OB Final Practice

When assessing a woman during pregnancy, the nurse needs to be alert for signs of preterm labor. Which of the following factors exhibited by a pregnant woman is associated with preterm labor?

Currently being treated for her second bladder infection in 4 months.

A patient has a very heavy rubra flow while receiving magnesium sulfate post delivery. Which one of the following agents would be appropriate for this patient if medical intervention is deemed necessary?

Cytotec

If nonsurgical treatment for subinvolution is ineffective, which surgical procedure is appropriate to correct the cause of this condition?

D&C (Dilation & curettage) D&C provides for examination of the uterine contents and removal of any retained placenta or membranes.

Embryonic Period

Day 15 to 8 weeks

The patient's LMP date is March 3. Which of the following is her expected date of confinement (EDC) based on Nagele's rule?

December 10

A nurse is caring for an infant with a high bilirubin level who is receiving high intensity light treatments (phototherapy). The nurse's highest assessment priority in monitoring this infant is to check frequently and carefully for signs of which of the following common and potential serious complications of phototherapy?

Dehydration Infants receiving phototherapy lose more water and have loose stools due to increased bilirubin excretion. This increases their risk of dehydation, a serious and sometimes life-threatening complication for the infant. Petinal damage may be a risk for the infant, so standard procedure is to protect the infant's eyes by covering them with eye patches while the infant is exposed to phototherapy. Due to the confinement of the patches, it is important for the nurse to assess the eyes between therapy sessions for signs of conjunctivitis. However, the nurse would not be able to detect signs of retinal damage during routine assessments. Bronze skin discoloration and maculopapular skin rash is possible, but is not life threatening.

Fetal Period

Development after 8 weeks to delivery

Fetal heart analysis demonstrated recurrent late decelerations, minimal variability, and tachysystole secondary to pitocin administration. This pattern would be best corrected by which of the following nurisng actions? (Select all that apply)

Discontinue Pitocin Consider administration of terbutaline

Which of the following nursing actions is most appropriate following delivery of healthy full term newborn?

Dry infant with warm blanket and place skin to skin with mother

An ultrasound has identified that a client's pregnancy is complicated by oligohydramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects?

Dysplastic kidneys

Which one of the following fetal heart patterns is frequently associated with second stage labor?

Early deceleration

Stages of Pregnancy: 3-4 weeks

Embryologic heart is beating

Stages of Pregnancy: 6 weeks

Embryonic red blood cells contain a weak Rh signature

A woman at 27 weeks of gestation experiences some mild uterine cramping. Which actions would be appropriate for the patient to take at this time? (Select all that apply)

Empty her bladder Drink several glasses of water Relax in a chair

Explain the use of contraception or hormone therapy related to treatment of endometriosis, premenstrual tension, and acne.

Endometriosis - provides pain relief and regular menses Premenstrual Tension - helps regulate hormones Acne - helps regulate hormones

Which of the following nonpharmacological interventions recommended by nurse midwives may help a client at full term to go into labor? (Select all that apply)

Engage in sexual intercourse Ingest evening primrose oil Massage the breast and nipples

Ways to increase the chance of conception

Engage in vaginal intercourse every other day Egg is available for conception for 12 to 24 hours post ovulation Sperm can live up to 5 days in the female reproductive tract Frequent intercourse to have sperm available to fertilize the egg before ovulation or the day of ovulation Men should not increase temperature of testicles through activities such as hot tubs, cycling, or tight spandex shorts as this can kill sperm Healthy nutrition Ideal BMI Drink plenty of water Start prenatal vitamin with folic acid to prevent neural tube defects Stop smoking Avoid alcohol intake Don't overdue the caffeine Preconceptual counseling to determine pre-existing medical conditions

What bodily fluids produce ferning

Estrogen

Discuss the hormonal implications of estrogen associated with pregnancy symptoms and discomforts

Estrogen • Uterine hyperplasia and growth • Uterine excitability • Morning sickness

Discuss the safety or complications posed by antacids

Evidence of teratogenic impact May have levels of sodium and aluminum which could be harmful Stomach acid is necessary for absorption of minerals; especially iron and calcium

A pregnant diabetic patient has been diagnosed with polyhydramnios. Which of the following would explain this finding?

Excessive fetal urination

The primary expected outcome for nursing care associated with the administration of magnesium sulfate would be met if which of the following assessment findings is present?

Expereinces no seizures

Which of the following instructions should be given if the rubella vaccine is indicated for a postpartum client?

Explain the risks if she should become pregnant

Which of the following findings would be most concerning to the infant nursery nurse performing an initial assessment on an infant born minutes ago?

Falling pulse rate, now less than 60

A 32 weeks' gestation client states that she "thinks" she is leaking amniotic fluid. Which of the following test could be performed to determine whether the membranes has ruptured?

Fern test

Stages of Pregnancy: 8-10 weeks

Fetal heart can be elicited with a doppler

The nurse is confronted with reassuring and non-reasurring fetal heart information per electronic monitor. In order to recognize the jeopardy or safety of the fetus the nurse could perform which of the following procedures?

Fetal scalp stimulation

Stages of Pregnancy: 37-39 weeks

Liberation of maternal antibodies cross placenta

Medications given through an umbilical vein catherization would have the greatest impact on the function of which organ?

Liver

You are caring for a multiparous client in active labor. The interpretation of the fetal heart monitor is normal baseline without accelerations or decelerations and minimal variability. Which of the following statements could be a possible interpretation of this pattern? (Select all that apply)

Low normal maternal blood sugar, has not eaten for a period of time Fetal distress Sleep cycle Administration of narcotic

Functions of amniotic fluid

Lung maturation -20 weeks Symmetrical growth -prevent bands -cushions and protects -infection barrier, may have antibacterial properties -temperature control -fluid electrolyte homeostasis -assists dilation of labor process

The nurse should suspect puerperal infection when a client exhibits which of the following?

Malodorous lochial discharge

A woman is recovering at the gynecologist's office following a late first-trimester spontaneous abortion. at this time, it is essential for the nurse to check which of the following?

Maternal blood type

A client is concerned about her baby's face due to small white marks on her nose. What are these marks commonly called?

Milia

A newborn admitted to the nursery has a positive direct coombs' test. Which of the following is an appropriate action by the nurse?

Monitor the baby for jaundice Coombs indicated presence of maternal antibodies in baby's blood stream, most likely concern is hemolysis and increased levels of bilirubin creating jaundiced appearance.

Copper IUD

Must be placed in the uterus by a health care provider, usually removed by health care provider Pros - may be left in place for up to 12 years, no pill to take daily, can be used while breastfeeding, you can become pregnant right after it is removed Cons - may cause more cramps and heavier periods, may cause spotting between periods, rarely uterus is injured during placement, does not protect agains HIV or other STIs

Progestin IUD (Liletta, Mirena, Skyla, Kyleena)

Must be placed in uterus by a health care provider, usually removed by a health care provider, client should seek provider if any of the following occur (PAINS) - period late, aboral spotting or bleeding; abdominal pain, pain with intercourse; infection exposure, abnormal vaginal discharge; not feeling well, fever or chills; string is missing: shorter or longer Pros - may be left in lace 3-7 years, depending on which IUD you choose, no pill to take daily, may improve period cramps and bleeding, can be used while breastfeeding, you can become pregnant right after it is removed, damages sperm and ability to transit/irritate lining of uterus Cons - may cause lighter periods, spotting, or no period at all; rarely uterus is injured during placement; does not protect against HIV or other STIs; may experience more bleeding and cramping in the first year; can increase risk of pelvic inflammatory disease, uterine rupture, ectopic pregnancy; contraindicated in women if not in a monogamous relationship

Diaphragm (Caya and Milex)

Must be used each time you have sex, must be used with spermicide, fits snuggly over the cervix, device needs to be replaced every 2 years Pros - can last 2 years, costs little to use, may protect against some infections but not HIV, can be used while breastfeeding Cons - Using spermicide may raise risk of HIV, should not be used with vaginal bleeding or infection, raises risk of bladder infection, risk for toxic shock syndrome, should not be used by a patient with a history of toxic shock syndrome of frequent recurrent UTIs. To reduce risk of TSS remove 6 hours after intercourse, don't use during menses, know s/s of TSS

Progestin-Only Pills

Must take the pill daily around the same time Pros - Can be used while breastfeeding, you can become pregnant right after stopping the pills Cons - Often causes spotting, which may last for many months; may cause depression, hair or skin changes, change in sex drive; does not protect against HIV or other STIs

Stages of Pregnancy: 23-24 weeks

Surfactant becomes adequate for potential survival

Which of the following is/are necessary for extra uterine respiration? (Select all that apply)

Surfactants Capillary network Alveoli development

Sterilization

Surgical procedure to render the person infertile Most involve occlusion of passageways for the ova and sperm Only surgical removal of the ovaries and/or uterus will render woman completely sterile Vasectomy is not immediate (man can remain fertile for several months after), but tubal ligation is

A nurse notes that a 6-hour-old neonate has cyanotic hands and feet. Which of the following actions by the nurse is appropriate?

Swaddle baby in blanket The infant is demonstrating a normal newborn trait called acrocynosis, therefore, the first three possible answers are unecessary.It is possible that swaddling correctly could warm the baby and improve a sluggish circulation.

The nursing student assesses the newborn temperature to be 96º. What is the next action that should be taken?

