Ch.26 Health Promotion and Pregnancy

Methylergonovine

It affects the smooth muscle of a woman's uterus, improving the muscle tone as well as the strength and timing of uterine contractions. It is also used to help control bleeding and to improve muscle tone in the uterus after childbirth.

Daily fetal movement count

Measurement of fetal movement as an indicator of fetal health. Advantages of the test include that it is simple, low cost, noninvasive, and fast. Instruct woman to count fetal movements for 1 hour two or three times daily. No exact number of movements has been identified as a "failing test." However, fewer than three fetal movements in a 1-hour period or the absence of fetal movements for 12 hour is an indication for further evaluation

When can auscultation occur with a Doppler?

Practitioners can auscultate fetal heart tones between 10 and 12 weeks with Doppler scan

Hëgar's sign

Softening of the isthmus of the uterine cervix early in gestation; a probable sign of pregnancy.

Which cervical change is observed during pregnancy? Select all that apply. One, some, or all responses may be correct. 1 Cervical tip becomes soft. 2 Fragility of cervical tissues decreases. 3 Volume of cervical muscles increases. 4 External cervical os appears as a jagged slit. 5 Elasticity of cervical collagen-rich connective tissue increases.

1 Cervical tip becomes soft. 3 Volume of cervical muscles increases. 5 Elasticity of cervical collagen-rich connective tissue increases.

Which variable is a part of the score on a biophysical profile? Select all that apply. One, some, or all responses may be correct. 1 Fetal tone 2 Fetal position 3 Fetal movement 4 Amniotic fluid index 5 Fetal breathing movements 6 Contraction stress test results

1 Fetal tone 3 Fetal movement 4 Amniotic fluid index 5 Fetal breathing movements

Which antimicrobial drug is considered safe during breastfeeding? Select all that apply. One, some, or all responses may be correct. 1 Penicillins 2 Macrolides 3 Tetracycline 4 Cephalosporins 5 Chloramphenicol

1 Penicillins 2 Macrolides 4 Cephalosporins

Which is an action of oxytocin?

1 Promotes milk ejection during lactation 2 Controls uterine bleeding after delivery 3 Induces labor when uterine contractions are weak

Which recommendation would the nurse provide to a pregnant woman who reports leg cramps? 1 Application of an ice pack to relax the muscle 2 Dorsiflexion of the foot until the spasm passes 3 Over-the-counter analgesics to relieve inflammation 4 Sleeping with extra pillows at night to support the legs

2 Dorsiflexion of the foot until the spasm passes

Confidence: Just a guess Stats Issue with this question? 4. Which action does the nurse implement when providing care to the laboring client to address oral hydration needs during active labor? 1 Provide oral care every day 2 Ensure that ice chips are available. 3 Offer a nutritional supplement shake. 4 Implement strict intake and output monitoring.

2 Ensure that ice chips are available.

A pregnant client reports to the nurse that she often gets leg cramps. Which physiologic alteration of pregnancy can cause this discomfort, and which is the appropriate recommendation for relief? 1 Hypercalcemia; avoid eating hard cheeses 2 Hypocalcemia; increase her intake of milk 3 Hyperkalemia; consult her health care provider 4 Hypokalemia; increase intake of green leafy vegetables

2 Hypocalcemia; increase her intake of milk

Which drug is currently used to treat preterm labor? 1 Oxytocin 2 Nifedipine 3 Raloxifene 4 Clomiphene

2 Nifedipine

Which hormone can cause ovulation and promote lactation? 1 Estrogen 2 Oxytocin 3 Progestin 4 Vasopressin

2 Oxytocin

Which assessment is the nurse's priority when performing a 1-hour postpartum check on a client recovering from a cesarean section delivery under general anesthesia? 1 Level of pain 2 Respiratory status 3 Level of consciousness 4 Amount of vaginal bleeding

2 Respiratory status

Which drug would be prescribed to the client who is lactating and diagnosed with a migraine? 1 Morphine 2 Sumatriptan 3 Bromocriptine 4 Acetaminophen

2 Sumatriptan

A client is receiving an epidural anesthetic during labor. Which side effect would the nurse monitor the client for? 1 Hypertension 2 Urine retention 3 Subnormal temperature 4 Decreased level of consciousness

