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NCLEX-RN (7) Maternity > Prenatal > Flashcards

Flashcards in Prenatal Deck (92)
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How many weeks is the first trimester of pregnancy?

week 1 to week 13


At how many weeks is the second trimester of pregnancy?

week 14 to week 27


At how many weeks is the third trimester of pregnancy?

week 28 to week 40


At what week of gestation can the sex of the fetus be determined?

Sex of fetus determined at week 12 by ultrasound.


What is the normal 1st trimester fetal heart rate?

160 - 170 beats per minute


What is the normal heart rate of a fetus by the end of the 3rd trimester?

110 - 160 beats per minute


What are some risk factors for a difficult pregnancy or loss of the fetus?

  • age: <20 years old or >35 years old
  • obesity
  • abuse and violence
  • diabetes or cardiac disorders
  • drugs/smoking/alcohol
  • medications


How often are prenatal visits?

  • every 4 weeks from confirmation of pregnancy until end of 2nd trimester
  • every 3 weeks from 28 to 36 weeks (starting at 3rd trimester)
  • then weekly until delivery


What are the general assessments for every prenatal visit?

  1. pregnant woman assessment:
    • blood pressure
    • weight
    • urine screening for proteins (pre-eclampsia)
  2. fetus assessment:
    • fundal height (of woman)
    • fetal ultrasound for heart tones and growth


What is Nagele's rule?

Nagele's rule is calculating the due date of the baby:

  • due date = + 9 months + 7 days (adjust the year) from the date of when the last period started


Gravida and Para

  • Gravida: the number of total pregnancies (including present one)
  • Para: the number of births after 20 weeks


What does GTPAL stand for?

  • Gravida: number of pregnancies
  • Term: births after 37 weeks
  • Preterm: births before 37 weeks
  • Abortions (miscarriages)
  • Living children


What is a presumptive sign of pregnancy?

  • quickening (feeling movement of fetus)
  • nausea/vomiting
  • sore breasts
  • missed period


What is a probable sign of pregnancy?

A probable sign of pregnancy is a pregnancy test that comes back positive and the signs detected by the HCP such as:

  • Heger's sign
  • Goodell's sign
  • Chadwick's sign


What is Heger's sign?

A probable sign of pregnancy when the lower part of uterus starts to get soft at about week 6.


What is Goodell's sign?

A probable sign of pregnancy when there is softening of the cervix at about week 9.


What is Chadwick's sign?

A probable sign of pregnancy when the cervix turns a bluish-purple color at about week 6.


What is ballottement?

A probable sign of pregnancy of when the fetus rebounds when the HCP presses on the uterus.


What are Braxton-hick contractions?

A probable sign of pregnancy of irregular contractions.


What hormone indicates a positive pregnancy test?

Human chorionic gonadotropin (HCG) indicates a positive pregnancy test (which is a probable sign of pregnancy).

HCG can be detected in urine in as early as 8 days after conception.


What is a positive sign of pregnancy?

  • fetal heart rate is detected by doppler and fetoscope
  • HCP can feel the fetus move on palpation
  • fetus is seen on ultrasound


What is the fundal height?

A measurement from the top of the fundus to the symphysis pubis as measured in centimeters.

It estimates the gestational age.

Complete the sentence:

After week 18, the fundal height in centimeters = number of    ______ pregnant. 

After week 18, the fundal height in centimeters = number of weeks pregnant. 


The fundal height and gestational age of fetus can be off by how many centimeters? 

Fundal height and gestational age can be off by plus or minus 2 centimeters.

Ex: a fundal height of 20 cm can indicate that the fetus is somewhere between 18 and 22 weeks old.


What are the physical and psychological changes in pregnancy caused by?

Changes are caused by hormones.


What cardiovascular changes does a pregnant woman go through?

  • lower than normal hemoglobin and hematocrit
  • heart rate increases
  • blood pressure changes

Changes are due to increased blood volume.