Swaddle the newborn and place a cap on the baby's head

Endometrial Cycle: Secretory Phase

Swollen & vascular endometrium develops full of blood & nutrients creating optimum place for a fertilized ovum to implant Progesterone secreted by corpus luteum allows endometrium to develop (ovulation - 3 days before period)

Which of the following concepts explains thermoregulation and cold stress in the newborn? (Select all that apply)

Tachypnea and generalized irritability occur in an attempt to produce heat increasing oxygen consumption lowering pO2 which could trigger vasoconstriction and decreased pulmonary perfusion Cold stress can produce a downward spiral for the infant to include respiratory distress, hypoglycemia, hypothermia, and acidosis Brown fat can produce significant heat, it can be rapidly depleted through cold stress Cold stress leads to anaerobic metabolism and metabolic acidosis

A woman expresses a need to review her labor and birth experience with the nurse who cared for her while in labor. This behavior is most characteristic of which of the following phases of maternal postpartum adjustment?

Taking-in (dependent phase) Taking-in is the first 1 to 2 days of recovery following birth; other behaviors exhibited include reliance on others to help her meet needs, being excited, and talkative.

Basal Body Temperature

Temperature decreases prior to ovulation Assess temperature prior to getting out of bed everyday Can be affected by jet lag, alcohol consumption the night before, less than 3 hours of sleep, infection, awakening late, warmth and coolness of sleeping environment

Which infant is at risk for heat loss? (Select all that apply)

Term newborn undressed after physician assessment 38 week gestation laying on a baby scale

A client who is 3727 weeks gestation has been advised that she is group beta strep positive. Which of the following comments by the nurse is appropriate at this time?

The bacteria are living in your vagina. They will not hurt you but your doctor will order medication in labor to protect your baby from getting sick

Which of the following long-term goals is appropriate for a client, 10 weeks' gestation, who is diagnosed with gestational trophoblastic disease (hydatiform mole)?

The client will be cancer-free one year from diagnosis

A woman states that all of a sudden her 4-day-old baby is having trouble feeding. On assessment, the nurse notes that the mother's breasts are firm, red, and warm to the touch. The nurse teaches the mother manually to express a small amount of breast milk from each breast. Which observation indicates that the nurse's intervention has been successful?

The collecting duct behind the mother's nipples are soft to the touch

Which finding assessed by the nurse would indicate that the newborn is preterm?

The labia minor are larger than the labia majora

A rubella nonimmune, breastfeeding client has just received the rubella vaccine. Which of the following side effects should the nurse warn the client about?

The mother's joints may become painful and stiff

Trimesters of pregnancy

- 1st trimester: week 1-13 - 2nd trimester: week 14-26 - 3rd trimester: week 27-40

Endometrial Cycle 4 Phases

1. Menstrual Phase 2. Proliferation Phase 3. Secretory Phase 4. Ischemic Phasee

Amniotic Fluid Index

10 cm is considered just right

Which of the following temperatures indicates the presence of postpartum infection?

100.8° F on the second and third postpartum days A temperature elevation greater than 100.4° F on two postpartum days, not including the first 24 hours, meets the criteria for infection as defined by the Joint Committee on Maternal Welfare

A client who was seen in the prenatal clinic at 20 weeks' gestation weighed 128 lb. at that time. Approximately how many pounds would the nurse expect the client to weigh at their next visit at 24 weeks gestation?

132 lb

Lymphocytes, %

15-40

RBC volume, per mL

1650

A nurse is collecting data during an admission assessment of a patient who is pregnant with twins. The patient has a healthy 5-year-old child that was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. How would the nurse document the GTPAL for this patient?

2,1,0,0,1

Four newborns are in the neonatal nursery. Which of the babies should the nurse report to the neonatologist?

2-day-old who is breathing irregularly at 70 breaths per minute

Endometrial Cycle: Menstrual Phase

2/3 of endometrial lining is shed

Fetal demise

20 weeks or more most often associated with cord accidents though not exclusively

A patient who has moved to another community arrives for a prenatal visit. The client is unaware of her LMP date, McDonald's method measures 28 cm., ultrasound at this visit results are 30 weeks plus or minus three weeks. What is the best estimate of gestational age of the baby based on this data?

28 weeks

The nurse assesses the following newborn characteristics one minute after birth to include: -heart rate 70 -weak cry -little flexion -grimaces when suctioned -pallor Identify the infant's apgar score.

4

Plasma volume, per mL

40%-45% increase

One minute post delivery the nurse makes the following infant assessments to include: on-going positive pressure ventilation related to grunting respirations at delivery with adequate chest excursion, apical heart rate is 110, no grimacing or crying related to stimulation, partially flexed extremities and central pink coloration and blueish limbs. Which of the following is the correct Apgar score for this infant? (Hint: effective PPV is = 1 point)

5

White blood cells, total per mm3

5,000-15,000

Neutrophils, %

60-85

Hemoglobin

>11

Hematocrit, packed cell volume, %

>33

The Implant (Nexplanon)

A health care provider places it under the skin of the upper arm, it must be removed by a health care provider Pros - Long lasting (up to 4 years); no pill to take daily; often decreases cramps; can be used while breastfeeding; you can become pregnant right after it is removed Cons - can cause irregular bleeding; after 1 you may have no period at all; does not protect agains HIV or other STIs

multipara

A woman who has had more than one pregnancy

Multigravida

A woman who is or has been pregnant for at least a second time

Primigravida

A woman who is pregnant for the first time

The Patch (Ortho Evra)

Apply a new patch once a week for three weeks, no patch in week 4 Pros - can make periods more regular and less painful, no pill to take daily, you can become pregnant right after stopping patch Cons - Can irritate skin under the patch, may cause spotting the first 1-2 months, does not protect against HIV and other STIs

What is the earliest point in time that Rh sensitization could occur assuming the antepartum client is Rh negative and there is a break between maternal and fetal circulation such as miscarriage? (Explain your answer)

Around 6 weeks there are enough precursory RBC with a defined Rh factor that sensitization could under correct circumstances occur

The fetal heart rate has been reactive and variable with a baseline of 130. The fetal heart baseline suddenly decreased to 100 and continues to have moderate variability. What does clinical judgment indicate the nurse should do first?

Assess maternal pulse while listening to fetal heart rate

A woman, 35 weeks gestation, with preeclampsia, has just had a seizure. Immediately after the seizure, the nurse's first priority action is best described by which of the following statements?

Assess status of maternal airway, respiratory effort, and pulse

Discuss potential complications of oral contraception through the mnemonic ACHES

Abdominal pain Chest pain Headaches Eye problems (blurry vision, flashing lights, blindness) Severe leg pain Warning signs may signal gallbladder disease, liver problems, pulmonary embolism, MI, CVA, hypertension, migraines and blood clots

A client is 36 hours post-cesarean section. Which of the following assessments would indicate that the client may have a paralytic ileus?

Absent bowel sounds

Which assessment is a definitive indicator of a reactive NST?

Accelerations of fetal heart

A pre-gestational diabetic woman at 20 weeks of gestation exhibits the following: thirst, nausea and vomiting, abdominal pain, drowsiness, and increased urination. Her skin is flushed and dry, her breathing is rapid and her breath has a fruity odor. Which of the following would be an appropriate priority nursing action when caring for this woman?

Administer insulin according to the woman's blood glucose level.

Which of the following nursing actions would be implemented related to admission of preeclamptic patient with standard magnesium sulfate orders? (Select all that apply)

Administered ordered loading dose of 4 or 6 grams over 15 minutes Report respiratory rate of 10 breaths or less per minute to provider

Stages of Pregnancy: 8 weeks

All organs in embryo have developed

The first period of reactivity is a great time for the nurse to do which action for the baby?

Allow for maternal and infant bonding

A pregnant woman at 6 weeks of gestation tells her nurse midwife that she has been experiencing nausea with occasional vomiting every day. The nurse could recommend which of the following as an effective relief measure?

Alter eating patterns to small meals every 2-3 hours

What structural and chemical development is necessary for extra-uterine respiration?

Alveoli differentiation, surfactant production, and a capillary network associated with alveoli

An antenatal client is informing the nurse of her prenatal signs and symptoms. Which of the following findings would the nurse determine are presumptive signs of pregnancy? (Select all that apply)

Amenorrhea Breast Tenderness Quickening

Which of the following assessments are completed through biophysical profile on the high risk antepartum patient? (Select all that apply)

Amniotic fluid index Reactivity fetal heart rate Fetal breathing movements

A 5-week gravid patient is having a thorough pelvic and abdominal assessment. Which of the following physiologic changes associated with early pregnancy would the practitioner expect to find?

An enlarged ovary

Which finding would the nurse view as expected when evaluating the laboratory reports of a 34-week gestation client?

Anemia

Ovarian cycle

Anterior Pituitary - secretes follicle stimulating hormone (FSH) and starts development of new follicles Ovary - 1 to 30 follicles begin to develop in each ovary, one follicle becomes dominant & will grow rapidly (ovulated for potential pregnancy) Anterior Pituitary - secretes luteinizing hormone (LH) Ovary - follicle reaches full maturity & ovulation occurs Empty follicle where egg was becomes corpus luteum - secretes progesterone to help support pregnancy, hormones become mostly progesterone not estrogen 1. If ovulated egg becomes fertilized - secrete HCG, corpus luteum - continues to secrete progesterone until placenta takes over around 7-8 weeks 2. If ovulated egg does NOT become fertilized, corpus luteum - degenerates around 9-11 days, progesterone decreases sharply & menses occurs

A patient delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a puddle of blood. What is your first action?

