Antepartum

Rank these test in order from least invasive (1) to most invasive (4) -Non-stress testing in 3rd trimester -Chorionic Villus Sampling in 1st trimester -Alfa-fetoprotein (Quad Screen) at 15-21 weeks -Amniocentesis at 20 weeks

(1) Non-stress testing in 3rd trimester (3) Chorionic Villus Sampling in 1st trimester (2)Alfa-fetoprotein (Quad Screen) at 15-21 weeks (4) Amniocentesis at 20 weeks

Hagar's sign is considered a: A. Problem in pregnancy B. Positive sign of pregnancy C. Presumptive sign of pregnancy D. Probably sign of pregnancy

D. Probably sign of pregnancy You have to know the difference between the Presumptive (what the patient complains of), Probably (what the provider sees on exam), and Positive (can only be a fetus).

A patient comes into the office with a blood pressure elevation of 142/92. What other test result will support the diagnosis of Mild Preeclampsia? A. A urine protein level of 3+ (300 mg/dL) B. A weight gain of 6 lbs is her last 4 week visit. C. An elevation of serum liver enzymes from previous levels D. An elevation of serum platelet counts

A. A urine protein level of 3+ (300 mg/dL) Mild preeclampsia is treated at home with modified bedrest, charting of frequent blood pressure readings, and follow-up labs that includes urine protein levels, liver enzymes, and platelet counts to name a few.

A multigravida who is at 28 weeks of gestation has a fundal height of 29 cm. Which of the following is the best recommendation for this patient? A. Advise the mother that her pregnancy is progressing well B. Order an ultrasound of the uterus C. Schedule an amniocentesis D. Recommend bed rest with bathroom privileges

A. Advise the mother that her pregnancy is progressing well This question asks you to identify the expected fundal height measurement based on gestational age. After 20 weeks gestation, the fundus should measure =/- 2 cm for the gestational age.

A patient at 5 weeks gestation desires an abortion. The provider is pro-life and is hesitant to counsel this patient. What should the provider do? A. Advise the patient that she has a peer that can answer her questions more thoroughly B. Refer the patient to another provider C. Tell the patient about her pro-life views D. Excuse herself from the case

A. Advise the patient that she has a peer that can answer her questions more thoroughly This is time sensitive given Georgia's Heartbeat law. The patient is just about at the limit with heartbeat seen on ultrasound at 5.5-6 weeks gestation.

A non-reassuring FHR pattern would include which observation on the fetal monitoring strip? A. Moderate variability B. Early decelerations of any magnitude C. Severely high accelerations D. Prolonged deceleration

D. Prolonged deceleration

Sara, a 17 yr old primigravida, is admitted in the latent phase of labor. Her boyfriend, Dan, is with her as her only support. They appear committed to each other. During the admission interview, Sara tells you that they did not go to any classes because she was embarrassed about not being married. Both Sara and Dan appear very nervous, and the assessment indicates that they know little about what is happening, what to expect, or how to work together during the process of labor. What is the best choice for a nursing diagnosis for this couple? A. Anxiety related to lack of knowledge and experience regarding the process of childbirth. B. Ineffective coping related to adolescent pregnancy and poor family support. C. Situational stress related to poor compliance with contraception. D. Knowledge deficit related to community resources.

A. Anxiety related to lack of knowledge and experience regarding the process of childbirth.

Preconception counseling would include all of the following except: A. Exercise regimen that does not increase the heart rate twice a week B. Daily vitamins with 0.4-0.8 mg folic acid C. Decrease or increase weight to ideal levels prior to conception D. Stop smoking

A. Exercise regimen that does not increase the heart rate twice a week

Which of the following tests would you recommend to patients to confirm the diagnosis of beta thalassemia or sickle cell anemia? A. Hemoglobin electrophoresis B. Bone marrow biopsy C. Reticulocyte count

A. Hemoglobin electrophoresis

Patient confidentiality is breached when: A. Medical information is given to a spouse B. Records are subpoenaed C. Reports are sent to the Public Health Department D. Records are released to insurance companies

A. Medical information is given to a spouse Know your HIPAA rights to privacy. Make sure there is permission from your patient to discuss their care with others, even their spouse.

