR increased pressure from displacement, constipation due to increased transit time through the GI tract
59
What are some renal changes (adaptations) during pregnancy?
Filtration rate increases due to hormones and increase in blood volume, urinary frequency common in first and third trimester
60
What are some endocrine changes (adaptations) during pregnancy?
Placenta grows and produces hCG, progesterone, estrogen, and prostaglandins
61
What are some skin changes (adaptations) during pregnancy?
chloasma: increased pigment in face, linea nigra: dark line from belly button to pubic symphysis, striae gravidarum: stretch marks
62
What are signs and symptoms of supine hypotensive syndrome?
low blood pressure, lightheadedness & faintness, dizziness
63
When does supine hypotension occur?
When a patient lies flat on their back and the weight of the grand uteris compresses the vena cava. It reduces blood supply to the fetus.
64
What should you teach a client to do if they are experiencing signs and symptoms of supine hypotension?
Teach the client to lay in a side lying (left lateral) position OR in a semi-sitting position with knees slightly flexed
65
What is the normal fetal heart rate?
110-160/min
66
This type of pregnancy occurs when the ovum implants in the fallopian tubes due to the presence of endometrial tissue.
Ectopic pregnancy
67
Does the patients risk increase or decrease for an ectopic pregnancy after they have already had one?
Increase
68
In an ectopic pregnancy the fallopian tube can ______ , and extensive ______ occurs.
rupture; bleeding
69
```
A nurse in an infertility clinic is providing care to clients who have been unable to conceive for 18 months. Which of the following data should the nurse assess? Select all that apply.
A. Occupation
B. Menstrual history
C. Childhood infectious diseases
D. History of falls
E. Recent blood transfusions
```
A. Occupation
B. Menstrual history
C. Childhood infectious diseases
70
```
What is the reccomended weight gain based on a single pregnancy?
A. 25 to 35 lbs
B. 40-50 lbs
C. 15-25 lbs
D. 35-45 lbs
```
A. 25-35 lbs
71
What is the general rule regarding clients gaining weight during the first trimester of pregnancy?
They should gain 2.2 to 4.4 lbs.
72
```
After the first trimester, how much should the client gain per week for the last two trimesters?
A. 0.5 lbs
B. 2 lbs
C. 1 lb
D. 1.5 lbs
```
C. 1 lb
73
What could excessive weight gain lead to? _____ and _______ _______.
macrosomia and labor complications
74
```
Increasing _______ intake is essential to basic growth.
A. Magnesium
B. Vitamin K
C. Carbohydrates
D. Protein
```
D. Protein
75
What are some examples of protein rich foods?
lean meats, chicken, turkey, eggs, milk, yogurt, cheese, seeds, nuts, kale, spinach, broccoli, tomatoes, cucumbers, cauliflower, mushrooms, parsley, chick peas, whole grain crackers
76
____ ____ is crucial for neurological development and the prevention of neural tube defects.
Folic Acid
77
What are some foods you can teach your client to incorporate in their diet that have folic acid?
spinach, broccoli, lettuce, chickpeas, bananas, watermelon, beans, lemons, peas, papaya, cauliflower, beets, avacados, leafy greens
78
```
Increasing calories of how much a day is recommended in the second trimester?
A. 340
B. 452
C. 450
D. 500
```
A. 340
79
```
What is the recommended increase of calories per day in the third trimester?
A. 340
B. 452
C. 450
D. 500
```
B. 452
80
If a client is breast feeding, should they increase or decrease their caloric intake?
increase
81
______ _______ are often added to the prenatal plan to facilitate an increase of the maternal RBC mass.
Iron supplements
82
What should you teach a patient who is taking iron supplements?
It is best absorbed between meals, and when given with a source of vitamin C.
83
What two things interfere with the absorption of iron supplements?
milk and caffeine
84
What are some food sources that are rich in iron?
beef liver, red meats, fish, poultry, dried peas and beans, tofu, baked potatoes, cashews, spinach, collard greens, lima beans, olives, brussel sprouts, kale, broccoli, asparagus, leeks, soybeans, romaine lettuce
85
______ which is important to a developing fetus, is involved in bone and teeth formation.
Calcium
86
What are some different sources of calcium?
milk, nuts, legumes, and dark green leafy vegetables.
87
What is the recommended intake of caffeine?
no more than 200 mg per day
88
What can excessive caffeine intake lead to?
infertility, spontaneous abortion, or intrauterine growth restriction (IUGR)
89
Identify who is at risk for nutrition-related problems during pregnancy.