Assess the fundus for firmness.

A patient delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a puddle of blood. What is your first action?

Assess the fundus for firmness. Firmness of the uterus is necessary to control bleeding from the placental site. The nurse should first assess for firmness and massage the fundus as indicated.

Which of the following describe the LATCH assessment? (Select all that apply)

Assess type of nipple Assess for correct latch of infant to areolar patch Assess for audible swallowing

Hypothalamic-pituitary cycle (the boss) (FIRST HALF OF CYCLE)

At the end of a cycle estrogen & progesterone are low and menses begins Low hormone levels cause the hypothalamus to start a new cycle secreting Gnrh hormone to anterior pituitary Anterior pituitary senses Gnrh hormone and secretes follicle stimulating hormone (FSH) Ovary senses the FSH and prepares an egg. Preparing an egg increases estrogen levels Hypothalamus senses increased estrogen levels and secretes Gnrh Anterior pituitary senses the increased levels of estrogen and Gnrh and secretes lutenizing hormone (LH) Ovary senses LH and releases egg

A client received general anesthesia during her cesarean section 4 hours ago. Which of the following postpartum nursing interventions is important for the nurse to make?

Auscultate lung fields

A mother asks whether or not she should be concerned that her baby never opens his mouth to breathe when his nose is so small. Which of the following is the nurses's best response?

Babies usually breathe in and out through their noses so they can feed without choking.

The nurse is discharging four Rh-negative clients from the postpartum unit. The nurse knows that further teaching is needed when the client who had which of the following deliveries asks why she has not received her Rhogam?

Birth of Rh-negative twins at 35 weeks' geatation

Second Trimester: Relationship of pelvic organs anatomically and how this influences health and well-being

Bladder relief!!! Uterus grows up into the abdomen taking pressure off the bladder Possible for ureters to kink causing urinary stasis and infection; pyelonephritis. Not expected but can happen. More likely to assess costovertebral angle tenderness in this situation To provide drainage the client might be taken to surgery for application of stints Spasms produced and increase in uterine contractility that accompany this procedure are very painful Short term opioid prescription may be appropriate, long term injures mom and fetus will become addicted. Fetal movement on top of the bladder or strong sneeze can cause release of urine (2nd & 3rd trimester)

The nurse is caring for a newborn whose mother has gestational diabetes. His estimated gestational age is 41 weeks, and his weight indicates that he is macrosomic. When assessing this newborn, the nurse should be alert for which of the following potential complications?

Blood sugar below 40 mg/dl Diabetic infants primary concern is hypoglycemia secondary to intrauterine environment ladened with glucose, producing fetal hyperinsulemia. The infant's pancreas will not alter direction for several days. This combined with the abrupt discontinuation of sugar through the umbilical cord places the infant at risk for hypglycemia or blood sugar below 40 mg/dl. Though birth trauma can also occur this would not include fracture of femur though fracture of clavicle is a possibility during a vaginal birth. Severe polycythemia is a threat to SGA babies whereas this infant is likely to be LGA. Polycythemia is also a normal conditon at birth.

A spiral elctrode and an intrauterine catheter are inserted for direct monitoring of a woman in labor. The nurse observes the following data on the monitor strip: Contractions every 3 minutes, lasting 80 seconds; fetal heart rate baseline 140 beats/minute, gradual fall in fetal heart rate to a nadir of 95 beats/minute that begins and ends with the contraction, variability is 6-10 beats. Which nursing action is most appropriate?

Continue monitoring per standard; this is a benign pattern.

A female African American baby has been admitted into the nursery. Which of the following physiological findings would the nurse assess as normal? (Select all that apply)

Blood/mucous discharge from the vagina Bilateral whitish discharge from the breasts Purple-colored patches on the buttocks and torso it is normal for infant girls to have enlarged breasts with exudate and bloody type discharge in response to maternal hormones. The purple patch to the low back and buttocks is a mongolian spot, normal to those with mediterranean ancestry. A hair tufted dimple is not normal and could represent a pilonidal cyst or a small defect related to closure of the spinal column.

A nurse is discussing diet with a pregnant woman. Which of the following foods should the nurse advise the client to avoid consuming during her pregnancy?

Bologna

A nurse is performing a postpartum assessment on a newly delivered client. Which of the following actions will the nurse perform? (Select all that apply)

Breast Assessment Check for vaginal discharge Assess the extremities

The nurse is discussing the neonatal blood screening test with a new mother. The nurse knows that more teaching is needed when the mother states that which of the following diseases is included in the screening test?

Cerebral Palsy

What procedure is contraindicated or limited after rupture of membranes

Cervical assessment

Which of the following statements is true regarding delivery of newborn?

Cesarean deliveries do not allow for thoracic squeeze of fluid

Identify at least two potential complications associated with rupture of membranes

Chorioamnionitis • Bacterial infection of the amniotic cavity. • Major cause of complications for mothers and newborns at any gestational age Postterm Pregnancy • Pregnancy that has 42 weeks of gestation or more from the first day of the last menstrual period Dysfunctional labor (Dystocia) • Long, difficult, or abnormal labor caused by various conditions associated with the five factors affecting labor Five Factors: Ineffective uterine contractions or maternal bearing-down efforts (the powers) Alterations in the pelvic structure (the passage) Fetal causes, including abnormal presentation or position, anomalies, excessive size, and number of fetuses (the passenger) Maternal position during labor and birth Psychologic responses of the mother to labor related to past experiences, preparation, culture and heritage, and support system

Which of the following hormone elevations indicate a high probability that the client is pregnant?

Chorionic gonadotropin

Antepartum: Relationship of pelvic organs anatomically and how this influences health and well-being

Client throughout all the three trimesters of pregnancy: Educate importance of Kegel's exercise to sustain perineal tone before during and after pregnancy Assume a knee chest position at least 3 times daily to assist the displaced uterus into correct position

Which of the following measures may prevent mastitis in a breastfeeding mother?

Complete emptying of the breasts

The nurse is examining a fetal heart monitor strip with baseline of 125, moderated variability, acceleration with fetal scalp stimulation, and recurrent decelerations sharp nadir down and spontaneous recovery within 35 seconds. The most likely explanation of this pattern is best described by which of the following comments?

Compresson of umbilical cord which may or may not be related to uterine contractions

1Relate fetal heart analysis expected with placental/cord disorders either producing cord constriction or poor placental perfusion.

Cord Constriction/Prolapse •Variable decelerations •Prolonged decelerations •Bradycardia

Significant folic acid in the pre-conceptual and antepartum diet is advised based on which of the following statements? (Select all that apply)

Folic acid supports rapid mitosis Folic acid supports replication of DNA Folic acid inhibits the development of anencephaly

The rationale for increasing folic acid in the diet of any woman wishing to conceive is best portrayed by which of the following statements?

Folic acid supports rapid mitosis, thereby, decreasing neurological tube defects

Stages of Pregnancy: 20 weeks

Fundal height is expected to be at the maternal umbilicus Presence of fetal lanugo and vernix Quickening presumptive sign of pregnancy

A nurse has administered Methergine (methylergonovine) 0.2 mg IM to a grand multipara who delivered vaginally 30 minutes earlier. Which of the following outcomes indicates that the medication is effective?

Fundus firm at umbilicus

The Shot (Depo-Provera)

Get a shot every 3 months Pros - each shot works for 12 weeks, private, usually decreases periods, helps prevent cancer of the uterus, no pill to take daily, can be use while breastfeeding Cons - may cause spotting, no period, weight gain, depression, hair or skin changes, change in sex drive; may cause delay in getting pregnant after you stop the shots; side effects may last up to 6 months after you stop the shots; does not protect against HIV or other STIs

Status of possible complications

Glucose Positive in gestational diabetes Protein Normal: Negative or < 20 mg/% (< 0.2 g/L SI Units) (trace) If +1: Take BP to rule out Pre-eclampsia Increased: Pre-eclampsia Nonrenal Disease Abdominal tumor, aging, anemia (severe), ascites, bacterial toxins (acute streptococcal, diphtheria, pneumonia, scarlet and typhoid fever), cardiac disease, central nervous system lesion, convulsive disorders, fever, hepatic disease (jaundice), hypersensitivity reaction, hyperthyroidism, infection (acute), ingestion of or overexposure to certain substances (arsenic, carbon tetrachloride, ether, lead, mercury, mustard, opiates, phenol, propylene glycol, sulfosalicylic acid, turpentine), intestinal obstruction, leukemia (chronic lymphocytic), subacute bacterial endocarditis, toxemia, and trauma Transient Proteinuria Dehydration, diet (excessive protein), emotional stress, exposure to cold, exercise (strenuous), fever, orthostatic hypotension, proteinuria, posthemorrhage, and sodium depletion Drugs: epinephrine bitartrate, epinephrine borate, epinephrine hydrochloride, and levarterenol bitartrate

A postpartum woman has been diagnosed with postpartum psychosis. Which of the following signs/symptoms would the client exhibit?

Hallucinations

Define lactational amenorrhea and indicate what protective response it provides to inhibit pregnancy.

Have to exclusively breastfeed: mouth to nipple Intervals between feedings no more than 4 hours during the day or 6 hours at night Supplemental feedings (rice cereal) are less than 5% of total feeding Exclusive breastfeeding is associated with elevated prolactin levels, amenorrhea and anovulation If truly exclusive, 98% protection from pregnancy within the first 6 months of newborn's life Effectiveness decreases when breastfeeding is less frequent

Develop a plan of nursing assessment related to vaginal bleeding to determine source of blood and probable management of nursing and medical care

Have you had a vaginal exam today? Sex? Which pregnancy is this for you? Are you feeling pain? •Painful: abruption •No Pain: placental previa/cervical bleeding/ How long have you noticed the vaginal bleeding?