A second triple screen on a 35-year-old primigravida reveals abnormally low levels of the alpha fetoprotein and estriol and high levels of human chorionic gonadotropin. Which of the following interventions is the best choice for this patient? A. Order an ultrasound B. Order a computed tomography (CT) scan of the abdomen C. Order a 24-hour urine for protein clearance D. Assess for a history of illicit drug or alcohol use

A. Order an ultrasound This question asks you, "What is a safe test in pregnancy, and will they add to the diagnosis of Trisomy in the fetus?"

A 38-year-old multigravida who is at 32 weeks of gestation calls the office complaining of bright red vaginal bleeding. There is no watery discharge. She complains that her uterus feels hard and is very painful. Which of the following conditions is most likely? A. Placenta abruptio B. An ectopic pregnancy C. Placenta previa D. A molar pregnancy

A. Placenta abruptio Know the source of bleeding in pregnancy and how they are diagnosed and treated

Jane is a young primigravida and reports to you that she is starting to feel the baby's movements in her uterus. This is considered to be which of the following? A. Presumptive sign B. Probably sign C. Positive sign D. Possible sign

A. Presumptive sign

RhoGAM's mechanism of action is: A. The destruction of Rh-positive fetal RBCs that are present in the mother's circulatory system B. The stimulation of maternal antibodies so that there is a decreased risk of hemolysis C. The destruction of maternal antibodies against fetal RBCs C. The destruction of maternal antibodies against Rh-positive fetal RBCs

A. The destruction of Rh-positive fetal RBCs that are present in the mother's circulatory system It is important that you understand the risk for women with an Rh-negative blood type and the risk to her baby who is Rh-positive. These are the only two blood types that matter when we discuss Rh incompatibility

A positive Coombs test on an Rh-negative pregnant woman means: A. The mother has antibodies against Rh-positive red blood cells (RBC) B. The mother does not have Rh factor against fetal RBCs C. The fetus does not have RBC antibodies D. The fetus has antibodies against maternal RBCs

A. The mother has antibodies against Rh-positive red blood cells (RBC)

Fetal TORCH infections can cause microcephaly, mental restrictions, hepatosplenomegaly, and intrauterine growth restrictions. The acronym TORCH stands for: A. Toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes B. Toxic shock syndrome, ocular infections, rubella, cytomegalovirus, and herpes zoster C. Tetanus, ophthalmic infections, roseola, cancer, and head abnormalities D. Toxins, other infections, roseola, candidiasis, and head abnormalities

A. Toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes Based on the Acronym, what do we need to include in the education process? What does she need to avoid? Of course, pre-conception would be the ideal time to do this to prevent any exposure to the fetus.

The biophysical profile (BPP) evaluates fetal well-being by combining fetal heart rate monitoring with A. Ultrasonography examination of established fetal parameters B. Fetal Kick Counts C. External monitoring of uterine contractions D. Serum complete blood count (CBC)

A. Ultrasonography examination of established fetal parameters The patient will begin with a Non-stress test with a subsequent evaluation by ultrasound looking for fetal parameters. Each test is given 0 or 2 points. A total of 10 points is possible. A reactive Non-stress test gets 2 points. A non-reactive gets 0. The ultrasound gets 8 points total, 2 for a (2) 2 cm perpendicular pockets of fluid, 2 for 3 fetal movements, 2 for tone, and 2 for fetal breathing of 30 seconds or more. The ultrasound testing can take up to 30 minutes to complete.

After analyzing an internal fetal monitor tracing, the nurse concludes that there is moderate long-term variability (6-24 beats). Which of the following interpretations should the nurse make in relation to this finding? A. The fetus is becoming hypoxic. B. The fetus is becoming alkalotic. C. The fetus is in the middle of a sleep cycle. D. The fetus has a healthy nervous system.

D. The fetus has a healthy nervous system

Physiologic anemia of pregnancy is due to: A. An increase in the need for dietary iron in pregnancy B. An increase of up to 50% of the plasma volume in pregnant women

B. An increase of up to 50% of the plasma volume in pregnant women

The nurse is assessing the fetal heart rate (FHR) pattern. She notes that there are contractions every 2-3 minutes, each lasting 60-80 seconds. She also assesses the FHR strip for: A. Bleeding and clot formation. B. Baseline and variability in FHR tracing. C. Amount of amniotic fluid. D. Uterine contraction strength.

