Week 1: Antenatal Care and Assessment

Question 1

What does perinatal nursing focus on? What periods do you care for?

Answer 1

caring for clients and their families from the preconception period throughout the child-bearing year

Question 2

Explain the childbearing journey

Answer 2

unique, influenced by values, culture, ethnicity, religion, and SDoH

Question 3

women centered care

Answer 3

assumption that clients know their bodies best and are experts of their own health - need to acknowledge and validate

Question 4

Aspects of trauma informed care

Answer 4

informed decision making
safe environment
trust and transparency
collaboration and mutuality
safety and confidentiality
support
empowerment - voice & choice

Question 5

aspects of informed decision making (acronym)

Answer 5

BRAINS
B - benefits
R - risks
A - alternatives
I - intuition
N - nothing right now/re-evaluation
S - space for decision

Question 6

goals of preconception health

Answer 6

• improve health status of women and men before conception
• reduce behaviours and environmental factors that lead to poor maternal and child health outcomes

Question 7

health promotion topics

Answer 7

• nutrition and healthy diet
• optimal weight
• exercise
• avoid tobacco, alcohol, recreational drugs
• risk-reducing sexual practices
• oral hygiene

Question 8

medical history topics

Answer 8

• immune status
• family history of genetic disorders
• illness
• medications

Question 9

what type of vaccine do you not give to pregnant women? how much before do you need to give?

Answer 9

• live attenuated
• 28 days before conceiving

Question 10

reproductive history aspects

Answer 10

• contraceptives - short/long term?
• obstetrical- pregnancies, infertility

Question 11

when would you refer someone to a fertility specialist?

Answer 11

• when trying for 1 year
• 6 months for advanced age

Question 12

psychosocial aspects

Answer 12

• partner and family situation
• intimate partner violence
• readiness for pregnancy
• financial resources
• environmental conditions

Question 13

Which of the following statements is correct regarding folic acid?

a) Folic acid is recommended once pregnancy is confirmed.

b) Folic acid is not required within North America as many foods have additional fortification which is enough during pregnancy.

c) Folic acid supplementation during preconception and pregnancy helps prevent neural tube defects.

d) Folic acid supplementation dosing is standard regardless of risk factors

Answer 13

c) Folic acid supplementation during preconception and pregnancy helps prevent neural tube defects.

Question 14

what are the folic acid recommendations in low risk?

Answer 14

• 1mg 3 months prior until the end of 1st trimester and then decrease to 0.4mg

Question 15

what are the folic acid recommendations in high risk/previous pregnancies with neural defects?

Answer 15

4.0mg 3 months prior until the end of 1st trimester and then decrease to 0.4mg

Question 16

benefits of folic acid

Answer 16

decrease facial clefts
limb differences
congenital health defects

Question 17

Which is earliest biochemical marker of pregnancy?

Answer 17

Human chorionic gonadotropin (hCG)

Question 18

where is hCG tested in?

Answer 18

blood - more reliable
urine

Question 19

when is hCG detected?

Answer 19

7-10 days after conception

Question 20

what does a very high hCG mean?

Answer 20

carrying multiples or molar pregnancy

Question 21

what does a very low hCG mean?

Answer 21

early miscarriage indication

Question 22

what is the most popular test for pregancy?

Answer 22

ELISA
Enzyme linked immunosorbent assay

Question 23

factors that can influence the accuracy of pregnancy test results

Answer 23

• expired
• not enough urine
• time of taking test
• taking test too early

Question 24

what is the length of pregnancy

Answer 24

9 months
40 weeks
280 days

Question 25

how is length of pregnancy calculated

Answer 25

from the first day of last menstrual period (LMP)

Question 26

most clients give birth within how many days of their estimated due date?

Answer 26

7 days before and 7 days after

Question 27

what is an accurate method of early pregnancy dating?