Which of the following symptoms are not associated with the development of increased blood volume during pregnancy?

Headache at 35 weeks

Which of the following vital signs would the nurse expect to assess on a healthy full term newborn?

Heart rate of 148

Discuss healthcare education and prevention related to constipation

High fiber whole foods o No SAD diet (standard American diet) Drink lots of water o Less soda, more water Exercise routinely Need more fluid if client loves Metamucil

What complication of early pregnancy can place the antepartum client at risk for metabolic alkalosis? Explain your response.

Hyperemesis gravidarum is a complication of early pregnancy that can take place in the antepartum client, causing metabolic alkalosis. Since nausea and vomiting are a common occurrence in the first trimester, loss of fluids and electrolytes can lead to dehydration. If nausea and vomiting become uncontrollable the acid-base balance can be disturbed and cause either metabolic alkalosis or ketosis. Although this is not common, this complication is severe

The nurse is assessing the vital signs of a client in labor at the peak of a contraction. Which of the following findings would the nurse expect to see?

Hypertension

Postpartum: assessment and impact on recovery from childbirth: Relationship of pelvic organs anatomically and how this influences health and well-being

If bladder fills, it will press on the uterus which will cause it to be displaced up into the abdomen and will lean to one side. Can decrease uterine tone and increase post-delivery uterine bleeding Empty the bladder!! Empty bladder before nurse assesses the fundus after birth to enable accuracy Depending on how many infants were birthed as well as overall maternal health, supporting structures can sag which can cause inadvertent (accidental) loss of urine and/or uterine prolapse Educate importance of Kegel's exercise to sustain perineal tone before during and after pregnancy Assume a knee chest position at least 3 times daily to assist the displaced uterus into correct position Menopause, uterine prolapse, and bladder incontinence

Describe expected nursing and medical management associated with diagnosis of prolapsed cord

If prolapsed cord is to occur, it usually happens at the same time as the membrane rupture A prolapsed cord is a medical emergency. Now the uterus may contract and drive the fetal presenting part down on top of the umbilical cord. Variable decelerations, possible prolonged decelerations, bradycardia Positions that may decrease pressure of the presenting part on the cord is knee chest Assess for a cord, if you feel something below the head pulsating then you have a cord. The gloved hand for examination should apply pressure to liberate the presenting part from the cord and call for emergency assistance Help is required to prepare for emergency cesarean, that is if this has just happened and we do have fetal heart tones. The nurse does not remove hand until patient is in OR, draped, and surgery has commenced.

hyperemesis gravidarum vs normal nausea & vomiting

If the patient is experiencing weight loss, dehydration, and electrolyte imbalance this is hyperemesis or complicated pregnancy

Develop a plan of patient care with emphasis on safety for both mom and baby associated with ruptured membranes

If truly ruptured, more fluid loss should occur at least within a half hour First priority in labor and delivery: placing client on fetal heart monitor Do not check pre-term clients without an order NO UA: if she is ruptured you will possibly collect maternal urine (what you want) but also amniotic fluid Amniotic fluid will decrease specific gravity & increase protein Increase in urinary loss of protein is indicative of severe malady of pregnancy called preeclampsia Perform Nitrazine test

The fetal heart strip you are assessing demonstrates minimal variability, baseline 160, recurrent decelerations of fetal heart tones after the peak with resolution to baseline in 30 seconds after the contraction is completed. Which of the following nursing actions would be the best choice?

Implement intrauterine resuscitation

Stages of Pregnancy: Birth

Importance of being warm! Thermoregulation, respiration and blood sugar interact

Which of the following statements identifies functions of amniotic fluid? (Select all that apply)

Important to lung development Allows for symmetrical growth

What is the major cause of sore nipples in breastfeeding mothers?

Improper placement of the baby's mouth on the breast Placement of the baby's mouth on just the nipple rather than the areola will cause soreness.

The Ring (NuvaRing)

Insert a small ring into the vagina, change ring each month Pros - one size fits all, does not require spermicide, can make periods more regular and less painful, no pill to take daily, you can become pregnant right after stopping the ring Cons - can increase vaginal discharge, may cause spotting in the first 1-2 months of use, does not protect against HIV or other STIs, can come out of place

Spermicide

Insert spermicide each time you have sex Pros - can buy at many stores, can be put in as part of play/foreplay, comes in many forms: cream, fell, sponge, foam, inserts, film, Can be used when breastfeeding Cons - may raise the risk of getting HIV, may irritate vagina or penis, can be messy

How can the nurse help the mother who is nursing and has engorged breasts?

Instruct and assist the mother to massage her breasts. Engorgement is more likely to increase if breastfeeding is delayed or infrequent. A well-fitting bra should be worn both day and night to support the breasts. Cold applications are used between feedings to reduce edema and pain. Heat is applied just before feedings to increase vasodilatation. Massage of the breasts causes release of oxytocin and increases the speed of milk release.

A client has severe preeclampsia. The nurse would expect the primary health care practitioner to order tests to asses the fetus for which of the following complications?

Intrauterine growth restriction

Which of the following symptoms would be indicative of magnesium toxicity?

Irritability and personality changes

A client who has just found out that she is approximately 7 weeks pregnant tells the nurse that she isn't sure that she is happy about being pregnant. The nurse's best response to the client is reflected in which of the following statement?

It is normal to have feelings of ambivalence during first trimester pregnancy

A woman who is seen in the prenatal clinic is found to be 8 weeks pregnant She confides to the nurse that she is afraid her baby may be "permanently damaged because I had at least 5 beers the night I conceived". Which of the following responses by the nurse would be appropriate?

It is unlikely that the baby was affected

Mom is O+ with a positive antibody screen. This information would increase the nurse's awareness and assessment for which phenomenon in the newborn?

Jaundice within 24 hours based on increased hemolysis

You are the transition nurse attending a delivery. How could you support blood sugar for a newly delivered infant at risk for hypoglycemia?

Keep the baby warm!

Nutritional status

Ketones Normal: Negative or 0.3 - 2.0 mg/dL (< 0.17 mmol/L, SI units) Panic Level: > 20 mg/dL (> 3.4 mmol/L, SI units) Symptoms Fruity breath, acidosis, ketonuria, depressed level of consciousness Treatment 1. Perform blood glucose measurements every hour 2. Infuse insulin 3. Perform neurologic checks every hour Positive: Gestational Diabetes After anesthesia, alcoholism, carbohydrate deficiency, diabetes mellitus, eclampsia, fasting, glycogen storage disease, high-fat (ketogenic) diet, hyperglycemia, isopropanol alcohol ingestion, ketoacidosis, pregnant diabetic woman, prolonged exercise, reducing diets, starvation, and von Gierke's disease Drugs: methyldopa, propranolol (poisoning)

Infection Status

Leukocytes Normal: </= 4 cells/ HPF (or moderate) Nitrite If positive: UTI

The Pill (Oral Contraception)

Must take the pill daily around the same time Pros - can make periods more regular and less painful, can improve PMS symptoms, can improve acne, helps prevent cancer of the ovaries, you can become pregnant right after stopping the pills Cons - May cause nausea, weight gain, headaches, change in sex drive - some of these can be relieved by changing to a new brand; may cause spotting the first 1-2 months; does not protect against HIV or other STIs; Complicated effects: thrombosis, fluid retention, increase in cancer, absorption with antibiotics & anticonvulsants, decrease lactation, depo and weight gain/bone demineralization, implants increase risk of ectopic pregnancy

A client is receiving a blood transfusion after the delivery of a placenta acreta and hysterectomy. Which of the following complaints by the client would warrant immediately discontinuing the infusion?

My lower back hurts all of a sudden

A client who is postpartum and prenatal indicates blood type as O negative delivered an infant who is also Rh negative 12 hours ago. Upon reviewing laboratory findings, which data would require intervention by the nurse for this situation? (Select all that apply)

Neonatal blood type of A negative Positive direct Coombs testing The question refers to specific situation which is related to blood type. Because both mom and baby are Rh negative this is not a concern. However, there is a potential for ABO incompatibility, therefore, the question directs you to appreciate that infant blood type of A negative. Direct Coombs demonstrated that maternal antibodies exist in the infant and the nurse can anticipate developing concerns with hyperbilibuinemia. Glucose testing is not related to question and value is normal, past history of Rhogam has no bearing on this question, Bili level is currently normal, however, positive coombs directs nurse to continue infant skin assessments and may require a bili level in the future.

Stages of Pregnancy: 5 weeks

Neuro-tube folds in on itself and creates brain and spinal cord (Folic Acid aids replication)

Which of the following newborn assessments findings is the most concerning to the newborn nursery nurse?

Newborn has not voided in 24 hours

Which of the following are indicators of spontaneous rupture of membranes? (Select all that apply)

Nitrazine blue, pH of 7.4 Positive for ferning Positive for pooling

A patient has just arrived in labor and delivery who is 3857 weeks gestation and reported loss of clear vaginal fluid. Which nursing assessment would assist determining source of fluid loss?

