OB Exam 1

Which of the following is a presumptive sign or symptom of pregnancy? A. Restlessness B. Elevated mood C. Urinary frequency D. Low backache

C. Urinary frequency

For the woman who is pregnant for the first time when does lightening occur?

2 weeks before the onset of labor *For women who have had more preganancies it occurs on the onset of labor

A fine hair develops on the head of the fetus called lanugo, sucking otions are made with the mouth and fetal movement (quickening) is detected by the mother during what week of pregnancy?

13-16

A reactive NST includes at least two FHR accelerations of _________ BPM for 15 seconds within a 20 minute period.

15 *If the test does not meet these criteria after 40 minutes, it is considered nonreactive.

During what week of pregnancy does vernix caseosa, a white greasy film, cover the fetus?

17-20

What are the top three nonfood items ingested by pregnant women?

- Clay (geophagia) - Ice (pagophagia) - Laundry starch (amylophagia)

What are three positive signs of pregnancy?

- Ultrasound - Fetal movement felt by the provider - Auscultation of fetal heart tones via Doppler

Abstinence is usually only recommended for women who are at risk for ______________ or __________________ because of placenta previa.

- preterm labor - antepartum hemorrhage

Amniotic fluid surrounds the embryo and increases in volume as the pregnancy progresses, reaching ____________ at term.

1 L

The normal fetal heart rate range is

110 to 160

Fetal gender can be determined by week _________

12

Put these events in order from the first that happens to the last during the preembryonic development 1. The inner cell mass is called a blastocyst 2. Fertilization takes place 3. Zygote is formed 4. Implantation occurs 5. Morula is formed (mass of 16 cells) 6. Trophoblast is formed

2, 3, 5, 1, 6, 4 Rationale: Fertilization > Zygote > Morula >Blastocyst > Trophoblast > Implantation

Screening for gestational diabetes is best done between ______________ weeks' gestation.

24 and 28

During what week of pregnancy does the fetus usually assume the head down position?

25-28

Place the following events in the sequence the pregnant woman would experience them, from first to last. All options must be used. 1 quickening 2 labor 3 ammenorrhea 4 Braxton Hicks contractions 5 uterine enlargement

3, 5, 1, 4, 2 ammenorrhea > uterine enlargement > quickening > Braxton Hicks contractions > labor

This prenatal test can prevent inheritable genetic disease before implantation by transfering embryos without genetic alterations into the woman's uterus to start a pregnancy.

Preimplantation genetic diagnosis

Which vaccines are contraindicated during pregnancy since they may transmit a viral infection to the fetus? Select all that apply. A. measles B. mumps C. influenza D. rubella E. Tdap vaccine (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis)

A, B, D Measles, Mumps, Rubella

A client in her 10th week of gestation arrives at the maternity clinic reporting morning sickness. The nurse needs to inform the client about the body system adaptations during pregnancy. Which factors correspond to the morning sickness period during pregnancy? A. Reduced stomach acidity B. Elevated human chorionic gonadotropin (hCG) C. Increased red blood cell (RBC) production D. Increased estrogen level E. Elevated human placental lactogen (hPL)

A, B, D Reduced stomach acidity, Elevated hCG, Increased estrogen level

During pregnancy, one of progesterone's actions is to allow sodium to be "wasted" or lost in the urine. The nurse would expect to see which hormone increased to help counteract this loss? A. aldosterone B. ADH C. glycogen D. cortisol

A. Aldosterone

A potential complication for the mother and fetus is Rh incompatibility; therefore, assessment should include blood typing. If the mother is Rh negative, her antibody titer should be evaluated. If treatment with Rho(D) immune globulin is indicated, the nurse would expect to administer it at which time? A. at 28 weeks B. at 32 weeks C. at 36 weeks D. only at birth

A. at 28 weeks

What prenatal test takes a sample of the woman's blood to evaluate plasma protein. Increased levels indicate a neural defect and decreased levels indicated Down syndrome.

Alpha-fetoprotein *Performed between 15 and 18 weeks*

What prenatal test takes a sample of amniotic fluid to perform chromosome analysis. Results take 2-4 weeks.

Amniocentesis *Contraindicated in HIV patients. Done between 15-20 weeks*

Preconception carrier screening for conditions such as Tay-Sachs disease has been in place among high-risk populations such as __________________

Ashkenazi Jews

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. Normally, blood pressure increases steadily throughout pregnancy. B. Blood pressure remains stable until decreasing the day of the birth. C. A decrease in the second trimester may occur because of placental growth. D. Blood pressure progressively decreases throughout the entire pregnancy.

