344 worksheets exam 1

a) Bologna b) Wine c) Sushi

What foods should the nurse counsel a woman in the first trimester to avoid? Select all that apply.

a) Asking the client what she usually eats at each meal; Always start with assessment, in order to tailor your teaching.

What initial approach should the nurse use when teaching a pregnant woman about a healthy pregnancy diet?

Caused by the displacement of the intestines by the uterus

What is the cause of constipation during pregnancy

Increased in progesterone, increase glomerular filtration and crowed bladder

What is the cause of urinary frequency during pregnancy

a) Pedal edema may be significant. b) The joints loosen, resulting in a swaying or waddling walk. c) Intestinal motility decreases, often causing constipation.

What physiologic alterations commonly occur near the end of pregnancy? Select all that apply.

a) Eat dry crackers or toast before getting out of bed in the morning. b) Avoid spicy and acidic foods. c) Have a high protein snack before bed.

What recommendations should the nurse make to a woman with morning sickness? Select all that apply.

Your diaphragm has been displaced upward.

What suggestion could the nurse offer a primigravida at 32 weeks gestation who is beginning to experience lower back pain?

Positive quickening; Quickening, the first time the mother feels fetal movement, would be expected at 16-18 weeks for multips and ~20 weeks for primips. A woman who reports quickening at 12 weeks is either feeling something else (most commonly gas) or is much further along in her pregnancy than 12 weeks.

Which finding would be abnormal at a prenatal visit at 12 weeks gestation?

Fundal height at the umbilicus. This would be normal at 20 weeks, should be measuring ~22 cm by 22 weeks, which is above the umbilicus. FHR 100 bpm. Although 100 is only 10 bpm below the bottom of the normal range, this is clinically very significant and could indicate fetal distress. Would need an immediate assessment

Which findings require follow up at a woman's prenatal visit at 22 weeks gestation? (Select all that apply)

Hemoglobin 10 g/dL

Which initial prenatal exam laboratory finding requires further assessment on a client at 8 weeks gestation?

a) Increase in blood volume of 40-50% b) Urinary frequency in the 1st and late 3rd trimesters. c) Nosebleeds and swollen gums. d) Heart rate increases by 10-15 bpm in 2nd trimester.

Which of the following are normal physiologic changes of pregnancy? Select all that apply.

Snowstorm pattern on ultrasound with no fetus.

Which of the following findings occur with hydatidiform mole?

History of previous baby with fetal alcohol syndrome. (FAS is caused by maternal alcohol use in pregnancy, not by DNA abnormalities, so couldn't be diagnosed by amniocentesis.)

Which of the following is not an indication for amniocentesis in the 2nd trimester?

a) It is highly effective to treat genital warts (condyloma). b) It prevents approximately 99% of cervical cancers. It is recommended for girls and boys from 9 to 26 years old

Which of the following statements about HPV vaccine are correct?

Cervical dilation.

Which sign distinguishes threatened abortion from inevitable abortion?

Since oxygenation occurs in the placenta, fetal circulation completely bypasses the lungs. Although most blood bypasses the lungs (since oxygenation occurs in the placenta), some blood goes to the lungs to keep the lung tissue alive.

Which statement about fetal circulation is FALSE?

a) "The fetus gets nutrients from the amniotic fluid." (gets it From the placenta.)

Which statement indicates that a pregnant client requires further teaching about fetal growth and development?

Gas exchange occurs via the placenta.

Which statement is accurate about fetal gas exchange during pregnancy?

MSAFP has high rates of false positives and false negatives.

Which statement is true about maternal serum AFP testing, such as the sequential screen or quad screen?

a) The woman's bladder must be full. b) It is done under ultrasound guidance. c) It has a 0.5 to 1% risk of miscarriage. d) An Rh negative woman needs a RhoGam injection afterward

Which statements are accurate about an amniocentesis done in early pregnancy? (Select all that apply.)

a) A woman with a history of ectopic pregnancy. b) A woman with a history of pelvic inflammatory disease. c) A woman who became pregnant despite a tubal ligation.