Nitrazine the perineum

Normal Values of a UA

Normal Values (all negative unless indicated) • Appearance: Clear to faintly hazy • Color: Yellow • Odor: Faint (not fruity, fishy, or fetid) • pH: 4.5 - 8.0 • Specific Gravity: 1.003 - 1.030 • Erythrocytes: < 3 cells/high power field (HPF) • Leukocytes: </= 4 cells/ HPF • Urinary Tract Epithelium: </= 10 cells/HPF • Casts: Moderate clear protein casts • Crystals: Small amount • Bacteria: None or < 1000/mL

Explain appropriate birth control choices for women with thrombophilia

Not the combined pill

The nurse is examining the CBC results for a preeclamptic patient who is in active labor and requesting an epidural. The results are WBC 18,000, HGB 10.9, platelet count 68,000. Interpretation of these results indicates which of the following nursing actions?

Notify anesthesia of thrombocytopenia

Which of the following respiratory assessments indicates that a newborn is adapting to extrauterine life? (Select all that apply)

Obligatory nose breathing Respirations of 46/min Apnea for 10 second periods Normal respiratory rate for a neonate increases from 30 to 60/min with short periods of apnea (less than 15 sec) occurring most frequently during the rapid eye movement (REM) sleep cycle. Periods of apnea lasting longer than 15 sec need to be evaluated. Grunting and nasal flaring are signs of respiratory distress Crackles and wheezing are symptoms of fluid or infection in the lungs.

Endometrial Cycle: Ischemic Phase

Occurs if fertilization does not occur Progesterone drops if egg has not been fertilized Blood supply becomes blocked & necrosis starts Menstrual bleeding begins & so does day 1 of next cycle

A high risk mother has arrived at the clinic for a scheduled NST at 0800. The fetal heart rate is 130 with minimal variability, no accelerations nor decelerations. The patient is not well aware of fetal activity. Which is the most reasonable nursing response to this situation?

Offer cool fluids and something to eat

Discuss healthcare education and prevention related to morning sickness

One explanation Vomiting the body's natural way of protecting the embryo from potentially dangerous food chemicals, especially those that come from food that become easily spoiled or toxic when not refrigerated. If you experience morning sickness, it's not totally necessary to force yourself to eat things that don't agree with you (even if they are superfoods for pregnancy). Instead, eat plenty of the healthy things that you can tolerate well What to Avoid o Alcohol o Caffeine o Strong-tasting or smelling vegetable o Low-quality meat, fish, poultry, eggs o Greasy, fatty, salty, processed/packaged foods Eat this o Ginger o Veggies o Fresh fruit o Starchy veggies o Soups and bone broth o Organic & Unsweetened dairy products o Healthy fats

In which of the following situations should a nurse report a possible deep vein thrombosis (DVT) even when the woman has a negative Homan's sign?

One of the woman's calves is swollen, red, and warm to the touch

The umbilical cord contains which of the following blood vessels?

One vein and two arteries The umbilical cord contains two umbilical artieries that carry deoxygenated blood from the fetus to the placenta and one umbilical vein that supplies the embryo with oxygen and nutrients from the placenta (maternal blood supply).

Periods of fetal development

Ovum Period, embryonic period, fetal period

Which symptom would the nurse expect the postpartum client to experience with a vaginal hematoma?

Pain

Which of the following characteristics are true of placenta abruption in comparison to placenta previa? (Select all that apply)

Painful bleeding Placenta dissociates from the uterus prior to delivery

A gravida 1 para 0 is having her first prenatal physical examination. Which of the following assessments should the nurse inform the client that she will have that day?

Pap smear

The nurse inquires of a client 48 hours post delivery what her newborn's name is. The client shrugs and stated that she has not thought of a name yet. What is the nurses priority concern for this patient and her newborn?

Parent-to-newborn attachment may be a concern

Which of the following exercises should be taught to a pregnant woman who complains of backaches?

Pelvic tilt

Menstruation

Periodic uterine bleeding that begins approximately 14 days after ovulation

A client is G2 P1, 5 cm, 80% effaced, and has just received an epidural with unstable blood pressure. Which of the following actions is important for the nurse to make at this time?

Place a wedge under the woman's side

Building onto medical surgical concepts and assuming all prerequisites for these measures do exist, identify the best treatment for hyperemesis gravidarum from the following interventions?

Place the GI tract at rest and provide intravenous fluids to correct fluid and electrolyte imbalance

You are the nurse in delivery giving intial cares to an infant. The baby is somewhat limp and apneic. The single most effective mechanism to establish respirations would be which of the following actions?

Positive pressure ventilation If an infant is not immediately aroused by use of bulb syring or other stimulation the nurse must proceed to initiate respirations with positive pressure ventilation the most effect mechanism to reverse apnea, deep suctioning is utilized to clear secretions only after respirations have been established.

Fertility Awareness (Natural Family Planning)

Predict fertile days by taking temperature daily, checking vaginal mucous for changes, and/or keeping a record of your periods, avoid sex or use condoms/spermicide during fertile days Pros - costs little, can be used while breastfeeding, can help with avoiding or trying to become pregnant Cons - must use another method during fertile days, does not work well if your periods are irregular, many things to remember with this method, does not protect against HIV or other STIs

Third Trimester: Relationship of pelvic organs anatomically and how this influences health and well-being

Presenting part of the fetus will lower into pelvis in preparation for labor, client is back where they started; running for the bathroom. Important to be well hydrated as pregnancy continues Dehydration can cause contractions that are irritating and nonproductive Drink at least 2 liters of water a day Eating a diet with processed food is very dehydrating to anyone and can also present lack of nutrient density as well as low hydration; requiring more WATER. Eating lots of fruits and vegetables provides some hydration and eliminating dehydrating chemicals is an important factor to calm uterine activity Best if filtered water without chlorine and run off chemicals is the fluid of choice. Fetal movement on top of the bladder or strong sneeze can cause release of urine (2nd & 3rd trimester)

Discuss the importance of the nutrient folate to conception

Prevents neuro tube defects to include spina bifida and anencephaly

Which of the following situations would contraindicate the use of cytotec for cervical ripening?

Previous cesarean section

Which of the following situations would contraindicate an induction with pitocin?

Primigravida with a transverse lie.

Describe expected nursing and medical management associated with diagnosis of ROM

Priority: Place client on fetal heart monitor 20-minute strip to assess fetal heart tones & uterine contraction pattern if any Listen to what she has to say: does it add up or sound like rupture of membranes? DO NOT PERFORM VAGINAL EXAM WITHOUT ORDER NO UA Nitrazine test Provider might order speculum exam to test fluids - retest nitrazine Ferning & pooling indicate SROM

Discuss the hormonal implications of progesterone associated with pregnancy symptoms and discomforts

Progesterone • Relaxes smooth muscle • Constipation • Heartburn

Discuss the use of progesterone injections for women who have had recurrent miscarriages

Progesterone secreted by corpus luteum allows endometrium to develop full of blood & nutrient's creating optimum place for a fertilized ovum to implant. For women with recurrent miscarriages this can allow for creating this optimum place for a fertilized ovum to implant.

The external monitor fetal heart tracing prior to amniotomy is baseline 140, moderate variability, with occasional early decelerations. Immediately following the procedure an internal tracing shows a fetal heart rate of 110 with variable decelerations after gush of clear fluid. Nursing judgment would conclude that one of the following events had occurred?

Prolapsed cord

Billings/Spinnbarkeit Pros and Cons

Pros - very reliable indicator of ovulation Cons - It only dictates when ovulation occurs, sexual intercourse a few days before can still produce pregnancy because sperm can live for 5 days in the female reproductive tract patiently stalking the potential ovum, some women and uncomfortable touching their genitals and mucous and find this method objectionable

Withdrawal (Pull-Out) / Coitus Interruptus

Pull penis out of vagina before ejaculation Pros - costs nothing, can be used while breastfeeding Cons - less pleasure for some, does not work if penis is not pulled out in time, does not protect against HIV or other STIs, must interrupt sex

Methylergonovine (Methergine) 0.2 mg is ordered to be administered intramuscularly to a woman who gave birth vaginally 1 hour ago for profuse lochial flow with clots. Her fundus is boggy and does not respond well to massage. She is still being treated for preeclampsia with intravenous magnesium sulfate at 2 gm/h. Her blood pressure measured 5 minutes ago was 155/98. The nurse's responsibility related to this order is best expressed by which of the following statements?

Question the order based on the woman's hypertensive status.

Calendar Method

Record 6 cycles, subtract 18 days from shortest cycle, subtract 11 days from longest cycle - abstain from intercourse between those days during the cycle Example - Shortest cycle 26 days - 18 = day 8 Longest cycle 30 days - 11 = day 19 Abstain from intercourse between day 8 to day 19 of cycle.

A woman gave birth to twin girls, one of whom was stillborn. Which of the following nursing actions would be least helpful in supporting the woman as she copes with her loss?

Remind her that she should be happy that one daughter survived and is healthy.

A full-term newborn was just born. The nurse warms, dries, and stimulates the infant while assessing airway and respiration. Which nursing intervention is important for the nurse to perform next?

Remove wet linen After delivery it is very important to support thermoregulation of the newborn. Initial steps of resuscitation include warm, dry, stimulate, while ensuring air way then remove wet blankets to prevent loss of body heat which could produce cold stress. This should be done before one minute of age and will assist stability in the newborn.

You are the nurse caring for a client in active labor and noticed a small amount of bloody show. Your cervical exam was 6 cm. 80%, -1 station, able to palpate the anterior fontenal. Based on this assessment priority nurisng action is best described by which of the following statements?

Reposition to far side or use peanut ball

Cervidil has been ordered for a pregnant woman at 43 weeks' gestation. The nurse recognizes that the purpose of this medication is best represented by which of the following statements?