B. Baseline and variability in FHR tracing.

Which of the following is recommended for the outpatient treatment of mild preeclampsia? A. Restrict fluid intake to less than 1 liter per 24 hours B. Bed rest on the left side with bathroom privileges C. Aldomet (methyldopa) 250 mg PO (orally) twice a day D. Severe sodium restriction

B. Bed rest on the left side with bathroom privileges

Chadwick's sign is characterized by: A. Softening of the cervix in early pregnancy B. Blue coloration of the cervix and vagina in early pregnancy C. Nausea and vomiting during the first trimester of pregnancy

B. Blue coloration of the cervix and vagina in early pregnancy

You are educating a group of patients in a prenatal class. What information should you include regarding obesity during pregnancy? A. The fetus is small-for-gestational age B. Cesarean birth C. Rapid postpartum weight loss D. Hypoglycemia

B. Cesarean birth Obesity creates a high-risk pregnancy. She is at increased risk for gestational diabetes, large infant, abruptio placentae, and many more. Losing weight prior to pregnancy is ideal.

The nurse notes a non-reassuring fetal heart rate tracing. She will notify the PCP about the tracing. What other intervention should she include in treating the problem? A. Rush patient to the operating room. B. Discontinue oxytocin if being administered C. Turn mother to her back. D. Administer maternal oxygen by nasal cannula at 2 L/min.

B. Discontinue oxytocin if being administered

An Rh-negative pregnant woman with negative rubella titers should be vaccinated at what time period in pregnancy? A. She can be vaccinated at any time in her pregnancy B. During the postpartum period C. During the second trimester D. During the third trimester

B. During the postpartum period This question asks about Rubella and its effect on the fetus.

Which of the following findings is most likely a result of pregnancy-induced hypertension (PIH)? A. Abdominal cramping and constipation B. Edema of the face and the upper extremities C. Shortness of breath. D. Dysuria and increased frequency of urination

B. Edema of the face and the upper extremities

A multigravida who is at 34 weeks gestation wants to know at what level her uterine fundus should be. The best answer is to advise the mother that her fundus is: A. Midway between the umbilicus and the lower ribs B. From 33-35 cm C. At the level of the umbilicus D. from 32-34 cm

B. From 33-35 cm This question is related to normal measures of fundal height. Remember you have to accommodate for those measures that are above and below the gestational age.

A 35-year-old primigravida who is at 20 weeks of gestation is expecting twins. What would you expect her alpha fetoprotein (AFP) values to be? A. Normal B. Higher than normal C. Lower than normal D. None of the above

B. Higher than normal

Human placental lactogen (HPL) regulates glucose availability for the fetus and promotes fetal growth by what means? A. It causes an increase in insulin transportation across the placenta. B. It alters maternal protein, carbohydrates and fat metabolism. C. It causes an increase in insulin transportation across the placenta, D. It causes the pancreas to excrete less insulin

B. It alters maternal protein, carbohydrates and fat metabolism.

A pelvic exam on a woman who is 12 weeks pregnant would reveal that her uterus is located at which of the following areas? A. Between the umbilicus and the xiphoid process B. Just rising above the suprapubic bone C. Between the suprapubic bone and the xiphoid process D. Between the umbilicus and the suprapubic bone

B. Just rising above the suprapubic bone At suprapubic = 12 weeks Midway between suprapubic and umbilicus = 16 weeks Umbilicus = 20 weeks

of a 37-year-old primigravida who is at 30 weeks of gestation. Her first trimester bp was 102/78. Her bp today is 142/88. You note the following result on a routine urinalysis: Leukocyte = trace, nitrite = negative, protein = 2+, blood = negative. Her weight has increased by 3 lbs. during the past week. Which of the following is most likely? A. Primary hypertension B. Pregnancy-induced hypertension (preeclampsia) C. Eclampsia of pregnancy D. HELLP Syndrome

B. Pregnancy-induced hypertension (preeclampsia)

Folic acid supplementation is recommended for women who are planning pregnancy in order to: A. Prevent renal agenesis B. Prevent anencephaly C. Prevent kidney defects D. Prevent heart defects

B. Prevent anencephaly Folic acid supplementation reduces the risk for a defect in the neuro tube. It should be given at 0.4 mg for those at low risk and 0.8 mg for those at increased risk (previous neuro tube defect in pregnancy or a family history of neuro tube defect) As a side bar, this is why some antibiotics cannot be given in first trimester. Septra and Bactrim are examples. They inhibit folic acid!!

