OB Exam I

Nutritional needs in pregnancy

-Only 300 calories added, -Vitamins & mineral supplement,

Ovaries enlarge until when?

12th-14th week of gestation

Hegar's sign

softening of the lower uterine or isthmus

Colostrum

antibody rich yellow fluid expressed after 12th week turns to mature milk after delivery

In the Luteinizing phase the Uterine lining is in the

secretory phase

Fetal Height

20 cm=20wks; reliable until 36 weeks' gestation

When is the Follicular Phase

Day 1-13

Ovulatory phase is when

Day 14

Endocrine system Adaptation Pituitary Gland

Enlargement, decrease Thyroid stimulating Hormone(TSH), GH. -Inhibited Follicle-stimulating hormone(FSH) & Luteinizing hormone(LH), -Increased Prolactin, Melanocyte-Stimulating hormone:pigment hormone(MHS), -gradually increase in oxytocin w/ fetal maturation

Follicular phase from the Ovaries

Estrogen dominate

In follicular Phase the Pituitary

FSH dominates

The Uterus shape changes from

Pear shape to Ovoid shape

In the Luteinizing phase what dominates in the ovaries?

Progesterone

Follicular phase in the Uterine lining in in the

Proliferative phase

Endocrine system Adaptation Thyroid gland:

Slight enlargement: increased activity, & Basal Metabolic rate(BMR)

Reproductive adaptation of Cervix

Softening (Goodell's sign), Increased vascularization (Chadwick's sign), Ripening(softening) about 4 weeks before birth

In the Luteinizing phase from the pituitary FSH & LH are

both low

Braxton Hicks

false contractions

Endocrine system Adaptation Placental secretion

hCG,hPL, relaxin:associated w/ pregnancy waddle, progesterone, estrogen

Endocrine system Adaptation Adrenal glads

increased in cortisol(alarm clock) & aldosterone(regular bp) secretion.

Integumentary System adaptation

-Hyperpigmentation: facial melasma(darkening of skin), - Linea nigra(dark line down belly), -Striae gravidarum(stretch marks), -Varicosities, -Vascular spiders, -Palmar erythema(reddening of palms), -Increased hair & nail growth

Cardiovascular system Adaption

-Increase in blood volume 40%-45%, -Increased cardiac output, -Increased venous return, -increase heart rate 10-15, -decreased bp(until mid pregnancy), -Hemodilution (anemia), -Increase in iron demands, fibrin & plasma fibrinogen levels, and some clotting factors, leading to hypercoagulable state

Musculoskeletal system adaptation

-Softening and stretching of ligaments holding sacroiliac joints and pubis symphysis -Postural changes: increased swayback and upper spine extension -Forward shifting of center of gravity -Increase in lumbosacral curve (lordosis); compensatory curve in cervicodorsal area -Waddle gait

Dietary Recommendations for pregnancy

-increase protein, iron, folate, -Use USDA's My plate, -Avoid fish(mercury)

The Uterus increases in

-weight, length, width, depth, volume, and overall capacity, -positive Hegar's sign, -Enhanced uterine contractility, -Ascent into abdomen after first 3 months;

Endocrine system Adaptation Prostaglandin secretion

Possible softening cervix, initiate/ maintain labor

Which are presumptive signs of pregnancy that the nurse would expect when assessing a client at 10 weeks' gestation? Select all that apply. One, some, or all responses may be correct. 1. Amenorrhea 2. Breast changes 3. Urinary frequency 4. Abdominal enlargement 5. Positive urine pregnancy test

