OB Exam 1

Positive signs of pregnancy

- A medical test - Visualizations of fetus upon ultrasound - Fetal heart rate - Fetal movement

Nursing priorities for a spontaneous abortion

- CBC to assess for blood loss - Rhogam if Rh- - Iron supplements if anemic - Certain abortion types may need medication or medical intervention

Signs and symptoms of a spontaneous abortion

- Cramping - Bleeding - Passage of tissue

How do you diagnose iron deficiency anemia?

- Hemoglobin level < 7 - Usually occurs in 3rd trimester

Nursing priorities for hyperemesis gravidarum

- IV rehydration - IV medication administration - May require a NG tube or PICC line for TPN

Dietary recommendations

- Increase calories by 350 per day starting 2nd trimester - More calories for more babies (twins) - Take folic acid daily when reaching child bearing age (neural tube development, spinal cord) - Hydration

Nursing priorities for iron deficiency anemia

- Iron supplements (found in most prenatal vitamins) - Iron transfusion if GI system symptoms challenging

Dietary restrictions in pregnancy

- Mercury (fish) - Raw meat - Eggs - Deli meat - Soft cheese - Unwashed fruits and vegetables - Alcohol (no amount safe - FAS) - Excess caffeine - Unpasteurized milk (or foods containing it)

Signs and symptoms of an ectopic pregnancy

- Severe pelvic pain that refers to shoulder and recurrent or persistent bleeding - Beta hCG levels will be lower than anticipated

Nursing education for iron deficiency anemia

- Take on an empty stomach to maximize absorption - Avoid milk, antacids, high fiber foods, and caffeine for 2 hours - Black stools not uncommon when taking iron supplements - Discuss how to address constipation (prescribe stool softeners if necessary)

How do you diagnose gestational diabetes?

2 step process: 1 hour GTT and 3 hour GTT - If 3 hour GTT failed, patient is diagnosed

Preterm pregnancy length

24-37 weeks

Term pregnancy length

37-40 weeks

Post-term pregnancy length

40-42 weeks

A couple has decided to use the basal body temperature method of natural family planning. Which time period would the nurse teach them is the most fertile period in the menstrual cycle? 12 hours before to 24 hours after ovulation 72 hours before to 24 hours after ovulation 72 to 80 hours before to 72 hours after ovulation 24 to 48 hours before to 48 hours after ovulation

72 hours before to 24 hours after ovulation

A gravida 1 client with B negative blood gives birth to a baby whose blood type is O positive. Which intervention would the nurse expect to be included in the client's plan of care? Administration of Rho (D) immune globulin Determination of the father's blood type Check for signs of ABO incompatibility Blood typing and cross-matching

Administration of Rho (D) immune globulin

Which populations are at a higher risk of gestational diabetes during pregnancy?

African Americans Native Americans Latinas Asian Americans

A couple in their late 30s are planning a genetic amniocentesis and would like to complete the testing as soon as possible. At which time would the test be scheduled? When quickening is felt During the last trimester At the 10th week of gestation After the 14th week of pregnancy

After the 14th week of pregnancy

What psychological changes occur in the 2nd trimester?

Altered body image Awareness of pregnancy Openness or more awareness to discussing and regarding health habits

What psychological changes occur in the 1st trimester?

Ambivalence (fluctuation between happy and scared) Uncertainty

What are some presumptive signs of pregnancy that the nurse would expect when assessing a client at 10 weeks' gestation? Select all that apply. Amenorrhea Breast changes Urinary frequency Abdominal enlargement Positive urine pregnancy test

Amenorrhea Breast changes Urinary frequency

Which action would the nurse take first when an adolescent client presents to the clinic with complaints of amenorrhea for 2 months? Help evaluate the adolescent's stress factor Ask the adolescent to take a pregnancy test Make a proper dietary and exercise plan with the adolescent Refer the adolescent to use biofeedback or massage therapy