Adolescents with poor nutritional habits, clients who follow a vegetarian diet (might have decreased intake of protein, calcium, iron, zinc, and vitamin B), Nausea and vomiting clients, Anemia, Eating disorders (anorexia, bulimia), PICA (craving to eat nonfood substances), inability to purchase/access foods
90
What are some of the basic risk factors of nutrition-related problems during pregnancy?
Age, culture, education, and socioeconomic issues.
91
If a client is experiencing nausea and vomiting during pregnancy what might you educate them to do?
eat starchy foods (crackers or toast) before rising, avoid an empty stomach, avoid spicy, greasy, or gas-forming foods, drink fluids between meals, no anti-nasuea mes without checking with the HCP, ginger and herbal tea may be helpful, small frequent meals
92
This is a maternal genetic disease in which high levels of phenylaline pose a danger to the fetus. (intellectual disabilities, behavioral problems)
Maternal phenylketonuria (PKU)
93
It is important to resume the PKU diet for at least how many months prior to pregnancy and to continue it throughout?
3 months prior
94
What are some food sources that are supposed to be AVOIDED for a PKU diet?
foods high in protein such as fish, poultry, meat, eggs, nuts, dairy products.
95
_________ should be avoided for pregnant women who have PKU.
Aspertame
96
What is involved during the initial prenatal visit?
we determine the estimated date of birth, obtain medical and nursing history to include social supports and review of systems (to determine risk factors), perform a physical assessment to include a client's baseline weight, vitals, and pelvic exam, obtain initial laboratory tests.
97
What are some of the labratory tests performed on the initial prenatal visit?
hemoglobin, hematocrit, WBC, blood type and Rh, rubella titer, urinalysis, renal function test, pap test, cervical cultures, HIV antibody, hep B surface antigen, taxoplasmosis, and RPR or VDRL.
98
When should the initial prenatal visit be scheduled?
within the first 12 weeks.
99
When does the patient go monthly for prenatal visits?
weeks 16 through 28
100
From 29 weeks to 36 weeks how often should the patient be seen for prenatal visits?
every 2 weeks
101
From the 36th week of pregnancy until birth, how often is the patients prenatal visit?
Every week
102
What should the nurse instruct the client to do before a gynecological exam?
Empty the bladder to decrease discomfort.
103
What type of vaccines is a client not allowed to get during pregnancy?
Live vaccines
104
What should be involved in ongoing prenatal visits?
Monitor weight, blood pressure, and urine for glucose, protein, and leukocytes (WBC's), monitor for the presence of edema (facial), monitor fetal development fetal heart rate, fundal height, begin assessing for fetal movement between 16 and 20 weeks of gestation. Provide education for self care including management of the common discomforts of pregnancy
105
Have the client take deep breaths during the gynecological exam to......
decrease discomfort
106
When should you administer Rho(d) immune globulin IM around 28 weeks of gestation for clients who are Rh ______.
negative
107
Which trimester does nausea and vomiting occur?
first
108
which trimester does breast tenderness occur?
first
109
which trimesters does urinary frequency occur?
first and third
110
which trimesters does fatigue occur?
first and third
111
which trimesters does heart burn occur?
second and third
112
which trimesters does constipation occur?
second and third
113
which trimesters does hemorrhoids occur?
second and third
114
which trimesters does backaches occur?
second and third
115
which trimester does SOB occur?
third
116
Which trimester do leg cramps occur?
third
117
which trimestes does varicose veins and lower-extremity edema occur?
second and third
118
Should a pregnant woman ingest foods high in mercury such as sword fish, shark, king macral, and some tuna?
NO
119
When does gingivitis, nasal stuffiness, and epistaxis occur during pregnancy?
whenever the patients estrogen level is high
120
which trimester do braxton hick's contractions occur?
first through the third
121
Why is nutrition important during pregnancy?
to promote fetal health and maternal health
122
How much folic acid is recommended for a woman who is pregnant according to the march of dimes?
600 mcg
123
What should you tell a woman experiencing breast tenderness in the first trimester to help ease discomfort?
wear a support bra
124
What should you educate your patient on when they are dealing with urinary frequency during the first and third trimesters?
empty the bladder frequently, decrease fluid intake before bed time, and use perineal pads. Teach the client kegel exercises to reduce stress incontinence (leakage of urine while coughing or sneezing)
125
Are urinary track infections common during pregnancy? If so, why?