C. A decrease in the second trimester may occur because of placental growth

____________________ inheritance occurs when a single gene in the heterozygous states is cabable of producing the phenotype.

Autosomal dominant inheritance

____________________ inheritance occurs when two copies of the mutant or abnormal gene in the homozygous state are necessary to produce the phenotype.

Autosomal recessive inheritance

The nurse is counseling a couple who are concerned that 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." Rationale: This is an autosomal dominant disorder. It does not discriminate between male or female.

A young woman who is pregnant for the first time goes to the clinic for her first prenatal visit. During the interview, she informs the primary are provider that there is no history of genetic defects in her or her husband's family. What test will most likely be prescribed for this client as a routine screening? A. amniocentesis B. MSAFP C. CVS D. PPD

B. Maternal Serum Alpha-fetoprotein (MSAFP) Test Rationale: Routine test

Which client immunization titer is most important to assess and document in the prenatal record of the pregnant woman? A. Polio B. Rubella C. Rotavirus D. Diphtheria

B. Rubella

When measuring the diagonal conjugate of a woman's pelvis, the distance between which anatomic landmarks would be used? A. When measuring the diagonal conjugate of a woman's pelvis, the distance between which anatomic landmarks would be used? B. anterior surface of the sacral prominence and the anterior surface of the symphysis pubis medial surface of the ischial tuberosities C. interior surface of the sacral prominence and the posterior surface of the symphysis pubis D. posterior surface of sacrum and the axis of the ischial tuberosities

B. anterior surface of the sacral prominence and the posterior surface of the symphysis pubis

A ____________uses a real-time ultrasound and NST to allow assessment of various parameters of fetal well-being.

Biophysical Profile

The primary objectives of the __________________ are to reduce stillbirth and to detect hypoxia early enough to allow delivery in time to avoid permanent fetal damage resulting from fetal asphyxia.

Biophysical Profile

This childbirth method stresses that childbirth is a joyful, natural process and emphasizzes the partner's involvement during pregnancy, labor, birth, and the early newborn period. Training techniques are directed toward the coach.

Bradley (Partner-Coached) Method

The nursing student correctly identifies what information about oogenesis? A. It begins at puberty in the male. B. It is the process by which gametes undergo two sequential cellular divisions of the nucleus. C. It begins in the ovaries before birth but is not fully complete until the childbearing years. D. It is the process by which somatic cells give birth to daughter cells.

C. It begins in the ovaries befire birth but is not fully complete until the childbearing years.

A 28-year-old primigravida client with diabetes mellitus, in her first trimester, comes to the health care clinic for a routine visit. The client reports frequent episodes of sweating, giddiness, and confusion. What should the nurse tell the client about these experiences? A. tissue sensitivity to insulin increases as pregnancy advances B. use of insulin needs to be reduced as pregnancy advances C. increased secretion of insulin occurs in the first trimester D. insulin resistance becomes minimal in the latter half of the pregnancy

C. increased secretion of insulin occurs in the first trimester *A woman's insulin secretion works on a supply versus demand mode. As the demand to meet the needs of pregnancy increases, more insulin is secreted.

This classification of drugs have been tested and found safe during pregnancy. Examples include: folic acid, vitamin B6 and thyroid medicine.

Category A

This class of drugs ahve been used frequently during pregnancy and do not appear to cause major birth defects or other fetal problems. Examples include: acetaminophen, famotidinem prenisone, insulin and ibuprofen.

Category B

These class of drugs are more likely to cause problems and safety studies have not been completed. Examples include: fluconazole, ciprofloxacin

Category C

This class of drug has clear health risks for the fetus. Examples include: phenytoin, alcohol, lithium and drugs to treat cancer.

Category D

This class of drugs ahve demonstrated poistiove evidence of fetal abnormalities and are contraindicated in women who are or may become pregnant. Examples include: Accutane, Coumadin, Streptomycin.

Category X

Between weeks 6 and 8 of gestation, softens due to vasocongestion

Cervix

What prenatal test requires removal of small tissue specimen from the fetal portion of the placenta to detect fetal karyotype, sickle cell anemia...etc.

Chorionic villus sampling *Done between 10-12 weeks

______________ is a psychoprophlylactic ("mind prevention") method of preparing for labor and birth that promotes the use of specific breathing and relxation techniques. It believes that women needed to alter the perception of suffering during childbirth.

