Maternal Newborn Nursing NUR2234
A nurse is caring for a client who is pregnant and reviewing manifestations of complications the client should promptly report to the provider. Which of the following complications should the nurse include? A. Vaginal bleeding B. Swelling of the ankles C. Heartburn after eating D. Lightheadedness when lying on back
A. Vaginal bleeding
involves the ingrowth of the endometrium into the uterine musculature
Adenomyosis
__________________, or having conflicting feelings at the same time, is an emotion expressed by most women upon learning they are pregnant.
Ambivalence
Absence of menses during the reproductive system
Amenorrhea
The _____________originates from the ectoderm germ layer during the early stages of embryonic development; it is a thin protective membrane that contains the amniotic fluid.
Amnion
A nurse is reviewing findings of a client's biophysical profile (BPP). The nurse should expect which of the following variables to be included in this test? Select all that apply. A. Fetal weight B. Fetal breathing movement C. Fetal tone D. Fetal position E. Amniotic fluid volume
B. Fetal breathing movement C. Fetal tone E. Amniotic fluid volume
Endocrine system
Basal metabolic rate increases and metabolic function increases. The anterior lobe of the pituitary gland enlarges and produces serum prolactin needed for the lactation process. The posterior lone of the pituitary gland produces oxytocin, which stimulates uterine contractions. The thyroid enlarges slightly, and thyroid activity increases. The parathyroid increases in size. Aldosterone levels gradually increase. Body weight increases. Water retention is increased, which can contribute to weight gain.
Recommended before infertility treatment
Counseling, preferably before infertility treatment begins can be beneficial. Counseling can help the couple understand each other's feelings, as well as to develop realistic expectations of infertility treatment.
Why do pregnant women get UTI's more frequently?
Enlarged uterus puts added pressure on the bladder and dilates the ureters, the dilated ureters then act as a road block causing urine back up/urinary stasis and urinary stasis is a medium for bacterial growth Progesterone is also a reason
Fetal Blood Flow
Fetal blood flows from the placenta in its most oxygenated state via the one umbilical vein ("the main vein") to the fetal body. The blood enters fetal circulation into the inferior vena cava via the ductus venosus. Blood enters the fetal heart via the right atrium (just like adult blood only its oxygenated). A small amount of blood goes to the right ventricle and to the pulmonary arteries. However, most oxygenated fetal blood goes from the right atrium to the left atrium via the foramen ovale. From the left atrium, blood travels to the left ventricle and then to the aorta and circulation throughout the body. Now, back to that small amount of blood that went to the right ventricle instead of through the foramen ovale... The pulmonary artery is connected to the aorta via the ductus arteriosus so the blood can be shunted into circulation to the body without going to the lungs, as they are not functional in utero. Finally, the de-oxygenated blood then travels back to the placenta by way of the two umbilical arteries. The nutrient and gas exchange happens and the cycle starts all over! Remember, no actual blood is exchanged in the placenta.
autosomal dominant disorders
Huntington's Disease Achondroplasia Neurofibromatosis
Clomid/clomiphene
Infertility medication Helps force ovulation Doctor will give a calendar with days on when to take the medication and when to have intercourse to try to conceive
LMP
Last Menstrual Period
Heavy bleeding occurring at irregular intervals with flow lasting more than 7 days
Menometrorrhagia
Gastrointestinal system
Nausea and vomiting may occur as a result of secretion of hCG, typically subsides by the third month. Poor appetite may occur because of decreased gastric motility. Alterations in taste and smell may occur. Constipation may occur because of an increase in progesterone production or pressure of the uterus resulting in decreased gastrointestinal motility. Flatulence and heartburn may occur because of decreased GI motility and slowed emptying of the stomach caused by an increase in progesterone production. Hemorrhoids may occur because of increased venous pressure. Gum tissue may become swollen and easily bleed because of increasing levels of estrogen. Ptyalism (excessive secretion of saliva) may occur because of increasing levels of estrogen.
Bleeding occurring at intervals of more than 35 days
Oligomenorrhea
5 S's that can be anticipated in couples experiencing infertility
Stress, Strain between partners, Strain w/in extended family, Social isolation, Self-esteem issues
Fern test
Test for amniotic fluid leakage. estrogens in amniotic fluid cause crystallization of the salts ; crystals appear as a blade of fern
Gravida
a pregnant woman
One of two or more alternative versions of a gene at a given position or locus on a chromosome that imparts the same characteristic of that gene
allele
The ___________________________ body temperature refers to the lowest body temperature and is reached upon awakening.
basal
between weeks 6 and 8 of gestation, softens due to vasocongestion
cervix
Musculoskeletal system
changes in the center of gravity begin in the second trimester and caused by the hormones relaxin and progesterone. lumbrosacral curve increases. aching, numbness, and weakness may results; walking becomes more difficult and women develop a waddling gait and is at risk for falls. Relaxation and increased mobility of pelvic joints occur, which permit enlargement of pelvic dimensions. Abdominal wall stretches with loss of tone throughout pregnancy, regained postpartum. Umbilicus flattens and protrudes. Postural changes occur as the increased weight of the uterus causes a forward pull of the bony pelvis. Important for nurse to encourage client to implement measures that maintain safety and correct posture to prevent back pain.
_______________ is a creamy, yellowish breast fluid that provides nourishment for the newborn during the first few days of life.
colostrum
autosomal recessive disorders
cystic fibrosis, taysach's, sickle cell
EDB
estimated date of birth
both alleles for a trait are the same in the individual
homozygous
The pictorial analysis of the number, form, and size of an individual's chromosomes is termed _________________.
karyotype
Most women experience an increase in whitish vaginal discharge, called _____________ during pregnancy.
leukorrhea
Supine Hypotension
low blood pressure that occurs in a pregnant woman when she is lying on her back - as a result of pressure of the uterus on the inferior vena cava
In a __________________ abortion, the woman takes certain medications to induce a miscarriage to remove the products of conception.
medical
Oral contraceptives (OCs), called _________________________, contain only progestin and work primarily by thickening the cervical mucus to prevent penetration of the sperm and make the endometrium unfavorable for implantation.
minipills
There is only one copy of a particular chromosome instead of the usual pair
monosomies
Any change in gene structure or location leads to a ____________________, which may alter the type and amount of protein produced
mutation
Nullipara
no viable offspring; para 0
Biophysical Profile (BPP)
noninvasive assessment of the fetus that includes fetal breathing movements, fetal movements, fetal tone, amniotic fluid index, and fetal heart rate patterns via a nonstress test. normal fetal biophysical activities indicate that the central nervous system is functional and the fetus is not hypoxemic
Parity
number of births carried past 20 weeks of gestation
During what, the ovary begins to falter, producing irregular and missed periods and occasional hot flash
perimenopause
The genotype, together with environmental variation that influences the individual, determines the ______________________, or the observed, outward characteristics of an individual.
phenotype
At birth, as soon as the _______________is expelled, and there is a drop in progesterone, lactogenesis can begin.
placenta
Fibronectin test
protein produced by the fetal membranes that can leak into vaginal secretions if uterine activity infection or cervical effacement occurs -Test used if at risk for preterm labor, before 37 wks of gestation -positive results may indicate onset of labor in 1-3 weeks, negative test results are more predictive that preterm labor will not begin
Ballottement
rebounding of the fetus against the examiner's fingers on palpation
Gravidity
refers to number of pregnancies
Goodell's Sign
softening of the cervix
Hegar's sign
softening of the lower uterine segment or isthmus
At the onset of ovulation, cervical mucus that is more abundant, clear, slippery, and smooth is known as ___________________ mucus.
spinnbarkeit
there are three copies of a particular chromosome instead of the usual two
trisomies
Multipara
two or more pregnancies resulting in viable offspring
elongate, widen, and curve above pelvic rim by 10th gestational week
ureters
Frequency of doctor's visits
-Every 4 weeks up to 28 weeks -Every 2 weeks from 29 to 36 weeks -Every week from 37 weeks to birth
Fetal development of the eyes
-Eyelids present but closed at 12 weeks -Eyelids begin to open and close at 28 weeks.