1. Amenorrhea 2. Breast changes 3. Urinary frequency Rationale:The key to answering this question is understanding the difference between presumptive versus probable signs of pregnancy. Presumptive signs of pregnancy are less specific subjective changes that are reported by the client during an assessment interview. Probable signs of pregnancy are more objective changes that can be measured in the reproductive organs during a physical assessment. The absence of menstruation (amenorrhea) is a presumptive sign of pregnancy that is recognized at 4 weeks' gestation. Breast changes, related to increased levels of estrogen and progesterone, are a presumptive sign of pregnancy that is recognized at 3 to 4 weeks' gestation. Urinary frequency, related to pressure of the enlarging uterus on the urinary bladder, is a presumptive sign of pregnancy that is recognized at 6 to 12 weeks' gestation. Abdominal enlargement related to the enlarging uterus is a probable sign of pregnancy that is recognized when the enlarging uterus rises out of the pelvis at 14 to 16 weeks' gestation. A positive urine pregnancy test result, indicating an increase in human chorionic gonadotropin (hCG), is a probable sign of pregnancy that can be detected 26 days after conception. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer.

With which problem is a low maternal serum alpha-fetoprotein associated? 1. Fetal demise 2. Down syndrome 3. Neural tube defects 4. Esophageal obstruction

2. Down Syndrome Rationale: Chromosomal trisomies such as Down syndrome may be marked by a lower-than-typical level of alpha-fetoprotein. Fetal demise, neural tube defects, and esophageal obstruction typically result in increased levels of alpha-fetoprotein. STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections.

Which clinical finding would the nurse evaluate before continuing the administration of intravenous (IV) magnesium sulfate therapy? 1. Temperature and respirations 2. Patellar reflexes and urinary output 3. Urinary glucose and specific gravity 4. Level of consciousness and funduscopic appearance

2. Patellar reflexes and urinary output Rationale:Adequate urinary output, an indicator of effective renal function, is necessary to prevent toxicity, because magnesium sulfate is excreted by the kidneys. Signs of magnesium sulfate toxicity include an absence of patellar reflexes and slowed respiration; therefore, these assessments are essential. Although slowed respiration may indicate magnesium sulfate toxicity, deviations in temperature are not relevant. Urinary glucose and specific gravity are urine tests; they are not relevant to magnesium sulfate therapy. The client's level of consciousness and funduscopic appearance are assessments that may indicate worsening preeclampsia; they are not determinants of the response to magnesium sulfate therapy.

Presumptive signs of Pregnancy(what client tells you)

-Breast tenderness(3-4wks)/enlargment(6wks), -N&V(4-14wks), -Delayed Mense(4wks), -Urinary Frequency(6-12wks), -Uterine enlargment(7-12wks), -Fatigue(4-12wks), -Hyperpigmentation(16wks), -Fetal movement(16-20 wks)

Respiratory System Adaptation

-Breathing more diaphragmatic than abdominal due to increase in diaphragmatic excursion, chest circumference, and tidal volume -Increased oxygen consumption, -Congestion due to increased vascularity/hormones

Special considerations for nutritional needs in pregnancy

-Culture, -Lactose intolerance, -Vegetarianism, -Pica(craving non nutritional things like ice)

Probable Signs of Pregnancy

-Positive pregnancy test(4-12wks), -Goodell's sign(5wks), -Chadwick's sign(6-8wks), -Hegar's Sign(6-12wks), -Abdominal enlargement(14wks), -Ballottement(16-28wks)

What is the normal BMI

18-24

Fetal movement

20 weeks

Maternal Weight Gain Healthy BMI:

25-35 lbs, -1st trimester: 3.5-5 lbs, -2nd & 3rd trimester: 1lb/week

When is the Luteinizing phase

Day 15-28

Reproductive adaptation of Vagina

Increased vascularity with thickening; Lengthening of vaginal vault; Secretions more acidic, white, and thick; leukorrhea

Reproductive system adaptations in Breast

increased size & nodularity, -Increased nipple size, -Production of colostrum

Endocrine system Adaptation Pancreas

insulin resistance due to Human placenta lactogen(hPl) &other hormones in 2nd half of pregnancy