Lamaze

A couple asks the nurse what color eyes their baby will have if the mother has brown eyes and the father has blue eyes. What is the best response by the nurse? A. blue B. hazel C. differing D. brown

D. Brown Rationale: If the two alleles differ, the dominant one will usually be ex[ressed in the phenotype of the individual.

A nurse is teaching a preconception class discussing the process of conception. Which information would the nurse likely include? A. Conception occurs when the sperm travels through the vagina to unite with the ovum. B. Conception occurs when a zygote travels through the vagina to meet the sperm. C. Conception occurs when an ovum passes into the uterus to unite with sperm. D. Conception occurs when an ovum passes into a fallopian tube to unite with sperm.

D. Conception occurs when an ovum passes into a fallopian tube to unite with sperm

The ____________ stage of development begins at day 15 through week 8. Basic structures of all major body organs and the main external features are completed during this time period.

Embryonic stage

The recommended follow-up visit schedule for 29-36 weeks is _______________

Every 2 weeks

The recommended follow-up visit schedule for 28 weeks (7 months) is ____________________

Every 4 weeks

The recommended follow-up visit schedule from 37 weeks to birth is ___________________

Every week

The __________________ begins with fertilization through the second week also called conception.

Preembryonic stage

What marker screening test is routinely used for Down syndrome screening in the first trimester?

Pregnancy-associated plasma protein (PAPP-A)

___________________ typically occurs around 2 weeks after the last normal menstrual period in a 28-day cycle.

Fertilization

____________________ is the union of ovum and sperm, which is the starting point of pregnancy and takes place in the ampulla of the fallopian tube.

Fertilization

Spotting or bleeding Painful urination Severe vomiting Fever Lower abdominal These are all danger signs that a client should contact her health care provider during which trimester?

First trimester

During which task of becoming a mother does the woman focus on herself, not on the fetus?

First trimester (Ensuring safe passage throughout the pregnancy and birth )

Amniotic fluid is derived from what two sources?

Fluid transported from the maternal blood Fetal urine

Prader-Willi syndrome, Angelman syndrome and Beckwith-Wiedemann syndrom are examples of what type of nontraditional inheritance disorder?

Genomic printing

The total nubmer of times a woman has been pregnant, regardless of whether the pregnancy resulted in a termination or if multiple infants were born from a pregnancy

Gravida/Gravidity

Research from the __________________has provided a better understanding of the genetic contribution to disease.

Human Genome Project

This hormone modulates fetal and maternal metabolism, participates in the develpment of maternal breasts for lacation, and decreases maternal insulin sensitivity to increase it's availability for fetal nutrition

Human placental lactogen (hPL)

A fetal nuchal translucency test, as seen on ultrasound, may be suggestive of the presence of trisomy 21 or Down syndrome if what is found?

Increased nuchal thickness

Advise pregnant women to avoid live virus vaccines such as ________ and ________________ and to avoid becoming pregnant within 1 month of having recieved one of these.

MMR and varicella

Patterns that occur because a single gene is defective when it comes to genetics is known as ___________law

Mendel's laws of inheritance *The disorders are reffered to as monogenic or Mendelian disorders*

Kearns-Syre syndrome and Leber's hereditary optic neruopathy are examples of what type of nontraditional inheritance disorder?

Mitochondrial *Exclusively comes from the mother*

____________, or cleavage occurs as the zygote is slowly transported into the uterine cavity by tubal muscular movements.

Mitosis

What chromosomal abnormality occurs when the abnormalities do not show up in every cell, only some cells and tissues carry it?

Mosaic

A womant pregnant for at least the third time

Multigravida

A woman who has had two or more pregnancies of at least 20 weeks' gestation resulting in viable offspring. Commonly referred to as a "multip"

Multipara

What procedure requires the client to eat a meal, lay on their left lateral recumbent position with a button that she pushes every time she perceives fetal movement.

Nonstress test (NST)

When analyzing amniotic fluid the nurse notices that it is clear with white flecks of vernix caseosa in a mature fetus, is this considered normal or abnormal?

Normal *Port wine fluid may indicate abruptio placentae*

A woman who has never experienced pregnancy

Nulligravida

A woman who has not produced viable offspring

Nullipara

Active in hormone production to support the pregnancy until about weeks 6 to 7

Ovaries

The number of times a woman has given birth to a fetus of at least 20 gestational weeks (viable or not), counting multiple births as one birth event

Para

This prenatal test is used for diagnosis of inherited blood disorders such as hemophilia A. Performed at 16 weeks.