Ask the adolescent to take a pregnancy test

A pregnant client was exposed to a teraton in her 10th week of gestation. Which nursing intervention would the nurse include in the plan of care? Advise termination of the pregnancy Discuss surgical treatment for the newborn Assure the client that the risk of malformation is greater in very early pregnancy Suggest at least 2 ultrasound scans to assess the extent of the injury

Assure the client that the risk of malformation is greater in very early pregnancy

Nursing actions and education to prevent vena cava syndrome

Avoid laying supine - Optimize circulation laying in the left lateral position

What is vena cava syndrome?

Blood flow through the vena cava has been slowed. Can be caused by the uterus compressing the inferior vena cava and the aorta.

Signs and symptoms of gestational diabetes

Can have none at all - Increased thirst - Frequent urination - Excessive hunger - Fatigue

Signs and symptoms of iron deficiency anemia

Check H&H - slightly lower is okay Check ferritin levels

What is a hypertensive screening?

Checking BP using a BP cuff

The nurse is teaching a class of expectant parents about changes that are to be expected during pregnancy. Which changes would the nurse explain result from melanocyte-stimulating hormone? Select all that apply. Chloasma Linea nigra Effacement Morning sickness Cervical softening Urinary frequency

Chloasma Linea nigra

Which is the most highly sensitive time within the developing embryo for the risk of malformation related to environmental teratogens? Heart at 32 week' gestation Cleft lip at 18 weeks' gestation Cleft palate at 8 weeks' gestation Upper limbs at 24 weeks' gestation

Cleft palate at 8 weeks' gestation

Which statement would the nurse include in a teaching session for pregnant clients regarding fetal growth and development? Select all that apply. All major organs are developed and function before birth Development occurs in a head-to-toe and central-to-peripheral pattern The fetal stage of development is most vulnerable to teratogenic influences Pregnancy includes the preembryonic, embryonic, and fetal stages of development During pregnancy the embryo grows from a single cell to a complex physiologic being

Development occurs in a head-to-toe and central-to-peripheral pattern Pregnancy includes the preembryonic, embryonic, and fetal stages of development During pregnancy the embryo grows from a single cell to a complex physiologic being

At which point during a human pregnancy does the embryo become a fetus? During the 8th week of pregnancy At the end of the 2nd week of pregnancy When the fertilized egg becomes implanted When the products of conception are seen on the ultrasound

During the 8th week of pregnancy

Nursing priorities for an ectopic pregnancy

Early: managed medically with methotrexate to terminate pregnancy Late: managed surgically if fetus is more developed and high risk for hemorrhage

Complications of worsening preeclampsia

Eclampsia (seizure) Preterm birth HELLP syndrome S&S: hyperreflexia (positive clonus, DTR), blurred vision, headache, proteinuria, epigastric pain, high BP, and nausea and vomiting

A client who has missed two menstrual periods arrives at the prenatal clinic with vaginal bleeding and one-sided lower quadrant pain. Which condition would the nurse suspect? Placenta previa Ectopic pregnancy Incomplete abortion Rupture of a graafian follicle

Ectopic pregnancy

Which intervention would the nurse recommend to a client in her 37th week of gestation who calls the clinic and reports, "My ankles are so swollen"? Limiting fluid intake during the day Elevating her legs more frequently during the day Restricting salt intake for the remainder of her pregnancy Taking a mild diuretic that the health care provider will prescribe

Elevating her legs more frequently during the day

Which physiological changes are expected during the first trimester of pregnancy? Select all that apply. Fatigue Increased libido Morning sickness Breast enlargement Braxton Hicks contractions

Fatigue Morning sickness Breast enlargement

What is quickening?

Fetal movement

Nursing priorities for gestational diabetes

Fetal surveillance - Close monitoring fetal size and organ development - Nonstress tests 2 times a week - Biophysical profiles (BPPs)

Primigravida

First pregnancy

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How would the nurse, using the GTPAL format, document the client's obstetric history?