Goodell's sign

softening of cervix

A 37-year-old G3P2001 client with hypertension and type 1 diabetes with good glycemic control is seen in the antepartum testing unit for a nonstress test (NST) at 36 weeks. Her obstetric (OB) history includes an intrauterine fetal death at 38 weeks. What risk factors in the client's history indicate the need for an NST? Select all that apply. One, some, or all responses may be correct. 1. Age older than 35 years 2. The risk for placenta previa 3. The risk for placental insufficiency 4. A history of stillbirth from her last pregnancy 5. Hypertension 6. Type 1 diabetes

1, 3,4,5,6 Rationale:This client has multiple risk factors that would indicate the need for an NST to evaluate fetal status. Maternal age over 35 is considered advanced maternal age and is associated with a slightly increased risk of stillbirth and fetal growth restriction. The history of a prior stillbirth increases her risk of stillbirth in the current pregnancy. This client also has diabetes and hypertension, both of which put her at risk for placental insufficiency. Although advanced maternal age increases the risk of placenta previa, it is not the primary reason for having an NST.

Severe pain accompanied by bleeding at term or close to it is symptomatic of complete premature detachment of the placenta (abruptio placentae). A hydatidiform mole is diagnosed before 36 weeks' gestation; it is not accompanied by severe pain. There is no bleeding with vena cava syndrome. Bleeding caused by placenta previa should not be painful 1. Mild preeclampsia 2. Severe preeclampsia 3. Chronic hypertension 4. Gestational hypertension

1. Mild Preeclampsia Rationales: Preeclampsia is hypertension that develops after 20 weeks' gestation in a previously normotensive woman. With mild preeclampsia the systolic blood pressure is below 160 mm Hg and diastolic BP is below 110 mm Hg. Proteinuria is present, but there is no evidence of organ dysfunction. Severe preeclampsia is a systolic blood pressure of greater than 160 mm Hg or diastolic blood pressure of at least 110 mm Hg and proteinuria of 5 g or more per 24-hour specimen. Chronic hypertension is hypertension that is present before the pregnancy or diagnosed before 20 weeks' gestation. Gestational hypertension is the onset of hypertension during pregnancy without other signs or symptoms of preeclampsia and without preexisting hypertension. Test-Taking Tip: Read carefully and answer the question asked; pay attention to specific details in the question.

Which are risk factors of diabetes in pregnancy? Select all that apply. One, some, or all responses may be correct. 1. Preterm birth 2. Hypertension 3. Cesarean birth 4. Placenta previa 5. Placental abruption

1. Preterm birth 2. Hypertension 3. Cesarean Birth Rationale:Maternal complications associated with diabetes include preterm birth, hypertension, and cesarean birth. Placenta previa and placental abruption are not directly associated with diabetes.

Which nursing interventions are applicable to a client receiving an infusion of magnesium sulfate for severe preeclampsia? Select all that apply. One, some, or all responses may be correct. 1. Restricting visitors 2. Limiting fluid intake 3. Preparing for a precipitate birth 4. Maintaining a quiet environment 5. Keeping magnesium gluconate at the bedside

1. Restricting visitors 4. Maintaining a quiet environment Rationale: Visitors should be limited to significant others to reduce excessive stimuli that could precipitate a seizure. A quiet room helps reduce stimuli and the risk of seizures. Fluid intake should not be restricted. A precipitous birth is not a usual side effect of magnesium sulfate therapy. Calcium gluconate, not magnesium gluconate, is the antagonist for magnesium sulfate and should be readily available if signs of toxicity appear.

A number of routine screens are performed on the pregnant client during the course of her gestation. Place the tests in order from first to last test done. 1. Sickle Cell screening 2. Alpha-fetoprotein(AFP) testing for neural tube defects 3.Serum glucose for gestational diabetes 4.Fetal Movement test 5.Group B streptococcus culture

1.Sickle Cell screening(initial visit) 2. Alpha-fetoprotein(AFP) testing for neural tube defects(14-16 weeks) 3.Serum glucose for gestational diabetes(26-28 weeks) 4.Fetal Movement test(28 weeks) 5.Group B streptococcus culture(36-38weeks)

The nurse genetic counselor is working with a couple, each of whom is a carrier of an autosomal-recessive disorder. Which statement indicates that the couple has understood the teaching about this disorder? 1 "Most of our children will have the disorder." 2 "None of our children will have the disorder." 3 "There is a 1-in-4 chance of having a child with the disorder." 4 "There is a 1-in-2 chance of having a child with the disorder."