Ripen the cervix in preparation for labor induction.

The blood of a pregnant client was initially assessed at 10 weeks' gestation and reassessed at 38 weeks' gestation. Which of the following results would the nurse expect to see?

Rise in white blood cell count from 5,000 cell/mm3 to 15,000 cell/mm3

Explain nursing and medical assessments related to either SROM or AROM

SROM Spontaneous Rupture of Membranes (SROM) If full term, provider may encourage delivery rather than risk infection Could order Pitocin IV titration for induction or Misoprostol vaginally for cervical ripening AROM Place IV before AROM in case of prolapsed cord & immediate cesarean is needed Want butt or head right on top of cervix right before AROM to make sure cord can't come first First thing to assess after AROM: FHR Administer Pitocin IV to initiate contractions

Intrapartum: influence of labor: Relationship of pelvic organs anatomically and how this influences health and well-being

Secondary lower abdominal bulge (filling bladder) pushes on fetus and causes presenting part to not be well applied to cervix. Empty the bladder!! Process of labor uses presenting part to give birth. If presenting part is not in position with the cervix the progress of labor can be slowed. If client has a foley it needs to be removed when she begins to push otherwise the body will attempt to birth the bladder in front of the baby

Placental Abruption

Something causes the placenta to pull away from the uterine wall Disrupts placental blood vessels and maternal uterine blood vessels oBoth will bleed freely Bleeding does not stop unless it is small enough that platelet aggregation and clotting cascade can intervene Concealed/Hidden Abruption: oDehiscence occurs somewhere in the middle of placental tissue so the bleeding is encapsulated between the uterus and placenta If it continues and continues without intervention the outcome can be disastrous oFirst the fundal height increasing to accommodate the blood, abdominal pain, contractions that are very painful, eventually non-reassuring fetal heart tones, initially maternal tachycardia, eventually but much later on decreasing blood pressure. Painful vaginal bleeding unless hidden abruption Any contraction is extremely painful Hurt between contractions with active bleeding High frequency, low amplitude contractions

Hydration Status

Specific Gravity Normal: 1.003 - 1.030 Increased: adrenal insufficiency, bacteriuria, congestive heart failure, diabetes mellitus, diarrhea, fever, fluid volume deficit, glomerulonephritis, obstruction uropathy, proteinuria, syndrome of inappropriate antidiuretic hormone secretion (SIADHS), toxemia of pregnancy, and vomiting. Drugs: dextran, radiographic contrast media, and sucrose. Decreased: Chronic renal insufficiency, diabetes insipidus, fluid volume excess, hypothermia, increase in intracranial pressure, and malignant hypertension Drugs: aminoglycosides, carbenoxolone, lithium, and methoxyflurane Color Normal: Yellow

Which of the following diagnostic tests is signifcant to the evaluation and diagnosis of preterm labor? Select all that apply)

Speculum exam for fetal fibronectin Ultrasound for cervical shortening

Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased?

Squatting

What speeds lung development in the fetus?

Stressors are the primary factors which could include contractions, rupture of membranes, steroids endogenous or exogenous, infection, maternal hypertension Note that diabetes slows lung development; also, male fetuses have slower rate of lung development than females

A pospartum client has been diagnosed with deep vein thrombosis. For which of the following additional complications is this client high risk?

Stroke

Stages of Pregnancy: 28 weeks

Strong Rh signature

Identify with rational what IV solution the nurse would expect to receive for treatment of a client with metabolic alkalosis

The nurse should expect to use an IV isotonic sodium chloride solution or lactated ringers to treat a patient with metabolic alkalosis. This is because isotonic solution has the same osmotic pressure across the semipermeable membrane as our blood. Since the osmotic pressure will remain the same as the blood, water will be able to move freely cross the membrane while the concentration remains the same. Lactated Ringers is an isotonic solution with added electrolytes that can benefit the patient more than saline solution.

The health care practitioner is educating a 40-year-old client who is 16 weeks' gestation regarding advisability of completing a maternal alphofetal protein test. The provider's rationale for offering this test is best described by which of the following statements?

The results may be indicative of Down's syndrome

A patient who is gravida 2 para 1, has progressed one centimeter in the past 3 hours. Her uterine contractions are 3 minutes apart and 50-60 seconds in duration. She is now 5 centimeters dilated. The health care provider inserts an intrauterine pressue catheter (IUPC) to asess the strength of the uterine contractions. During the peak of contractions the intensity ranges from 25-30 mmHg. Clinical reasoning related to this scenario suggests which of the following statements is true? (Select all that apply)

The strength of the uterine contractions is not adequate to dilate the cervix The nurse should anticipate an order for oxytocin

A woman had a baby by normal spontaneous delivery 5 minutes ago. The nurse notices a gush of blood expelled from the vagina and the umbilical cord lengthened. What should the nurse conclude?

The woman is about to deliver the placenta

A client is being taught fetal kick counting. Which of the following should be included in the patient teaching?

The woman should lie on her side while counting baby kicks

Which of the following symptoms that a postpartum client might experience would the nurse recognize as normal recovery? (Select all that apply)

Third spacing after the delivery has occurred Frequent large quantity of urine during micturition Diaphoresis

A 2-day-old breastfeeding baby born via normal spontaneous vaginal delivery has just been weighed in the newborn nursery. The nurse determines that the baby has lost 3.5% of the birth weight. Which of the following nursing actions is appropriate?

This is a normal weight loss; may need to explain to parents

What is the best measure to prevent abdominal distention following a cesarean birth?

Tightening and relaxing abdominal muscles

Discuss healthcare education and prevention related to heart burn

To Stop Pain Now: o Drink a glass of water o Eat yogurt or drink a glass of milk o Try a tablespoon of honey in a glass of warm milk o Discuss use of antacids with healthcare provider: Evidence of teratogenic impact on fetus Level of sodium and aluminum Stomach acid is necessary to absorb minerals, this includes iron and calcium Routine Maintenance: o Eat five to six smaller meals throughout the day o Wait an hour after eating to lie down o Avoid spicy, greasy and fatty foods o Try liquids in between meals; no more than 1 cup with meals o Apple cider vinegar o Lemon water o Peppermint and ginger o Papaya o Handful of almonds or cashews o Know your triggers Coffee, chocolate, and alcohol Tomato products o Do not eat before bed o Elevate head of bed o Lie on right side to promote gastric emptying o Consider digestive enzymes/probiotics-consult provider

An ultrasound has identified that a client's pregnancy is complicated by hydramnios. the nurse would expect that an ultrasound may show that the baby has which of the following structural defects?

Tracheoesophageal fistula

Which of the following are indicators of infant preterm gestation? (Select all that apply)

Translucent skin Lanugo Vernix Signs and symptoms of a preterm infant include an increased respiratory effort and/or respiratory distress and minimal subcutaneous fat deposits. Skin is thin, smooth, shiny, and may be translucent. There is lanugo over the body. Ears are soft and the cartilage is pliable. Long hair and nails are signs of a postterm infant. A plump face would be seen in a macrosomic infant.

True or False: The blood pumped through the left ventricle in fetal circulation contains oxygenated and deoxygenated blood.

True

A woman at 30 weeks' gestation assumes a supine position for a fundal measurement and Leopold's maneuvers. She begins to complain about feeling dizzy and nauseated. Her skin feels damp and cool. What should be the nurses first action?

Turn the woman on her side

Mittelschmerz

Twinge of pain at the time of ovulation

An initial assessment of a newborn's urine shows rust-colored streaks in the diaper. Which of the following factors is the probable cause?

Uric acid crystals

Male/External Condom

Use a new condom each time you have sex, use a polyurethane condom if allergic to latex Pros - can buy at many stores, can put on as part of sex play/foreplay, can help prevent early ejaculation, can be used for all types of sex, protects agains HIV and other STIs, can be used while breastfeeding Cons - can decrease sensation, can cause loss of erection, can break or slip off

Female/internal condom

Use a new condom each time you have sex, use extra lubrication as needed Pros - can buy at many stores, can put in as part of sex play/foreplay, can be used for all types of sex, may increase pleasure when used for vaginal sex, good for people with latex allergy, protects against HIV and other STIs, Can be used while breastfeeding Cons - can decrease sensation, may be noisy, may be hard to insert, may slip out of place during sex

A client is 35 weeks' gestation. Which of the following findings would the nurse expect to see?

Use of three pillows for sleep comfort

Amnihook

Used with AROM to induce or accelerate labor

A woman who is GTPAL=50401, is in the post-anesthesia recovery after a cervical cerclage procedure. During the immediate postprocedure period, what should the nurse carefully monitor this client for?

Uterine contractions

First Trimester: Relationship of pelvic organs anatomically and how this influences health and well-being

Uterus grows within the pelvis and the uterus will place pressure on the outside of the bladder which gives the same sensations as pressure within the bladder Client may feel the need to micturate (urinate) more frequently. Urinary frequency is normal to pregnancy Suggest a greater opportunity for UTIs during pregnancy; depending on urinary stasis and this is true but not expected UTI vs. Urinary Frequency UTI: frequency and urgency, painful, hematuria UA: cloudy, positive for blood, large leukocytes & nitrates become nitrites in the presence of bacteria

A woman is 36-week gestation. Which of the following tests will be done during her prenatal visit?

Vaginal and rectal cultures

A client has just received hemabate (carboprost) because of uterine atony not controlled by IV oxytocin. For which of the folllowing side effects of the medication will the nurse monitor this patient?

