Pregnancy

Question 1

Positive (definitive) signs of pregnancy

Answer 1

Fetal heart sounds, seeing fetus on ultrasound, fetal movement felt by healthcare provider

Question 2

T or F: a positive pregnancy test is a positive (definitive) sign of pregnancy

Answer 2

FALSE; it is probable but not definitive. A pregnancy test detects the presence of human gonadotropic hormone (HCG), but there are other reasons HCG may be present in the body aside from pregnancy!

Question 3

A pregnant patient’s blood volume may increase by almost ___% leading to side effects such as

Answer 3

50%; edema, tachycardia, low Hgb and Hct (diluted)

Question 4

A pregnant patient is not considered to be anemic UNLESS the Hgb is less than ___ g/dL in the first and third trimesters or less than ___ g/dL in the second trimester

Answer 4

11; 10.5

Question 5

Prevention of supine hypotension syndrome

Answer 5

Avoid laying on back (heavy uterus puts pressure on vena cava); OR place pillow under one hip

Question 6

Expected integumentary findings of pregnancy

Answer 6

Chloasma (mask of pregnancy; facial discoloration), striae gravidarum (stretch marks), linea nigra (darkening of abdomen; verticals line running down the belly)

Question 7

First trimester of pregnancy visit

Answer 7

Fetal HR ultrasound, CBC, STI testing, PAP, blood typing (including Rh factor), test for HBV

Question 8

Second trimester visits

Answer 8

Maternal serum alpha fetoprotein (MSAFP), gestational diabetes screening for high risk patients, anatomy scans (fetal anatomy), fundal height assessment

Question 9

Fundal height is measured in centimeters from

Answer 9

The pubic symphysis up to the fundus (topmost part of uterus)

Question 10

The gestational age of the pregnancy should correlate to the fundal height in centimeters plus or minus _________

Answer 10

2 weeks

Question 11

Third trimester visits

Answer 11

Patient receives Rhogam (if Rh negative), TdaP vaccine to pregnant patient, Non-stress tests if indicated, vaginal and rectal swab for group B strep

Question 12

GTPAL

Answer 12

G- gravidy (how many times has patient been pregnant no matter the outcome?)
T- term (how many term deliveries (past 38 wks) has patient had?)
P - preterm (how many preterm (from 20ish weeks to 37 wks) has patient had?)
A- abortion (how many lost pregnancies, whether elective or spontaneous?)
L - how many children are living now?

Question 13

Nulligravida

Answer 13

Never been pregnant

Question 14

Primigravida

Answer 14

First pregnancy

Question 15

Multigravida

Answer 15

Multiple pregnancies

Question 16

Easy way to calculate pregnancy term

Answer 16

Add 9 months and 1 week to first day of last menstrual period

Question 17

Naegele’s rule

Answer 17

Subtract three months from first day of last menses, add one week, add one year

Question 18

RhoGAM is administered at ___ weeks, within ___ hours of delivery, and any time there is pelvic/abdominal trauma or vaginal bleeding

Answer 18

28; 72

Question 19

Increased MSAFP is indicative of __________, and a decreased MSAFP is indicative of _________

Answer 19

Neural tube defects; Down syndrome

Question 20

One hour glucose tolerance test (gestational diabetes screening)

Answer 20

No fasting required; patient consumes 50 g glucose solution, wait and hour, draw blood

Question 21

A 1 hour glucose tolerance test above ____ requires moving forward to

Answer 21

140; 3 hour glucose testing

Question 22

3 hour glucose testing

Answer 22

Must have been fasting except for water; draw fasted blood level, administer 100 g glucose solution, take blood test at 1 hr, 2 hr, and 3 hr.

Question 23

___ abnormal results in 3 hour glucose test is diagnostic for gestational diabetes

Answer 23

2

Question 24

The nurse should educate a pregnant client to increase intake of what three dietary components?

Answer 24

Folic acid, iron, protein

Question 25

A pregnant patient should increase their folic acid intake to ___ mcg/day to prevent neural tube defects

Answer 25

600

Question 26

How many grams of protein should the nurse advise a pregnant patient to consume per day?

