Obstetrics
probable signs
These STRONGLY hint to, but do NOT confirm pregnancy.
presumptive signs
These may suggest pregnancy, but not confirm it
Nagele's Rule
1st day of last period + 7 days - 3 months
The nurse is conducting a teaching session for breastfeeding mothers. Which statement by a mother requires further clarification by the nurse?
"I am glad I can have my two cups of coffee in the morning again." Page 412
A nurse is educating a pregnant client about obtaining a blood sample for an alpha-fetoprotein (AFP) level. Which response by the client indicates that the health teaching was successful?
"If my AFP level is high, it could mean there is a problem with my baby's spinal cord." Page 399
At 24 weeks' gestation a client is asked to drink a sweet orange solution and then wait an hour to have blood drawn. The client asks if this is the test to determine if she has diabetes. What is the best response by the nurse?
"This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes." Page 395
What are the priorities of care if a pregnant woman experiences an eclamptic seizure?
- Administer oxygen - protect the patient from injury - clear the airway
Cardiovascular changes to a pregnant woman
- Cardiac output increases - Blood volume increases - HR increases - BP slightly decreases
Misoprostol
- This med reduces gastric acid secretions so that ulcers can heal. - Pt's taking this should avoid taking magnesium containing antacids as this will increase the risk of diarrhea. - Misoprostol tends to cause diarrhea. - This can induce uterine contractions, so women of childbearing age must r/o pregnancy.
What are signs of magnesium toxicity?
- central nervous system depression - hyporeflexia - respiratory depression
What are signs of severe preeclampsia?
- unusual weight gain - scotomata - epigastric pain - high blood pressure - oliguria
What are signs of central nervous system involvement in patients with severe preeclampsia?
- visual changes - 4 plus tendon reflexes - positive clonus
The nurse is assessing a pregnant client at 20 weeks' gestation and obtains a hemoglobin level. Which result would be a cause for concern?
10.6 g/dl
What is the therapeutic blood level for a patient receiving IV infusion of magnesium sulfate?
4 to 7
Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks' pregnant. The nurse would expect this woman's heart rate to be approximately what?
85 bpm (During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.)
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
At her 16-week checkup, a client's blood pressure is slightly decreased from her prepregnancy level. The nurse evaluates this change based on which statements concerning blood pressure during pregnancy?
A decrease in blood pressure in the second trimester may occur because of placental growth.
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 the 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, C, D, E
When might colostrum start being expressed from the breast?
As early as 16 weeks
placental abruption
Premature separation of the placenta from the uterine wall after 20 weeks' gestation and before the fetus is delivered.
The Nurse is obtaining a client's history during an initial prenatal visit. The client's last menstrual period was from January 8 to January 13, 2021. Unprotected intercourse occurred on January 15. Slight vaginal spotting was noted on January 23. The client's menstrual cycles are regular and 28 days long. Using the Nägele rule, what is the estimated date of birth (or estimated due date). A.October 10, 2022 B.October 15, 2022 C.November 21, 2022 November 29, 2022
B.
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 Sign B. Goodall's Sign C. Ballottement D. Chadwick's Sign E. Quickening
BCD
What labs provide information about the function of the kidneys?
BUN BUN/Creatinine ratio 24- hour quantitative urine protein
Braxton Hicks contractions (probable)
Braxton Hicks contractions are sporadic contractions and relaxation of the uterine muscle.
Patients with severe preeclampsia are at risk for developing acute pulmonary edema. What can a nurse do to prevent the development of this condition?
Control the rate of administration of intravenous fluids.
A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history?
G3 P0020 Page 391
A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur during pregnancy. Which hormones would the nurse most likely identify as being inhibited during the pregnancy?
FSH (Follicle Stimulating Hormone) LH (Luteinizing hormone)
A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history?
G3, T0, P1, A1, L1
GTPAL
Gravida, Term, Preterm, Abortions, Living
The nurse is educating a woman about the importance of folic acid before conception and during pregnancy, to prevent neural tube defects in the fetus. The client plans to take prenatal vitamins and minerals. What food source would the nurse recommend to add to the woman's diet?
Green leafy vegetables Page 382
A 28-year-old client who has just conceived arrives at a health care facility for her first prenatal visit to undergo a physical examination. Which intervention should the nurse perform to prepare the client for the physical examination?
Instruct the client to empty her bladder. Page 390
Which nursing intervention should the nurse perform when assessing fetal well-being through abdominal ultrasonography in a client?
Instruct the client to refrain from emptying her bladder. Page 401-402
methotrexate
It is a medicine that can be used to treat an ectopic pregnancy. It stops cells from dividing by interfering with the folic acid in your body. It is given by injection. You often only need 1 dose. Sometimes you will need a second dose.
Living children
Number of living children (twins and triplets count individually)
The nurse performs a nonstress test (NST) on a client at 36 weeks' gestation. What criteria does the nurse look for on the tracing to determine that the NST is reactive?