2 Urine retention

Which potential complication is associated with ketonuria that can occur when clients severely restrict their calorie intake during pregnancy? 1 Preterm labor 2 Placenta previa 3 Gestational diabetes 4 Hyperemesis gravidarum

3 Gestational diabetes

Which factor is frequently associated with hyperemesis gravidarum? 1 History of cholecystitis 2 Large amount of amniotic fluid 3 High level of chorionic gonadotropin 4 Decreased secretion of hydrochloric acid

3 High level of chorionic gonadotropin

Which drug may be used for cervical ripening during labor and as a stomach protectant? 1 Raloxifene 2 Clomiphene 3 Misoprostol 4 Dinoprostone

3 Misoprostol

A nurse instills an antibiotic ophthalmic ointment into a newborn's eyes. Which condition would this medication prevent? Incorrect1 Herpetic ophthalmia 2 Retinopathy of prematurity 3 Ophthalmia neonatorum 4 Hemorrhagic conjunctiviti

3 Ophthalmia neonatorum

A 23-year-old primigravida receives an ultrasound that indicates that she is at 9 weeks' gestation. She asks the nurse when she can expect to feel her baby move. How would the nurse respond? 1 "You should be able to feel the baby move any day now." 2 "You should feel your first light movement of the baby around 24 weeks." 3 "Most women can first detect movement of their babies by 12 to 14 weeks. 4 "Many women are able to first feel light movement between 18 and 20 weeks."

4 "Many women are able to first feel light movement between 18 and 20 weeks."

A postpartum client, who was receiving an intravenous infusion of oxytocin to stimulate labor, asks the nurse why it is not being discontinued now that the baby is born. How would the nurse respond? 1 "The oxytocin promotes the flow of lochia." 2 "The oxytocin eases the discomfort of uterine muscle contraction." 3 "The oxytocin enhances the healing of tissue in the uterus." 4 "The oxytocin causes contraction of the uterine muscle."

4 "The oxytocin causes contraction of the uterine muscle."

A nonstress test (NST) is scheduled for a client with mild preeclampsia. During the test, the client asks the nurse what it means when the fetal heart rate goes up every time the fetus moves. How should the nurse respond? 1 "These accelerations are a sign of fetal well-being." 2 "These accelerations indicate fetal head compression." 3 "Umbilical cord compression is causing these accelerations." 4 "Uteroplacental insufficiency is causing these accelerations."

4 "Uteroplacental insufficiency is causing these accelerations."

A client in active labor becomes very uncomfortable and asks the nurse for pain medication. Nalbuphine is prescribed. Which is the action of this medication? 1 Producing increased maternal respirations 2 Acting as a preliminary anesthetic 3 Inducing sleep until the time of birth 4 Acting on opioid receptors

4 Acting on opioid receptors

A nurse is counseling a pregnant client with iron-deficiency anemia about when and how to take supplemental iron. Which time of day and with which drink is iron absorption most efficient? 1 Dinnertime with water 2 Bedtime with a milkshake 3 After lunch with cranberry drink 4 Before breakfast with orange juice

4 Before breakfast with orange juice

A postpartum client asks the nurse why she is always being encouraged to walk. Which physiologic response occurs with ambulation? 1 Respirations are enhanced. 2 Bladder tonicity is increased. 3 Abdominal muscles are strengthened. 4 Peripheral vasomotor activity is promoted.

4 Peripheral vasomotor activity is promoted.

Morula

A solid ball of cells that makes up an embryo; in humans, this stage occurs within four days of fertilization.

Nuchal translucency screening

Ultrasound screening to measure fetal nuchal folds to assess for potential Down syndrome.

Therapy for ptyalism

astringent mouthwash chewing gum sucking on hard candy

Taking-hold

mother begins to initiate action and becomes interested in caring for infant

Implantation

process in which the blastocyst attaches to the wall of the uterus

Zygote

the fertilized egg; it enters a 2-week period of rapid cell division and develops into an embryo

Perinatal

the time and events surrounding birth

The nurse obtains the health history from a client who is seeking contraceptive information. Which factor in the client's history indicates that oral contraceptives are contraindicated? 1 Older than 30 years 2 Current hypothyroidism 3 Two multiple pregnancies 4 Blood pressure 162/110 mm Hg

4 Blood pressure 162/110 mm Hg

Which factor is the most important in the survival of a client's newborn? 1 Reproductive history 2 Adequacy of prenatal care 3 Health habits and social class 4 Gestational age and birth weight

4 Gestational age and birth weight

Hydatidiform mole

(abnormal growth of a fertilized ovum in which a large vascular mass, but no fetus, develops).

