CFAM Exam 2

As the nurse is completing the assessment of a newly pregnant Kelly, the patient shares that she wasn't planning another pregnancy at this time and isn't sure how she feels about it. What is the nurse's best response to the patient?

"It is normal to fell ambivalent the first few months. Would you like to talk about it?" Even when a pregnancy is planned, the confirmation may come as a surprise and with feelings of ambivalence.

Which statement by the nurse to Lilly demonstrates an application of knowledge about the developmental tasks that take place during the first trimester of pregnancy?

"Many women feel uncertain about the news that they are pregnant" Feeling uncertain about the news of a pregnancy is a normal response, even when the couple was actively trying to become pregnant.

Match the comment made by a future sibling during a pregnancy with the child's age range.

"Mommy's fat!" - Toddler "How does the baby eat?" - Preschool-aged "How will the baby get out of your belly?" - School-aged "What will people think?" - Early adolescent

Readiness for parenthood involves mastery of certain developmental tasks. What are the developmental tasks Lilly needs to master during pregnancy?

- Accepting the pregnancy - Identifying with the role of mother - Reordering relationships between herself and/or mother and/or partner - Establishing a relationship with the unborn child Lilly needs to accept the pregnancy and then identify herself in the role of mother.

At 32 weeks' gestation, Cali experiences constipation. Which actions would the nurse recommend to resolve this problem?

- Increase fiber in the diet - Drink 8 to 10 glasses of water per day - Take a 20-minute walk every day Increasing fiber, drinking water, and walking are strategies to prevent and to treat constipation during pregnancy.

Cali asks what other signs or symptoms are commonly experienced during the second trimester of pregnancy. Which signs and symptoms should the nurse practitioner discuss with Cali?

- Increased sex drive - Increased energy After the fatigue, nausea, and mood swings of the first trimester, the woman has increased energy in the second trimester.

What would be some of Lilly's expected behaviors during the second trimester of pregnancy?

- Inward focus on her pregnancy - Think about her relationship with her mother With the perception of fetal movement in the second trimester, the woman turns her attention inward to her pregnancy and to relationships with her mother and other women who have been or are pregnant.

Kelly experienced UTIs in her previous pregnancies. What teaching does the nurse provide to decrease the risk of developing a UTI during this pregnancy?

-Wipe the perineal area front to back after voiding -Wear cotton underpants -Drink at least 8 glasses of water per day

Laura asks if there is a pattern of weight gain she should work toward for the remainder of this pregnancy. What is the expected pattern of weight gain for Laura in the second and third trimesters?

3 to 4 pounds per month A woman with a BMI in the normal weight range needs to gain 25 to 35 pounds

The nurse seizes this teachable moment and points out that pregnant women can't really eat for two, but during the 2nd and 3rd trimester of pregnancy, the woman needs additional calories per day beyond the woman's pre pregnancy nutritional requirement. How many extra calories per day does the woman need?

300 The woman needs an additional 300 calories per day during the 2nd and 3rd trimester, to support fetal growth, growth of the placenta, increased amniotic fluid, breast tissue development, increased blood supply, maternal fat storage, and uterine growth

For a nonstress test to be considered reactive, two ______________ in the fetal heart rate are required in a 20-minute period.

Accelerations

Cali experienced fatigue early in her pregnancy but it may not have been caused by her pregnancy. In fact, many of the presumptive indicators of pregnancy can be caused by conditions other than pregnancy.

Amenorrhea: Excessive exercise Fatigue: Anemia Abdominal enlargement: Fibroid growth Nausea and vomiting: GI upset Presumptive signs are findings that are often associated with pregnancy but that can have other causes.

Kelly is 8 weeks' pregnant during her first prenatal visit. Her midwife follows a traditional schedule for prenatal visits. Using a traditional prenatal visit schedule, how many prenatal visits will Kelly have if the pregnancy remains low-risk and continues to 40 weeks' gestation?