While performing Leopold's maneuvers on a woman in labor, the nurse palpates a hard round mass in the fundal area, a flat surface on the left side, small objects on the right side, and a soft round mass just above the symphysis. Which of the following is a reasonable conclusion made by the nurse? A. The fetal position is transverse. B. The fetal lie is vertical C. The fetal presentation is vertex. D. The fetal attitude is flexed.

B. The fetal lie is vertical

A 30-year-old female has had no period for 12 weeks. Urine test is positive. Which statement is true regarding this pregnancy? A. Hegar's sign is present during this period of pregnancy B. The fundus of the uterus should be at the level of the symphysis pubis C. The cervix should be dilated about 0.5 in at this time of gestation D. "Quickening" starts during this period

B. The fundus of the uterus should be at the level of the symphysis pubis

A benefit to Ultrasound (US) monitoring of a fetus is what? A. It cannot be used to establish growth patterns in the fetus. B. The limited pain involved is worth the benefit of the results. C. A pregnancy can be monitored serially. D. There is an associated risk of neuro tube defect in fetus' that undergo multiple US exams.

C. A pregnancy can be monitored serially.

A 42 y/o client has an amniocentesis during the 20th week of gestation because of concern about Down syndrome. Examination of the amniotic fluid will also provide information on: A. Fetal Diabetes B. Cardiac anomalies C. Alterations in the Fetal DNA D. Presence of neural tube defects

C. Alterations in the Fetal DNA

Human chorionic gonadotropin (hCG) is produced by the.. A. Ovaries B. Anterior pituitary C. Conceptus D. Hypothalmus

C. Conceptus

When monitoring four assigned antepartum patients, which one would be more likely to experience Abruptio Placentae? A. Admitted with a cardiac disorder. B. Hyperthyroidism C. Gestational Hypertension D. Cephalopelvic disproportion

C. Gestational Hypertension

All of the following vaccines are contraindicated in pregnancy except? A. Varicella B. Mumps C. Influenza D. Rubella

C. Influenza Vaccines safe in pregnancy are those that are not live. Any attenuated vaccine can be given safely.

Which is NOT a function of the amniotic fluid? A. Controls the embryo's temperature. B. Allows for symmetrical growth. C. Keeps the fetus from moving to prevent injury. D. Amniotic fluid cushions the fetus against mechanical injury.

C. Keeps the fetus from moving to prevent injury.

Which of the following systems will be affected primarily by a mother's alcohol consumption during the fetal period? A. None of these B. Muscular C. Nervous D. Integumentary

C. Nervous Alcohol consumption should be avoided since a safe level has not been established. Although 1-2 drinks per week appear to be safe, binge drinking 5 or more drinks carries the most risk. Alcohol cessation support should be given to any woman who is unable to quit drinking alcohol during pregnancy.

A client at 30-weeks gestation and is complaining of pressure over the pubic area. She is admitted for observation. She is contracting irregularly and demonstrates underlying uterine irritability. Vaginal examination reveals that her cervix is closed, thick, and high. Based on this data, what recommendation should the nurse give? A. Provide intravenous hydration. B. Have a complete blood count (CBC) drawn. C. Obtain a specimen for urine analysis with reflex Culture and Sensitivity D. Place the client on strict bedrest

C. Obtain a specimen for urine analysis with reflex Culture and Sensitivity Remember a urinary tract infection is the most likely cause for preterm contractions. This will tell you there is a urinary tract infection. A reflex C&S would be done when the lab points towards this infection.

The positive signs of pregnancy include: A. Fetal heart tones and felling of movement of the baby by the mother B. Fetal heart tones and a positive quantitative serum pregnancy test C. Palpation of the fetus and auscultation of the fetal heart tones by the nurse D. Palpation of the fetus and a positive quantitative serum pregnancy test

C. Palpation of the fetus and auscultation of the fetal heart tones by the nurse You have to know the difference between Presumptive (what the patient states), Probable (what the provider finds on exam), and Positive (what can only be attributed to a fetus)

Oxytocin (Pitocin) is stored in which portion of the brain? A. Madulla oblongata B. Hypothalmus C. Posterior pituitary gland D. Occipital lobe

C. Posterior pituitary gland Pitocin is produced in the posterior pituitary gland. Another hormone also produced there is the Antidiuretic hormone. As such, the body reacts to both of them almost identically. What can we expect from pitocin then? Fluid retention! What can we expect from ADH? Contractions. This is why women who are dehydrated come in with contractions. And why women in labor retain fluid until 3 days postpartum when they undergo diuresis to rid themselves of excess fluid.