Percutaneous umbilical blood sampling

A woman pregnant for the first time

Primigravida

A woman who has given birth once after a pregnancy of at least 20 weeks, commonly referred to as a "primip" in clinical practice

Primipara

What is the role oxytocin in pregnancy?

Responsible for uterine contractions and milk ejection

__________________ identified maternal tasks that a woman must accomplish to incorporate the maternal role into her personality.

Reva Rubin

Preterm labor Pain in calf Sudden gush or leakage of fluid from vagina Absence of fetal movement for more than 12 hours These are all danger signs that a client should contact her health care provider during which trimester?

Second trimester

During which primary task of becoming a mother does the mother acknowledge the fetus as a separate entity within her due to quickening?

Second trimester (binding in)

A woman pregnant for the second time

Secundigravida

Obstetric History: GTPAL What does the P stand for?

The number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks

Sudden weight gain Facial edema Severe upper abdominal pain or headace with visual changes Decrease of fetal movement more than 24 hours These are all danger signs that a client should contact her health care provider during which trimester?

Third trimester

Why does hypertrophy of the heart occur in pregnant women?

To accomodate the increase in cardiac output and blood volume

Elongate, widen, and curve above pelvic rim by 10th gestational week

Ureters

Its size increases from 70 g to about 1,100 to 1,200 g at term

Uterus

Connective tissue loosens and smooth muscle begins to hypertrophy

Vagina

During what week of pregnancy does the brain spinal cord and heart begin development. The neural tube forms later becoming the spinal cord.

Week 3

During what week of pregnancy does the fetal heart now beat at a regular rhythm?

Week 5

During what week of pregnancy does the lungs begin formation?

Week 6

During what week of pregnancy can the fetal heartbeat be heard?

Week 7

_________________ a specialized connective tissue, surrounds the three blood vessels in the umbilical cord to prevent compression.

Wharton's jelly

What marker screening test is used to confirm a fetal abnormality when other screening tests detect a possible problem.

amniocentesis

The ________________ is formed as fluid, which provides nutrients, from the uterine cavity enters the morula.

blastocyst

The outer surface of the blastocyst, called the trophoblast, will form the __________ and ______________.

chorion and placenta

During the stress of pregnancy, _______________ is secreted by the adrenal glands to help keep up the level of glucose in the plasma by breaking down noncarbohydrate sources.

cortisol

The ____________________ is the disance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis.

diaganol conjugate

The _____________________ is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is under 12.5 cm

diagonal conjugate

Recently the FDA approved _________ as the first medication to specifically treat morning sickness in pregnancy.

doxylamine succinate 10mg (Diclegis)

The ___________ layer of the embryonic cell forms the central nervous system, special senses, skin, and glands

ectoderm

The three embryonic layers of cells formed are

ectoderm, mesoderm, endoderm

hCG levels in normal pregnancy usually doubles every 48 to 72 hours until they peak 60 to 70 days after fertilization. Clinicians use this as a marker to differentiate normal or abnormal gestations. What type of pregnancy would low levels indicate?

ectopic pregnancy *higher than normal levels may indicate a molar or multiple gestational pregnancy

The inner surface of the blastocyst will form the __________ and ____________.

embryo and amnion

The ___________ layer of the embyronic cell forms the respiratory system, liver, pancreas, and digestive system.

endoderm

Palmar erythema, a well-delineated pinkish area on the palmar surface of the hands, is caused by elevated _______________ levels.

estrogen

This hormone causes enlargment of a woman's breasts, uterus, and external genitalia; stimulates myometrial contractility

estrogen (estriol)

Sex determination is determined at _________________ and depends on whether the ovum is fertilized by a Y-bearing sperm or X-bearing sperm.

fertilization

When assessing amniotic fluid a ratio of more than 2 of Lecithin-to-sphingomyelin ratio (L/S) generally indicates what?

fetal pulmonary maturity

The________________ stage is from the end of the 8th week until birth. It is the longest period of prenatl development.

fetal stage

The formation of gametes by the process of meiosis is known as ________________________.

gametogenesis

The state of being pregnant

gravid

Pelvic shape is typically classifed as one of four types: android, anthropoid, gynecoid, and platypelloid. The _________________ type is the typical female pelvis and offers the best shape for a vaginal delivery.