Answer 26

60

Question 27

Iron should be increased to ___ mg/day in pregnant patients

Answer 27

27 (take with vitamin C if supplement)

Question 28

A patient with average weight should gain roughly ___ to ___ lbs throughout pregnancy

Answer 28

25-35

Question 29

Warning signs of potential pregnancy complications

Answer 29

Diarrhea, fever, chills, severe abdominal cramping, severe vomiting, decreased fetal activity

Question 30

Interventions for hemorrhoids

Answer 30

Witch hazel, warm sitz baths

Question 31

Interventions of N/V associated with pregnancy

Answer 31

Eat crackers or a carb-heavy snack before getting out of bed; eat smaller, frequent meals and bland foods (or anything the patient prefers/can stomach)

Question 32

Abdominal ultrasound patient education

Answer 32

Encourage having a full bladder as this helps to better reflect sound waves

Question 33

Chorionic villus sampling is an invasive diagnostic that helps to diagnose

Answer 33

Genetic conditions

Question 34

Chorionic villus sampling complications

Answer 34

Bleeding, Infection, miscarriage

Question 35

Because of the risk for bleeding, an Rh negative pregnant patient should receive __________ after chorionic villus sampling to prevent complications should there be mixing of maternal and fetal blood

Answer 35

RhoGAM

Question 36

Removal of fluid from amnion for genetic testing

Answer 36

Amniocentesis

Question 37

Amniocentesis complications

Answer 37

Infection, fetal harm, rupture of membranes leading to amniotic fluid leakage/loss which can cause miscarriage or fetal death

Question 38

An amniocentesis is completed along with an _________ to prevent fetal harm

Answer 38

Ultrasound

Question 39

Nonstress test (NST) patient education

Answer 39

Press the button any time you feel the baby move

Question 40

A reactive NST is ideal and consists of acceleration of fetal heart rate (FHR) by ___ bpm for at least ___ seconds in duration ___ times during the NST (20 min)

Answer 40

15; 15; 2

Question 41

What does a NST assess?

Answer 41

Fetal wellbeing and oxygenation

Question 42

A score below ___ on a biophysical profile (BPP) is indicative of fetal hypoxia

Answer 42

8

Question 43

Contraction Stress Tests (CST) can lead to

Answer 43

Preterm labor (d/t release/administration of oxytocin)

Question 44

The loss of a pregnancy for any reason

Answer 44

Spontaneous abortion (AKA miscarriage)

Question 45

A miscarriage is the loss of a pregnancy before ___ weeks gestation

Answer 45

20

Question 46

Procedures that cleanses of the uterus of a miscarriage

Answer 46

Dilation and curettage (D&C)

Question 47

Medication used for miscarriage that allows the cervix to soften and dilate on its own to allow for easier passage of pregnancy contents

Answer 47

Misoprostol

Question 48

Abnormal growth of the trophoblastic villi in the placenta which prevents normal embryo maturity

Answer 48

Hydatidiform mole

Question 49

A hydatidiform mole may look like

Answer 49

Grape-like clusters

Question 50

S/S of hydatidiform mole

Answer 50

Dark vaginal bleeding (prune juice consistency or color), rapid growth of pregnancy hormone levels

Question 51

Hydatidiform mole treatment

Answer 51

D&C, HCG monitoring for 6 months to ensure levels return back to 0

Question 52

Hydatidiform mole patient education

Answer 52

Avoid pregnancy for 1 whole year to accurately monitor for choriocarcinoma

Question 53

Pregnancy that grows outside of the uterine cavity

Answer 53

Ectopic pregnancy

Question 54

S/S of ectopic pregnancy

Answer 54

Unilateral stabbing pain in early pregnancy (5-9 weeks)

Question 55

Treatment for ectopic pregnancy

Answer 55

Methotrexate, surgery

Question 56

Mnemonic to help remember infections that are teratogenic

Answer 56

TORCH: toxoplasmosis, other, rubella, cytomegalovirus, HIV

Question 57

A parasitic infection found in cat feces, dirt, and some foods

Answer 57

Toxoplasmosis (this is why pregnancy patients are advised to avoid handling cat litter and gardening, and ensure that foods are cooked thoroughly)

Question 58

What infections fall in the “other” component of TORCH?