Approximately 14 visits Routine prenatal care for a low-risk pregnancy includes 1 visit every 4 weeks until 28 week's gestation, 1 visit every 2 weeks until 36 weeks gestation, and then weekly visits until birth.

Based on the information provided by the patient, what is the expected date of birth?

April 14 Naegele's rule is used to calculate the expected date of birth (EDB). To calculate the EDB, subtract 3 months and then add 7 days to the first day of the last menstrual period.

Lilly is experiencing baby blues. Identify which condition each characteristic represents.

Baby Blues: -Having sudden periods of moodiness -Crying without a reason -Occurs 2 to 3 days after birth -Feeling sad despite having a healthy baby -Transient condition Postpartum depression: -Hopelessness -Suicidal thoughts -Feeling like a failure -Feeling panicky a lot of the time -Occurs in the first year after birth

The nurse recognizes Lilly is displaying behavior of which condition?

Baby blues Baby blues are feelings of sadness that mothers experience in the first few days after giving birth.

During the first prenatal visit, which laboratory test will be obtained for the patient who is 6 weeks' pregnant?

CBC Rh factor Rubella titer A CBC is obtained to identify signs of anemia or clotting problems. The Rh factor is needed to identify women who are Rh negative and need treatment with Rho(D) immune globulin. Knowing if the woman is rubella immune is important in determining the risk of congenital rubella in the fetus.

One indication of pregnancy often seen during the first prenatal pelvic exam is the blue-violet discoloration of the cervix and vagina or __________________ sign.

Chadwick's

Match the following common skin changes of pregnancy with their description.

Chloasma: Increased pigmentation on the face Linea nigra: A dark line from the umbilicus to the pubic area Striae gravidarum: Stretch marks Palmar erythema: Redness of hands Varicose veins: Bulky bluish veins on the legs Spider veins: Reddish blood vessels that branch outward

____________________, the breast milk product in Lactogenesis I, is rich in immunologic components.

Colostrum

Lilly tells the nurse that she is concerned because Don has been gaining weight, having mood swings, and complaining of nausea and abdominal pains, especially when she has episodes of Braxton-Hicks contractions. the nurse explains he is experiencing which condition?

Couvade syndrome Couvade syndrome is a documented condition in which men experience physical symptoms of pregnancy, such a s weight gain, mood changes, nausea, and abdominal pains.

A pregnancy that is 37 0/7 weeks through 38 6/7 weeks is referred to as a(n) __________________ term pregnancy.

Early

Kelly tells the nurse she has been experiencing nausea in the morning, immediately after getting out of bed. The nurse teaches the patient to take which action to decrease nausea?

Eat plain crackers before getting out of bed. A common recommendation for self-care is to eat plain crackers or dry toast before getting out of bed to prevent nausea.

The nurse completes a nutrition assessment and determines that Laura is experiencing pica. Which findings from the data collected during the assessment support the finding of pica.

Eating starch Eating ice Pica is eating nonfood items which have no nutritional value, such as starch, ice, dirt, or clay.

The midwife orders a pregnancy blood test. Which finding would confirm the findings of the home pregnancy test?

Elevated human chorionic gonadotropin level At the time of conception, the zygote begins producing human chorionic gonadotropin (HcG), which is the hormone detected in pregnancy tests.

Early in pregnancy, many women like Cali experience extreme fatigue and sleep more than usual. What hormone change is responsible for fatigue in early pregnancy?

Elevated progesterone levels Hormones, especially increased progesterone levels, are responsible for the extreme fatigue many women experience in early pregnancy.

_____________________, is a common infection of the lining of the uterus.

Endometritis

___________________ is secreted by the ovaries after ovulation.

Estrogen

Blood show is absent. True or False?

False

Contractions do not result in cervical change. True or False?

False

Discomfort is localized to one area of the uterus. True or False?

False

It is not necessary to seek early prenatal care if a woman is healthy. True or False?

False

It is possible for ova to be fertilized up to 5 days after release into the Fallopian tubes. True or False?

False

Severe hypotension is one of the serious side effects of methylergonovine. True or False?

