Second Semester Exam 1

Question 1

What hormone is most responsible for physiological changes in pregnancy?

Answer 1

HCG

Human Chorionic Gonadotropin

Question 2

When placenta develops, which hormones does the placenta produce to maintain the rest of pregnancy?

Answer 2

Estrogen
Progesterone
Human placental lactogen
Relaxin

Question 3

What is a zygote?

Answer 3

Cell formed by union of sperm and ovum

Question 4

What is an embryo?

Answer 4

Second to eighth week of development

Question 5

When does the fetus develop?

Answer 5

ninth week to until birth

Question 6

What is the fetus most vulnerable to?

Answer 6

Teratogens:
drugs
alcohol
infections, viruses
rubella
syphillis
toxoplasmosis

Question 7

What is foramen ovale?

Answer 7

Opening between left and right atria

Question 8

Where is the ductus arteriosus?

Answer 8

connects pulmonary artery to the aorta

Question 9

Where is the ductus venosus?

Answer 9

Connects the umbilical vein to the inferior vena cava

Question 10

What is the function of amniotic fluid?

Answer 10

Maintains an even temperature
Prevents the amniotic sac from adhering to the fetal skin
Allows symmetrical growth of fetus
Allows buoyancy and fetal movement
Acts as a cushion to protect the fetus and umbilical cord from injury

Question 11

What are abnormalities of the amniotic fluid?

Answer 11

Polyhydramnios-excessive amniotic fluid

Oligohydramnios-less than expected fluid

Question 12

What is the function of the umbilical cord?

Answer 12

Provide nutrients and oxygenation

Remove waste products

Question 13

What is the structure of the umbilical cord?

Answer 13

AVA (Artery/Vein/Artery)
Two umbilical arteries
One umbilical vein
Wharton’s jelly

Question 14

What are body system changes of the reproductive system during pregnancy?

Answer 14

Reproduction System
Breasts
Increased blood supply
Increased size
Darkened pigmentation 
Ovulation and menses cease
Uterus
Increased size, weight & shape
Increased contractibility
Braxton Hicks

Question 15

What are cardiovascular changes in body systems during pregnancy?

Answer 15

Hypervolemia of Pregnancy
Blood volume increases by 50 % or 1500ml
Heart enlarges slightly
Heart rate increases 15 to 20 BPM
Systolic murmurs common
Physiological anemia of pregnancy
Plasma blood volume increase > RBC increase
Iron deficiency anemia
 Hgb 11.0g/dl and Hematocrit <33
Blood Pressure
Position Effects
Supine Hypotension
Increased WBCs in absence of infection
15,000 
Hypercoagulation – fibrinogen increases by 50%
Decreased risk of post partum (PP) hemorrhage
Increased risk of DVT

Question 16

What are respiratory changes during pregnancy?

Answer 16

• Oxygenation needs increase
• Resp. increase 1-2/minute
• Diaphragm displaced upwards
• Size of maternal chest enlarges
• Change from abdominal to thoracic breathing
• Physiologic dyspnea common
• Vascular engorgement
• Nasal and sinus congestion
• Epistaxis (nose bleeds)

Question 17

What are changes in the GI system during pregnancy?

Answer 17

• Hormonal influences
• Nausea and vomiting in early pregnancy
• Food cravings, avoidance
• Uterine enlargement
• Stomach, liver and intestinal displacement

Question 18

What are musculoskeletal changes during pregnancy?

Answer 18

• Low back pain
• Ligament stretching
• Difficulty walking -“Pregnancy Waddle”
• Leg cramps
• Relaxation of pelvic joints
• Change in center of gravity
• Balance may become an issue

Question 19

What are Urinary system changes in pregnancy?

Answer 19

• Filtration rate increases
• Mild proteinuria (Trace) or glucosuria normal
• Positional variation in function
• Left lateral recumbent optimal
• Anatomical & hormonal changes
• Frequency, urgency and nocturia

Question 20

Common discomforts and interventions of pregnancy?