Answer 58

Varicella, syphilis, parvovirus

Question 59

T or F: herpes can be transmitted to the baby during childbirth if the patient has active lesions

Answer 59

True

Question 60

Interventions for herpes during pregnancy

Answer 60

Antivirals, C-section (especially if active lesions)

Question 61

T or F: gonorrhea and chlamydia are often asymptomatic

Answer 61

True!

Question 62

Untreated gonorrhea and chlamydia can cause ophthalmia neonatorum, which is

Answer 62

An infection of the baby’s eyes

Question 63

Ophthalmia neonatorum prophylaxis

Answer 63

Erythromycin eye ointment at birth

Question 64

Syphilis is easily treatable with a shot of

Answer 64

Penicillin G

Question 65

S/S of trichomoniasis

Answer 65

Yellow-green discharge, intense itching, painful urination

Question 66

Trichomoniasis treatment

Answer 66

Antibiotics

Question 67

HIV can be passed through body fluids such as

Answer 67

Blood, semen, vaginal secretions, and breast milk

Question 68

Breastfeeding is contraindicated for patients with

Answer 68

HIV

Question 69

Plan for C-section around 38 weeks of gestation if maternal HIV viral load is greater than _____ copies/mL

Answer 69

1000

Question 70

Throwing up more than usually during pregnancy

Answer 70

Hyperemesis gravidarum

Question 71

Complications of hyperemesis gravidarum

Answer 71

Clinical dehydration, electrolyte imbalances, weight loss

Question 72

Hallmark of hyperemesis gravidarum

Answer 72

Ketones in urine

Question 73

Yeast infection

Answer 73

Candidiasis

Question 74

Hallmark symptom of candidiasis

Answer 74

Thick, white discharge (cottage cheese-like in consistency); other symptoms include intense itching (pruritis), burning with urination, vaginal inflammation

Question 75

Candidiasis patient education

Answer 75

Avoid tight and damp clothing, NO douching or scented products, wear COTTON underwear

Question 76

S/S of iron-deficiency anemia

Answer 76

Fatigue, pallor, SOB upon exertion, pika (the craving or eating on non-food substances such as dirt, clay, laundry detergents), decreased H&H

Question 77

Iron supplement education

Answer 77

Take in morning with orange juice (vitamin C increases absorption of iron); increase fluid intake to help combat constipation

Question 78

Risk factors for gestational diabetes

Answer 78

Obesity, GDM in previous pregnancy, family hx, HTN

Question 79

Complications of gestational diabetes

Answer 79

Fetal macrosomia, fetal hypoglycemia, maternal pre-eclampsia, birth trauma, diabetes following pregnancy

Question 80

Premature dilation of the cervix

Answer 80

Cervical insufficiency (incompetent cervix)

Question 81

S/S of cervical insufficiency

Answer 81

Increased pelvic pressure, vaginal bleeding, pink-tinged discharge, gush of fluid from vagina, cervical dilation

Question 82

Treatment for cervical insufficiency

Answer 82

Cervical cerclage (suture placed in cervix allowing it to be closed); bed rest and pelvic rest (avoiding any penetrative sexual activity)

Question 83

Cervical cerclage is placed around ___ to ___ weeks and removed at ___ to ___ weeks gestation

Answer 83

12; 14; 36; 38

Question 84

Complication of pregnancy by which the placenta itself implanted near or over the opening of the cervix (cervical OS)

Answer 84

Placenta previa

Question 85

S/S of placenta previa

Answer 85

Painless, bright red vaginal bleeding

Question 86

Vaginal bleeding nursing consideration

Answer 86

Do NOT perform a cervical check

Question 87

What class of medications is administered to improve lung maturation of infants that are anticipated to be born preterm?