Chorionic villi

-microscopic fingerlike projections that penetrate the endometrium -develop into the placenta & support maternal-fetal gas exchange

Contraction stress test (CST)

-nipple stimulation or oxytocin stimulation evaluates fetal response to stress -no deceleration with a min of 3 contractions lasting 40-60 seconds in 10 min -done at 32 wks

During a childbirth class, a woman asks the nurse, "When does an embryo become a fetus?" Which is the correct nursing response? 1 "During the eighth week of pregnancy." 2 "At the end of the second week of pregnancy." 3 "When the fertilized egg becomes implanted." 4 "When the products of conception are seen on the sonogram."

1 "During the eighth week of pregnancy."

A client is admitted to the birthing center in active labor. She is 100% effaced, dilated 3 cm, and at +1 station. The client is in which stage of labor? 1 First 2 Latent 3 Second 4 Transition

1 First

How many grams of protein will a nurse instruct a pregnant client to consume when discussing increased daily requirements during pregnancy? 1 65 g 2 60 g 3 55 g 50 g

2 60 g

A nitrazine test strip turns deep blue. This indicates that the amniotic fluid being tested has which pH? 1 4.5 2 5.5 3 6.5 4 7.5

4 7.5

What does elevated alpha-fetoprotein indicate?

Elevated levels are suggestive of neural tube defects.

Nonstress test (NST)

Evaluation of fetal response (fetal heart rate) to natural contractile uterine activity or to an increase in fetal activity.

Postpartal

The final stage of the maternity cycle

Where does fertilization occur?

The process of fertilization usually takes place in the ampulla of the fallopian tube.

Hirsutism

excessive hair growth over the body

Fundus

rounded upper portion of the uterus

Chorionic villus sampling

sampling of placental tissue for microscopic and chemical examination to detect fetal abnormalities

Goodell's sign

softening of the cervix

Positive Signs of Pregnancy

• Visualization: The fetal skeleton seen on x-ray examination is a positive sign of pregnancy, but use of radiation generally is limited during pregnancy because of possible danger to the fetus. Ultrasound tracing of the fetus is also a positive indication of pregnancy. • Fetal movement: Fetal movement may be detected by a trained observer (the primary care practitioner). • Auscultation of fetal heart tone: Fetal heart activity can be detected with ultrasound scan at 6 weeks; tones are heard with Doppler at 10 to 12 weeks and with stethoscope at approximately 18 to 20 weeks.

Which nursing intervention will assist the client to minimize perineal edema after an episiotomy? 1 Applying ice packs 2 Offering warm sitz baths 3 Administering aspirin as needed (PRN) 4 Elevating the hips on a pillow

1 Applying ice packs

Which condition identified by the client indicates understanding of when prescribed oral contraceptives need to be stopped immediately and the health care provider notified? 1 Chest pain 2 Menorrhagia 3 Mittelschmerz 4 Increased leukorrhea

1 Chest pain

Which request for a laboring client's medical information would the nurse deny? 1 Department supervisor with no direct or indirect care duties 2 Nursing student caring for clients under nursing instructor supervision 3 A safety officer at the facility who does not have direct contact with clients 4 The hospital's performance improvement director who does not have direct contact with clients

1 Department supervisor with no direct or indirect care duties

The nurse is caring for a pregnant client undergoing a first trimester ultrasound examination. The nurse informs the client that a first trimester ultrasound is utilized for which purpose? 1 Estimating fetal age 2 Detecting hydrocephalus 3 Ruling out congenital defects 4 Approximating fetal growth

1 Estimating fetal age

Which high-risk nutritional practice must be assessed for when a pregnant client is found to be anemic? 1 Pica 2 Caffeine intake 3 Alcohol abuse 4 Artificial sweetener use

1 Pica

While inspecting her newborn who was born at 37 weeks' gestation, the client becomes concerned and asks, "What's this sticky white stuff all over him?" How would the nurse respond? 1 "It's a secretion from the baby's fat cells called milia." 2 "This is vernix. It helps protect the baby while in the uterus." 3 "Your baby was born several weeks early, so we expect to see this." 4 "It's nothing to be concerned about. Most newborns are covered with it."