Answer 20

Nausea and Vomiting

Heartburn

Backache

Urinary Frequency

Fatigue
Varicosities

Leg Cramps

Constipation

Hemorrhoids

Question 21

What are educational topics for pregnancy?

Answer 21

Bathing

Hot Tubs Or Saunas

Douching

Breast Care

Immunizations

Exercise

Sleep And Rest

Employment

Travel

Clothing

Question 22

Pregnancy definitions

Answer 22

Presumptive-Perceived by the woman
Probable-Perceived by the provider
Positive-Can only be attributed to the fetus

Question 23

Presumptive signs of pregnancy

Answer 23

Subjective
Amenorrhea
Nausea and vomiting
Fatigue
Urinary frequency
Breast changes
Quickening

Question 24

Probable signs of pregnancy?

Answer 24

Objective Signs
Goodell’s sign
Chadwick’s sign
Hegar’s sign
McDonald’s sign
Abdominal enlargement
Braxton Hicks contractions
Ballottement/fetal outline
Abdominal striae
Positive pregnancy test

Question 25

Positive signs of Pregnancy?

Answer 25

``` Can only be attributed to fetus Fetal Heart (FH) auscultation Fetal movement and palpation noted by provider Ultrasound (US) visualization Positive FH noted at 4-8 weeks ```

Question 26

How to calculate Naegeles rule

Answer 26

Calculate estimated due date (EDD) 28-day cycle Subtract 3 months from first day of LNMP-last normal menstrual period Add 7 days Don’t forget to change the year when needed Important in the accuracy of Naegele’s rule Regularity of periods Length of menstrual cycle

Question 27

Name the trimesters

Answer 27

Pregnancy is divided into 3 periods 1st trimester -> First day of LMP through 14 weeks 2nd trimester –> 15 through 28 weeks 3rd trimester -> 29 through 40 weeks Most births are within 3 weeks before or 2 weeks after EDD (37-42 weeks = term gestation)

Question 28

Calculation of Gravida and para

Answer 28

``` GTPAL G = Number of times pregnant Para = Births after 20 weeks gestation T = Number of term births P= Number of pre-term births A = Number of abortions L= Number of children currently living ```

Question 29

Never been pregnant

Answer 29

Nulligravida

Question 30

Pregnant for the first time

Answer 30

Primigravida

Question 31

Pregnant two or more times

Answer 31

Multigravida

Question 32

Types of nutrition needed in pregnancy?

Answer 32

``` Fruits Vegetables Folic Acid Lean Protein Whole Grains Healthy Fats Iron Water Prevent Food-borne Illnesses ```

Question 33

Factors Influencing proper Nutrition?

Answer 33

``` Culture Age Nutritional knowledge Nutritional risk factors Socioeconomic status Lifestyle Adolescence Vegetarianism Lactose intolerance ```

Question 34

When to have prenatal visits?

Answer 34

``` Prenatal Visits Uncomplicated Pregnancies Conception 28 wk….Every 4 weeks 29 wk  36 wk……………. Every 2-3 weeks 37 wk Birth…………… Every 1 week Goals Maintain maternal/fetal health Accurate determination of gestational age Implement appropriate interventions Build rapport ```

Question 35

What to look for on first assessment?

Answer 35

``` History – Initial visit OB Menstrual Contraceptive Medical And Surgical Family Health Psychosocial Health ```

Question 36

What are the initial labs to be taken in pregnancy?

Answer 36

``` CBC Blood Grouping Rh Factor And Antibody Screen VDRL Rubella Titer Genetic screening Sickle cell Tay-Sachs Hepatitis B Antigen HIV PPD Urinalysis Urine C & S Pap Smear Cervical Cultures (GC & Chlamydia) ```

Question 37

What to be done during return assessment?

Answer 37

``` Vital Signs (Blood pressure) Weight 25-35 lb. average wt. gain recommendation Urinalysis Protein, Glucose, Ketones 1-hour Glucola 24-28 Wks. (Screen) Group-B Strep Culture 35-37 weeks HIV (3rd Trimester) Fundal Height Leopold’s Maneuvers ```