What hemoglobin and hematocrit levels is considered anemia in a pregnant client?

Hematocrit < 30% and Hemoglobin < 10 is considered anemia in a pregnant client.

Pregnant clients have a slightly lower hemoglobin and hematocrit due to increased fluid volume.


How high does the heart rate of the pregnant woman increase due to increased blood volume during pregnancy?

A pregnant woman's heart rate increases 10-15 beats per minute from the baseline.

Ex: if the heart rate is normally 60 bpm, it will increase to 70-75 bpm


What are the blood pressure changes of a pregnant woman?

  • blood pressure ↓ in 1st and 2nd trimester
    • hormonal changes cause vessel dilation
  • blood pressure ↑ in 3rd trimester
    • due to increased blood volume being pumped to fetus


What interventions help relieve morning sickness for a pregnant woman?

Eat crackers and small meals to help relieve morning sickness.


What urinary changes occur in a pregnant woman?

  • 1st trimester increased urination is caused by hormone changes
  • 2nd trimester urinary frequency decreases
  • 3rd trimester increased urination is caused by increased pressure of fetus on bladder


What is linea nigra during pregnancy?

dark line down the middle of the abdomen


What is chloasma during pregnancy?

Chloasma is the "mask of pregnancy": brown spots on the face.



What are the typical psychological changes that occur to the woman when she finds out she is pregnant?

  • ambivalent, excited or scared
  • very emotional


What is the recommended weight gain for a pregnant woman for the entire pregnancy?

25 - 35 pounds (11 - 16 kg)


What is the recommended weight gain during the first trimester of pregnancy?

3 - 5 pounds (1.4 - 2.3 kg)


What is the recommended weight gain during the 2nd and 3rd trimesters of pregnancy?

1 pound per week (0.5 kg per week)


How many extra calories per day are recommended during pregnancy?

An extra 300 calories are needed per day while pregnant.


How many extra calories per day are recommended while breastfeeding?

An extra 500 calories are needed per day while breastfeeding.


What vitamin supplements are commonly prescribed to pregnant clients?

  • folic acid - to prevent neural tube defects
  • iron - to prevent anemia due to increased blood plasma

Classification and indication:

Rho D immune globulin

  • given to Rh-negative moms to prevent blood incompatibility between mom and baby's blood
  • given after miscarriage or abortion to prevent Rh antibody formation
  • given after birth to mom's that give birth to a Rh-positive baby


What vaccinations are contraindicated during pregnancy or when planning to become pregnant?

Do not give measles, mumps, rubella (MMR) and varicella vaccines during pregnancy or planning to become pregnant.

Vaccine can harm fetus.


What could glucose in the urine of a pregnant client indicate?

Glucose in the urine could indicate diabetes mellitus.


What does protein in the urine of a pregnant client indicate?

Protein in the urine could indicate infection or pre-eclampsia.


What is a fetal ultrasound?

A picture of the fetus. It includes information such as:

  • gestational age
  • breathing
  • movements
  • tone
  • amniotic fluid volume


What will the pregnant client need to due to prepare for a fetal ultrasound?

Drink 2 glasses of water one hour before the ultrasound in order to see the fetus and structures better.


What is a biophysical profile?

A non-invasive test that checks the fetus. It includes:

  • ultrasound
  • non-stress test



What is a nonstress test?

A nonstress test is a non-invasive test of the fetus to check fetal heart rate patterns. 

The pregnant client lies down with two belts around her waist. One belt measures the fetal heartbeat and the other measures contractions. It takes about 20 minutes. 


What is a reactive nonstress test?

A reactive nonstress test is a normal finding and that the fetal heart rate went up normally. It indicates that the fetal heart rate is "reassuring":

  • fetal heart rate increases at least 15 beats per minute over the baseline (between 120 and 160 beats per minute)
  • The increase in heart rate lasts at least 15 seconds within a 20-minute timeframe



What is a NON-reactive nonstress test?