2 "This is vernix. It helps protect the baby while in the uterus."

The nurse assists a client to the bathroom to void several times during the first stage of labor. Why is this an important nursing intervention? 1 A full bladder is often injured during labor. 2 A full bladder may inhibit the progress of labor. 3 A full bladder jeopardizes the status of the fetus. 4 A full bladder predisposes the client to urinary infection.

2 A full bladder may inhibit the progress of labor.

According to the U.S. Food and Drug Administration (FDA) pregnancy risk categories, which category of drugs may cause minimal risk to the fetus? Incorrect1 A 2 B 3 C 4 D

2 B

Which drug used to promote fertility may cause esophageal burns? 1 Estrogen 2 Clomiphene 3 Nifedipine 4 Indomethacin

2 Clomiphene

A woman at 23 weeks of gestation calls to tell the nurse she thinks she is leaking fluid from her vagina. What information should be included in the nurse's response to the patient? 1. "As long as the baby is still moving around, there is nothing to worry about." 2. "Come to the office right away." 3. "Call me back in 2 hours, and tell me if there is any change in the leakage." 4. "We can wait until your next appointment to check you."

2. "Come to the office right away."

When obtaining a reproductive health history from a female patient, what should the nurse do? 1. Limit the time spent on exploration of intimate topics. 2. Explain the purpose of questions asked and how they will be used. 3. Avoid asking questions that may embarrass the patient. 4. Use only acceptable medical terminology when referring to body parts and functions.

2. Explain the purpose of questions asked and how they will be used.

The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. Which are positive signs of pregnancy? (Select all that apply.) 1. A positive pregnancy test 2. Fetal movement palpated by the primary caregiver 3. Braxton Hicks contractions 4. Nausea and vomiting 5. Presence of fetal heart tones

2. Fetal movement palpated by the primary caregiver 5. Presence of fetal heart tones

Taking-in

24-48 hours after birth: dependent, passive; focuses on own needs; excited, talkative

Which nursing assessment of the fundus is expected 1 day after birth in a postpartum client whose bladder is not distended? 1 One fingerbreadth above the umbilicus 2 Deviated to the right side 3 1 cm below the umbilicus 4 3 cm below the umbilicus

3 1 cm below the umbilicus

A nurse assesses a pregnant client and determines that her uterus has risen out of the pelvis and is now an abdominal organ. At what week of gestation would this clinical finding occur? 1 8th week of pregnancy 2 10th week of pregnancy 3 12th week of pregnancy 4 18th week of pregnancy

3 12th week of pregnancy

A multipara is admitted to the birthing center in active labor. Her temperature is 98ºF (36.7ºC), pulse is 70 beats per minute, respirations are 18 breaths per minute, and blood pressure is 126/76 mm Hg. A vaginal examination reveals a cervix that is 90% effaced and 7 cm dilated with a vertex presentation and is at +2 station. The client is complaining of pain and asks for medication. Which medication should be avoided because it may cause respiratory depression in the newborn? 1 Naloxone 2 Lorazepam 3 Butorphanol 4 Promethazine

3 Butorphanol

The primigravida asks the nurse about the changes in her body. While describing the pregnancy changes in each body system, the nurse informs the client that which system has the most profound change? 1 Urinary system 2 Endocrine system 3 Cardiovascular system 4 Gastrointestinal system

3 Cardiovascular system

A pregnant client has a family history of Down syndrome. Which prenatal test provides the earliest diagnosis with rapid test results? 1 Nonstress test 2 Amniocentesis 3 Chorionic villus sampling (CVS) 4 Percutaneous umbilical blood sampling

3 Chorionic villus sampling (CVS)

A pregnant woman is being induced because she is past her due date. Which drug would be administered to the client to soften the cervix and promote labor? 1 Clomiphene 2 Menotropins 3 Dinoprostone 4 Choriogonadotropin alfa

3 Dinoprostone

Which color does the nurse teach a group of new mothers that the lochial discharge will be on the fourth postpartum day? 1 Dark red 2 Deep brown 3 Pinkish brown 4 Yellowish white

3 Pinkish brown

Which hormone maintains pregnancy? 1 Prolactin 2 Estrogen 3 Progesterone 4 Somatotropin

3 Progesterone

A breastfeeding mother asks the nurse what she can do to ease the discomfort caused by a cracked nipple. Which intervention would the nurse suggest? 1 Stop nursing for a few days and allow the nipple to heal. 2 Manually express milk and feed it to the baby in a bottle. 3 Start feedings on the unaffected breast and then the affected breast. 4 Use a breast shield to keep the baby from making direct contact with the nipple.