G5 T2 P1 A1 L4

What does each letter of GTPAL stand for?

G: Gravidity - number of pregnancies including the current one T: Term - number of pregnancies carried to 37 weeks P: Preterm - number of pregnancies carried between 20 weeks and 36 weeks and 6 days A: Abortion - number of pregnancies lost before 20 weeks L: Living - number of living children (only category twins count as 2)

What is a GDM screening?

GTT: drink a liquid and they test your blood glucose after 1 hour GTT: if levels are too high, you go back for the 3 hour GTT test - no fasting before test 3 hour GTT: If you fail this, you are diagnosed with gestational diabetes - fast before test

Which laboratory finding of a pregnant client would alert the nurse to the need for further assessment? Hemoglobin of 10 g/dL Urine specific gravity of 1.020 Glucose level of +1 in the urine White blood cell count of 9000/mm3

Hemoglobin of 10 g/dL (lowest resulting from anemia is 12, this is because the plasma volume increases to a greater extent than the red blood cells during pregnancy)

When are people screened for gestational diabetes?

High risk: 1st prenatal visit All others: 24-48 weeks gestation

Which is an appropriate response to a 24-year-old client with type 1 diabetes who asks how her pregnancy will affect her diet and insulin needs? Insulin needs will decrease; the excess glucose will be used for fetal growth Diet and insulin needs won't change, and maternal and fetal needs will be met Protein needs will increase, and adjustments to insulin dosage will be necessary Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring

Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring

What are the musculoskeletal changes that occur during pregnancy?

Lower back pain Pressure on the diaphragm Pressure on the bladder Weak/loose joints and joint pain Lower bone density (increased risk of osteoporosis) Round ligament pain Increased fall risk Waddle gait Leg cramps

What should you monitor for with Magnesium Slfate?

Magnesium toxicity - Antidote: Calcium gluconate - Look for dizziness, vision changes, hyporeflexia, lethargy, respiratory distress, LOC changes, slurred speech, and oliguria

What is Rh alloimmunization?

Maternal Rh antibody screen (indirect coombs test): determines if antibodies have developed and it sensitization has occurred - If negative - fetus not at risk -If positive - fetus may be at risk. Positive result means the antibodies have developed. - Rh antibodies enter fetal circulation resulting in hemolysis of fetal RBC and fetal anemia - Rhogam given at 28 weeks gestation if the mom is Rh-, if any trauma occurs, and at 72 hours postpartum if mom is Rh- and baby is Rh+

Spontaneous abortion

Miscarriage - Fetal loss due to mother's body recognizing chromosomal abnormalities - Peak time: 5-8 weeks

What psychological changes occur in the 3rd trimester?

More vulnerable and dependent on partner Anxious about late pregnancy loss Compromised sleep Fixated on due date Formulate/ prepare for the newborn

For which reason may insulin requirements of a client with type 1 diabetes decrease during the first trimester? Body metabolism is sluggish in the first trimester Morning sickness may result in decreased food intake Fetal requirements of glucose in this period are minimal Hormones of pregnancy increase the body's need for insulin

Morning sickness may result in decreased food intake

Multigravida

Multiple pregnancies

Nulligravida

Never been pregnant

Which nursing intervention is the priority intervention for this client with preeclampsia? Assessing the fetal heart rate for tachycardia Promoting adequate urine output by offering oral fluids Monitoring respiratory status and ascertaining that calcium gluconate is at the bedside Notifying the primary health care provider regarding the epigastric pain, headache, and blurred vision

Notifying the primary health care provider regarding the epigastric pain, headache, and blurred vision

Which precaution would the nurse implement for a client with a diagnosis of severe preeclampsia? Padding the side rails on the bed Having a vacuum extractor available at the time of birth Placing 2 units of Packed Red Blood Cells (PRBCs) on hold in the blood bank Assigning a nursing assistant to stay with the client