The fetal/neonatal lung substance that improves pulmonary compliance by decreasing alveolar surface tension is: A. Meconium B. Prostaglandin C. Surfactant D. Phospholipid

C. Surfactant The more surfactant present, the more compliant the lungs become. It is much more difficult to ventilate a preterm lung than it is to ventilate a baby at term. There is artificial surfactant (Curosurf) that can be placed by endotracheal tube in a preterm infant. An L/S ratio can be done testing the amniotic fluid by amniocentesis. The ration should be 2:1.

The results from a fetal blood sampling test are reported as pH 7.30. The nurse interprets the results as: A. The baby must be delivered as soon as possible. B. The baby is severely acidotic. C. The results are within normal limits. D. The results are equivocal warranting further sampling.

C. The results are within normal limits.

An amniocentesis is scheduled for your patient 48 hours after her last dose of Betamethasone. She asks you why the test is needed. Your best answer is? A. The test will tell us how far along you are in pregnancy B. The test will evaluate any TORCH issues from the drug C. The test will take amniotic fluid to test for the lung maturity of your baby D. The test will tell us why you are not getting pregnant

C. The test will take amniotic fluid to test for the lung maturity of your baby

A 30-year-old primigravida is diagnosed with a possible threatened abortion. The result of the urine pregnancy test is positive. Which of the following statements is true regarding a threated abortion? A. Vaginal bleeding and cramping are present along with a dilated cervix. B. The fetus and placenta are all expelled. C. Vaginal bleeding and cramping are present, but the cervix remains closed. D. The products of conception and the placenta remain inside the uterus along with a dilated cervix.

C. Vaginal bleeding and cramping are present, but the cervix remains closed. Any loss of pregnancy before the 20th week is called an abortion. You must be able to tell the difference between them and how they will be treated.

When palpating a woman who is at 20 weeks of gestation, the uterine fundus should be palpated at what level? A. Above the level of the umbilicus B. Between the pubic symphysis and the umbilicus C. Just rising above the level of the pubic symphysis D. At the level of the umbilicus

D. At the level of the umbilicus

Why would there be a need to do fetal blood sampling for pH? A. This is a normal part of the fetal assessment. B. To prove in court that the injury to the fetus was not caused during labor. C. Rhogam may need to be administered to the mother prior to delivery. D. If acid-base information is needed to rule out hypoxia.

D. If acid-base information is needed to rule out hypoxia.

A major risk factor for Down syndrome infants is: A. Maternal age younger than 16 years of age B. A positive family history of genetic disease C. A positive family history of Down syndrome D. Maternal age older than 35 years of age

D. Maternal age older than 35 years of age

Which of the following conditions is a possible complication of severe eclampsia? A. Erythroblastosis fetalis B. Placenta previa C. Uterine rupture D. Placenta abruptio

D. Placenta abruptio

A 28-year-old multipara who is at 32-weeks gestation presents to your office complaining of a sudden onset of small amounts of bright red vaginal bleeding. She has had several episodes and appears anxious. On exam, her uterus is soft to palpation. Which of the following is most likely? A. Molar pregnancy (hydatidiform mole) B. Acute cervicitis C. Placenta abruptio D. Placenta previa

D. Placenta previa Can you tell the difference between these disorders? When do they occur? What symptoms does the patient have?

A 25-year-old woman's last menstrual period was 6 weeks ago. She is complaining of nausea with vomiting in the morning and fatigue. Her breasts feel bloated. The nurse suspects she may be pregnant. Her symptoms would be considered: A. Positive signs of pregnancy B. Possible signs of pregnancy C. Probably signs of pregnancy. D. Presumptive signs of pregnancy

D. Presumptive signs of pregnancy Know the difference between the 3

For teratogens or environmental factors, the extent of damage depends on the developmental timing, duration, and dosage exposure. True False

True

Accelerations in the fetal heart rate pattern are non-reassuring signs of fetal well-being when they occur during contractions. True False

False

All translocations of genetic material are expressed the same in all individuals. True False

False

Oxygen, nutrients and waste are transported back and forth between fetus and mother by the functions of this organ. A. Placenta B. Amniotic fluid C. Spleen D. Heart

Placenta