3 Start feedings on the unaffected breast and then the affected breast.

For which condition are pregnant women at a five- to sixfold increased risk? 1 Bradycardia 2 Hypertension 3 Thromboembolic disease 4 Decreased cardiac output

3 Thromboembolic disease

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. What information can be provided by the nurse? 1. "You do not need to modify your exercising anytime during your pregnancy." 2. "Stop exercising because it will harm the fetus." 3. "You may find that you need to modify your exercising to walking later in your pregnancy, around the seventh month." 4. "Jogging is too hard on your body; switch to walking now."

3. "You may find that you need to modify your exercising to walking later in your pregnancy, around the seventh month."

A woman who is in her first trimester is talking with the nurse. The patient has inquired about the feelings she will have when she first feels her baby move. What information can be provided by the nurse? 1. The movement will feel like cramps. 2. The movement is rhythmic and called Goodell's sign. 3. The movement is flutter-like and is called quickening. 4. The movement is like a thud and is called Hëgar's sign.

3. The movement is flutter-like and is called quickening.

A 25-year-old woman comes to the clinic and says she thinks she is pregnant. Her last period was July 20. Based on this fact, what is the expected date of delivery (EDD)? 1. April 13 2. April 27 3. May 20 4. March 27

4. March 27

Letting-go

A phase of maternal adaptation that involves relinquishment of previous roles and assumption of a new role as a parent.

Chadwick's sign

Bluish-purple coloration of the vaginal mucosa and cervix

Which over-the-counter (OTC) prescription does the nurse question when reviewing medications for a pregnant client during the third trimester of pregnancy?

Ibuprofen

A client making her first prenatal clinic visit asks what immunization can be administered safely to a pregnant woman.

The inactive influenza and diphtheria, tetanus, acellular pertussis (DTaP) immunizations can be safely administered during the first trimester of pregnancy, although DTaP is recommended at 27 to 36 weeks' gestation to provide immunity to the mother and infant.

Human placental lactogen

This hormone promotes insulin resistance by the maternal cells resulting in elevations in serum glucose levels. It affects maternal metabolism, resulting in the maintenance of energy sources for the fetus.

Prenatal

before birth

Para

beside, near

Nausea is thought to be caused by?

by increased HCG levels and changes in carbohydrate metabolism.

Ptyalism

excessive salivation

Lanugo

fine, downy, unpigmented hair that appears on the fetus in the last 3 months of development

Biophysical profile (BPP)

Assessment of five variables in the fetus that help to evaluate fetal risk: breathing movement, body movement, tone, amniotic fluid volume, and fetal heart rate reactivity.

Which complication would the nurse anticipate when a client who is 36 weeks' pregnant presents with swelling of the face, blurred vision, and epigastric discomfort? 1 Preeclampsia 2 Placenta previa 3 Gestational diabetes 4 Hyperemesis gravidarum

1 Preeclampsia

Which statement defines the second stage of labor? 1 It ends at the time of birth. 2 It ends as the placenta is expelled. 3 It begins with the transition phase of labor. 4 It starts with the onset of strong contractions.

1 It ends at the time of birth.

Intrapartal

Period that begins with the onset of labor and ends with the delivery of the placenta; also called perinatal.

Nursing responsibilities for a no stress test

explaining the procedure to the patient assuring the patient that no discomfort is associated with the NST encouraging the patient to verbalize her fears ensuring the patient eats before the test to elevate serum glucose level, requesting the patient empty her bladder and then assume a Sims position applying the external fetal monitors to the patient's abdomen observing for an increase in fetal heart rate with fetal movement and stimulating fetal activity with external methods if the fetus remains quiet for more than 20 minutes.

Chorionic villi secrete which hormone?

human chorionic gonadotropin (HCG), a hormone that stimulates the continued production of progesterone and estrogen by the corpus luteum, which is the reason ovulation and menstruation cease during pregnancy.