A NON-reactive nonstress test is an abnormal finding and that the fetal heart rate did not increase enough. It indicates more testing is needed. 

It can also indicate that the fetus was sleeping.



What is an amniocentesis?

An amniocentesis tests the amniotic fluid for genetic disorders and fetal lung maturity.

A needle is used to aspirate a small amount of amniotic fluid through the pregnant client's abdomen guided by ultrasound. 




What are the interventions before and after an amniocentesis?

  1. before procedure - get informed consent
  2. after procedure - assess for signs of complications
    • bleeding, infection, decreased fetal movement, and cramping


What is quickening in pregnancy?

Quickening is the moment when the pregnant woman starts to feel or perceive fetal movements in the uterus.

It usually occurs between week 15 and 25. About 50% of women don't feel anything until after 24 weeks gestation.


What is a kick count test?

A kick count test is when the pregnant client counts the number of kicks by the fetus in a 2-hour period. 

Notify the HCP if there are < 10 kicks in two consecutive 2-hour periods.


What is a fern test?

A fern test identifies the presence of an amniotic fluid leak. 

It will make a fernlike pattern on a microscopic slide.


What is a nitrazine test?

A nitrazine test identifies the presence of amniotic fluid in vaginal secretions by putting a drop of fluid on a paper strip.

It will turn the paper blue if there is amniotic fluid.


What is a contraction stress test?

A contraction stress test is performed at the end of pregnancy to determine how well the fetus will cope with the contractions of childbirth.

Contractions are induced by administering oxytocin (or nipple stimulation) and the contractions and heart rate of the fetus is recorded.


Immediate complication

What is a positive/abnormal contraction stress test?

A positive/abnormal result indicates a bad finding and that late decelerations of the fetal heart rate were noted.

Late decelerations are never a good finding.


What is a negative/normal contraction stress test?

A normal/negative indicates a good finding and that no late decelerations of the fetal heart rate were noted.

Immediate complication

If a client is bleeding from a miscarriage or abortion, how many saturated pads are considered hemorrhage?

For miscarriage or abortion, hemorrhage is:

  • > 1 saturated pad/hour
  • one pad that gets saturated within 15 minutes


What are the insulin needs for a pregnant client with diabetes mellitus?

During 2nd and 3rd trimester pregnant client needs more insulin

The hormones in the placenta block insulin. 


Disseminated intravascular coagulation (DIC) during pregnancy

Immediate complication

Disseminated intravascular coagulation is a serious bleeding and clotting complication in a pregnant client with eclampsia, placenta abruptio, a dead fetus, placenta retention, or infection. 

The clotting factors are becoming over or underactivated. 


Disseminated intravascular coagulation (DIC) during pregnancy

  • give oxygen
  • blood transfusions if bleeding
  • heparin if clotting
  • monitor kidney function

​Blood clots can damage vessels in the kidneys.


Hyperemesis gravidarum

Hyperemesis gravidarum is when a pregnant client has severe nausea and vomiting. 

This puts her at risk of fluid and electrolyte imbalances.


Hyperemesis gravidarum

  • give IV fluids
  • monitor intake and output
  • antiemetics



Endometritis is an infection of the lining of the uterus that may cause peritonitis.





Fetal utero in death

Fetal utero in death is fetal death that occurs at > 20 weeks gestation.

Pregnant client can develop DIC if fetus is left in client for more than 3 weeks.


Fetal utero in death

  • appropriate cultural and religious care
  • therapeutic communication
  • possible touching of baby
  • private room
  • may be moved off maternity floor or away from any babies


Hepatitis B

Hepatitis B a viral infection that can be transmitted to baby through blood, sputum, vaginal secretions, semen, and breast milk.