GTPAL
-G (gravida): the current pregnancy -T (term births): the number of pregnancies ending >37 weeks' gestation, at term -P (preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks -A (abortions): the number of pregnancies ending before 20 weeks or viability -L (living children): number of children currently living
Kick counts
-Lay somewhere quiet and count -Healthy baby should move 10 times in 2 hours -If baby doesn't, may repeat test or come in hospital and do a non-stress test
Fetal development of the respiratory function
-Surfactant production in the alveoli begins at 24 weeks and respiratory movements can be seen via US. -Gas exchange is possible at 29 weeks, but lungs are not fully mature. -Fully developed at 38-40 weeks (term)
Alpha-fetoprotein screening
-fetal serum protein used to predict neural tube defects -performed between 16-18 weeks -high incidence of false positives -done by drawing blood -If level is abnormal and gestation is less than 18 weeks, a second sample is drawn -Ultrasound is performed for elevated levels to rule out fetal abnormalities or multiple gestation
3 categories of female causative factors and their treatment options
1. Ovulatory dysfunction -> Lifestyle changes first, then medications, such as clomiphene citrate 2. Tubal and pelvic pathology -> Surgery to adjust structure of fallopian tubes or remove uterine fibroids 3. Cervical mucous factors -> Antibiotic treatment if caused by infection
Nagele's Rule
A method of determining the estimated date of birth (EDB): after obtaining the first day of the last menstrual period, subtract 3 months and add 7 days. Example: 1st day of last menstrual period Sep 12, 2018 Subtract 3 months June 12, 2018 Add 7 days June 19, 2018 Add 1 year June 19, 2019 EDD - June 19, 2019
chorionic villus sampling (CVS)
A technique for diagnosing genetic and congenital defects in a fetus by removing and analyzing a sample of the fetal portion of the placenta Done at 10-13 wk gestation Informed consent needed
A nurse in a prenatal clinic is providing education to a client who is at 8 weeks of gestation. The client states, "I don't like milk." Which of the following foods should the nurse recommend as a good source of calcium? A. Dark green leafy vegetables B. Deep red or orange vegetables C. White breads and rice D. Meat, poultry, and fish
A. Dark green leafy vegetables
A client who is at 7 weeks of gestation is experiencing nausea and vomiting in the morning. Which of the following information should the nurse include? A. Eat crackers or plain toast before getting out of bed. B. Awaken during the night to eat a snack C. Skip breakfast and eat lunch after nausea has subsided D. Eat a large evening meal
A. Eat crackers or plain toast before getting out of bed.
A client would like some information about the use of a cervical cap. Which information should the nurse include in the teaching plan of this client? Select all that apply. A. Inspect the cervical cap before insertion B. Apply spermicide to the rim of the cervical cap C. Wait for 30 mins after insertion before engaging in intercourse D. Remove the cervical cap immediately after intercourse E. Do not use the cervical cap during menses
A. Inspect the cervical cap before insertion C. Wait for 30 mins after insertion before engaging in intercourse E. Do not use the cervical cap during menses
Mendelian disorders
Autosomal dominant Autosomal recessive X-linked
A rubella titer result of a 1-day postpartum client is less than 1:8, & a rubella virus vaccine is prescribed to be administered before discharge. The nurse provides which information to the client about the vaccine? Select all that apply. A. Breastfeeding needs to be stopped for 3 months B. Pregnancy needs to be avoided for 1 to 3 months C. The vaccine is administered by the subcutaneous route D. Exposure to immunosuppressed individual needs to be avoided. E. A hypersensitivity reaction can occur if the client has an allergy to eggs F. The area of the injection needs to be covered with a sterile gauze for 1 week.
B. C. D. E
A nurse is reviewing the health record of a client who is pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following findings should the nurse expect? Select all that apply. A. Montgomery's glands B. Goodell's sign C. Ballottement D. Chadwick's sign E. Quickening
B. Goodell's sign C. Ballottement D. Chadwick's sign
A client arrives at the clinic for the first prenatal assessment. She tells the nurse that the first day of her last menstrual period was October 19, 2018. Using Nagele's rule, which expected date of delivery should the nurse document in the client's chart? A. July 12, 2019 B. July 26, 2019 C. August 12, 2019 D. August 26, 2019
B. July 26, 2019
A healthy 28-year-old female client who has a sedentary lifestyle and is a chain smoker is seeking information about contraception. The nurse informs this client of the various options available and the benefits and the risks of each. Which should the nurse recognize as contraindicated in the case of this client? A. the medroxyprogesterone injection B. combination oral contraceptives C. a copper intrauterine device D. Implantable contraceptives
B. combination oral contraceptives
Chadwick's Sign
Bluish-purple coloration of the vaginal mucosa and cervix
A nurse is caring for a couple who is being evaluated for infertility. Which of the following statements by the nurse indicates understanding of the infertility assessment process? A. "You will need to see a genetic counselor as part of the assessment." B. "It is usually the female who is having trouble, so the male doesn't have to be involved." C. "The male is the easiest to assess, and the provider will usually begin there." D. "Think about adopting first because there are many babies that need good homes."
C. "The male is the easiest to assess, and the provider will usually begin there."
A client needs additional information about the cervical mucus ovulation method after having read about it in a magazine. She asks the nurse about cervical changes during ovulation. About which should the nurse inform the client? A. Cervical os is slightly closed B. Cervical mucus is dry and thick C. Cervix is high or deep in the vagina D. Cervical mucus breaks when stretched
C. Cervix is high or deep in the vagina
A pregnant client is seen for a regular prenatal visit and tells the nurse that she is experiencing irregular contractions. The nurse determines that she is experiencing Braxton Hicks contractions. On the basis of this finding, which nursing action is appropriate? A. Contact the health care provider B. Instruct the client to maintain bed rest for the remainder of the pregnancy C. Inform the client that these contractions are common and may occur throughout pregnancy D. Call the maternity unit and inform them that the client will be admitted in a preterm labor condition
C. Inform the client that these contractions are common and may occur throughout pregnancy
A client has been informed that the result of her pregnancy test indicates that she is 3 weeks pregnant. Which instructions should the nurse give the client in regard to her condition? A. Avoid exercising during pregnant B. Discontinue intercourse until after the baby is born C. Stop using drugs, alcohol, and tobacco D. Wear comfortable clothes that are not tight or restrictive
C. Stop using drugs, alcohol, and tobacco
The nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the fundal height in centimeters and notes that the fundal height is 30 cm. How should the nurse interpret this finding? A. The client is measuring larger for gestational age. B. The client is measuring small for gestational age. C. The client is measuring normal for gestational age. D. More evidence is needed to determine the size for gestational age.