Which self-care measure does the nurse reinforce when providing education regarding nausea for the pregnant client in the first trimester of pregnancy? Select all that apply. One, some, or all responses may be correct. 1 Avoid spicy foods. 2 Eat small, frequent meals. 3 Increase intake of vitamin B6. 4 Decrease fluid intake between meals. 5 Eat dry crackers 30 minutes before getting out of bed.

1 Avoid spicy foods. 2 Eat small, frequent meals. 3 Increase intake of vitamin B6. 4 Decrease fluid intake between meals. 5 Eat dry crackers 30 minutes before getting out of bed.

A pregnant patient is seen during her second trimester at the health care provider's office. She asks the nurse, "What can I do when my leg goes into a cramp?" The patient demonstrates understanding of the nurse's instruction regarding relief of leg cramps if she takes which action? 1. Wiggles and points her toes during the cramp 2. Applies cold compresses to the affected leg 3. Extends her leg and dorsiflexes her foot during the cramp 4. Avoids weight bearing on the affected leg during the cramp

1. Wiggles and points her toes during the cramp

A pregnant client in the first trimester is experiencing nausea and vomiting. Which nursing response is most appropriate? 1 It is always present during early pregnancy. 2 It will disappear when lightening occurs. 3 It is a common response to an unwanted pregnancy. 4 It may be related to an increased human chorionic gonadotropin level.

4 It may be related to an increased human chorionic gonadotropin level.

The nurse explains physiologic anemia to a pregnant client by which description? 1 Erythropoiesis decreases. 2 Plasma volume increases. 3 Utilization of iron decreases. 4 Urine volume increases.

2 Plasma volume increases.

A patient is scheduled for an ultrasound scan. She is at 22 weeks' gestation. The patient asks how they will be able to tell the gestational age of her fetus. When planning the response, the nurse correctly recognizes that which measurements will be used in this determination? (Select all that apply.) 1. Abdominal circumference 2. Biparietal diameter 3. Quantity of amniotic fluid 4. Femur length 5. Crown rump length

2. Biparietal diameter 4. Femur length

A nurse is educating a group of expectant mothers on how to perform effleurage during labor. Which explanation of effleurage does the nurse provide the group? 1 Rocking gently on their knees 2 Practicing panting to avoid pushing during labor 3 Taking deep breaths before imagined contractions 4 Massaging their abdomens gently with their fingertips

4 Massaging their abdomens gently with their fingertips

An expectant father confides in the nurse that his pregnant wife (10 weeks of gestation) is driving him crazy. "One minute she seems happy, and the next minute she seems unhappy, and the next she is crying over nothing at all. Is there something wrong with her?" What is the most appropriate response by the nurse? 1. "This is normal behavior and should begin to subside by the second trimester." 2. "She may be having difficulty relating to the pregnancy. I will refer her to a counselor I know." 3. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will subside as she adjusts to being pregnant." 4. "You seem impatient with her. Perhaps this is precipitating her behavior."

3. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will subside as she adjusts to being pregnant."

The patient reports experiencing nausea, vomiting, and breast tenderness along with missing her period. These symptoms are considered to be what type of signs of pregnancy? 1. Probable 2. Positive 3. Presumptive 4. Possible

3. Presumptive

A pregnant woman at 32 weeks of gestation reports feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. What should the nurse's initial action be? 1. Assess the woman's blood pressure and pulse. 2. Have the woman breathe into a paper bag. 3. Raise the woman's legs. 4. Turn the woman on her side.

4. Turn the woman on her side.

Spider nevi

red elevations of skin with lines radiating from center

Antepartal

refers to pregnancy before the onset of labor

Hyperemesis Gravidarum

severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus

Preparing for Ultrasound Scan Examination

Inform the woman that she needs a full bladder for an abdominal ultrasound scan to allow better imaging of the fetus. Position her comfortably, with pillows under her head and knees, while the test is conducted. Apply ultrasonic gel to the abdomen and pass the scanner over it while images are reproduced. The woman and her partner can watch if they wish. The woman should not feel any discomfort. For a transvaginal ultrasound scan, tell the woman that she may either be in a lithotomy position or have her pelvis elevated. These positions are optimal for imaging the pelvic structures. Introduce a transducer with a protective sheath covering into the vagina. If the woman wants to insert it herself, allow her to do so. The angle of the probe or the tilt of the table may be altered during the examination, but the procedure should not be painful.