Which woman is at elevated risk of an ectopic pregnancy? (Select all that apply.)

It maintains the corpus luteum, which produces estrogen and progesterone to prevent sloughing of the endometrium.

Why is human chorionic gonadotropin (hCG) so important in early pregnancy?

It can destroy the fetus' thyroid as well as the mother's

Why is radioactive iodine not used to treat hyperthyroidism during pregnancy?

March 19, 2021

Your client's LMP was June 8-12, 2020. What is her EDD?

Take a mild laxative twice weekly.

Your patient is suffering from constipation in the second trimester. Your patient education could include all of the following EXCEPT:

Hydatidiform mole

a benign tumor of the placenta consisting of multiple cystic and resembling a bunch of grapes

Bacterial vaginosis

a condition in women in which there is an abnormal overgrowth of certain bacteria in the vagina

zygote

a fertilized egg is called ______

Chloasma

a pigmentation disorder characterized by brownish spots on the face

Leukorrhea

a profuse, whitish mucus discharge from the uterus and vagina; protection from bacterial invasion

Ballottement

a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus

Lordosis

abnormal anterior curvature of the lumbar spine (sway-back condition)

pica

an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month

Graves Disease

an autoimmune disorder that results in the overproduction of thyroid hormones; having too many speeds up the ay the body uses energy and controls growth (which means that preggo women are more likely to have a baby with low birth weight or more likely to deliver preterm or develop preeclampsia/experience stillbirth)

Schedule a stat ultrasound and quantitative hCG levels.

At 8 weeks gestation, a woman calls complains of bleeding and lower abdominal pain. The top priority nursing action at this time is:

a) Expectant management—waiting to see if the body will miscarry on its own. b) Medication management—administering misoprostol or a similar medication that stimulates uterine cramps to expel the products of conception. c.) Surgical management—doing a dilation and curettage (D&C) to remove the products of conception.

At a routine dating ultrasound at 8 weeks gestation, there is an intrauterine pregnancy with no fetal heartbeat. The nurse explains to the woman that she has had a missed SAB and management options include (select all that apply):

a) Missed SAB. In a missed SAB, the embryo has died or stopped developing early on but the woman hasn't miscarried. Therefore there would be no fetal heartbeat. b) Hydatidiform mole. No embryo in a molar pregnancy. c) Inaccurate dating. Could be too early to hear the fetal heartbeat by doppler (first heard by doppler at 9-11 weeks gestation).

At a woman's first prenatal visit at 14 weeks gestation, the nurse cannot find a fetal heartbeat with a doppler. What are possible explanations? (Select all that apply.)

Maternal carrier testing.

At her initial prenatal appointment, a woman says that her niece has sickle cell anemia, an autosomal recessive condition. She wants to know if her fetus has it. What is the first step in testing?

Isotretinoin (Accutane)

At her initial prenatal visit at 5 weeks gestation, which medication would the nurse instruct the women to discontinue immediately?

a) Twin gestation. b) Inaccurate dating. c) Hydatidiform mole.

At her initial prenatal visit, a woman is 16 weeks gestation by EDD. Her fundus is at her umbilicus. What are possible explanations? (Select all that apply.)

50%

Blood volume increases by _____ during pregnancy

normally occurs towards end of term when uterus becomes larger which compresses inferior vena cava when in supine; so less blood is pumped out with every heartbeat—which leads to low BP (mom can get lightheaded)

Define supine hypotension:

estrogen, relaxin, hCG

Describe 3 hormones produced by the placenta and their function.

the fetus shifts mom's heart to the left a little and will enlarge slightly

Describe shift in cardiac position

it will be 20 cm because it is equal to the amount of weeks preggo

Describe the fundal height at 20 weeks gestation

Leukorrhea is uncommon in pregnancy

A pregnant woman asks about urinary frequency. The nurse takes this opportunity to educate the client regarding the physiologic changes of pregnancy. All of the following statements are true except:

25-35 lbs

Recommended weight gain during pregnancy for: normal weight

15-25

Recommended weight gain during pregnancy for: overweight woman

28-40 lbs

Recommended weight gain during pregnancy for: underweight woman

31-50 lbs

Recommended weight gain during pregnancy for: woman pregnant with twins

a) Bland diet; She would be NPO until the vomiting is controlled.