C. The client is measuring normal for gestational age.
A nurse is instructing a client who is taking an oral contraceptive about manifestations to report to the provider. Which of the following manifestations should the nurse include? A. Reduced menstrual flow B. Breast tenderness C. Shortness of breath D. Increased appetite
C. shortness of breath
A nurse in a clinic is teaching a client of childbearing age about recommended folic acid supplements. Which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency? A. Iron deficiency anemia B. Poor bone formation C. Macrosomic fetus D. Neural tube defects
D. Neural tube defects
A nurse is reviewing a new prescription for iron supplements with a client who is at 8 weeks of gestation and has iron deficiency anemia. Which of the following beverages should the nurse instruct the client to take the iron supplements with? A. Ice water B. Low-fat or whole milk C. Tea or coffee D. Orange juice
D. Orange juice
A 30-year-old client would like to try using basal body temperature (BBT) as a fertility awareness method. Which instruction should the nurse provide the client? A. Avoid unprotected intercourse until BBT has been elevated for 6 days B. Avoid using other fertility awareness methods along with BBT C. Use the axillary method of taking the temperature D. Take temperature before rising and record it on a chart
D. Take temperature before rising and record it on a chart
A nurse is caring for a 32-year-old Jewish client who is pregnant with a female baby. The parents are not directly related by blood. The mother reports that her husband's cousin had an infant born with Tay-Sachs disease that died 2 years ago and she is concerned about her baby. Which information does the nurse need to give the client to help alleviate her concerns regarding her baby having the same disease? A. Tay-Sachs disease affects only male infants so there is no problem with her baby B. The age of the client increases the susceptibility of the baby to Tay-Sachs disease C. There is no risk of Tay-Sachs disease because the parents are not related by blood D. There is a risk to the baby based upon the Jewish background so genetic testing would be recommended
D. There is a risk to the baby based upon the Jewish background so genetic testing would be recommended
The nurse is assessing a client for amenorrhea. During the assessment, the nurse notes facial hair and acne. The nurse knows this could be related to: A. anorexia nervosa B. enlarged thyroid gland C. excessive prostaglandin production D. an androgen excess secondary to a tumor
D. an androgen excess secondary to a tumor
Folic Acid
Encourage 400-800 mcg per day depending on risk profile
X-linked dominant disorders
Fragile X syndrome
Renal system
Frequency of urination increases in the first and third trimesters because of increased bladder sensitivity and pressure of the enlarging uterus on the bladder. Decreased bladder tone may occur and is caused by an increase in progesterone and estrogen levels; bladder capacity increases in response to increasing levels of progesterone. Renal threshold for glucose may be reduced.
Male Risk Factors for Infertility
Hormonal - Cushing syndrome Structural - Hernia repair, Enlarged prostate, Hypospadias or epispadias, Erectile dysfunction Environmental - Increased temperature or pressure, STIs, Exposure to toxic substances, Cigarette or marijuana smoke, Heavy alcohol consumption, Prescription drugs for ulcers or psoriasis
autosomal dominant
In an autosomal dominant disease, if you get the abnormal gene from only one parent, you can get the disease. Often, one of the parents may also have the disease
direct visualization of the internal organs with a lighted instrument inserted through an abdominal incision
Laparoscopy
Fundal Height
Measurement of the size of the uterus to determine gestational age of the fetus fundal height in cm should be equal to the fetal age in weeks + or - 2 weeks. (32 wks = 32 cm) At 36 weeks, the fundus is at the xiphoid process 20-22 weeks, fundus is approximately at the location of the umbilicus 16 wks, fundus can be found approximately halfway between the symphysis pubis and umbilicus
Bleeding between periods
Metrorrhagia
Normal Weight Gain During Pregnancy
Normal weight gain in pregnancy is 25-35 pounds (slightly more for pre-pregnancy underweight and slightly more for pre-pregnancy overweight); Only 1-5 pounds is gained during the first trimester
Percutaneous Umbilical Blood Sampling (PUBS)
Procedure for obtaining fetal blood through ultrasound-guided puncture of an umbilical cord vessel to detect fetal problems such as inherited blood disorders, acidosis, or infection; also called cordocentesis.
Progesterone
Smooth Muscle Relaxant
Contraction stress test
Test assesses placental oxygenation and function. Test determines fetal ability to tolerate labor and determines fetal well-being. Fetus is exposed to the stress of contractions to assess the adequacy of placental perfusion under simulated labor conditions. Test is performed if nonstress test is abnormal. Negative CST (Normal) - represented by no late decelerations of the FHR Positive CSR (Abnormal) - represented by late decelerations of the FHR, with 50% or more of the contractions in the absence of hyperstimulation of the uterus Equivocal - contains decelerations, but with less than 50% of the contractions, or uterine activity shows a hyperstimulated uterus Unsatisfactory - adequate uterine contractions cannot be achieved, or the FHR tracing is of insufficient quality for adequate interpretation
Para
a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more
Amniocentesis
aspiration of a small amount of amniotic fluid for analysis of possible fetal abnormalities Done between 15-20 wks of pregnancy because amniotic fluid volume is adequate and many viable fetal cells are present in the fluid by this time. Very dangerous with risks of hemorrhage, infection, abruptio placentae, Rh isoimmunization, amniotic fluid emboli, premature rupture of the membranes Inform consent needed
Human beings typically have 22 pairs of nonsex chromosomes or _________________ and 1 pair of sex chromosomes.
autosomes
DNA Genetic Testing
can be used to detect abnormalities related to an inherited condition. assists in determining if the woman is at risk for having a fetus with down syndrome, edwards syndrome, or Patau syndrome. Interventions: this type of testing can be done as early as 7 wks of gestation and a blood sample is used
_______________ are long, continuous strands of DNA that carry genetic information.
chromosomes
Gravida I (primigravida)
first pregnancy
A genetic disorder is a disease caused by an abnormality in an individual's genetic material or _____________________.
genome
Constipation, increased venous pressure, and pressure from the gravid uterus can lead to the formation of _____________________ during pregnancy.
hemorrhoids
Braxton Hick's Contractions
irregular, painless contractions that may occur intermittently throughout pregnancy
The __________________reaches the uterine cavity about 72 hrs after fertilization.
morula
chromosomal abnormalities that do not show up in every cell
mosaicism
Primipara
one birth of a pregnancy at least 20 weeks gestation
Condition in which bone mass declines to such an extent that fractures occur with minimal trauma
osteoporosis
Ultrasonography
outlines and identifies fetal and maternal structures. assists in confirming gestational age, EDD and evaluating amniotic fluid volume which is done via special measurements. May be done abdominally or transvaginally. Can be used to determine the presence of premature dilation of cervix (incompetent uterus). transvaginal ultrasound is used during first trimester to check the length of the cervix.