Yes because of renal changes and the vaginal flora becoming more alkaline.
126
How can a pregnant woman decrease her risk of getting a UTI?
Encouraging the client to wipe the perineal area from front to back, avoid bubble baths, wearing cotton underpants, avoiding tight-fitting pants, and consuming plenty of water
127
When should the patient notify the provider about her urine?
if it is foul smelling, contains blood, or appears cloudy.
128
What should you educate your paitent on if they are experiencing fatigue during the first and third trimester?
Have frequent rest periods
129
What should you educate your patient on if they are experiencing heart burn during the second and third trimesters?
eat small, frequent meals, not allow the stomach to get too empty or too full, and check with the HCP before taking any over the counter antacids.
130
Should the client immediately lie down after eating? Why?
No because it can cause reflux
131
What should you educate your patient on if they are experiencing constipation in the second and third trimesters?
encourage fiber intake, drink plenty of fluids, and exercise regularly
132
What should you educate your patient on if they are experiencing hemorrhoids in the second and third trimesters?
Take a warm sitz bath, witch hazel pads, and application of topical ointments
133
What should you educate your patient on if they are experiencing backaches in the second and third trimester?
exercise regularly, perform pelvic tilt exercises (straightening and arching the back), use a side lying position, lift with legs and not back
134
what should you educate your patient on if they are experiencing SOB during the third trimester?
maintain good posture, sleep with extra pillows, and contact the provider if it gets worse
135
What should you educate your patient on if they are experiencing leg cramps during the third trimester?
apply heat, extend the affected leg keeping the knees straight and dorsiflex the toes, foot massage, the client should notify the provider if frequent cramping occurs.
136
what should you educate your client on who is experiencing varicose veins and lower extremity edema during the second and third trimesters?
rest with the hips and legs elevated, avoid constricting clothing, wear support hose, avoid sitting or standing in one position for extended periods of time and don't cross your legs at the knees. the client should sleep in the left lateral position and exercise moderately with frequent walking.
137
what should you educate your client on who is experiencing gingivitis, nasal stuffiness, and epistaxis when their estrogen level is high?
gently brush teeth, perform good dental hygiene, use a humidifier, and use normal saline drops or nose spray
138
what should you educate your client on who is experiencing braxton hick's contractions during the first trimester & throughout the rest of their pregnancy?
A change in position and walking should & it should go away. if it doesn't and it occurs frequently and more intense, you should notify the HCP
139
What are some indications of dangereous situations during the first trimester of pregnancy?
burning on urination (infection), severe vomiting (hyperemesis gravidarum), diarrhea (infection), fever or child (infection), abdominal cramping and or vaginal bleeding (miscarriage or ectopic pregnancy)
140
What are some indications of dangerous situations in the second and third trimesters?
gush of fluid from vagina (amniotic fluid) before 37 weeks of gestation, vaginal bleeding (placental problems abruption or privera), abdominal pain (premature labor, abruptio placenta, or ecptopic pregnancy), changes in fetal cavity (decreased fetal movement), persistent vomiting (hyperemesis gravidarum), severe headaches (gestational hypertension), elevated temp, dysuria (UTI), blurred vision (gestational hypertension), edema of face and hands (gestational hypertension), epigastric pain (gestational hypertension), concurrent occurrence of flushed dry skin, fruity breath, rapid breathing, increased thirst and urination & headache (hyperglycemia), concurrent occurrence of clammy pale skin, weakness, tremors, irritability, and lightheadedness (hypoglycemia)
141
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A nurse is teaching a client who is at 6 weeks of gestation about common discomforts of pregnancy. Which of the following findings should the nurse include? Select all that apply.
A. Breast tenderness
B. Urinary frequency
C. Epistaxis
D. Dysuria
E. Epigastric pain
```
A. Breast tenderness
B. Urinary frequency
C. Epistaxis
142
A client who is at 8 weeks of gestation tells the nurse, "I am not sure I am happy about being pregnant." Which of the following responses should the nurse make?
A. "I will inform the provider that you are having these feelings."
B. "It is normal to have these feelings during the first few months of pregnancy."
C. "You should be happy that you are going to bring new life into the world."
D. "I am going to make an appointment with the counselor for you to discuss these thoughts."
B. "It is normal to have these feelings during the first few months of pregnancy."
143
What two tests does a BPP consist of?