The nurse is caring for a woman admitted with hyperemesis gravidarum. The nurse would expect initial treatment to involve all of the following except:

Slight increase in heart rate, Urinary frequency, Vaginal discharge

The physiologic changes that a woman typically experiences in pregnancy are: (select all)

The placenta weighs approximately 1.2 to 1.5 lbs at the time of birth

The placenta is a vital endocrine organ that plays an important role in sustaining a pregnancy. All of the following statements below are true except:

deoxygenated

The umbilical arteries carry _______ blood from the fetus to the placenta and then into maternal circulation for excretion.

Wharton's jelly

The umbilical cord is surrounded by connective tissue called

oxygenated

The umbilical vein carries ______ blood from maternal circulation through the placenta and then to the fetus.

fish with moderate to high mercury levels, shark, swordfish, soft cheese, meat spreads or deli meats, raw unpasteurized milk

list some food that are unsafe in pregnancy

Fundal height

measurement of the size of the uterus

nullipara

never been pregnant before

molar pregnancy

not a viable pregnancy -dark brown discharge -cannot become pregnant within one year and have frequent checks for cancer

General Fertility Rate (GFR)

number of births in one year per 1000 women is called _____

gravida

number of pregnancies

24 hours

ova (eggs) are fertile for about how long after ovulation?

Pancreas

pregnant woman has increased insulin needs, which decreases in the first trimester and increases for the 2nd and 3rd; insulin and glucagon

Chadwick's sign

purplish hue to cervix, vagina, and vulva

hyperemesis

severe or prolonged vomiting; can lead to weight loss and dehydration (aka extreme case of the morning sickness)

Thyroid

slightly enlarges due to increased vascularity and hyperplasia; back to normal a few weeks after birth (basal metabolic rate increases 25%)

Goodell's sign

softening of uterus and vagina

7 days; 72 hours

sperm lives for _____ inside a woman's body, but are most fertile in the first _____

Striae

stretch marks; are irregular streaks that appear on the abdomen, breasts, and butt in about 90% of women

Quickening

the first feeling of movement of the fetus in utero by the pregnant woman. It usually occurs between 16 and 20 weeks of gestation

urine hCG

the hormonal biochemical marker for positive preg test

uterus

the placenta develops from the _____

Linea negra

the skin in the middle of the abdomen may develop a pigmented line, which extends from umbilicus to the pubic area

Hypothyroid Disease

the thyroid is under-active and making insufficient amounts of thyroid hormones; which can lower IQ and impaired psychomotor development

serum hCG

this is quantitative; how MUCH hCG—would dictate if she has low or high hCG

Cervix friability

tissue that is easily irritated, which makes it more prone to inflammation, bleeding, or tearing

theyre finger like projections that form the fetal blood vessels of the placenta

what are chorionic vili and what is their function?

embryonic period (weeks 3-8)

when is the most vulnerable time for malformations from teratogen exposures?

Rectus abdominus

when the muscles separate during pregnancy from being stretched

maternal mortality

which biostatistic is often used as a measure of the health of a nation?

diets often lack calcium and iron; competition between growing adolescent and fetus for nutrients contribute to poor outcomes

why are adolescents at risk for inadequate nutrition during pregnancy

May cause more nutritious foods to be displaced from the diet, and the items consumed may interfere with the absorption of nutrients, Lower hemoglobin levels, can be contaminated with heavy metals or other toxic substances and Lead contamination

why is pica dangerous in pregnant women?