False

The pattern of contractions is irregular. True or False?

False

To be a culturally competent nurse, one must understand all aspects of a person's culture. True or False?

False

When assessing the fetal heart rate, an early deceleration may start before, during, or after a uterine contraction starts.

False

Based on the date of Kelly's LMP (first day of last menstrual period), it is estimated the pregnancy is approximately 6 weeks' gestation. At this gestational age, which findings on a sonogram would confirm the pregnancy?

Fetal pole Cardiac activity Gestational sac During the first 8 weeks of gestation the fetal pole and gestation sac are visible on ultrasound and are positive confirmation of the pregnancy.

During late pregnancy, Cali begins to experience sudden muscle spasms in the legs or feet, usually at night. What action can she take to relieve this spasm?

Flex the foot forward Flexing the foot stretches the muscle and relieves the cramp.

Using the GTPAL notation, which is the correct documentation of Kelly's pregnancy status?

G4 T3 P0 A0 L2 Kelly has had 3 previous pregnancies plus the current pregnancy, therefore she is a gravid 4, she delivered 3 pregnancies at term, she has no preterm births or abortions. Although her 3 previous pregnancies resulted in live births, her daughter died at 2 months of age, therefore has 2 living children.

At 39 weeks' gestation, Kelly wakes up with a backache and irregular contractions. Her husband massages her back, and she falls asleep again. Couple of hours later the contractions are still irregular, and the midwife suggests she stays at home until the contractions are coming every 5 to 7 minutes. Although Kelly is uncomfortable, she plays games with her boys and even takes a walk outside. Suddenly she feels a popping sensation, and there is a pool of fluid at her feet. What should Kelly do at this time?

Go to the labor and delivery unit. When the membranes rupture, the patient needs to go to labor and delivery. Getting to a facility where labor can be monitored and the risk for infection evaluated is a priority.

Which laboratory test is routinely obtained between 35 and 37 weeks' gestation?

Group B Streptococcus Vaginal and rectal swabs for Group B Streptococcus are obtained 4 to 5 weeks' prior to the due date.

Match each of the following probable signs of pregnancy with the corresponding description its physical change.

Hegar's sign: Softening of the lower uterine segment Chadwick's sign: Bluish color of cervix and vagina Goodell's sign: Softening of the cervical tip

In the early weeks of pregnancy, Lilly may exhibit increased irritability and outbursts of tears and anger alternating with feelings of joy and cheerfulness, usually with little or no provocation. What is the primary factor contributing to the emotional lability?

Hormonal changes Hormone changes that support the implantation and early development of the pregnancy also cause the irritability, mood swings, outbursts of tears and anger in the early weeks of pregnancy.

Based on the patient lab results, the nurse identifies that Laura may have, or is at risk for developing, which condition during this pregnancy?

Iron deficiency anemia The lab results reveal low hemoglobin and hematocrit values, which are indicators of possible anemia. In addition, the patient's mean corpuscular volume is low, and the red blood cell distribution width is elevated which are further evidence of iron deficiency anemia.

Kelly has a maternal serum alpha-fetoprotein (MSAFP) screening done at 16 weeks' gestation. The results are elevated. The nurse interprets these results as which of the following?

Kelly's fetus has an increased risk for an open neural tube defect. An elevated MSAFP indicates an increased risk for a multiple gestation pregnancy or an open neural tube defect.

During the second trimester, Cali notes a dark line extending from her umbilicus to her pubis. The nurse teaches Cali that this is which change associated with pregnancy?

Linea nigra Linea nigra is hyperpigmentation of the midline on the abdomen extending from the pubis to the umbilicus, and often to the top of the abdomen.

During one of Cali's prenatal visits, Brody mentions that Cali's posture seems to be changing. As the uterus enlarges during pregnancy, what adaptive posture changes occur in the woman?

Lordosis As the pregnancy grows, the center of gravity shifts and the lower back gradually starts to curve more.

During the first trimester, which of the following events would Lilly likely experience feelings of anxiety about?