Answer 27

transvaginal ultrasound

Question 28

Nagele's rule

Answer 28

assumes 28-day cycle and pregnancy occurred on day 14 - calculate: determine LMP, add 7 days and count forward 9 months

Question 29

why is it important to know an accurate estimated due date? (3)

Answer 29

- allows to prioritize types of care in each trimester - helps ensure patient is meeting the bench marks - helps with genetic testing

Question 30

what is the 1st trimester

Answer 30

weeks 1-13

Question 31

what is the 2nd trimester

Answer 31

weeks 14-26

Question 32

what is the 3rd trimester

Answer 32

weeks 27-term

Question 33

presumptive sign of pregnancy + examples and what time they occur at

Answer 33

subjective changes felt by patient - breast changes ~3-4 wks - amenorrhea (no period) ~4 wks - nausea/vomiting ~4-14 wks - urinating frequently ~6-12 wks - fatigue ~12 wks - quickening ~16-20 wks

Question 34

probable signs of pregnancy + examples

Answer 34

objective changes observed by examiner - + pregnancy test - Goodell sign - Chadwick sign - Hegar sign - Ballottement

Question 35

Godell sign

Answer 35

- 5-6 weeks - softening of cervical tip due to increase vascularity, hyperplasia, and hypertrophy

Question 36

Chadwick sign

Answer 36

- 6-8 weeks - violet-bluish colour of the vaginal mucosa and cervix

Question 37

Hegar sign

Answer 37

- softening and compressibility of the lower uterine segments - internal and external exam

Question 38

Ballottement

Answer 38

technique of palpitating a floating structure by bouncing it gently and feeling it rebound

Question 39

positive sign of pregnancy + examples

Answer 39

signs only attributed of presence of fetus - visualization - heart tones by ultrasound, doppler, fetal stethoscope - fetal movements palpated (19-20wks) - fetal movement visible

Question 40

therapeutic abortions

Answer 40

before 20 weeks gestation

Question 41

first trimester abortion

Answer 41

goal is to stop progression - Surgical (aspiration) abortion - Methotrexate and misoprostol (prostaglandin causing uterine contractions and expelling fetus) - Mifepristone and misoprostol

Question 42

Second trimester abortion

Answer 42

- Dilation and evacuation (D&E) - Medical induction (pregnancy not viable, but med given to induce labor) - Prostaglandins - Hypertonic and uterotonic agents

Question 43

gravidity

Answer 43

pregnancy

Question 44

gravida

Answer 44

client who is pregnant

Question 45

primigravida

Answer 45

pregnant for first time

Question 46

multigravida

Answer 46

has been pregnant for 2+ pregnancies

Question 47

nulligravida

Answer 47

never been pregnant

Question 48

parity

Answer 48

number of pregnancies in which fetus reached 20 weeks gestation

Question 49

primipara

Answer 49

completed one pregnancy 20+ weeks

Question 50

Multipara

Answer 50

completed 2 or more pregnancies 20+ weeks

Question 51

Nullipara

Answer 51

did not complete pregnancy 20+ weeks

Question 52

preterm

Answer 52

delivered after 20 weeks gestation but prior to 36 weeks

Question 53

Early term

Answer 53

completed between 37 weeks and 38 weeks 6 days

Question 54

Full term

Answer 54

completed between 39 weeks and 40 weeks 6 days

Question 55

late term

Answer 55

pregnancy in week 41

Question 56

Post term

Answer 56

pregnancy in week 42

Question 57

viability

Answer 57

capacity to live outside 22-25weeks

Question 58

function of placenta

Answer 58

gives O2 and nutrients

Question 59

amniotic fluid function

Answer 59

- secreted from resp and GI tract of fetus - thermoregulates - cushions - allows free movement for MSK development - barrier to infection - allows for lung development

Question 60

amnion vs chorion

Answer 60

fetal membranes - amnion = baby (develops from blastocyst, blends with umbilical cord) - chorion = mom (develops from trophoblast, blends with placenta)

Question 61

healthy amount of amniotic fluid

Answer 61

700-1000mL by term

Question 62

oligohydramnios

Answer 62

less than 300mL amniotic fluid - fetal renal abnormalities

Question 63

polyhydramnios

Answer 63

more than 2000mL amniotic fluid - GI malformations

Question 64

umbilical cord structure and function

Answer 64

- 3 vessels: 2 arteries that carry deoxygenated blood, 1 vein carrying oxygenated blood

Question 65

whartons jelly

Answer 65

in umbilical cord to prevent compression of blood vessels

Question 66

when is maternal-placenta embryonic circulation established

Answer 66

~day 17 - when heart begins to beat

Question 67

when is placenta structure complete

Answer 67

by week 12 and continues to grow until week 20

Question 68

what hormones does the placenta produce

Answer 68

- hCG - human chorionic gonadotropin - hPL -human chorionic somatomammotropin / human placental lactogen - progesterone - estrogen

Question 69

purpose of prenatal care

Answer 69

identify existing risk factors and other deviations from normal - health promotion - preventative care