Vomiting and diarrhea

Which method is correct for obtaining blood on the newborn for a glucose reading?

Warm the foot, clean with an alcohol pad, and puncture the side of the heel

Emergency Contraception Pills (Progestin EC [Plan B One-Step and others] and ulipristal acetate EC [Ella])

Works best the sooner you take it after unprotected sex, you can take EC up to 5 days after unprotected sex, if pack contains 2 pills take both together Pros - Can be used while breastfeeding, available at pharmacies, health centers, people of any age can get some brands without a prescription Cons - May cause stomach upset or nausea, your next period may come early or late, may cause spotting, does not protects against HIV or other STIs, pharmacies sell progestin EC to people of any age without a prescription, ulipristal acetate EC requires a prescription, may cost a lot

A 16-year-old primigravida is being seen at her 10-week gestation visit. She tells the nurse that she felt the baby move that morning. Which of the following responses by the nurse is appropriate?

Would you please describe what you felt for me?

nullipara

a woman that has never gave birth

nulligravida

a woman who has never been pregnant

Primipara

a woman who is giving birth for the first time

Discuss with a client medications that may decrease effectiveness of birth control

antibiotics

Average duration of menstrual flow

approximately 5 days with a range of 3-8 days

Other risk factors for prolapsed cord

breech or foot presentation

Estrogen

builds lining of uterus during proliferative phase Relationship - Happens as the increase in estrogen is used for developing the follicle Action - Endometrium restores itself from last menstruation during a period of rapid growth

Which of the following symptoms are not associated with the development of increased blood volume during pregnancy a. Dependent edema and/or carpal tunnel syndrome at 28 weeks b. Increased ptyalism at 16 weeks c. Headache at 35 weeks d. Tingling breast sensations at 12 weeks

c. Headache at 35 weeks

Ovum period

conception to day 15

Hallmark sign of molar pregnancy

dark red bleeding & extrusion of red grape like clusters with no pain Rapid growing uterus with no fetal heart tones, high hCG levels due to growth of placental tissue

Erythrocyte sedimentation rate, mm/hr

elevated in second and third trimesters (>20)

Polyhydramnios/Hydramnios

excessive amniotic fluid > 24 cm Sometimes it just happens Baby cannot swallow Tracheobronchial fistula Esophageal cardiac sphincter not attached to stomach Maternal diabetes

Which woman would be most likely to have severe afterbirth pains and request a narcotic analgesic?

gravida 5, para 5 The discomfort of afterpains is more acute for multiparas because repeated stretching of musclefibers leads to loss of uterine muscle tone. Afterpains are particularly severe during breastfeeding, not bottle feeding. The uterus of a primipara tends to remain contracted. The non-nursing mother may suffer from engorgement problems. She should empty her breasts regularly to stimulate milk production so she will have the milk when the baby is strong enough to nurse.

GTPAL

gravida, term births, preterm births, abortions, living children

A nurse should consider the possibility of neonatal withdrawal syndrome if a newborn

has a continuous high-pitched cry Symptoms of withdrawal from maternal substance abuse include central nervous system disturbances such as an excessie or continuous high-pitched cry and a markedly hyperactive Moro reflex. An infant withdrawing from narcotics or other substances abused maternally is likely to anve an increased muscle tone along with other central nervous system disturbances. Most infants sleep for varying amounts of time after feeding. Symptoms of withdrawal from maternal substance abuse include difficulty moving through various sleep stages. These infants may only sleep for very short periods of time. This sleep pattern disturbance is related to central nervous system excitation secondary to drug or alcohol withdrawal. Many newborns have mild tremors when they are disturbed. What distinguishes infants who have neonatal abstinence syndrom from this normal pattern is that they have moderate to severe tremors when they are undisturbed.

Number 1 major risk factor for prolapsed cord

high station

Progesterone

increases vascular and preserves the endometrium and encourages the corpus luteum during the secretory phase Relationship - Swollen & vascular endometrium develops full of blood & nutrient's creating optimum place for a fertilized ovum to implant Action - Progesterone secreted by corpus luteum allows endometrium to develop full of blood & nutrients creating optimum place for a fertilized ovum to implant

McDonald's method

measure uterine fundal height in centimeters from the symphysis pubis to the top of the uterine fundus

A multiparous woman is admitted to the postpartum unit after a rapid labor and birth of a 4000-g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the woman void and massages her fundus, but her fundus remains difficult to find and the rubra lochia remains heavy. What should the nurse do next in this situation?

notify the physician The uterine muscle can be overly stimulated by massage, leading to uterine atony and rebound hemorrhage. Treatment of excessive bleeding requires the collaboration of the physician and the nurses. The nurse should call the clinician while a second nurse rechecks the vital signs. Do not leave the patient alone. The woman has voided successfully so a Foley catheter is not needed at this time.

Postpartal overdistention of the bladder and urinary retention can lead to which complication?

postpartum hemorrhage and urinary tract infection

A client has changed cervix from 5 to 6 cm over three hours. This labor pattern is best described by which of the following statements?

protracted active phase

Miscarriage

spontaneous abortion is a loss prior to 20 weeks. Number one reason for miscarriage is chromosomal abnormality related to environmental idiosyncrasy

Nuchal Cord

• Cord around a body part • Most of the time it is constriction of the cord not the body part • Most commonly around fetal neck • Usually wrapped once • Doesn't matter length or surface of cord

Placental Previa

• Implanted over all or part of the internal cervical OS. • If cervix is manipulated or if contractions produce changes then the placenta will pull away from cervical tissue causing abruption • You will always see vaginal bleeding • Placenta is imbedded in tissue that does not move or contract vigorously so it is not painful • Painless bleeding • Use of Bakri balloon postpartum is used to place pressure throughout the lower uterine segment to prevent hemorrhage

Placental Accrete

• Rare condition, but has increased in the US at same time as cesarean sections • Inadequate blood supply in the endometrium and perhaps an indirect route provided by a previous cesarean section scar • Chorionic villi drill into muscle of the uterus (maternal myometrium) • Typically, baby is delivered and profuse bleeding occurs (maternal). Placenta cannot be delivered by manual extraction. Surgical removal of placenta is needed in all cases • All accreta's create a great deal of bleeding • Terms: oAccrete Invasion of first layer of muscle oIncreta Well embedded into middle muscle mass oPercreta Grows through the uterus and can be found on maternal abdominal organs

Ectopic Pregnancy

•Conception outside of the main body of the uterus oMost often occurring in the fallopian tubes •Primary Indication oUnilateral lower abdominal pain •Important to know if client has had a pregnancy test. Pregnancy guides towards diagnosis. If she has not had a pregnancy test, the provider might wish to order one oIf not pregnant, diagnosis will go a different direction oIf pregnant, an ultrasound would confirm •Symptoms oIntact Tube Unilateral lower abdominal pain Cullen's sign •Blue tinge around umbilicus oIndication of internal abdominal bleeding Fatigue Pallor Dizzy Nauseous oRuptured Tube Severe Pain Emergency requiring surgical intervention Causes significant blood loss into abdomen May or may not have vaginal bleeding Cullen's sign •Blue tinge around umbilicus oIndication of internal abdominal bleeding Fatigue Pallor Dizzy Nauseous •Treatment oIntact Tube oRuptured Tube Surgical salpingectomy (tube removal) OR Salpingostomy (cutting into tube to remove pregnancy) oGoal: Preserve tube and improve chance of future fertility oMethotrexate Given IM to inhibit cell division in the developing embryo Folic acid antagonist Chemotherapeutic agent Usually only one dose, but if follow up shows elevated hCG levels another IM is needed Nurse must explain: •Adverse side effects oNausea and vomiting oPhotosensitivity •Importance of communicating any continued symptoms •Refrain from drinking alcohol oDecreases effectiveness of med •Should not ingest vitamins that contain folic acid oModify diet to not include folate •Sex should be avoided until hCG is not detectable •Consider Rhogam if client is Rh negative •Nursing Implications oFocus: Prevention or Early Identification Hypovolemic Shock Pain Control Post-Methotrexate Home Care Psychological Support

Battledore Placenta

•Cord originates from side of placenta

Functions of the placenta

•Hormonal •Estrogen oRenin-Contractility Enhancement •Progesterone oCalm relaxing, decrease muscle tone oDecreases contractility oIncreases heartburn and constipation •hCG oCommunication with corpus luteum •hCS oInsulin resistance •Assist cardiovascular system •Provides endocrine stimulation •Respiratory or oxygenation •Nutritional oFetus receives first dibs oNutritional density of mother

Gestational Trophoblastic Disease/ Hydatidiform Molar Pregnancy (GTD)

•Placental anomaly in which trophoblasts (cells arising from placental tissue) grow rapidly and randomly •Can begin as benign growth but primary concern is development of carcinogenic cells and malignancy or spread of cancer to other areas in maternal body •Goal of Care: oInhibit or prevent carcinogenic changes to include malignancy •This type of pregnancy does not grow a baby. No viable fetus even if limbs or other parts are found. •Symptoms: oDark red bleeding, sometimes extrusion of red grape life clusters oNo pain oRapid growing uterus oNo fetal heart tones oNausea & Vomiting Because placental cells may secrete placental hormones, high hCG levels due to growth of placental tissue •Risk Factors: oOriental race oMother over 40 or under age 20 oDiet lacking in protein oFolic acid, carotene, & nutritional deficiency oHistory of GTD •Management: oRemove all of abnormal cells Dilation and evacuation of the uterus (D & E) •Monitor hCG levels weekly for at least 1 year in order to evaluate for evidence of continued placental cellular proliferation and potential for neoplasm oVery important & needs to be stressed to client •Other medical problems: oAtypical Pregnancy Pregnancy-induced hypertension Hyperemesis Gravidarum •Pregnancy should be prevented for at least one year in the event that chemotherapy is indicated •Bleeding oRh negative Given Rhogam just in case to prevent Rh positive signature which would impact other pregnancies

True Knot in Cord

•Problem can develop if knotted cord is tight •Restrict blood flow

Velamentous Insertion

•Vessels of cord transverse through membranes, poorly protected and eventually form a cord

Vasa Previa

•Vessels of the cord which may transfer through membranes are found in front of the fetal presenting part •If membranes rupture so might the vessels •Monitored by maternal fetal medicine •Cesarean section preterm, maybe 32 weeks in order to have a live birth oIM steroids for purpose of promoting fetal lung development

Nagele's Rule

EDC = (LMP + 7 days) - 3 months

Hegar's Sign

softening and compressibility of the lower uterine segment

Which of the following foods reduces absorption of iron supplements?