Losing the pregnancy

Elevated levels of estrogen are responsible for which change during pregnancy?

Nasal stuffiness Elevated levels of estrogen increase blood circulation, causing engorgement of the mucous membranes and nasal stuffiness.

Pregnant women who have Rh _________________ blood should receive the Rho (D) immune globulin injection at 28 weeks' gestation.

Negative

Three days before her due date, Lilly has a burst of energy. She vacuums the bedroom and puts clean sheets on the bed, cleans out Olivia's toy box, organizes all the baby's clothing and supplies, and then bakes and freezes soup, casseroles, and other meals and snacks. What behavior is Lilly exhibiting?

Nesting behavior It occurs in response to surging estradiol and prolactin levels.

Laura and Ellen also learn that women can make dietary changes and enhance nutritional practices during the preconception period to decrease the risk of which pregnancy outcome?

Neural tube defects Supplementation of the diet with folate (folic acid) has shown to decrease the incidence of neural tube defects in the developing embryo.

Based on the available information about Laura, how would her pre-pregnancy be classified?

Normal Weight Laura's BMI is 21.4 which is in normal range. To calculate a person's BMI = (weight in pounds x 703) divided by height in inches squared

Match each term with the correct definition.

Nulligravida: A woman who has never been pregnant Primigravida: A woman pregnant for the first time Primipara: A woman who has given birth once Multipara: A woman who has given birth two or more times Multigravida: A woman who has been pregnant more than once Gravida is the word for being pregnant, and para is the word for giving birth.

The nurse tells Laura that dietary sources and iron supplements need to be ingested in combination with which of the following foods in order to promote absorption?

Orange juice Strawberries Tomatoes Orange juice, strawberries, and tomatoes are all high in Vitamin C, which enhances the absorption of heme from dietary and supplemental forms of iron ingested.

The formation of fetal organs, or _____________________, is a critical period of fetal development that occurs between 3 and 10 weeks gestation.

Organogenesis

___________________ is an intravenous medication commonly used to induce labor.

Oxytocin

The nurse recommends that Laura add which foods to her diet to treat the iron deficiency anemia?

Peanut butter Shellfish Apricots Peanut butter, shellfish, and apricots are sources of iron that Laura can add to her diet. Red meat is a source of iron, but we know from Laura's history that she does not eat meat.

Recommended weight gain during pregnancy

Pre-pregnancy BMI - Recommended Weight Gain less than 18.5 = 28-40 lbs 18.5-24.9 = 25-35 lbs 25-29.9 = 15-25 lbs greater than 30 = 11-20 lbs Appropriate weight gain is important for the health of mothers and infants. Gaining insufficient weight is a risk for delivering small for gestational age infant, and gaining too much weight is associated with a large for gestational age infant.

Amenorrhea is a(n) ____________________ sign of pregnancy.

Presumptive

During the examination, the nurse and the patient discuss the signs and symptoms that Kelly is experiencing. Categorize each of the following to indicate which are presumptive signs and which are probable signs.

Presumptive: Nausea Breast tenderness Fatigue Probably: Positive home pregnancy test Chadwick's sign Montgomery glands Presumptive signs are symptoms experienced by the patient and can be due to present conditions other than pregnancy.

Kelly will receive which medication during the prenatal visit at 28 weeks' gestation?

Rho(D) immune globulin. Kelly's prenatal labs indicate she is Rh negative. A dose of Rho(D) immune globulin is given between 26 and 28 weeks to prevent the Rh-negative mother from making antibodies during the pregnancy.

During one prenatal visit, Cali complains of pain that runs from her lower back, down the back of one leg, to the knee or foot. What is the name of this condition?

Sciatica Sciatica is thought to occur when the uterus puts pressure on the sciatic nerve.

Week 24 of pregnancy lies in the __________________ trimester.

Second

A woman can have emotional reactions to pregnancy. Identify the trimester in which each reaction is most likely to occur.