active in hormone production to support the pregnancy until about weeks 6-7
ovaries
_______________, released by the posterior pituitary gland, is responsible for milk ejection during breastfeeding.
oxytocin
During pregnancy, elevated ______________ levels cause smooth-muscle relaxation, which results in delayed gastric emptying and decreased peristalsis.
progesterone
The postural changes of pregnancy coupled with the loosening of the ______________________ joints may result in lower back pain.
sacroiliac
Gravida II (secundigravida)
second pregnancy
Nitrazine test
this is a test of vaginal secretions if the client is uncertain whether the membranes have ruptured. Color will indicate whether amniotic fluid is present. Yellow = urine. Blue = Amniotic fluid. pH of 4.5-5.5 = vaginal secretions amniotic fluid pH - 7.0-7.5
Urinalysis and Urine Culture
urine specimen for glucose and protein determinations should be obtained at every antepartum visit. Glycosuria is a common result of decreased renal threshold that occurs during pregnancy. If glycosuria persists, it may indicate diabetes. White blood cells in the urine indicates infection. Ketonuria may result from insufficient food intake or vomiting. Levels of 2+ to 4+ protein in the urine may indicate infection or preeclampsia.
its size increases from 70g to about 1,100 to 1,200 g at term
uterus
connective tissue loosens and smooth muscle begins to hypertrophy
vagina
Male sterilization is accomplished with a surgical procedure known as a
vasectomy
autosomal recessive
you would inherit two mutated genes, one from each parent
Fetal development of the heart
-Begins to beat regularly at 5 weeks and development complete at 8 weeks -For assessment, can be heard by US at 7 weeks, by Doppler at 12 weeks, and by stethoscope at 17 weeks
Probable Signs of Pregnancy
-Braxton Hicks contractions (16-28 weeks) -Positive pregnancy test (4-12 weeks) -Abdominal enlargement (14 weeks) -Ballottement (16-28 weeks) -Goodell's sign (5 weeks) -Chadwick's sign (6-8 weeks) -Hegar's sign (6-12 weeks)
Fetal development of the thermoregulatory system
-Brown fat begins to develop at 20 weeks. -Increased amounts of adipose tissue present at 32 weeks. -Thermoregulatory system considered mature at 38-40 weeks.
A 52-year-old client is seeking treatment for menopause. She is not very active and has a history of cardiac problems. Which therapy option should the nurse recognize as contraindicated for this client? A. Long-term hormone replacement therapy B. Selective estrogen receptor modulators C. Lipid-lowering agents D. Bisphosphonates
A. Long-term hormone replacement therapy
A nurse in a prenatal clinic is caring for four clients. Which of the following clients' weight gain should the nurse report to the provider? A. 1.8 kg (4 lb) weight gain and is in the first trimester B. 3.6 kg (8 lb) weight gain and is in the first trimester C. 6.8 kg (15 lb) weight gain and is in the second trimester D. 11.3 kg (25 lb) weight gain and is in the third trimester
B. 3.6 kg (8 lb) weight gain and is in the first trimester First trimester should only have 3-4 lb weight gain
Infertility Causes
Cause of infertility (not pregnant after 12 months of trying in a woman age 35 or younger) is unknown in approx. 20% of cases. Female causative factors account for 40% of infertility cases and male causative factors also account for 40% of cases. Sometimes infertility is caused by a combination of male and female factors.
Cardiovascular system
Circulating blood volume increases, plasma increases, and total red blood cell volume increases and total volume increases by approximately 40-50%. Anemia occurs as the plasma increase exceeds the increase in production of red blood cells. Iron requirements are increased. Heart size increases, and the heart is elevated slightly upward and to the left because of displacement of the diaphragm as the uterus enlarges. Retention of sodium and water may occur.
A nurse in an obstetrical clinic is teaching a client about using an IUD for contraception. Which of the following statements by the client indicates an understanding of the teaching? A. "An IUD should be replaced annually during a pelvic exam." B." I cannot get an IUD until after I've had a child." C. "I should plan on regaining fertility 5 months after the IUD is removed." D. "I will check to be sure the strings of the IUD are still present after my periods."
D. "I will check to be sure the strings of the IUD are still present after my periods."
The nurse is caring for a client at the prenatal clinic. The client reports that she has felt some fluttering sensations in her lower abdomen and she noticed that her waistline is now totally gone. Additionally, she shows the nurse her nipples and the areola are much darker. Based upon this assessment, in which month of pregnant is this client? A. 3rd month B. 5th month C. 2nd month D. 4th month
D. 4th month
Correct sequence of events in human development after fertilization
Development of the morula Development of the fluid-filled blastocyst Formation of the amnion Development of the trophoblast Formation of the placenta
Difficult, painful or abnormal menstruation
Dysmenorrhea
Danger signs of Pregnancy
First trimester - spotting or bleeding (miscarriage), painful urination (infection), severe persistent vomiting (hyperemesis gravidarum), fever >100F, and lower abdominal pain with dizziness and accompanied by shoulder pain (ruptured ectopic pregnancy) Second trimester - regular uterine contractions (preterm labor), pain in calf, often increased with foot flexion (blood clot in deep vein), sudden gush or leakage of fluid from vagina (premature rupture of membranes), absence of fetal movement for more than 12 hrs (possible fetal distress or demise) Third trimester - sudden weight gain; preorbital or facial edema, severe upper abdominal pain, or headache with visual changes (gestational hypertension and/or preeclampsia), and a decrease in fetal daily movement for more than 24 hrs (possible demise), any of the previous warning signs and symptoms can be present in the third trimester also
X-linked recessive disorders
Hemophilia, color blindness, Duchenne's Muscular Dystrophy
Female Risk Factors For Infertility
Hormonal disruption Overweight or underweight Hormonal imbalances Chronic illnesses such as diabetes and thyroid disease Age older than 27 Endometriosis Menstrual abnormalities Eating disorders Structural disruption Uterine fibroids Tubal blockages Cervical stenosis STIs --> Pelvic inflammatory disease Environmental Congenital anomalies of the ovaries or uterus Chromosomal anomalies Immune system disorders Smoking and alcohol consumption Exposure to teratogenic or chemotherapeutic agents Psychological stress
Discomforts of pregnancy
N&V, syncope, urinary frequency/urgency, breast tenderness, increased vaginal discharge, nasal stuffiness, fatigue, heartburn, varicose vein, headaches, ankle edema, hemorrhoids, constipation, back ache, leg cramps, shortness of breath
Reproductive system
Uterus - enlarges, increasing in mass from approximately 60-1000 g as a result of hyperplasia (influence of estrogen) and hypertrophy. Size and number of blood vessels and lymphatics increase. Irregular contractions occur, typically beginning after 16 weeks of gestation. Cervix - becomes shorter, more elastic, and large in diameter. Endocervical glands secrete a thick mucous plug, which is expelled from the canal when dilation begins. Increased vascularization and an increase in estrogen cause softening and a violet discoloration known as Chadwick's sign, which occurs at about 6 weeks of gestation. Ovaries - major function of the ovaries is to secrete progesterone for the first 6-7 weeks of pregnancy. The maturation of new follicles is blocked. Ovaries cease ovum production. Vagina - Hypertrophy and thickening of the muscles occur, increase in vaginal secretions is experienced; secretions are usually thick, white and acidic. Breasts - changes occur because of estrogen and progesterone increasing. Size increases, may be tender, nipples become more pronounced, areola become darker in color, superficial veins become prominent, hypertrophy of Montgomery's follicles occurs, colostrum may leak from breasts.