3. "There is a 1-in-4 chance of having a child with the disorder." Rationale: According to Mendelian genetic theory, when both parents are carriers of an autosomal-recessive disorder there is a 1-in-4 chance or 25% probability that a child will have the disorder. The statement that none of the children will have the disorder indicates that the couple does not understand Mendel's theory of probability. When both partners are carriers, there is a 1-in-2 chance or 50% probability that a child will be a carrier and a 1-in-4 chance or 25% probability that a child will have the disorder. If one of the parents has the disorder, there is a 1-in-2 chance or 50% probability that a child will have the disorder.

Which type of surgery would be listed on the informed consent for a client with a ruptured ectopic pregnancy being prepared for surgery? 1. Myomectomy 2. Hysterectomy 3. Salpingectomy 4. Oophorectomy

3. Salpingectomy Rationale: The ruptured fallopian tube may be removed (salpingectomy) rather than repaired; repair of the tube may result in scarring, predisposing the client to another tubal pregnancy. Myomectomy is a procedure for removing leiomyomas (fibroids) from the uterus. The uterus is uninvolved in a tubal pregnancy and does not need to be removed (hysterectomy). The ovaries should not be removed (oophorectomy), especially if another pregnancy is desired. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of resources over an extended period of time ensures your understanding and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep yo

Which assessment findings correlate with a diagnosis of unruptured tubal pregnancy? Select all that apply. One, some, or all responses may be correct. 1. Rigid abdomen 2. Referred shoulder pain 3. Unilateral abdominal pain 4. History of a sexually transmitted infection (STI) 5. Ecchymotic blueness around the umbilicus

3. Unilateral Abdominal pain 4. History of a sexually transmitted Infection(STI) Rationale: Pain usually occurs at the location of the affected tube before it has ruptured. STIs are related to pelvic inflammatory disease; the finding that the client has had an STI increases the likelihood that the tubes will be affected, resulting in a tubal pregnancy. A rigid abdomen is not expected if the tube has not ruptured; this finding occurs after the rupture of a tubal pregnancy. Referred shoulder pain occurs as a result of diaphragmatic irritation caused by blood in the peritoneal cavity after a tubal pregnancy ruptures, not before rupture. Ecchymotic blueness around the umbilicus (the Cullen sign) indicates hematoperitoneum in a ruptured intra-abdominal ectopic pregnancy.

Which finding, other than increased blood pressure, may indicate preeclampsia? 1. Positive nonstress test 2. Negative contraction stress test 3. Weight gain of 6 lb (2.7 kg) in 1 month 4. Fetal heart rate below 120 beats/min

3. Weight gain of 6 lb (2.7 kg) in 1 month Rationale: In preeclampsia, renal blood flow and the glomerular filtration rate are decreased, resulting in fluid retention and rapid weight gain. A positive nonstress test and negative contraction stress test each indicate fetal well-being. The heart rate of a healthy fetus ranges from 110 to 160 beats/min.

A client at 36 weeks' gestation presents with severe abdominal pain, heavy vaginal bleeding, a drop in blood pressure, and an increased pulse rate. Which complication of pregnancy is suggested by these signs and symptoms? 1. Hydatidiform mole 2. Vena cava syndrome 3. Marginal placenta previa 4. Complete abruptio placentae

4. Complete abruptio placentae Rationale: Severe pain accompanied by bleeding at term or close to it is symptomatic of complete premature detachment of the placenta (abruptio placentae). A hydatidiform mole is diagnosed before 36 weeks' gestation; it is not accompanied by severe pain. There is no bleeding with vena cava syndrome. Bleeding caused by placenta previa should not be painful

