很重要SAUNDERS OB ANTEPARTUM (3)

Hearing fetal heart rate with a fetoscope

The fetal heart rate can first be heard with a fetoscope at 18 to 20 weeks(考） of gestation. If a Doppler ultrasound device is used, the fetal heart rate can be detected as early as 10 weeks of gestation.

preeclampsia (mild / severe )

1. Blood pressure must be taken in the same arm（记）, in a sitting position, every day to obtain a consistent and accurate reading. 2. Which comment by the client would indicate that teaching is effective? --ANS："I need to check my urine with a dipstick every day for protein and call the health care provider if it is 2+ or more."（考） 3. Bleeding is an early sign of disseminated intravascular coagulation (DIC), a complication of preeclampsia, and should be reported.（eg. Any bleeding, such as in the gums, petechiae, and purpura紫癜 ）（考） 4. The client with Severe preeclampsia is kept on complete bed rest in a quiet environment. External stimuli such as lights, noise, and visitors that may precipitate a seizure should be kept to a minimum（考）. 5. The client is instructed to rest in a left lateral position（考） to decrease pressure on the vena cava, thereby increasing cardiac perfusion of vital organs. 6. Food and fluid are not restricted unless prescribed by the care provider. 7. one sign to suggest mild preeclampsia: a trace amount of protein(考） Preeclampsia is considered mild when the diastolic blood pressure does not exceed 100 mm Hg; proteinuria is no more than 500 mg/day (trace to 1+), and symptoms such as headache, visual disturbances, or abdominal pain are absent（都是 severe preeclampsia 才有）

A pregnant woman has UTI

A primigravida client comes to the clinic and has been diagnosed with a urinary tract infection. She has repeatedly verbalized concern regarding safety of the fetus. Which client problem does the nurse identify as important at this time? --ANS: Fear about the safety of the fetus(考） （The primary concern for this client is safety of her fetus, not herself. ）

HIV antibodies detected test

ELISA test (考）（the enzyme-linked immunosorbent assay (ELISA) test）

patellar reflex 膝跳反射

Patellar reflexes would be used during magnesium sulfate administration

preterm labor：Teaching and learning principles.

The nurse is reinforcing instructions to a client about preterm labor. Which method of teaching should the nurse use? --ANS: Palpate for uterine contractions at the same time as the client(考）

pregnant woman with anemia has high risk for infection

Women with anemia have a higher incidence of puerperal产后的 complications such as infection（考）

Complications of multiple gestation（eg.pregnant with twins)

1 .Maternal anemia(考） occurs in a client pregnant with twins because the maternal system is nurturing more than one fetus. 2. Preterm labor, rather than postterm labor is likely to occur. 3. Hydramnios羊水过多 may be associated with a twin pregnancy as a result of increased renal perfusion from cross-vessel anastomosis with monozygotic单卵 twins.

gestational diabetes

1. A pregnant client is newly diagnosed as having gestational diabetes. She cries during the interview and keeps repeating, "What have I done to cause this? If I could only live my life over." Which client problem should initially direct nursing care at this time? --ANS: The client is blaming herself(考） （The client is putting the blame for the diabetes on herself. She is expressing fear and grief. ） 2. To be at high risk for gestational diabetes, the maternal age should be greater than 30 years. 3. A previous history of unexplained stillbirths or miscarriages puts the client at high risk for gestational diabetes（考）

Nonstress test (NST)

1. Reactive：(normal/negative)（考） indicates a healthy fetus. 即每次FM（fetal movement ）都会相应看到FHR（fetal heart rate) 增加 。20分钟内有15beats/15min. 2. A nonreactive nonstress test is an abnormal test and requires further follow-up.

What precipitates sickling?

Vaso-occlusive crises (obstruction of the microcirculation by sickled red blood cells, causing ischaemia): This is the most common type of crisis. It may be precipitated by cold, infection, dehydration(考）, exertion or ischaemia.

Treatment related to condyloma acuminatum（Genital warts）[ˌkɔndə'lomɚ ə,kjumə'netəm]尖锐湿疣

Genital warts are a common sexually transmitted infection caused by the human papillomavirus (HPV). The characteristic symptom is a small bump on the genitals. The primary neonatal effect of the virus is respiratory or laryngeal papillomatosis[肿瘤] 乳头瘤病. Laser therapy（考） is the most effective method of treatment for this disorder that is considered safe for pregnancy.

Human immunodeficiency virus (HIV) and pregnancy.

HIV is caused by a retrovirus that infects T lymphocytes（考）. This disables the body's ability to fight infection. Nursing goals are directed at the prevention of infections（考）. Sexual relations are not contraindicated with the proper use of protective devices.

pregnant PT has hemorrhoids

Hemorrhoids are varicosities and are most likely to be precipitated during pregnancy by the pressure of the growing fetus inside the abdominal cavity. Hormonal changes are Not a factor(考）. Standing aggravates the problem. Dietary factors such as fluids and roughage and the technique of manual reduction（eg."Hemorrhoids can be gently pushed back inside body using a lubricant."） should be included in the plan of care.

Pica cravings during pregnancy

Pica cravings often lead to iron deficiency anemia（eg.Hemoglobin ↓ 考）, resulting in a lowered hemoglobin. 注：怀孕期血量会增加，但HCT会减少，WBC 稍微有点升高。

Surfactant (a substance needed to facilitate neonatal breathing)

Surfactant begins to be produced at approximately gestational week 28

A young client develops melasma（黑斑） during pregnancy.

The nurse determines that the client is experiencing which problem? --ANS：Concern about her appearance（考）

gestational HTN（AKA PIH: pregnancy induced HTN）

The nurse is gathering data from a 16-year-old pregnant client during her initial prenatal clinic visit. The client is beginning week 18 of her first pregnancy. Which client statement indicates a need for further investigation? --ANS: "I don't like my face anymore. I always look like I have been crying."(考） （an implication of periorbital and facial edema, which could be indicative of gestational hypertension (GH). Because this is an adolescent who has not sought early prenatal care, she is at higher risk for the development of gestational hypertension.)

A pregnant client has hepatitis B virus (HBV)

can breast-feed baby after the baby has been vaccinated(考）(Although HBV is transmitted in breast milk, once serum immune globulin has been administered, the mother may breast-feed without risk to the newborn.)

Contraction stress test (CST)

oxytocin or nipple stimulated CST: normal is negative , 3 contractions in 1 min , NO late deceleration( 记住是no late) deceleration 应该是与contractions 同时发生的，没有late or early.

Oligohydramnios 羊水过少

羊水过少(oligohydramnios)是指妊娠28周以后羊水量羊水过少约1/3有胎儿畸形