during the stress of pregnancy, ______________ secreted by the adrenal glands, helps keep up the level of glucose in the plasma by breaking down noncarbohydrate sources
cortisol
EDD
estimated date of delivery
Fetal development of the external genitalia
-Can be visualized and sex differences noted at 12 weeks -Testes descend into upper portion of scrotum/labia equally prominent at 36 weeks (see also Ballard for more info on genitalia maturation
Presumptive Signs of Pregnancy
-Fatigue (12 weeks) -Breast tenderness (3-4 weeks) -Nausea and vomiting (4-14 weeks) -Amenorrhea (4 weeks) -Urinary frequency (6-12 weeks) -Hyperpigmentation of skin (16 weeks) -Fetal movements (quickening) (16-20 weeks) -Uterine enlargement (7-12 weeks) -Breast enlargement (6 weeks)
A client reports that she has multiple sex partners and has a lengthy history of various pelvic infections. She would like to know if there is any temporary contraceptive method that would suit her condition. Which should the nurse suggest for this client? A. IUD B. Condoms C. Oral contraceptives (OCs) D. Tubal ligation
B. Condoms
The nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5 yr old child who was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. Using GTPAL, what should the nurse document in the client's chart? A. G-3, T-2, P-0, A-0, L-1 B. G-2, T-1, P-0, A-0, L-1 C. G-1, T-1, P-1, A-0, L-1 D. G-2. T-0, P-0, A-0, L-1
B. G-2, T-1, P-0, A-0, L-1
A nurse in a clinic receives a phone call from a client who would like to be tested in the clinic to confirm pregnancy. Which of the following information should the nurse provide to the client? A. "You should wait until 4 weeks after conception to be treated." B. "You should be off any medications for 24 hours prior to the test." C. "You should be NPO for at least 8 hrs prior to the test." D. "You should collect urine from the first morning void."
D. "You should collect urine from the first morning void."
Skin
changes occur because of levels of melanocyte-stimulating hormone increase as a result of an increase in estrogen and progesterone levels. increased pigmentation dark streak down the midline of the abdomen (linea nigra) chloasma (mask of pregnancy) - blotchy, brownish hyperpigmentation, over the forehead, cheeks, and nose reddish, purple stretch marks (striae gravidarum) on the abdomen, breasts, thighs and upper arms. vascular spider nevi may occur on the neck, chest, face, arms and legs Rate of hair growth may increase
Palmar erythema, a well-delineated pinkish area on the palmar surface of the hands, is caused by elevated __________________ levels.
estrogen
Primary dysmenorrhea is caused by increased production of what by the endometrium in an ovulatory cycle
prostaglandin
Fetal development of the skin
-Skin is transparent and lanugo begins to develop on fetal head at 16 weeks. -Lanugo and vernix cover the body at 20 weeks. -Lanugo begins to disappear at 36 weeks.
Non-Stress Test
-Test performed to assess placental function and oxygenation -Test determines fetal well-being -Test evaluates the fetal heart rate response to fetal movement Reactive NST (Normal) - indicates healthy fetus, requires 2 or more FHR accelerations of at least 15 bpm, lasting at least 15 seconds from the beginning of acceleration to the end, in association with fetal movement, during a 20-minute period Nonreactive NST (Abnormal) - no accelerations or accelerations of less than 15 bpm or lasting less than 15 seconds in duration occur during a 40-minute observation Unsatisfactory NST - the result cannot be interpreted because of the poor quality of the FHR tracing
5 categories of male causative factors and their treatment options
1. Endocrine related -> Hormonal therapy 2. Spermatogenesis -> Lifestyle changes 3. Sperm antibodies -> Corticosteroids 4. Sperm transport -> Surgical repair of blocked pathway 5. Disorders of intercourse -> Surgery and medications
Common tests of fetal well being
A nonstress test (NST) is a non-invasive screening tool using electronic fetal monitoring that is widely accepted as a reliable method of evaluating fetal status. They are often used to rule out fetal distress in high-risk pregnancies. The goal is a "reactive" NST. A reactive NST is one in which there is a normal baseline (110-160 rate), moderate variability (6-25 bpm variations), and the presence of at least two accelerations (increases in fetal heart rate of at least 15bpm for at least 15seconds) within 20 minutes. This is different from a contraction stress test (CST), in which contractions are induced soley to evaluate the fetus's response to the stress of contractions. A negative CST is good news: the baby tolerated the contractions well and did not show signs of distress in any of the contractions. A positive CST spurs further fetal assessment and may require additional interventions to promote fetal wellbeing, or perhaps a Cesarean section. Another test of fetal well-being is fetal kick counts. This is something a woman does independently. She should be instructed to do these daily after 28 weeks gestation. She should seek additional monitoring if she does not feel at least 10 distinct fetal movements in a two hour timeframe, or 4 distinct fetal movements in a one hour timeframe.
A nurse in a health clinic is reviewing contraceptive use with a group of clients. Which of the following client statements demonstrates understanding? A. "A water-soluble lubricant should be used with condoms." B. "A diaphragm should be removed 2 hours after intercourse." C. "Oral contraceptives can worsen a case of acne." D." A contraceptive patch is replaced once a month."
A. "A water-soluble lubricant should be used with condoms."
A nurse in a clinic is caring for a client who is postoperative following a salpingectomy due to an ectopic pregnancy. Which of the following statements by the client requires clarification? A. "It is good to know that I won't have a tubal pregnancy in the future." B. "The doctor said that this surgery can affect my ability to get pregnant again." C. "I understand that one of my fallopian tubes had to be removed." D. "Ovulation can still occur because my ovaries were not affected."
A. "It is good to know that I won't have a tubal pregnancy in the future."
A nurse in a clinic is teaching a client about a new prescription for medroxyprogesterone. Which of the following information should the nurse include in the teaching? (Select all that apply) A. "Weight fluctuations can occur." B. "You are protected against STIs" C. "You should increase your intake of calcium." D. "You should avoid taking antibiotics." D. "Irregular vaginal spotting can occur."
A. "Weight fluctuations can occur." C. "You should increase your intake of calcium." E. "Irregular vaginal spotting can occur."