Second Trimester: -Becomes self centered -Feels a sense of well-being -Wants to learn about fetal development Third Trimester: -Feels clumsy -Reflects on own childhood -Feels unattractive

The nurse would anticipate which additional lab tests to be ordered for Laura?

Serum Iron TIBC Ferritin A serum iron less than 35, a TIBC (total iron binding capacity) greater than 430, and ferritin less than 100 are used to confirm the diagnosis of iron deficiency anemia.

What is included in a pescatarian diet?

Shellfish Fruits Legumes Eggs A pescatarian diet is a vegetarian diet with the addition of fish, but not meat.

Laura enjoys eating fish, which is a good source of Omega-3 fatty acids. Her instructor tells her that she should choose which of the following types of fish to eat while pregnant?

Shrimp Salmon Pollock Shrimp, salmon, and pollock are good sources of Omega-3 fatty acids. In contrast, large fatty fish such as swordfish or marlin, may contain enough mercury to damage the fetus's nervous system.

As previously mentioned, Lilly states, "For some reason, I feel a little sad and just started to cry when I looked at the baby. But I should be so happy; I have this wonderful, healthy baby, a great husband, and family, so I should be overjoyed, but I just started crying and I can't stop." How should the nurse respond to Lilly?

The nurse should explain baby blues to Lilly along with methods to decrease symptoms. The exact cause is unknown, but baby blues are thought to be related to the hormone changes that occur as the pregnancy ends.

The patient is scheduled for a glucose challenge test at 24 weeks' gestation. What is the purpose of the test?

To identify insulin resistance. A glucose challenge test involves drinking a concentrated glucose solution and then measuring a blood glucose level 1 hour later.

Blood show is present. True or False?

True

Cervical change is progressive. True or False?

True

Contractions are felt as discomfort in the suprapubic area or lower back and sometimes wrap around both. True or False?

True

Cystic Fibrosis is an autosomal recessive disease that requires both parents to be carriers of the men in order to pass it on to their child. True or False?

True

Gravidity (G) is the number of pregnancies a woman has had in her lifetime regardless of outcome. True or False?

True

Luteinizing hormone is the hormone responsible for the release of the mature egg from he follicle. True or False?

True

One identified risk factors for placental abruption is advanced maternal age. True or False?

True

The pattern of contractions is regular. True or False?

True

Kelly is scheduled for another prenatal appointment in 4 weeks. She is instructed to call the provider's office if which of the following signs and symptoms occur before the next visit?

Vaginal bleeding Abdominal cramping Dysuria Temperature >100.4 F Vaginal bleeding and cramping are signs of possible pregnancy loss. Dysuria is a sign of urinary tract infection, and elevated temperature may indicate infection.

A sibling is 24 months old when the new baby is born. What behavior is common in children of this age when a new baby is brought into the family?

Wanting to drink from a bottle when they have been using a cup for months. They are reacting to the changes in the environment and the need of the mother to attend to the newborn in addition to the toddler.

As an expectant father, what are the phases of developmental tasks that Don experiences?

- Announcement phase - Acceptance phase - Focusing phase Many men are ambivalent in the early stages of pregnancy.

At 36 weeks' gestation, Cali begins experiencing a backache and urinary urgency, as she had at the beginning of the pregnancy. She asks the nurse what is causing these symptoms. What is the nurse's best explanation?

- Backaches occur because the wight of the fetus pulls the women's center of gravity forward, stressing the lower back -Urinary frequency returns in the third trimester because of pressure from the fetus on the bladder

Cali made an appointment to see her nurse practitioner after she missed her period. What other signs and symptoms does a woman experience within the first 4 weeks of conception that might make her wants to seek confirmation pregnancy?

- Breast tenderness - Feeling pregnant - Fatigue Great tenderness and fatigue are experienced within the first 4 weeks following contraception, as hormone levels are changing and energy is diverted to the developing pregnancy.

During the first trimester, Don's response to pregnancy would typically include which reactions?

- Confused by his partner's mood swings - Feels left out During the first trimester, attention is focused on the woman and how she is feeling, so there father-to-be frequently feels left out.