At term a client's hemoglobin level is 10.6 g/dL (106 mmol/L) and her hematocrit is 31%. Which physiological factor accounts for these values? 1. Diuresis 2. Infection 3. Alkalosis 4. Hemodilution

4. Hemodilution Rationale: The increase in circulating blood volume during pregnancy is reflected in lower hemoglobin and hematocrit readings (physiological anemia of pregnancy); this represents hemodilution. Diuresis would contribute to hemoconcentration rather than hemodilution. Neither infection nor alkalosis lead to a lower hemoglobin or hematocrit. Test-Taking Tip: Do not spend too much time on one question because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore guess. Go for it! Remember: You do not have to get all the questions correct to pass.

A pregnant client's blood test reveals an increased alpha-fetoprotein (AFP) level. Which condition is indicated with this result? 1. Cystic fibrosis 2. Phenylketonuria 3. Down syndrome 4. Neural tube defect

4. Neural tube defect Rationale:Increased levels of alpha-fetoprotein in pregnant women have been found to reflect open neural tube defects such as spina bifida and anencephaly. Cystic fibrosis is a genetic defect that is not associated with the AFP level. A Guthrie test soon after ingestion of formula can determine whether an infant has phenylketonuria. Down syndrome is a chromosomal defect that is associated with a low AFP level.

Positive signs of Pregnancy

-Ultrasound of embryo/fetus, -Auscultation of fetal heart tones via doppler, -Fetal movement felt by experienced clinician

Fetal Heart tones

10-12 weeks

Ultrasound are performed

4-6 weeks

Which pH value of amniotic fluid is indicated by a Nitrazine test strip that turns deep blue? 1. 4.5 2. 5.5 3. 6.5 4. 7.5

4. 7.5 Rationale: Amniotic fluid changes the color of a nitrazine strip from yellow to deep blue if the pH of the fluid is 7.5. A pH of 4.5, 5.5, or 6.5 would result in a test strip of yellow, olive yellow, or blue green, respectively.

Which complication would the nurse anticipate when a client who is 36 weeks' pregnant presents with swelling of the face, blurred vision, and epigastric discomfort? 1. Preeclampsia 2. Placenta previa 3. Gestational diabetes 4. Hyperemesis gravidarum

1. Preeclampsia Rationale:Swelling of the face, blurred vision, and epigastric discomfort are classic signs of preeclampsia. Placenta previa, gestational diabetes, and hyperemesis gravidarum do not present with swelling of the face, blurred vision, and epigastric discomfort.

Which findings support the conclusion that a pregnant client's membranes have ruptured? Select all that apply. One, some, or all responses may be correct. 1.The expelled fluid totals 500 mL. 2. The expelled fluid is light yellow. 3. The expelled fluid smells similar to urine. 4. Nitrazine paper turns blue on contact with the fluid. 5. Microscopic examination of the fluid reveals ferning.

4. Nitrazine paper turns blue on contact with the fluid. 5. Microscopic examination of the fluid reveals ferning. Rationale: An alkaline fluid will turn nitrazine paper blue; amniotic fluid is alkaline. Amniotic fluid demonstrates a ferning pattern, which is visible with a microscope when placed on a slide. It is not the amount of fluid that is observed, but the characteristics of the fluid that are significant. Amniotic fluid should be clear and may contain white specks of vernix. Yellow coloration indicates that the fluid may be urine. Green fluid is indicative of meconium staining, which is a nonreassuring fetal sign. The odor of amniotic fluid is not similar to that of urine. Amniotic fluid has a mild, somewhat fleshy odor.