FHR (nonstress test) and fetal ultrasound
144
What would be a desirable score on a BPP test?
8-10
145
What are the labratory tests used during the antepartal period?
hemoglobin, hematocrit, CBC with diferential, blood type, rh antibody, indirect coombs test, rubella titer, Hep B screening, urinalaysis, Pap test, vaginal/cervical culture, HIV antibody, TORCH, Veneral disease research laboratory (VDRL), maternal serum alpga-fetoprotein, quad screen, one-hour glucose tolerance test, three-hour glucose tolerance test
146
What is the purpose for a maternal serum alpha-fetoprotein labratory test?
detects down syndrome and neural tube defects
147
What is the purpose for an Indirect Coombs test?
Identifies clients sensitized to Rh-positive blood
148
When is the one-hour glucose tolerance test completed?
During the first prental visit for at risk clients and at 24 to 28 weeks of gestation for all pregnant clients.
149
What score on a one-hour glucose tolerance test requires follow up?
Greater than 140 mg/dL
150
Which glucose tolerance test do you have to fast for?
three-hour glucose tolerance test
151
A diagnosis of gestational diabetes requires ___ elevated blood-glucose readings.
two
152
What does the one-hour glucose tolerance test identify?
hyperglycemia
153
When should you administer RhO (D) immune globulin IM for clients who are Rh-negative?
IM around 28 weeks of gestation
154
What does TORCH stand for?
Taxoplasmosis, other infections, rubella, cytomegalovirus, and herpes virus.
155
Is a syphillus (VDRL) screening required by law?
Yes
156
Which test is a more reliable indicator to rule out down syndrome and neural tube defects?
QUAD screening
157
What does a QUAD screening consist of?
AFP, inhibin-A, a combination analysis of HCG and estriol.
158
When is a QUAD screening performed?
16 to 18 weeks
159
When is a maternal serum alpha-fetoprotein screening performed?
15 to 22 weeks gestation
160
A feeling of ________ about the pregnancy, which is a normal response, might occur in the early pregnancy and resolve before the third trimester. It consists of conflicting feelings (joy, pleasure, sorrow, hostility) about the pregnancy.
Ambivalence
161
________ _______ is experienced by many clients with unpredictable mood changes and increased irritability, tearfullness, and anger alternating with feelings of joy and cheerfulness. This might result from hormonal changes.
Emotional Liability
162
Discuss how you would instruct a client to perform "kick counts".
Perform 2-3 times a day 2 hours after meals or bed times, fetal movements of less than 3/her or movements that stop entirely for 12 hours indicate a need for further evaluation.
163
What are the progressions of gestational hypertension?
From mild gestational hypertension; mild and severe preeclampsia; eclampsia; and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.
164
What is a major cause of maternal and perinatal morbidity and mortality?
gestational hypertension
165
What are some of the risk factors associated with gestational hypertension?
maternal age (teens/women over 35), first pregnancy, extreme obesity, multifetal pregnancy, chronic conditions, family history, diabetes
166
When does gestational hypertension occur?
20 weeks pregnant
167
What would a patients blood pressure reading be if they were experiencing gestational hypertension?
BP greater than 140/90 recorded two different occasions 4 hours apart
168
What is the hallmark sign for preeclampsia?
GH plus proteinuria greater than or equal to 1+
169
What would be some s/s of a patient who is experiencing mild preeclampsia?
transient headaches, irritability, edema may be present in their face and hands
170
what type of testing may be done in addition to glucose tolerance tests to check on the baby?
nonstress test
171
What are some of the risks of gestational diabetes on the fetus?
macrosomia, birth trauma, low blood sugar
172
What is the ideal blood glucose level during pregnancy?
60 to 99
173
If a client was expereincing severe preeclampsia, what might their blood pressure reading be?
BP of 160/110 or greater
174
If a client was experiencing severe preeclampsia, what might their proteinuria and blood creatinine level be?
proteinuria greater than 3+ and blood creatinine greater than 1.1 mg/dL
175
What are some s/s of severe preeclampsia?
visual disturbances, headache, hyperreflexia, epigastric or RUQ pain, increased DTR's, extensive edema in the face and hands because of high blood pressure
176
During eclampsia, what is a major hallmark sign?
onset of seizure activity or coma usually preceses by headache, severe epigastric pain, hyperreflexia
177
What do we need to see to diagnose HELLP syndrome?