As Cali's pregnancy enters the third trimester, she begins experiencing heartburn. What strategies will the nurse recommend to relieve her distress?

- Eat six small meals throughout the day - Don't eat within 2 hours of bedtime - Elevate head above stomach when lying down - Avoid spicy and fried foods As the uterus grows, the pressure on the stomach, combined with the relaxed sphincter, leads to heartburn.

Brody asks the nurse if Cali will continue to have the symptoms she has been experiencing in the first trimester for the entire pregnancy. The nurse explains to Brody and Cali that the following discomforts typically resolve during the second trimester.

- Fatigue - A backache - Urinary frequency - Morning sickness The nurse points out that many of the discomforts experienced in the first trimester go away in the second trimester.

During Cali's visit with the nurse practitioner, her pregnancy was confirmed. What are the positive signs of pregnancy?

- Hearing fetal heart sounds - Palpation of fetal movement - Visualization of the fetus on the ultrasound. Seeing, hearing, or feeling the fetus are the positive signs of pregnancy. A pregnancy test can give a false positive as a result of another condition that produces the hormone HcG.

Laura asks the nurse how iron deficiency anemia can impact a pregnancy. How would the nurse respond to Laura's question?

-Iron deficiency anemia could make her feel more fatigued -Iron deficiency anemia could make her more susceptible to infections -Iron deficiency anemia could make her infant more at risk for having a low birthweight -Iron deficiency anemia could make her infant more at risk for premature birth The nurse responds that iron deficiency anemia can impact both the mother and the fetus.

At 36 weeks' gestation, Cali calls the clinic because she has a package and urinary urgency. What condition might Cali be experiencing.

- Normal discomforts of pregnancy - Labor - Urinary tract infection Package and urinary urgency may be expected discomforts of late pregnancy, or they may be signs of labor or a urinary tract infection.

Which activities during her pregnancy enhance Lilly's attachment to the child she is carrying?

- Quickening - Ultrasound examination - Hearing the fetal heart Fetal movement (called quickening), seeing the fetus during an ultrasound examination, and hearing the fetal heartbeat are activities that make the future child "real" and enhance attachment.

Striae gravidarum (or stretch marks) are common change experienced by women during pregnancy. What causes this change?

- Tension and stretching of the skin - Presence of estrogen, relaxin, and cortisol - Change in the collagen and elastic fibers

Placenta _________________ occurs when the placenta overlies the cervix, thus increasing the risk for bleeding.

Previa

Good _________________ and having an open mind are essential for cultural competence.

Communication

In their preconception class, Laura and Ellen learn that according to the current recommendation all women who could become pregnant should take a daily vitamin. What should that vitamin contain?

Folic acid 400 micrograms Additional iron and and calcium are not needed until the second trimester of pregnancy.

Establishing and maintaining healthy eating habits before conceiving is important to both maternal and fetal well-being. Pregnant women should avoid which substances in their diet?

Raw seafood Uncooked processed meats Unpasteurized dairy Alcohol In general, raw, uncooked/undercooked and unpasteurized foods should be avoided during pregnancy because of the risk of food borne illnesses. Fats are macronutrients and essential during pregnancy.

Use of oxytocin to induce or augment labor increases the risk of maternal hemorrhage. True or False?

True

Uterine massage after delivery helps reduce bleeding by causing the uterus to contract. True or False?

True

At 36 weeks' gestation Kelly lies down on the examination table. Suddenly she says she feel dizzy and nauseous. The nurse observes her face is pale, she is sweating, and her skin is clammy. What is the priority action by the nurse?

Turn the patient on her left side. When a pregnant woman lies on her back, the weight of the gravid uterus may compress the vena cava, causing a decrease in blood pressure and a feeling of faintness.

Lilly and Don are preparing the nursery for the impending birth of their second daughter. The older daughter, Olivia, is 5 years old. Which activity is appropriate in this situation?

When the nursery is finished, update something in the 5-year-old's bedroom The 5-year-old needs to feel she is still valued in the family.