Chadwick's sign

Bluish-purple coloration of vaginal mucosa & cervix

Weight gain for BMI >25

15 -20 lbs 1st trimester: 2lbs 2nd & 3rd : 2-3lbs/week

Weight gain for BMI < 19.8

28-40lbs 1st trimester:5lbs 2nd & 3rd: 2-3lbs/week

Which statement by the client in the first trimester of pregnancy illustrates a psychologic reaction that usually occurs at this stage of pregnancy? 1. "I know I'm going to be a terrible mother; I'll forget the baby when I go out." 2. "I'm excited about the baby, but I'm not sure that I'm ready to be a mother." 3. "I know I'm going to have a girl. I dreamed that she would be a doctor or a lawyer and be very successful." 4. "I'm so excited about this baby, but I'm so afraid of losing control during labor. I know I'll be a terrible patient."

2. "I'm excited about the baby, but I'm not sure that I'm ready to be a mother." Rationale: The response "I'm excited about the baby, but I'm not sure that I'm ready to be a mother" reflects the ambivalence toward pregnancy that is typical during the first trimester. The statement "I know I'm going to be a terrible mother; I'll forget the baby when I go out" is a typical response during the third trimester, when the client begins to doubt her ability to be a good parent. Fantasizing about the infant, its sex, and its future is common during the second trimester. Expressing fears about the birthing process and parenting is common during the third trimester.

A client in her 36th week of gestation is admitted with vaginal bleeding, severe abdominal pain, a rigid fundus, and signs of impending shock. For which intervention would the nurse prepare? 1. A high-forceps birth 2. An immediate cesarean birth 3. Insertion of an internal fetal monitor 4. Administration of an oxytocin infusion

2. An immediate cesarean birth Rationale: The client's signs and symptoms are those of complete placental separation (abruptio placentae) for which an immediate cesarean birth is the ideal treatment. High-forceps birth is rarely used, because the forceps may further complicate the situation by tearing the cervix. The risk for fetal and maternal mortality is too high to delay action, so a fetal monitor would not be inserted. Administration of oxytocin would greatly increase the risk of fetal death. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency.

Which position increases cardiac output in the obstetrical client with cardiac disease? 1. Trendelenburg 2. Low semi-Fowler 3. Lateral positioning 4. Supine with legs elevated

3. Lateral positioning Rationale: Lateral positioning improves the cardiac output of an obstetrical client with cardiac disease. Trendelenburg, low semi-Fowler, and the supine position are not appropriate positions to improve the cardiac output of an obstetrical client with cardiac disease. Placing the client in these positions allows the weight of the uterus to remain on the vena cava, impeding the blood flow. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer.

Which condition is detected by an alpha-fetoprotein test? 1. Kidney defects 2. Cardiac anomalies 3. Neural tube defects 4. Urinary tract anomalies

3. Neural tube defects Rationale: The alpha-fetoprotein test detects neural tube defects, Down syndrome, and other congenital anomalies. It is a screening test that affords a tentative diagnosis; confirmation requires more definitive testing. Anomalies of the kidneys, heart, and urinary tract are not revealed by the alpha-fetoprotein test.

Which factor can cause a false-negative result on a home pregnancy test? 1. Saturation of the test strip 2. Use of the first void of the morning 3. Timing the test for 3 days after intercourse 4. Doing the test while taking a prescribed tranquilizer

3. Timing the test for 3 days after intercourse Rationale:The most common error made by women taking home pregnancy tests is to perform the test too early in the pregnancy. Although some tests may be accurate at 7 days, the test will be more accurate if performed at the time of the missed period. Saturation of the test strip and using the first void of the morning are necessary steps in the process. Taking a prescribed tranquilizer is more likely to cause a false-positive result.

The nurse is assessing a client with a tentative diagnosis of hydatidiform mole. Which clinical finding would the nurse anticipate? 1. Hypotension 2. Decreased fetal heart rate 3. Unusual uterine enlargement 4. Painless, heavy vaginal bleeding

3. Unusual uterine enlargement Rationale:The proliferation of trophoblastic tissue filled with fluid causes the uterus to enlarge more quickly than if a fetus were in the uterus. Hypertension, not hypotension, often occurs with a molar pregnancy. There is no fetus within a hydatidiform mole. There may be slight painless vaginal bleeding.