gynecoid

This hormone preserves the corpus luteum and its progesterone production so that the endometrial lining of the uterus is maintained

hCG

Constipation, increased venous pressure, and pressure from the gravid uterus can lead to the formation of _________________ during pregnancy.

hemmorhoids

_____________ acts as an antagonist against maternal insulin and thus more insulin must be secreted to counteract the increasing levels.

human placental lactogen (hPL)

_______________ should not be used after 36 weeks of pregnancy to avoid increased blood loss during parturition and to avoid premature closure of the ductus arterious in the fetus.

ibuprofen

The ___________________ diameter is the transverse diameter of the pelvic outlet.

ischial tuberosity (10.5> cm)

By 36 weeks of gestation the fundus is located ___________________

just below the xiphoid process

Too little amniotic fluid, termed oligohydraminos is less than __________ mL.

less than 500 mL *High risk of low birth weight infants*

Most women experience an increase in a whitish vaginal discharge, called ________________ during pregnancy.

leukorrhea

By 40 weeks, the fetal head begins to descend and engage in the pelvis, which is termed ________________________

lightening

At what ages male and female would it benefit them to go to genetic counseling?

male: 55 female: 35

The __________ layer of the embryonic cell forms the skeletal, urinary, circulatory, and reproductive organs.

mesoderm

At 16 weeks' gestation the fundus can be palpated ____________________

midway between the symphysis and the umbilicus

This type of breathing is used for increased work stress during labor to increase alerness or focus attention or when slow paced breathing is no longer affective

modified-paced breathing

Too much amniotic fluid, termed polyhydraminos is more than ________________ mL.

more than 2000 mL *Associated with diabetes and neural tube defects*

A ball of cells that reaches the uterine cavity about 72 hours after fertilization is called a ______________

morula

The ___________ provides an indirect measurement of uteroplacental function.

nonstress test (NST)

For a biophysical profile is a score of 10 considered normal or abnormal?

normal *Body movements, Fetal tone, Fetal breathing, Amniotic fluid volume and NST are all scored a 2 or 0*

Some women complain about excessive salivation, termed ________________ which may be caused by the decrease in unconscious swallowing by the woman when nauseated.

ptyalism

Refers to the number of pregnancies, not the number of fetuses, carried to the point of viability, regardless of the outcomeq

parity

What are the fetal tissues called that separate the maternal blood and the fetal blood?

placental barriers *Material is only interchanged through diffusion*

During pregnancy, elevated __________________ levels cause smooth-muscle relaxation, which results in delayed gastric emptying an decreased peristalsis.

progesterone

Thhis hormone maintains the endometrium, decreases the contractility of the uterus, stimulates maternal metabolism and breast deelpment, provides nourishment for the early conceptus

progesterone (progestin)

This hormone acts synergistically with progesterone to maintain pregnancy, causes relaxation of the pelvic ligaments, softens the cervix in preparation for birth

relaxin

The postural changes of pregnancy coupled with the loosening of the ___________________ joints may result in lower back pain.

sacroiliac

This type of breathing is the most relaxed pattern and is recommended throughout labor.

slow-paced

At 12 weeks' gestation the fundus can be palpated at the ___________________.

symphysis pubis

At 20 weeks the fundus can be palpated at

the umbilicus

The _________________ approach of the procedure chorionic villus sampling requires the client to have a full bladder to push the uterus into a position accessible to the catheter.

transcervical

Ultrasound is used to identify an increase in nuchal translucency, if this is increased it is associated with ______________________-

trisomy 21, 18 and 13

The _________________ is the measurement from the anterior surface of the sacral prominence to the posterior surface of th einferior margin of the symphysis pubis.

true conjugate (obstetric conjugate) *Can't truly be measured so determined by subtracting 1 to 2 cm from the diagonal conjugate

By 20 weeks' gestation, the fundus, or top of the uterus, is at the level of the _______________ and measures 20 cm

umbilicus

Normally implantation occurs in the ____________________, where a rich blood supply is available.

upper uterus (fundus)

The fundus reaches it highest level, at the ____________ , at approximately 36 week.

xiphoid process

The ________________ is a clear protein layer that blocks all but one sperm from entering the ovum to fertilize it. It disappears in 5 days.

zona pellucida

When the nucleus of the ovum and sperm combine to restore the 46 chromosomes the result is a _______________ which begins the process of a new life.

zygote