Increase calcium, for instance with dairy products and broccoli Increasing calcium intake can help, as can dorsiflexing the foot when calf cramping occurs.

A pregnant woman complains of frequent leg cramps. What dietary advice should the nurse give her?

g3 t1 p1 a0 l3

A pregnant woman has a healthy 4-year-old who was delivered at 41 weeks and twin 2-year-olds who delivered at 36 weeks. She has had no miscarriages or abortions. What is her GTPAL?

Your diaphragm has been displaced upward

A woman at 34 weeks gestation asks why her breathing has become more difficult. How would the nurse respond?

Incomplete SAB. (Retained products of conception, which occurs with incomplete SAB, can lead to prolonged bleeding and infection)

A few days later, the woman in the previous question experiences severe cramping for 2 hours and passes tissue. A week later, she is still bleeding and develops a fever of 100.8. What condition would the nurse suspect?

Normal pH during pregnancy

7.45-7.53

Mucous plug

A collection of thick mucus that blocks the cervical canal during pregnancy; Also called operculum.

There is a 25% chance the baby will have CF and a 50% chance s/he will be a carrier.

A couple whose first child has cystic fibrosis (CF) is concerned about having another child with the disease. Knowing this is an autosomal-recessive mode of inheritance, how would the nurse respond?

"I will maintain bedrest for 2 weeks after my last episode of bleeding." because Bedrest doesn't help

A woman experiences vaginal bleeding at 9 weeks gestation. Since the woman previously had an ultrasound documenting an intrauterine pregnancy, the nurse suspects a threatened SAB. Which client statement indicates a need for further education?

a) Fluid replacement. (A ruptured ectopic can lead to internal hemorrhage and death from blood loss. Fluid replacement can keep the mother alive until the tube can be urgently removed via surgery. Management of pain and emotional support are also done but are not as high a priority as keeping the mother alive)

A woman is admitted to the hospital with a ruptured ectopic pregnancy. A laparotomy is scheduled. Preoperatively, what is the top priority nursing intervention?

Maternal thyrotropin-receptor stimulating antibodies that cross the placenta.

A woman with Graves disease was treated with radioactive iodine and now takes Synthroid daily. Two years later she becomes pregnant. Her fetus is at risk for hyperthyroid and poor growth due to:

a) This weight gain is too low and could put the fetus at risk for intrauterine growth restriction (IUGR). (Although a woman whose pre-pregnancy weight is overweight or obese (BMI >24) is recommended to gain less weight, 15-25 pounds, 4 pounds at midway through the pregnancy is too little. A woman who has inadequate nutritional intake puts the fetus at risk of IUGR.)

A woman with a singleton pregnancy had a pre-conception BMI of 24. At 14 weeks gestation, she has gained 4 pounds since conception. How should the nurse interpret this?

"Most cases of Down syndrome are a new mutation so they do not necessarily run in families. Let's talk about the testing options."

A woman's sister has trisomy 21, Down syndrome. She has come for pre-conception counseling and asks if she has an elevated risk of having a baby with trisomy 21 because of her family history. How should the nurse respond?

1. respiratory 2. excretion 3. nutrition

List 3 main functions of the placenta:

Diagnostic of pregnancy; ultrasound detection, fetal heart beat (can hear at 10-12 weeks), fetal outline and movement felt by examiner, and height of growing fetus

List positive signs of pregnancy:

Changes felt by the woman; nausea and vomiting, amenorrhea, breast tenderness/enlargement, fatigue, urinary frequency, and quickening

List presumptive signs of pregnancy felt by woman:

Objective signs, the examiner observes; herger's sign, goodell's sign, chawick's sign, pregnancy test, and abdominal changes

List probable signs of pregnancy:

the placenta

Fetal circulation differs from extrauterine circulation because rather than getting oxygen from its lungs, the fetus gets oxygen from _____

The elevated hCG levels of pregnancy may mask a choriocarcinoma, which is most likely to develop in the first year after a molar pregnancy.