Lab work
178
What labs would you anticipate for a hypertensive disorder?
elevated liver enzymes (AST & ALT), Increased creatine, thrombocytopenia, hemoglobin, and hyperbilirubinemia
179
Should a HIV+ mother breast feed?
NO
180
For hypertensive disorders, which medications should you NOT take?
ACE inhibitors or ARBs
181
What is the antidote for magnesium sulfate?
calcium gluconate
182
What should your nursing actions be if a client is prescribed magnesium sulfate for a hypertensive disorder?
monitor respitory rate (because it decreases), give over a pump, assess DTR, LOC, and urinary output, place on fluid restriction, monitor for toxicity
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What does magnesium sulfate do?
Prevent seizures
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What is the antihypertensive of choice when dealing with a patient who has a hypertensive disorder?
Labetalol
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Is a patient a fall risk when they are receiving magnesium sulfate?
yes
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When monitoring for magnesium sulfate toxicity, what would you look for?
urinary output of less than 30 mL per hour, respiratory rate of less than 12, decreased LOC, cardiac dysrhythmias
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What do you do if you suspect magnesium toxicity?
Immediately stop the infusion, administer calcium gluconate, and take action to prevent respiratory or cardiac arrest
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What are some things you should educate your client to do if they have a hypertensive disorder?
bed rest (side lying position [left lateral]), avoid foods high in sodium, avoid alcohol and tobacco, limit caffeine (fluid retention), home blood pressure checks, fetal monitoring (kick counts), stay hydrated, have a dark quiet environment to avoid stimuli, maintain patent airway (ABC), take anti-hypertensives as prescribed. (labetlol)
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Which labratory test does a patient need a full bladder?
external abdominal ultrasound
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is a transvaginal ultrasound invasive?
yes
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What position should a patient be in for a transvaginal ultrasound?
lithotomy
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When is a transvaginal ultrasound done?
During the first few weeks; best image for early first trimester because until 12 weeks, the baby is very low.
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What are some indications for a BPP?
nonreactive nonstress test, suspected oligohydraaminos or polyhydraaminos, suspected fetal hypoxemia or hypoxia
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This uses real-time ultrasound to visualize physical and physiological characteristics of the fetus and observe for fetal biophysical responses to stimuli.
BPP (biophysical profile)
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bleeding during pregnancy is always _______
abnormal
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This is the test that is most widely used technique for antepartum evaluation of fetal well-being performed during the third trimester. It is a noninvasive procedure that monitors response of the FHR to fetal movement. The client pushes a button when they feel fetal movement.
Nonstress test
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What type of result do we want from a nonstress test?
reactive
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This test is an analysis of the FHR response to contractions determines how the fetus will tolerate the stress of labor. It consists of a client lightly brushing their palm across the nipple for 2 min, which causes the pituitary gland to release endogenous oxytocin, and then stopping the nipple stimulation when a contraction begins. The same process is repeated after a 5 min rest period.
Nipple-stimulated contraction test
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What should the pattern of contractions be for a nipple-stiulated stress test?
at least 3 contractions within a 10 min time period with a duration of 40 to 60 seconds each
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What type of test is used if nipple stimulation fails?
oxytoxin-stimulated contraction test
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Contractions started with _____ can be difficult to stop and can lead to preterm labor.
oxytocin
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What are some indications for a contraction stress test?
high-risk pregnancies (gestational diabetes mellitus, postterm pregnancy), nonreactive stress test
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What should you do to prepare a client for a contraction test?
obtain and document a baseline of the FHR, fetal movement, and contractions for 10 to 20 min. Explain the procedure to the client and obtain informed consent.
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Is a negative contraction stress test a normal or abnormal finding?
normal
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The aspiration of amniotic fluid for analysis by insertion of a needle transabdominally into a client's uterus and amniotic sac under direct ultrasound guidance locating the placenta and determining the position of the fetus. It may be performed after 14 weeks of gestation.
Amniocentesis
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What are some indications for an amniocentesis?
previous birth with chromosomal anomaly
a parent who is a carrier of a chromosomal anomaly, a family history of neural tube defects, parental diagnosis of a genetic disorder or congential anomaly of the fetus, AFP LEVEL FOR FETAL ABNORMALITIES, lung maturity assessment, fetal hemolytic disease
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Do you have to obtain an informed consent for an aminocentesis?
yes
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What should the client do prior to the amniocentesis?
empty the bladder
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What should the nurse do prior to the amniocentesis?
obtain and document (on mom and baby) baseline vital signs and FHR and assist client to supine position
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When should you administer Rho (D) immune golbulin for a client who is undergoing an aminocentesis?