Which answer would the nurse give to a client who asks what is the common cause of a spontaneous abortion? 1. Physical trauma 2. Unresolved stress 3. Congenital defects 4. Embryonic defects

4. Embryonic defects. Rationale: Approximately 75% of all spontaneous abortions take place between 8 and 12 weeks' gestation and reveal embryonic defects. Though possible, physical trauma rarely causes an abortion. Unresolved stress is rarely associated with spontaneous abortions. Congenital defects are asymptomatic during pregnancy and do not usually cause abortion.

Which result after 20 minutes of a nonstress test is suggestive of fetal reactivity? 1. Absence of long-term variability 2. Above-average fetal baseline heart rate of 160 beats/min 3. No late decelerations associated with contractions 4. Two accelerations of 15 beats/min lasting 15 seconds

4. Two accelerations of 15 beats/min lasting 15 seconds Rationale: According to the American Congress of Obstetricians and Gynecologists, fetal reactivity is a fetal tracing 15 beats' acceleration above baseline lasting 15 seconds or more, normal baseline rate, and long-term variability amplitude of 10 or more beats/min. An absence of long-term variability is an ominous sign that must be addressed. An above-average baseline heart rate is acceptable up to 160 beats/min. An increasing baseline heart rate is a sign of maternal infection. Contractions are not expected with a nonstress test; early, late, or variable fetal heart rate decelerations are associated with uterine contraction

GI system adaptions during pregnancy

Gingivitis(easily bleeds), -Ptyalism(excessive saliva), -Decreased peristalsis & smooth muscle relaxation, -Constipation increased venous pressure plus pressure from uterus + hemorrhoids, Prolonged gallbladder emptying, -N&V, Heartburn

Renal/Urinary system

-Dilation of renal pelvis; elongation, widening, and increase in curve of ureters, -Increase in length and weight of kidneys, -Increase in GFR; increased urine flow and volume, -Increase in kidney activity with woman lying down; greater increase in later pregnancy with woman lying on side

Intravenous magnesium sulfate therapy is instituted for a client with severe preeclampsia who has a blood pressure of 170/110 mm Hg, a pulse of 108 beats/min, and a respiratory rate of 24 breaths/min. Eight hours later her blood pressure is 150/110 mm Hg, the pulse is 98 beats/min, the respiratory rate is 10 breaths/min, and the knee-jerk reflex is absent. Which action would the nurse take in response to these findings? 1. Stop the infusion of magnesium sulfate and notify the primary health care provider. 2. Administer calcium gluconate, because it is an antidote to magnesium sulfate. 3. Continue the magnesium sulfate infusion, because the blood pressure is still high. 4. Check vital signs and reflexes in 1 hour and then discontinue the infusion if necessary.

1. Stop the infusion of magnesium sulfate and notify the primary health care provider. Rationale: Near-toxic levels of magnesium sulfate are suggested by the disappearance of the knee-jerk reflex and by depressed respirations (fewer than 12 breaths/min). This is a life-threatening situation, and the infusion must be stopped and the primary health care provider notified immediately. Calcium gluconate may be given as an antidote, but the infusion of magnesium sulfate must be stopped first. Magnesium sulfate is not an antihypertensive. Waiting may put the client in danger of respiratory arrest; signs of toxicity require immediate intervention. STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes you laugh, reading something funny, or sharing humor with friends helps decrease stress.

A nonstress test evaluates the condition of the fetus by comparing the fetal heart rate with which factor? 1. Fetal lie 2. Fetal movement 3. Maternal blood pressure 4. Maternal uterine contractions

2. Fetal Movement Rationale: In a healthy, well-oxygenated fetus the heart rate increases with fetal movement; there should be an acceleration of 15 beats with fetal movement. Fetal lie and maternal blood pressure are not a part of the evaluation of the fetus in the nonstress test. Maternal uterine contractions are used in the contraction stress test.