Hepatitis B

  • if pregnant client is positive for Hep B, clean newborn right away
  • administer Hep B immune globulin and vaccination
  • mom can breastfeed newborn as long as baby got vaccination


HIV and AIDs

HIV and AIDs is a viral infection that can be transmitted to baby through blood, semen, vaginal secretions, or breastmilk.

Procedures that increase the mixing of blood increases the risk of the baby getting HIV.


HIV and AIDs in newborn

  • avoid internal scalp electrodes and episiotomy
  • bottle feed if mom is HIV positive
  • clean baby well before shots - avoid mixing of blood
  • no live vaccines are given to baby (no MMR or varicella)
  • antivirals


Gestational hypertension

Gestational hypertension is new-onset hypertension during pregnancy after 20 weeks gestation. 



Preeclampsia is new-onset hypertension after 20 weeks gestation and protein in the urine


What are the assessments for gestational hypertension and preeclampsia?

  • assess for headaches
  • take blood pressure
  • get urine sample to check for proteins

These are all signs of hypertension. 



Immediate complication

Eclampsia is the onset of seizures for a pregnant client with preeclampsia.


HELLP syndrome

Immediate complication

HELLP syndrome is a condition that can cause severe bleeding in a pregnant client.

The cause is not known but associated with gestational hypertension and preeclampsia. 


What are the characteristic signs and symptoms of HELLP syndrome?

  • H: Hemolysis
  • EL: Elevated Liver enzymes
  • LP: Low Platelets

All these findings increase the risk of bleeding in a pregnant client.


HELLP syndrome

  • possible bedrest
  • antihypertensives and magnesium sulfate to prevent eclampsia and pre-eclampsia


"TORCH" screening

TORCH screening is screening the pregnant client for infections that are highly toxic to growing fetus. 

  • T: Toxoplasmosis
  • O: Other infections
  • R: Rubella (German measles)
  • C: Cytomegalovirus
  • H: Herpes simplex virus




Avoid raw meat and cleaning out the kitty litter box

Bacteria is in raw meat and cat feces.


What are the "Other" infections for "TORCH"?

  • Group B Streptococcus
  • HIV
  • syphilis
  • parvovirus
  • hepatitis B virus
  • West Nile virus

These are all infections that are highly toxic to growing fetus.


TORCH infections

antivirals or antibiotics


What are the interventions for sexually transmitted infections during pregnancy?

  • screen pregnant client for infections
  • if positive, give antibiotics, antivirals, or antifungals
  • have partner tested and treated


Tuberculosis in a pregnant client

  • if x-ray is needed, perform after 20 weeks gestation and use lead shield on pregnant client
  • TB skin test is safe during pregnancy
  • Give antituberculosis drugs during pregnancy


Tuberculosis in newborn

  • if skin test is positive in newborn, they will get antituberculosis drugs for at least 6 months
  • if mom's sputum culture comes back negative, newborn does not need to be isolated from mom


Ectopic pregnancy

An ectopic pregnancy is when the embryo is fertilized outside of the uterus, usually in the fallopian tube.


What are the characteristic signs and symptoms of an ectopic pregnancy?

  • vaginal spotting that is dark red or brown
  • if it ruptures it causes increased pain that radiates to the shoulder


Ectopic pregnancy

  1. give methotrexate
    • to prevent the fetus from developing
  2. prepare for laparotomy to remove fetus and tube
  3. give rho D immune globulin (if woman is Rh-negative)
    • helps to prevent bleeding


What are some risk factors for infertility?

  • Woman
    • maternal obesity
    • maternal age > 35
    • nutritional deficiencies
  • Man
    • alcohol and drug abuse
    • exposure of testes to heat (sauna use)
    • endocrine disorders that decrease testosterone


What are kegel exercises?

Kegel exercises are for strengthening the pelvic floor muscles in preparation for birth. They can also help prevent incontinence later in the pregnancy and postpartum life.  

A kegel exercise is like pretending you have to urinate and then holding it. (Men can do them also to strengthen the muscles for bladder control and sexual function).