How long does the zygote take to reach the uterine cavity?

It takes 3 or 4 days to enter the uterine cavity.

Effleurage

Light, continuous-stroking massage movement applied with fingers and palms in a slow and rhythmic manner.

Basic Prenatal Physical Examination

Measurement of vitals, height, and weight assessment of heart, lungs, and reflexes general physical inspection of skin and mobility laboratory studies (hemoglobin, hematocrit, serology, ABO and Rh factor, rubella titer) routine urinalysis for glucose, protein, and ketones pregnancy tests.

When does the fetal stage begin?

Starting with the ninth week, the embryo is referred to as the fetus, and the fetal stage begins.

Abortion

The deliberate termination of a pregnancy by killing the unborn child

Desirable outcomes for a Contraction Stress Test?

The desired response is termed negative, which means that no change in fetal heart rate occurs with the contractions.

When does the the embryonic stage begins?

The embryonic stage begins with implantation and encompasses approximately the first 8 weeks of pregnancy.

Crown-rump length

The measurement from the top of the fetal head to the buttocks

Which week does the placenta become fully functional?

Week 12

Relaxation and Muscle Ache Relief

Yoga • Biofeedback • Reflexology • Therapeutic touch • Massage

Presumptive Signs

• Amenorrhea: Absence of menstruation • Nausea and vomiting • Frequent urination • Breast changes: Swelling, tingling, and tenderness of the breasts are common during pregnancy, along with changes in pigmentation of the areolae. The sebaceous material secreted from the ducts of the glands to the skin of each areola lubricates and protects the breasts from infection and trauma during breast-feeding. • Change in the shape of the abdomen • Quickening: The subjective sensation of fetal movement first occurs at about 16 to 18 weeks of gestation in multigravida women. First-time mothers may not report these sensations until 18 to 20 weeks' gestation. • Skin changes: Pigment changes, such as darkening of some areas of the body such as the areolae, may occur. Some women may experience chloasma (melasma). • Chadwick's sign: During the pelvic examination, the physician may note that the vagina, the cervix, and sometimes the vulva have a violet or purplish discoloration. This change in color is the result of increased vascularity to the area.

Guidelines for Counting Fetal Movements (Kick Counts)

• Kick count monitoring should begin at 28 weeks' gestation. • The expectant mother should pick a time of day when she can sit or lie quietly. If deciding to lie down, a left side-lying position should be selected. • Each fetal movement or kick should be counted. The goal is to experience 10 to 12 movements/kicks in a 1-to 2-hour period.

Gynecologic Examination

• Palpation and auscultation of the abdomen • Visualization of the cervix and vagina • Evaluation of the bony pelvis • Palpation of the uterus externally or bimanually • Examination of the vulva, the perineum, the anus, and the rectum • Pap smear (done at the beginning of the examination)

Amniocentesis

needle puncture of the amniotic sac to withdraw amniotic fluid for analysis

Ectopic Pregnancy

implantation of the fertilized egg in any site other than the normal uterine location

Endoderm

innermost germ layer; develops into the linings of the digestive tract and much of the respiratory system

Alpha-fetoprotein

is a protein produced by the fetal yoke sac and liver.

What does declined levels of alpha-feta protein indicate?

low levels may suggest a fetus with Down syndrome (trisomy 21).

Mesoderm

middle germ layer; develops into muscles, and much of the circulatory, reproductive, and excretory systems

Gravida

pregnant woman

Probable Signs

objective signs may not be associated with pregnancy - hegar's sign, mcdonalds sign, enlarged abdomen, pigmentation, striae, ballottement, positive pregnancy test, palpation of fetal outline

Trimesters

a period of three months, especially as a division of the duration of pregnancy.