Answer 87

Corticosteroids

Question 88

The separation of the placenta from the uterine wall prematurely

Answer 88

Placental abruption (abruptio placenta)

Question 89

Placental abruptions places fetus at risk for _________ and mom at risk for __________

Answer 89

Hypoxia; hemorrhage/shock

Question 90

S/S of placental abruption

Answer 90

Dark red vaginal bleeding, severe abdominal pain, rigid board-like abdomen (d/t accumulation of blood in abdominal space), S/S of hypovolemic shock (tachycardia, hypotension, tachypnea, pallor)

Question 91

Placental abruption risk factors

Answer 91

Smokers, maternal hypertension, trauma (MVA, fall down stairs), multiparity (twin pregnancy, etc.), use of cocaine or other stimulants

Question 92

Placental abruption treatment

Answer 92

Emergency treatment, O2, IV fluids, blood products, avoid vaginal exams!

Question 93

Hypertension (BP > 140/90) after 20 weeks of gestation

Answer 93

Gestational hypertension

Question 94

Gestational hypertension is diagnosed through ___ abnormal blood pressures taken ___ hours apart

Answer 94

2; 4

Question 95

T or F: gestational hypertension is characterized by proteinuria

Answer 95

False

Question 96

Mild preeclampsia

Answer 96

BP > 140/90 with 1+ proteinuria

Question 97

Severe preeclampsia

Answer 97

BP > 160/100 and 3+ proteinuria; Other possible symptoms: severe headache that will not go away, blurred vision, epigastric pain, thrombocytopenia, impaired liver and kidney function, edema, hyperreflexia

Question 98

For a patient to be diagnosed with eclampsia, they must have had a

Answer 98

Seizure

Question 99

What does HELLP syndrome stand for?

Answer 99

Hemolysis, elevated liver enzymes, low platelets

Question 100

S/S of HELLP syndrome

Answer 100

Epigastric or RUQ pain (d/t liver involvement), elevated liver enzymes (AST, ALP), thrombocytopenia

Question 101

HELLP syndrome treatment

Answer 101

Antihypertensives (hydralazine, labetalol), magnesium

Question 102

Nursing care for the pregnant client receiving magnesium

Answer 102

Monitor respiratory status and quality

Question 103

Antidote for magnesium toxicity (decreased DTRs, RR < 12/min, oliguria)

Answer 103

Calcium gluconate

Question 104

Patient education for hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, eclampsia, HELLP syndrome)

Answer 104

Low sodium diet, limit caffeine, maintain quiet environment to prevent seizures, bed rest

Question 105

Group B Strep (GBS) is treated with _________ during birth

Answer 105

Antibiotics (penicillin G, ampicillin)

Question 106

Maternal complications related to GBS AFTER birth

Answer 106

Sepsis, chorioamnionitis

Question 107

Newborn complications related to GBS

Answer 107

Meningitis, pneumonia, sepsis

Question 108

GBS is diagnosed through a perineal and rectal swab between ___ to ___ weeks gestation

Answer 108

35-37

Question 109

Excess amniotic fluid

Answer 109

Polyhydramnios

Question 110

Polyhydramnios risk factors

Answer 110

Gestational diabetes, fetal congenital abnormalities

Question 111

Polyhydramnios treatment

Answer 111

Amniocentesis (to remove amniotic fluid from uterus)

Question 112

Decreased amniotic fluid volume

Answer 112

Oligohydramnios

Question 113

Oligohydramnios risk factors

Answer 113

Premature rupture of membranes, uretoplacental insufficiency, abnormalities of fetal genitourinary tract

Question 114

Infection or inflammation of the amniotic sac (chorion and amnion)

Answer 114

Chorioamnionitis

Question 115

Chorioamnionitis risk factors

Answer 115

Genitourinary infections like UTIs, infection affecting reproductive or urinary tract

Question 116

S/S of chorioamnionitis

Answer 116

Elevated WBCs, malodorous vaginal discharge, fever, uterine pain

Question 117

Chorioamnionitis treatment

Answer 117

Antibiotics