A nonstress test is performed on a client who is pregnant, and the results of the test indicate non-reactive findings. The health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document the finding? A. A normal test result B. An abnormal test result C. A high risk for fetal demise D. The need for a cesarean section
A. A normal test result
The nurse is performing an assessment on a client who suspects that she is pregnant and is checking the client for probably signs of pregnancy. The nurse should assess for which probable signs of pregnancy? Select all that apply. A. Ballottement B. Chadwick's sign C. Uterine enlargement D. Positive pregnancy test E. Fetal heart rate detected by a nonelectronic device F. Outline of a fetus via radiography or ultrasonography
A. B. C. D.
A nurse is teaching a client who is at 6 weeks of gestation about common discomforts of pregnancy. Which of the following findings should the nurse include? Select all that apply. A. Breast tenderness B. Urinary frequency C. Epistaxis D. Dysuria E. Epigastric pain
A. Breast tenderness B. Urinary frequency C. Epistaxis
A nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy. The client's health record includes this data: G3 T1 P0 A1 L1. How should the nurse interpret this information? Select all that apply. A. Client has delivered one newborn at term B. Client has experienced no preterm labor C. Client has been through active labor D. Client has had two prior pregnancies E. Client has one living child
A. Client has delivered one newborn at term D. Client has had two prior pregnancies E. Client has one living child
A nurse is caring for a client who is pregnant and is to undergo a contraction stress test (CSR). Which of the following findings are indications for this procedure? Select all that apply. A. Decreased fetal movement B. Intrauterine growth restriction (IUGR) C. Postmaturity D. Placenta previa E. Amniotic fluid emboli
A. Decreased fetal movement B. Intrauterine growth restriction (IUGR) C. Postmaturity
A nurse is providing genetic counseling to a pregnant client. Which are nursing responsibilities related to counseling the client? Select all that apply. A. Explaining basic concepts of probability and disorder susceptibility B. Ensuring complete informed consent to facilitate decisions about genetic testing C. Instructing the client on the appropriate decision to be taken D. Knowing basic genetic terminology inheritance patterns E. Avoiding explanation of ethical or legal issues and concentrating on genetic issues
A. Explaining basic concepts of probability and disorder susceptibility B. Ensuring complete informed consent to facilitate decisions about genetic testing D. Knowing basic genetic terminology inheritance patterns
A nurse is caring for a client who is pregnant and states that their last menstrual period was April 1st. Which of the following is the client's estimated date of delivery? A. January 8 B. January 15 C. February 8 D. February 15
A. January 8
A nurse in an infertility clinic is providing care to clients who have been unable to conceive for 18 months. Which of the following data should the nurse assess? (Select all that apply) A. Occupation B. Menstrual history C. Childhood infectious disease D. History of falls E. Recent blood transfusions
A. Occupation B. Menstrual history C. Childhood infectious disease
A client has opted to use an IUD for contraception. About which effect of the device on monthly periods should the nurse inform the client? A. Periods become lighter B. Periods become more painful C. Periods become longer D. Periods reduce in number
A. Periods become lighter
The nurse in a health care clinic is instructing a pregnant client how to perform "kick counts". Which statement by the client indicates a need for further instruction? A. "I will record the number of movements or kicks." B. "I need to lie flat on my back to perform the procedure." C. "If I count fewer than 10 kicks in a 2 hour period, I should count the kicks again over the next 2 hours." D. "I should place my hands on the largest part of my abdomen and concentrate on the fetal movements to count the kicks."
B. "I need to lie flat on my back to perform the procedure."
The nurse is counseling a couple who are concerned because the woman has achondroplasia in her family. The woman is not affected. Which statement by the couple indicates the need for more teaching? A. "If the mother has the gene, then there is a 50% chance of passing it on." B. "If the father doesn't have the gene, then his son won't have achondroplasia." C. "If the father has the gene, then there is a 50% chance of passing it on." D. "Since neither one of us has the disorder, we won't pass it on."
B. "If the father doesn't have the gene, then his son won't have achondroplasia."
A client who is at 8 weeks of gestations tells the nurse "I am not sure I am happy about being pregnant." Which of the following responses should the nurse make? A. "I will inform the provider that you are having these feelings." B. "It is normal to have these feelings during the first few months of pregnancy." C. "You should be happy that you are going to bring new life into the world." D. "I am going to make an appointment with the counselor for you to discuss these thoughts."
B. "It is normal to have these feelings during the first few months of pregnancy."
A pregnant client in the first trimester calls the nurse at a health care clinic and reports that she has noticed a thin, colorless vaginal drainage. The nurse should make which statement to the client? A. "Come to the clinic immediately." B. "The vaginal discharge may be bothersome, but is a normal occurrence." C. "Report to the ED at the maternity center immediately." D. "Use tampons if the discharge is bothersome, but be sure to change the tampons every 2 hrs."
B. "The vaginal discharge may be bothersome, but is a normal occurrence."
A nurse in a clinic is caring for a group of female clients who are being evaluated for infertility. Which of the following clients should the nurse anticipate the provider will refer to a genetic counselor? A. A client whose sister has alopecia B. A client whose partner has von Willebrand disease C. A client who has an allergy to sulfa D. A client who had rubella 3 months ago
B. A client whose partner has von Willebrand disease
A pregnant client arrives at the community health center for a routine check-up. She informs the nurse that a relative on her mother's side has hemophilia, and she wants to know the chances of her child acquiring hemophilia. Which characteristics of hemophilia should the nurse explain to the client to help her understand the odds of acquiring the disease? Select all that apply. A. Affected individuals will have affected parents B. Affected individuals are usually males C. Daughters of an affected male are unaffected and are not carriers D. Female carriers have a 50% chance of transmitting the disorder to their sons E. Females are affected by the condition if it is a dominant X-linked disorder
B. Affected individuals are usually males D. Female carriers have a 50% chance of transmitting the disorder to their sons E. Females are affected by the condition if it is a dominant X-linked disorder
A 25-year-old client wants to know if her baby boy is at risk for Down Syndrome, because one of her distant relatives was born with it. Which information would the nurse share with the client while counseling her about Down Syndrome? A. Instances of Down Syndrome in the family greatly increases the risk for the baby also having Down syndrome. B. Children with Down syndrome have extra genetic material in the 21 chromosomes that occurs during development of sperm or egg. C. Down syndrome occurs only in females, and there is no risk as the baby is male. D. Children with Down syndrome are usually born to older mothers.
B. Children with Down syndrome have extra genetic material in the 21 chromosomes that occurs during development of sperm or egg.