Presence of 2 accelerations in 20 minutes Page 403-404
Ballottement
Rebound of the fetus when the cervix is tapped during vaginal examination
A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her?
Rest on the left side for at least 1 hour in the morning and afternoon. Page 398
Positive sign
These CONFIRM pregnancy!
The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement?
Take antacid 1 hour after the multivitamin. Page 406
abortions/miscarriages
Termination before 20 wks gestation (a set of twins before 20 wks gestation is A-1)
The nurse is assisting a pregnant client who underwent a nonstress test that was ruled reactive. Which factor will the nurse point out when questioned by the client about the results?
The fetal heart rate increases with activity and indicates fetal well-being. pp. 403-404.
Relaxin
The hormone that increases the flexibility of the pubic symphysis during pregnancy is
During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first?
Turn the client on her left side.
hydatidiform mole
a benign tumor of the placenta consisting of multiple cystic and resembling a bunch of grapes
linea nigra
a dark line appearing on the abdomen and extending from the pubis toward the umbilicus
nulligravida
a woman who has never been pregnant
nullipara
a woman who has never borne a viable child
The nurse discovers a new prescription for Rho(D) immune globulin for a client who is about to undergo a diagnostic procedure. The nurse will administer the Rho(D) immune globulin after which procedure?
amniocentesis
A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function?
amniotic fluid volume Page 404-405
preterm births
births that take place prior to 37 weeks of gestation (alive or stillborn) (twins/triplets count as one)
Chadwick sign (probable)
bluish-purple coloring of the vaginal mucosa and cervix
A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client?
dark, leafy green vegetables Page 408
Which finding is most worrisome in a client in her 26th week of pregnancy?
facial edema Page 397
primipara
first birth
primigravida
first pregnancy
McDonald's Rule
fundal height in cm's equals wks gestation w/in 2 wks
HELLP syndrome
hemolysis, elevated liver enzymes, low platelet count
human chorionic gonadotropin (hCG)
hormone for recognition of pregnancy
facial melasma or Chloasma
hyperpigmentation of the face
The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects?
maternal serum alpha-fetoprotein analysis Page 399
Term births
number born (alive or stillborn) at 37 weeks gestation onward (*twins/triplets count as one)
gravidity
number of pregnancies (twins and triplets count as one)
parity
number of pregnancies in which fetus or fetuses have reached viability (20 weeks), not the number of fetuses born
The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care?
once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth Page 395
A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. What does the nurse anticipate in this woman's pregnancy?
potential for greater than usual back pain Page 409
preterm premature rupture of membranes (PPROM)
premature spontaneous rupture of membranes after 20 weeks of gestation and prior to 37 weeks of gestation.
A nurse is instructing a pregnant woman about monitoring fetal movements and informs her that normally the fetus will move the same amount every day. The nurse also adds that the client may notice an unusual increase or decrease in movement, explaining that this is due to which situation?
response to a need for oxygen Page 395
Which vaccines are contraindicated during pregnancy since they may transmit a viral infection to the fetus? Select all that apply.
rubella measles mumps Page 419
Goodell's sign (probable)
softening of the cervix
Hegar Sign (probable)
softening of the uterine isthmus
couvade syndrome
somatic symptoms experienced by the father during pregnancy simulating those of the pregnant mother
Why is magnesium sulfate administered in pregnant women with preeclampsia?
to prevent an eclamptic seizure
Polyhydramnios/Hydramnios
too much amniotic fluid > 2 L
A client who is 8 weeks' pregnant comes to the emergency department reporting abdominal pain and spotting. The client also reports breast tenderness and fatigue. Additional assessment suggests a possible ectopic pregnancy and diagnostic evaluation is scheduled. The nurse would prepare the client for which test(s) to aid in confirming this diagnosis? Select all that apply. platelet level urine for protein complete blood count transvaginal ultrasound beta-human chorionic gonadotropin (hCG) level
transvaginal ultrasoundbeta-human chorionic gonadotropin (hCG) level Explanation:The use of transvaginal ultrasound to visualize the misplaced pregnancy and low levels of serum beta-hCG assist in diagnosing an ectopic pregnancy. The ultrasound determines whether the pregnancy is intrauterine, assesses the size of the uterus, and provides evidence of fetal viability. The visualization of an adnexal mass and the absence of an intrauterine gestational sac are diagnostic of ectopic pregnancy. In a normal intrauterine pregnancy, beta-hCG levels typically double every 2 to 4 days until peak values are reached 60 to 90 days after conception. Concentrations of hCG decrease after 10 to 11 weeks and reach a plateau at low levels by 100 to 130 days. Therefore, low beta-hCG levels are suggestive of an ectopic pregnancy. Urine for protein, platelet level, and complete blood count would provide no information about an ectopic pregnancy.
palmar erythema
unusual redness of the palms of the hands
multigravida
woman who has been pregnant more than once
multipara
woman who has given birth to two or more children