Following a dilation and curettage (D&C) to remove a molar pregnancy, a woman is cautioned to avoid pregnancy for a year. Why?

Electrolyte imbalance, Dehydration, Weight loss of >5% from pre-pregnancy weight

Hyperemesis gravidarum is distinguished from normal nausea and vomiting of pregnancy by: (select all the apply)

25% bc If the son receives a hemophilia gene from the mother, he will have hemophilia. Even though this is a recessive condition, since it's on the X-gene, he won't have a normal X-gene to overcome it (since boys are XY, with only 1 X-gene); 0 bc Since Dad has no hemophilia gene, the daughter can't inherit one from him.

In X-linked recessive conditions such as hemophilia, the trait is carried on the X chromosome. Therefore, the condition usually affects male offspring. If the baby's father does not have hemophilia and the mother is a carrier, what is the chance their son will have hemophilia?; what are the chances their daughter will have it?

a) Maternal blood pressure b) Maternal weight

In a normal, low risk pregnancy, each prenatal appointment would include: (Select all that apply)

a) During a spontaneous abortion. b) At the time of amniocentesis.

In which situations would a woman with A negative blood would need Rh immune globulin (RhoGam)? Select all that apply.

CVS can be done in the first trimester.

One advantage of chorionic villi sampling over amniocentesis is:

carpal tunnel syndrome (CTS)

compression of the median nerve as it passes between the ligament and the bones and tendons of the wrist; preggo women are particularly susceptible to this

decreases

describe the changes for: BP

the change that happens relating to anemia, they are both lowered.

describe the changes for: hemoglobin and hematocrit

increases

describe the changes for: pulse

take deeper breathes and longer exhalations; O2 consumption increases by 15% due to increased metabolic rate

describe the changes for: respirations

it is due to the GI system because it has been linked to high levels of hCG, high levels of circulating estrogen, reduced stomach acidity, and the lowered tone and motility of the digestive tract; ginger is also effective in reducing mild to moderate nausea and vomiting

discuss teaching you would give to patient suffering from nausea and vomiting in her early pregnancy

Human chorionic gonadotropin (hCG).

elevations in which pregnancy hormone cause morning sickness?

pytalism

excessive salivation (caused by increased estrogen levels)

fallopian tube; uterus; ectopic pregnancy

fertilization normally occurs in ________ and then fertilized ovum travels and implants in the _____. if implantation occurs in the tubes, it will result in a _____ ________.

nagel's rule

first day of normal LMP, subtract 3 months, then add 7 days

primipara

first time being pregnant

first

globally, the US ranks where for maternal mortality?

multipara

had more than one pregnancy

multigravida

had more than one pregnancy after 20 weeks

pyrosis

heartburn (avoid gastric irritants and sodium antacids)

Turn to left lateral position

how does RN correct supine hypotension

no calc increase needed; weight gain should be minimal

how many additional calories are recommended for: 1st trimester

approximately 1 lb per week

how many additional calories are recommended for: 2nd and 3rd trimester

postpartum hemorrhage, postpartum infections, abortion complications

identify 3 leading causes of maternal death in the US

societal & structural

identify two barriers that contribute to adequate prenatal care in this country

6-10 days; implantation bleeding

implantation occurs _______ after conception and may result in the woman having what symptom?

Braxton Hicks contractions

irregular prelabor contractions of the uterus that occurs all throughout pregnancy

first trimester ultrasound

known as crown to rump and this is another measurement done to determine due date

1. maintain constant body temp for fetus 2. permit symmetric growth and development 3. cushion fetus from trauma 4. promote fetal movement to enhance musculoskeletal devlopment

list 4 functions of the amniotic fluid

certified nurse midewife & neonatal nurse practictioner

list at least two professional nursing roles tat involve providing care to woman across their lifetime