A nurse is reviewing the medical record of a client who is to undergo hysterosalpingography. Which of the following data alert the nurse that the client is at risk for complication related to this procedure? A. Vital Signs - Temp 97* F, HR 60bpm B. History and physical - Employed as a radiology technician, allergy to shrimp, tonsillectomy at age 18 C. Laboratory findings - Glucose 103, Hgb 13.1, Total cholesterol 265 D. Medications - Rosuvastatin, Magnesium oxide, Mafenide acetate
B. History and physical
The nurse is instructing a client with dysmenorrhea on how to manage her symptoms. Which should the nurse include in the teaching plan? Select all that apply. A. Increase intake of salty foods B. Increase water consumption C. Avoid keeping legs elevated while lying down D. Use heating pads or take warm baths E. Increase exercise and physical activity
B. Increase water consumption D. Use heating pads or take warm baths E. Increase exercise and physical activity
A nurse is teaching a client about potential adverse effects of implantable progestins. Which of the following adverse effects should the nurse include? (Select all that apply.) A. Tinnitus B. Irregular vaginal bleeding C. Weight Gain D. Nausea E. Gingival hyperplasia
B. Irregular vaginal bleeding C. Weight Gain D. Nausea
A nurse is caring for a client who is in preterm labor and is scheduled to undergo an amniocentesis. The nurse should evaluate which of the following tests to assess fetal lung maturity? A. Alpha-fetoprotein (AFP) B. Lecithin/sphingomyelin (L/S) ratio C. Kleihauer-Betke test D. Indirect Coombs' test
B. Lecithin/sphingomyelin (L/S) ratio
When caring for a client with reproductive issues, the nurse is required to clear up misconceptions. This enables new learning to take hold and a better client response to whichever methods are explored and ultimately selected. Which misconceptions will the nurse need to clear up? Select all that apply. A. Breastfeeding does not protect again pregnancy B. Taking birth control pills protects against STIs C. Douching after sex will prevent pregnancy D. Pregnancy can occur during menses E. Irregular menstruation prevents pregnancy
B. Taking birth control pills protects against STIs C. Douching after sex will prevent pregnancy E. Irregular menstruation prevents pregnancy
A nurse is teaching a female client about fertility awareness as a method of contraception. Which should the nurse mention as an assumption for this method? A. Sperm can live up to 24 hrs after intercourse B. The "unsafe period" is approximately 6 days C. The exact time of ovulation can be determined D. The "safe period" is 3 days after ovulation
B. The "unsafe period" is approximately 6 days
A client in her second trimester of pregnancy asks the nurse for information regarding certain oral medications to induce a miscarriage. What information should this client be given about such medications? A. They are available only in the form of suppositories B. They can be taken only in the first trimester C. They present a high risk of respiratory failure D. They are considered a permanent end to fertility
B. They can be taken only in the first trimester
A 30-year-old client tells the nurse that she would like to use a contraceptive sponge but does not know enough about its use and whether it will protect her against STIs. Which information should the nurse provide about using a contraceptive sponge? Select all that apply. A. Keep the sponge for more than 30 hours to prevent STIs B. Wet the sponge with water before inserting it C. Insert the sponge 24 hrs before intercourse D. Leave the sponge in place for at least 6 hrs following intercourse E. Replace sponge every 2 hrs for the method to be effective
B. Wet the sponge with water before inserting it C. Insert the sponge 24 hrs before intercourse D. Leave the sponge in place for at least 6 hrs following intercourse
A nurse in a prenatal clinic is caring for a client who is pregnant and experiencing episodes of maternal hypotension. The client asks the nurse what causes these episodes. Which of the following responses should the nurse make? A. "This is due to an increase in blood volume." B. "This is due to pressure from the uterus on the diaphragm." C. "This is due to the weight of the uterus on the vena cava." D. "This is due to increased cardiac output."
C. "This is due to the weight of the uterus on the vena cava."
A nurse is obtaining the genetic history of a pregnant client by eliciting historical information about her family members. Which question is most appropriate for the nurse to ask? A. "Were there any instances of premature birth in the family?" B. "Is there a family history of drinking or drug abuse?" C. "What was the cause and age of death for deceased family members?" D. "Were there any instances of depression during pregnancy?"
C. "What was the cause and age of death for deceased family members?"
A 49-year-old client who is in the perimenopausal phase of life reports to the nurse a loss of lubrication during intercourse, which she feels is hampering her sex life. Which response by the nurse is appropriate? A. "Don't worry! This is a normal process of aging." B. "Have you considered contacting a support group for women your age?" C. "You can manage the condition by using OTC moisturizers or lubricants." D. "All you need is a positive outlook and a supportive partner."
C. "You can manage the condition by using OTC moisturizers or lubricants."
A nurse is teaching a client who is pregnant about the amniocentesis procedure. Which of the following statements should the nurse include in the teaching? A. "You will lay on your right side during the procedure." B. "You should not eat anything for 24 hours prior to the procedure." C. "You should empty your bladder prior to the procedure." D. "The test is done to determine gestational age."
C. "You should empty your bladder prior to the procedure."
The nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. What instruction should the nurse provide? A. Strict bed rest is required after the procedure. B. Hospitalization is necessary for 24 hrs after the procedure. C. An informed consent needs to be signed before the procedure. D. A fever is expected after the procedure because of the trauma to the abdomen
C. An informed consent needs to be signed before the procedure.
A client has been following the conventional 28-day regimen for contraception. She is now considering switching to an extended oral contraceptive (OC) regimen. She is seeking information about specific safety precautions. Which is true for the extended OC regimen? A. It is not as effective as the conventional regimen B. It prevents pregnancy for 3 months at a time C. It carries the same safety profile as the 28-day regimen D. It does not ensure restoration of fertility if discontinued
C. It carries the same safety profile as the 28-day regimen
A nurse is teaching a group of clients who are pregnant about measures to relieve backache during pregnancy. Which of the following measures should the nurse include? Select all that apply. A. Avoid any lifting B. Perform Kegel exercises twice a day. C. Perform the pelvic rock exercises every day D. Use proper body mechanics E. Avoid constrictive clothing
C. Perform the pelvic rock exercises every day D. Use proper body mechanics
A pregnant client and her husband have had a session with a genetic specialist. What is the role of the nurse after the client has seen a specialist? A. Identify the best decision to be taken for the client B. Refer the client to another specialist for a second opinion C. Review what has been discussed with the specialist D. Refer the client for further diagnostic and screening tests
C. Review what has been discussed with the specialist
The physician has ordered a karyotype for a newborn. The mother questions what type of information will be provided by the test. What information should be included in the nurse's response? A. The karyotype will provide information about the severity of your baby's condition. B. A karyotype is useful in determining the potential complications the baby may face as a result of its condition. C. The karyotype will assess the baby's chromosomal makeup. D. The karyotype will determine the treatment needed for the infant.
C. The karyotype will assess the baby's chromosomal makeup.
Positive Signs of Pregnancy
Confirmation that viable fetus is growing in the uterus -Ultrasound of fetus in-utero (4-6 weeks) -Palpation by provider of fetal movement (20 weeks) -Auscultation of fetal heartbeat (10-12 weeks)
The nurse is caring for a client and her partner who are considering a future pregnancy. The client reports her last two pregnancies ended in stillbirth related to an underlying genetic disorder. What response by the nurse is most appropriate? A. "You should contact a geneticist after you become pregnant to closely watch your condition." B. "Your risk of repeated occurrences likely increases with future pregnancies." C. "You are strong to consider such an undertaking." D. "Consultation with a genetic counselor before you become pregnant would likely be beneficial."
D. "Consultation with a genetic counselor before you become pregnant would likely be beneficial."
A nurse is reviewing postpartum nutrition needs with a group of clients who has begun breastfeeding their newborns. Which of the following statements by a member of the group indicates an understanding of the teaching? A. "I am glad I can have my morning coffee." B. "I should take folic acid to increase my milk supply." C. "I will continue adding 330 calories per day to my diet." D. "I will continue my calcium supplements because I don't like milk."
D. "I will continue my calcium supplements because I don't like milk."
A nurse is caring for a client who is pregnant and undergoing a nonstress test. The client asks why the nurse is using an acoustic vibration device. Which of the following responses should the nurse make? A. "It is used to stimulate uterine contractions." B. "It will decrease the incidence of uterine contractions." C. "It lulls the fetus to sleep." D. "It awakens a sleeping fetus."