Egg yolks

preterm premature rupture of membranes

rupture of membranes during pregnancy before 37 weeks gestation

Goodwell's Sign

softening of the cervix, probable sign of pregnancy occurring during the second month

Intrauterine growth restriction (IUGR)

Growth rate does not meet expected norms. Also can be called small for gestational age (SGA)

The following four changes occur during pregnancy. Which of them usually increases the father's interest and involvement in the pregnancy?

Hearing fetal heart beat

The nurse has taken a health history on four primigravid clients at their first prenatal visits. It is high priority that which of the clients receives nutrition counseling?

The woman who has phenylketonuria

Unable to auscultate fetal heart tones at 8 weeks

Though the literature stated that fetal heart rate can be heard between 8 and 12 weeks, it is not likely that fetal heart rate can be auscultated with most 8-week pregnancies; more often heart rate is head between the 10th and 12th week.

Chadwick's Sign

Deep bluish color of cervix and vagina as a result of increase circulation during pregnancy

Abstinence

Don't have sex

An antepartum client with mitral valve stenosis is placed at risk for cardiac decompensation during pregnancy associated with which one of the following physiologic changes?

Elevated maternal heart rate by 10-20 beats per minute

Which of the following time frames represents the greatest danger to zygote/embryo/ fetus in terms of teratogenic activity?

Embryonic period of development

During an examination of a pregnant woman, the nurse notes that her cervix is soft on its tip. How would the nurse document this finding?

Goodell's sign

Gravida (Gravidity) & Para (Parity)

Gravida (gravidity): total number of confirmed pregnancies that a woman has had Para (parity): number of births that a woman has had after 20 weeks gestation

RAAS System

In pregnancy, hyperplasia of uterus activates renin. The increase in renin triggers adrenal stimulation of angiotensin and release of aldosterone. Aldosterone increases reabsorption of sodium and fluid. This leads to an increased blood volume. The primary difference between this process in a pregnant person is the RAAS system causes vasodilation. In a normal person that is not pregnant it causes vasoconstriction. This increased blood volume causes an increased work load of the heart. This causes the chambers of the heart to hypertrophy. This increases contractility of an OB patient and makes for a more effective heart beat instead of decompensation and decreased cardiac function in a normal medical surgical patient.

An essential component of prenatal health assessment of pregnant women is the determination of vital signs. Which of the following statements describes expected change(s) in vital signs associated with pregnancy? (Select all that apply) PARTIAL

Increased depth and rate of respiration Elevation in pulse rate by approximately 10-20 beats per minute

A pregnant woman must have a glucose challenge test (GCT). Which of the following should be included in the preprocedural teaching?

The test should be drawn at one-hour post glucola ingestion

Discuss healthcare education and prevention related to heartburn

To Stop Pain Now: Drink a glass of water Eat yogurt or drink a glass of milk Try a tablespoon of honey in a glass of warm milk Discuss use of antacids with healthcare provider: -Evidence of teratogenic impact on fetus -Level of sodium and aluminum -Stomach acid is necessary to absorb minerals, this includes iron and calcium Routine Maintenance: o Eat five to six smaller meals throughout the day o Wait an hour after eating to lie down o Avoid spicy, greasy and fatty foods o Try liquids in between meals; no more than 1 cup with meals o Apple cider vinegar o Lemon water o Peppermint and ginger o Papaya oHandful of almonds or cashews Know your triggers -Coffee, chocolate, and alcohol -Tomato products o Do not eat before bed o Elevate head of bed o Lie on right side to promote gastric emptying o Consider digestive enzymes/probiotics-consult provider

Friability

refers to cervical fragility resulting in slight bleeding when scraped or touched

Oligohydramnios

too little amniotic fluid < 5 cm Sometimes just happens Baby is not producing much urine -fetal kidney function is a concern -baby not opening mouth leading to no produced urine contraindication for version

Which of the following statements identifies normal physiologic changes which occur during pregnancy? (Select all that apply)

Increased clotting factors Immunosuppression Increased circulating blood volume

Macrosomia

Big for gestational age

A patient's history identifies her GTPAL as 41123. Based on this information which of the following statements is true?

The woman has had twins

Follicle Stimulating Hormone (FSH)

Relationship - Secreted by anterior pituitary when hypothalamus sends Gnrh Action - Tells the ovary to start development of new follicles

Premature rupture of membranes

rupture of membranes before labor begins

The nurse working in an outpatient obstetric office assesses four primigravid clients. Which of the client findings would the nurse highlight for the physician?

24 weeks' gestation; fundal height at the umbilicus

A woman states that she frequently awakens with "painful leg cramps" during the night. Which of the following assessments should the nurse make?

Dietary Evaluation

When analyzing the need for health care teaching of a prenatal multigravida, the nurse should ask which of the following questions?

Do you ever drink alcohol?

The nurse is advising the patient about warning signs of pregnancy. The nurse should teach the mother that she should notify the physician immediately if she experiences which of the following signs/symptoms? (Select all that you apply)

Double vision Epigastric pain Persistent vomiting

Endometrial Cycle: Proliferation Phase

During the increase in estrogen for developing the follicle, the endometrium restores itself during a period of rapid growth (Day 5-14)

The nurse is providing anticipatory guidance to a woman in her second trimester regarding signs/symptoms that she might experience in the coming weeks. Which of the following comments by the client indicates that further teaching is needed?

During the third trimester I may experience persistent headache

Develop an educational plan in order to assist a woman or couple determine appropriate birth control through informed consent by discussing birth control using the mnemonic BRAIDED

Benefits, Risks, Alternatives, Inquiries, Decision, Explanation, Documentation

Which of the following symptoms indicates probable labor? (Select all that apply)

Cervical shortening and effacement Changing cervical dilation Uterine contraction pattern demonstrating contractions that are longer, stronger, and closer together, especially with increased activity

Unexplained multiple miscarriages would cause the health care provider to consider testing for which of the following co-existing conditions? (Select all that apply)

Leiden factor V Antiphospholipid syndrome MTHFR

Hypothalamic-pituitary cycle (SECOND HALF OF CYCLE)

Mainly progesterone - hypothalamus and anterior pituitary stop secreting hormones to see if pregnancy has been achieved or if cycle should restart

Laboratory results on a 51 year old woman indicated: high levels of follicle stimulating hormone (FSH). Why would this occur?

Menopause: Decrease in estrogen, all follicles of the ovary are gone and there is no follicle to stimulate. Luteinizing hormone (LH) is elevated but FSH elevation is more marked. If in younger woman this could be an indication of fertility issues such as poor ovarian reserve or premature ovarian aging.

A 10-week gravid client is being seen in the prenatal clinic. Which of the following statements is the highest priority for the nurse in order to provide anticipatory guidance for this client?

Methods to relieve backache

Nursing assessment related to a healthy gravida 1 para 0, 3657 weeks who is concerned that she is experiencing contractions included: fetal heart tones reactive and variable, irregular mild contractions which patient is able to walk and talk through, dependent pedal edema, dipstick UA negative except for trace protein, specific gravity 1.030, pH 6.5, and dark amber appearance. Based on this information which of the following describes appropriate nursing intervention.

Offer PO hydration with water

luteinizing hormone (LH)

Relationship - secreted by anterior pituitary when estrogen levels are high and hypothalamus sends Gnrh Action - tells the ovary follicle has reached full maturity & ovulation occurs

PICA in pregnancy is usually associated with which one of the following disorders?

Severe iron deficiency anemia

A woman is diagnosed with an ectopic pregnancy and is given an intramuscular injection of methotrexate. The nurse would tell the woman which of the following?

She should avoid alcohol until her primary care provider tells her the treatment is complete

Spinnbarkeit (Billings) & Basal Body Temperature

Spinnbarkeit (Billings) - cervical mucous tends to be thick, sticky, or tacky during most of the menstrual cycle. Cervical mucous becomes very different - stretchy when ovulation occurs Basal Body Temperature - 0.5 to 1.0 degree increase in basal body temperature is indicative of ovulation Combining basal temperature with Spinnbarkeit (Billings) test can provide even more accurate information regarding a woman's menstrual cycle and fertility time

McDonald's method is not an appropriate assessment prior to 20 weeks' gestation. The rationale for this statement is best identified by which of the following explanations?

The fundus of the uterus is within the bony pelvis until around 20 weeks