Chloasma

a pigmentation disorder characterized by brownish spots on the face

Ballottement

a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus

Teratogenic agents

agents that cause damage during embryonic or fetal development

Pica

an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month

A woman admitted in labor has an obstetric history that indicates that she has had four pregnancies and has 3 living children. One was born at 39 weeks of gestation, another at 34 of weeks of gestation, and another at 35 weeks of gestation. She had a miscarriage at 16 weeks gestation. What are her gravidity and parity with the TPAL system? 1. 1-2-1-3 2. 1-2-0-3 3. 3-0-3-0 4. 2-2-0-3

1. 1-2-1-3

Ectoderm

outermost germ layer; produces sense organs, nerves, and outer layer of skin

Where is the Doppler positioned to auscultate fetal heart rate?

place the instrument in the midline, just above the symphysis pubis, and apply firm pressure.

Nondesirable outcomes for a Contraction Stress Test?

A positive test is noted when the fetal heart rate declines with the contractions. A drop in fetal heart rate indicates placental insufficiency and fetal hypoxia. Declines in fetal heart rates are identified by where in the cycle of the contraction they occur. Declines in the heart rate at or after the midpoint of the contraction are referred to as late decelerations. Late decelerations are considered an ominous sign. The fetus may be at risk during labor and need delivery via cesarean section.

Constipation is a frequent symptom as a pregnancy progresses. Which measures should be recommended to the gravid woman? (Select all that apply.) 1. Drink six to eight glasses of water daily. 2. Take an over-the-counter laxative. 3. Take an iron supplement only every other day. 4. Take mineral oil at bedtime. 5. Increase dietary fiber intake.

1. Drink six to eight glasses of water daily. 5. Increase dietary fiber intake.

A test that may be done in late pregnancy to determine fetal well-being is the nonstress test. This test is based on which phenomenon? 1. Fetal heart rate increases in connection with fetal movement. 2. Braxton Hicks contractions cause an increase in fetal heart rate. 3. Fetal heart rate slows in response to contractions. 4. Fetal movement causes an increase in maternal heart rate.

1. Fetal heart rate increases in connection with fetal movement.

While giving a health history to the nurse, the patient reports that she usually has a glass of wine with dinner. What is the safe level of alcohol intake for her during her pregnancy? 1. No alcohol 2. Wine only; one or two glasses daily with meals 3. Up to 4 oz daily 4. Beer or wine only after the first trimester

1. No alcohol

At one of her prenatal visits, the patient is scheduled for a sonogram. Sonography can be used to assess which of the following? (Select all that apply.) 1. Number of fetuses 2. Gestational age of fetus 3. Down syndrome 4. Congenital anomalies 5. Placement of the placenta

1. Number of fetuses 2. Gestational age of fetus 3. Down syndrome 4. Congenital anomalies 5. Placement of the placenta

When planning a diet with a pregnant woman, what should the nurse's initial action be? 1. Review the woman's dietary intake. 2. Teach the woman about the ChooseMyPlate guide. 3. Caution the woman to avoid large doses of vitamins, especially those that are fat soluble. 4. Instruct the woman to limit the intake of fatty foods.

1. Review the woman's dietary intake.

The nurse explains to the patient that she should contact her health care provider if she experiences any of the danger signs of pregnancy. Which symptoms are a danger sign during pregnancy? (Select all that apply.) 1. Urinary frequency 2. Severe headaches 3. Dyspepsia 4. Heartburn 5. Diplopia

1. Urinary frequency 2. Severe headaches 3. Dyspepsia 4. Heartburn 5. Diplopia

Blastocyst

A fluid-filled sphere formed about 5 days after fertilization of an ovum that is made up of an outer ring of cells and inner cell mass. This is the structure that implants in the endometrium of the uterus.

Villi

Fingerlike extensions of the intestinal mucosa that increase the surface area for absorption

Which hormones does the placenta excrete?

HCG and the steroidal hormones estrogen and progesterone, which maintain the pregnancy.

Ultrasonography (ultrasound)

common prenatal test that uses sound waves to create a visual image of a developing fetus

Wharton's jelly

mucoid connective tissue that surrounds the vessels within the umbilical cord

Flagellation

whipping; flogging

How is testing done in a Nonstress test.

with the tocotransducer recording fetal movement and the ultrasound transducer recording the fetal heart rate.

Morning Sickness and Hyperemesis alternative therapy

• Acupuncture • Acupressure • Shiatzu • Motion sickness bracelets (Sea Bands) • Aromatherapy with lavender or rose scents • Herbal remedies a • Lemon balm • Peppermint • Spearmint • Ginger root • Raspberry leaf • Fennel • Chamomile • Hops • Meadowsweet • Wild yam root