D. "It awakens a sleeping fetus."
The nurse is caring for a client at the ambulatory care clinic who questions the nurse for information about contraception. The client reports that she is not comfortable about using any barrier methods and would like the option of regaining fertility after a couple of years. Which method should the nurse suggest to this client? A. Basal Body Temperature (BBT) B. Coitus interruptus C. Lactational amenorrhea method D. CycleBeads or medroxyprogesterone injection
D. CycleBeads or medroxyprogesterone injection
A couple is being assessed for infertility. The male partner is required to collect a semen sample for analysis. What instruction should the nurse give him? A. Abstain from sexual activity for 10 hours before collecting the sample. B. Avoid strenuous activity for 24 hours before collecting the sample. C. Collect a specimen by ejaculating into a condom or plastic bag D. Deliver sample for analysis within 1 to 2 hrs after ejaculation
D. Deliver sample for analysis within 1 to 2 hrs after ejaculation
A nurse is interviewing the family members of a pregnant client to obtain a genetic history. While asking questions, which information would be most important? A. Socioeconomic status of the family members B. Avoidance of questions on race or ethnic background C. Specific physical characteristics of family members D. If couples are related to each other or have blood ties
D. If couples are related to each other or have blood ties
A client is to be examined for the presence and extent of endometriosis. For which test should the nurse prepare the client? A. Tissue biopsy B. Hysterosalpingogram C. Clomiphene citrate challenge test D. Laparoscopy
D. Laparoscopy
Conception
Gestational period for humans is 40 weeks, beginning on the first day of the woman's last menstrual period (LMP). Fertilization happens 2 weeks into this timeframe, at or in the first few days after ovulation. Fertilization occurs usually in the fallopian tube and the fertilized egg, now called a zygote, continues down the fallopian tube to the uterus. Implantation usually occurs in the posterior, superior part of the uterus and the implanted zygote is now called an embryo. The greatest timeframe of risk of fetal injury due to teratogenic exposure is during organogenesis (2.5-8 weeks gestation). Embryos develop from three germ layers: endo-, meso-, and ectoderms. Body structures differentiate from these germ layers during the embryonic stage to become what we know them as.
Timing/Use of Ultrasounds
In the first trimester (T1), ultrasounds are generally done with a transvaginal probe. T1 ultrasounds are routinely used to confirm an intrauterine pregnancy and estimate gestational age by measuring fetal size. In the second trimester (T2), a transabdominal ultrasound will likely be used instead of a transvaginal. At around 20 weeks gestational an US is routinely done to detect fetal anomalies, if present. This is often when families find out the sex of their baby; however, this is not the primary reason. Knowing the sex of a baby is in most cases for entertainment. In T2 and T3, a transabdominal US may be used to evaluate the fetus, uterus, placenta, and/or amniotic fluid for screening or diagnostic purposes when there is suspected problems. US may be used at any stage to guide the progress of another test. For example, for amniocentesis or umbilical blood sampling, where a needle is inserted into the abdomen, US is used to ensure needle placement and safety of both the mom and baby. Another example is the use of US to see the baby and evaluate the four measures of the biophysical profile for fetal well-being.
Contraceptives
Natural methods require extensive self-monitoring, but are generally free. They also generally do not contradict religious or culturally restrictive views on contraceptive options. Barrier methods can be purchased OTC but must be readily available at the time of intercourse, or sometimes several hours in advance of intercourse. Effectiveness can be increased with the use of spermicidal gel. Hormonal methods require a prescription and have multiple side effects, including N/V, headache, spotting, weight gain and bone loss. These methods, such as birth control pills, patches and injections, are not recommended for women over 35 or for women who smoke, as the fluctuation in hormone levels create additional cardiovascular risks. Long acting reversible contraceptives have a much more steady level of hormone release. There are still side effects involved, but not generally to the same degree as oral contraceptives. Sterilization methods are options, as well, for those couples who know they do not want any more children. However, it is important to note that another contraceptive method may be needed until confirmation of successful procedure is made, ie a man must have two negative sperm analyses following a vasectomy in order for the procedure to be knows as effective.
Functions of the placenta
Nutrient exchange Gas exchange Transfer of viruses from mom to baby Waste removal from fetus No actual exchange of blood Hormone production once mature at 10ish weeks gestation Maternal side: called Decidua basalis, created from endometrial lining at implantation of zygote. Maternal side of placenta has visible lobes called cotyledons Fetal side: called Chorionic villi, created from trophoblast on blastocyst at implantation of zygote.
Respiratory system
Oxygen consumption increases by approximately 15-20%. Diaphragm is elevated because of the enlarged uterus. Shortness of breath may be experienced. During pregnancy, a woman's HR may increase 10-15 bpm, BP slightly decreases in the second trimester, then increases in third trimester, but not above the pre-pregnancy level and the respiratory rate remains unchanged or slightly increases.
Timing and Purpose of Antepartum Testing
Screening vs. diagnostic testing Assessment for structural and functional abnormalities in pregnancy can be done via ultrasound pictures of various types. 2D, 3D, and 4D ultrasound are used for various reasons. See the chart and info on pages 117-120 in your book. Umbilical artery Doppler flow looks at the function of the placenta and the blood flow to/from the placenta. Assessment for genetic and chromosomal abnormalities can be done by several methods. Keep in mind that any risky procedure that involves putting a needle into the woman's abdomen for aspiration of tissue includes risks that maternal blood work does not. A woman should be instructed to monitor for vaginal bleeding or leakage of fluid and abdominal cramping. The RN monitors maternal VS and fetal well-bring prior to discharge, and an Rh-negative woman is administered Rhogam after these procedures.Chorionic Villus Sampling (aspiration of placental tissue done at 10-12 weeks gestation)Amniocentesis (aspiration of amniotic fluid done at 14-20 weeks gestation)Fetal Blood Sampling or Percutaneous Umbilical Blood Sampling (aspiration of fetal blood from the umbilical cord generally done in 2nd trimester to assess and treat hematological disorders of the fetus)Alpha-fetoprotein (blood test done at 15-20 weeks gestation)Triple or Quad screen (blood test that includes the AFP, done at 15-16 weeks gestation) Amniocentesis can also be used later in pregnancy to assess fetal lung maturity.
Emotional Implications of Infertility
The emotional implications of infertility are real and need to be acknowledged by all healthcare providers, not just those working in obstetrics and gynecology. Infertility can be viewed as a crisis situation and will likely affect most areas of their lives, including personal, professional, and social relationships. Couples experiencing infertility express frustration when they work with healthcare professionals who do not understand the effect infertility has on their lives.
common lab/screening tests in each of the 3 trimesters
VS/weight (at every visit) Urinalysis or urine dip stick (each visit) Serologies for rubella, Hepatitis B, syphillis (at first visit) Fetal kick counts (daily by pt after 28 weeks) Fundal height measurement (at each visit by provider) Auscultation of FHT (at each visit) Glucose testing (routinely at 26-ish weeks gestation) RhoGAM admin (to Rh negative women prophylactic ally at 28 weeks gestation) Screening for Group B Steptococcus (GBS) (at 35-37 weeks gestation) •Urinalysis •Complete blood count •Blood typing •Rh factor •Rubella titer •Hepatitis B surface antigen •HIV, VDRL, and RPR testing •Cervical smears •Ultrasound