After the procedure for clients who are Rh-negative
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What should the client report to the provider after the aminocentesis?
If experiencing fever, chills, leakage of fluid or bleeding from the insertion site, decreased fetal movement, vaginal bleeding, or uterine contrations after the procedure
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What is good to help wake the baby up for a nonstress test?
orange juice and crackers, caffeine
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When might you give a percutaneous umbilical blood sampling?
In high risk pregnancies, moms antibodies are attacking the babies, determines fetal blood type, anemia screening
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_______ _______ has occured when a pregnancy ends as a result of natural causes before 20 weeks of gestation.
spontaneous abortion
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What are some major risks associated with spontaneous abortion?
CHROMOSOME ABNORMALITIES, matenal illness, advanced age, substance use
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What are some expected findings when dealing with spontaneous abortions?
abdominal cramping or pain, rupture of membranes, dilation of the cervix, fever, manifestations of bleeding (hypotension/tachycardia)
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What should you avoid when dealing with spontaneous abortions?
vaginal exams
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What should you educate your client on if they have experienced a spontaneous abortion?
Notify the HCP of heavy bright red bleeding, small amounts of discharge are normal, take prescribed antibiotics, refrain from baths, sex or placing anything vaginally for 2 weeks.
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Abnormal implantation of a fertilized ovum outside of uterine cavity usually in fallopian tube.
Ectopic pregnancy
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What are some risk factors associated with ectopic pregnancies?
STI's, assisted reproductive technologies, tubal surgery, IUD
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What are some expected findings of someone who is experiencing an ectopic pregnancy?
UNILATERAL stabbing pain and tenderness in the lower abdominal quadrant, menses that is delayed (1 t 2 weeks), lighter than usual or irregular, scan, dark red, or brown vaginal spotting 6 to 8 weeks after last normal menses; red vaginal bleeding if rupture has occurred, referred shoulder pain, findings of hemorrhage and shock
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Is the proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid-filled, and takes on the appearance of grape-like clusters. (molar growths)
Gestational Trophoblastic Disease
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What are some expected findings associated with GTD (molar pregnancy)?
Excessive vomiting (hyperemesis gravidarum) due to elevated hCG levels, rapid uterine growth more than expected for the duration of the pregnancy, bleeding is often dark brown resembling prune juice or bright red that is either scant or profuse and continues for a few days or intermittently for a few weeks, anemia, clinical findings of preeclampsia that occur prior to 24 weeks of gestation.
224
How important is a follow up after GTD (molar) pregnancy)
VERY important due to the risk fo choriocarcinoma
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When should a serum hCG analysis be done following GTD (molar) pregnancy?
Weekly for 3 weeks then monthly for up to 6 months up to 1 year to detect GTD
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What should you do as a nurse with a client who has suspected GTD (molar pregnancy)
measure fundal height, monitor for manifestations of preeclampsia, Administer Rho(D) immune golbulin to the client who is Rh negative, provide client education and emotional support, assess vaginal bleeding and discharge
227
The placenta is attached at the wrong spot
Attaches over the cervical opening – (supposed to be attached at the fundus)
Painless bright red vaginal bleeding
The uterus is soft and relaxed
The fetal heart rate is okay
We don’t see the baby suffer
The fundus height might be a little higher (like molar pregnancy)
Mom’s vital signs are fine
Placenta previa
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What nursing care should you provide for a patient with placenta previa?
Do NOT stick your finger in cervix, No vaginal exams (ultrasound to confirm what they think is going on)
Assess bleeding,
On some type of activity restriction or bed rest,
No sexual intercourse,
C-section will have to happen
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Is the premature separation of the placenta from the uterus, which can be partial or complete detachment. this separation occurs after 20 weeks of gestation, which is usually in the third trimester. It is a leading cause of maternal death.
Abruptio placentae
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Expected findings for this include:
sudden onset of intense localized uterine pain with dark red vaginal bleeding, area of uterine tenderness can be localized or diffuse over uterus and boardlike, contractions with hypertonicity, fetal distress, clinical findings of hypovolemic shock
Abruptio placentae
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One of the biggest risk factors is – maternal hypertension
| We can also see it with trauma and cocaine
Abruptio placentae
