Prenatal Care and Nutrition

Question 1

Prenatal visits and schedule

Answer 1

1st trimester: 1 visit (confirmation of pregnancy)
12-28 weeks: every 4 wks
29-36 wks: every 2 wks
37-delivery: every week

Question 2

What should the nurse anticipate during a pt initial visit?

Answer 2

Confirm pregnancy/determine due date
Obtain history
VS, including weight
Full PE
Initial heart tones (FHTs): should hear by 10 wks, no later than 12 wks
Anticipatory guidance: self-care of common complaints, warning s/s

Question 3

What initial screening tests would the nurse conduct during initial visit?

Answer 3

Hgb & Hct, WBC
Blood type, Rh factor
Rubella titer: looking to see if they are immune, rubella is detrimental
Urinalysis: protein, glucose, infection, confirmation of pregnancy
Pap smear
STI screening: gonorrhea, chlamydia, HIV, syphilis, Hep B antigen, Hep C

Question 4

Initial visit: history components

Answer 4

Current symptoms
Reproductive and obstetric hx
Medical hx
Nutritional hx
Medications/smoking/substance use
Psychosocial (feeling about pregnancy, support system, employment hx, depression hx/screening, intimate partner abuse screening)

Question 5

What assessments should the nurse expect during follow up visits?

Answer 5

VS, weight
Urine for protein/glucose/nitrites/WBCs
Gestational-age based screening tests
FHTs (10-12 wks)
Fetal movement (at 16+ wks)
Fundal height (20+ wks)
Edema
Preterm labor or other complication s/s
Discuss birth plan

Question 6

Normal fetal heart rate

Answer 6

110-160

Question 7

Fundal height landmark for 12 wks

Answer 7

Pubic symphysis

Question 8

Fundal height landmark at 20 wks

Answer 8

Umbilicus

Question 9

Fundal height landmark at 36 wks

Answer 9

Xiphoid process

Question 10

Fundal height landmark 37-40 wks

Answer 10

Regression of fundal height b/w 36-32 cm

Question 11

Normal fundal growth

Answer 11

1 cm per week

Question 12

When do we start assessing fetal movement

Answer 12

16 wks

Question 13

Kick count instruction

Answer 13

Start at 28 wks
same time every day, generally a time baby is usually active
Have a snack or drink first
Sit or lie on side
Note time kick count is started
Continue counting until 10 movements are felt
If <10 movements in 2 hrs, contact provider

Question 14

When is cfDNA genetic screening done and what does it indicate

Answer 14

10-14 wks
Aneuploidy/Rh/sex

Question 15

When is AFP/Quad Screen done and what does it indicate

Answer 15

16-18 wks
May indicate neural tube defect
May indicate trisomy 18 or 21
Can be done earlier (10-14wks) in conjunction w/ nuchal translucency screening

Question 16

When do we do ultrasound

Answer 16

1st trimester to confirm gestational age
18-22 weeks for fetal anatomy scan

Question 17

When do we screen for gestational diabetes

Answer 17

24-28 wks
1st trimester if high risk
initial screen: 1 hour OGTT
If initial screen >140 then 3 hours OGTT

Question 18

Group B strep

Answer 18

35-37 wks
Via vaginal/rectal swab

Question 19

What immunizations should be given in pregnancy

Answer 19

Injectable Flu vaccine
TDAP
COVID

Question 20

When is Rh Immune globulin (RhoGAM) given to a pregnant person is RH negative

Answer 20

at 26-28 wk
at 72 hours after delivery of RH positive infant
After procedures/events with increased risk of bleeding

Question 21

Common discomforts of pregnancy during 1st trimester

Answer 21

Nausea & vomiting
Fatigue
Breast tenderness
Nasal stuffiness & epistaxis
Heartburn
Constipation
Leukorrhea

Question 22

Common discomforts of pregnancy: 2nd trimester

Answer 22

1st trimester discomforts may continue
Backache
Leg cramps
Varicosities
Hemorrhoids

Question 23

Common discomforts of pregnancy: 3rd trimester

Answer 23

1st and 2nd trimester discomforts may continue
SOB/dyspnea
Dependent edema
Hemorrhoids
Braxton-hicks contractions

Question 24

Warning signs in pregnancy

Answer 24

Persistent vomiting
Fever
Dysuria
Severe back/flank pain
Pelvic cramping/pain
Vaginal bleeding
Gush of vaginal fluid
UCs prior to 37 weeks
Decrease fetal movement

Question 25

Severe/Urgent warning signs

Answer 25

Severe, persistent or frequent headaches
Visual changes: spots, blurring, double vision
Epigastric pain
Severe swelling of lower extremities
Swelling of face, fingers, or sacrum