Padding the side rails on the bed

Which direction would be given to a primigravida at 34 weeks' gestation who is beginning to experience lower back pain? Wear a maternity girdle during waking hours Sleep flat on her back with her feet elevated Perform pelvic tilt exercises several times a day Take an ibuprofen (Motrin) tablet at the onset of back pain

Perform pelvic tilt exercises several times a day

Which activity would be part of the plan of care for a couple beginning their care in the fertility clinic? Planning when to have intercourse Having a procedure to retrieve the egg at ovulation Visiting the fertility clinic daily Taking medication to induce ovulation

Planning when to have intercourse

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

Preeclampsia

Which hormone is crucial in maintaining the implanted ovum at its site? Inhibin Estrogen Progesterone Testosterone

Progesterone Inhibin - regulates the release of FSH and GRH Estrogen - vital role in development and maintenance of secondary sexual characteristics Testosterone - bone strength and development of muscle mass

What influence would the nurse draw when crackles are heard while auscultating the lungs of a client admitted with severe preeclampsia? Seizure activity is imminent Pulmonary edema may have developed Diaphragmatic function is being impaired by the enlarged uterus Bronchial constriction was precipitated by the stress of pregnancy

Pulmonary edema may have developed

Which foods would the nurse counsel the client at 14 weeks' gestation to avoid during pregnancy? Select all that apply. Yogurt Oily fish Apricots Raw shellfish Herbal supplements Soft-scrambled eggs

Raw shellfish (may be contaminated with hepatitis or typhoid) Herbal supplements (contain medicinal ingredients) Soft-scrambled eggs (may be contaminated with salmonella)

Nursing priorities with severe preeclampsia

Seizure precautions (suction, O2, left lateral side lying position, time the seizure, bed pads) Draw labs Betamethasone ready for preterm birth Hydralazine for BP Delivery is the only cure

Which of these clinical manifestations would the nurse report to the healthcare provider immediately in a client with preeclampsia? Audible crackles in the lower lung fields Weight gain of 5 pounds in 2 weeks Severe headache Generalized facial edema

Severe headache

Assessment of a primigravida at 32 weeks' gestation shows a blood pressure of 170/110 mmHg, 4+ proteinuria, and edema of the face and extremities. With which complication are these findings consistent? Eclampsia Severe preeclampsia Chronic hypertension Gestational hypertension

Severe preeclampsia

The nurse is conducting the admission assessment of a client in labor who is positive for group B streptococcus (GBS). Which finding is of concern to the nurse? Continued bloody show Cervical dilation of 4 cm Contractions every 4 minutes Spontaneous rupture of membranes 3 hours ago

Spontaneous rupture of membranes 3 hours ago

Presumptive signs of pregnancy

Subjective signs and symptoms (reported by mother) - Missed period - Breast tenderness - Fatigue

Which assessment finding would the nurse expect in a client with preeclampsia? Ketonuria Tonic-clonic seizure Hemoglobin 10 g/dL Systolic blood pressure higher than 140 mmHg

Systolic blood pressure higher than 140 mmHg

A physically active 19-year-old primigravida attends the prenatal clinic for the first time. She asks the nurse whether she may continue playing tennis and riding horses while she is pregnant. How would the nurse reply? Tell me more about how you engage in these activities Horseback riding is acceptable, but only up to the last trimester Tennis is good exercise for you, but horseback riding is too strenuous Both of these sports have been found to be too strenuous for a pregnant woman

Tell me more about how you engage in these activities

The nurse notes in the history of the client in labor that she is a gravida 5 para 2112. Which statement would be true based on this information? The client has given birth to four children The client has had 2 preterm children The client has 2 living children The client has had one elective abortion

The client has 2 living children

Which statement indicates that a pregnant client requires further teaching about fetal growth and development? The fetus keeps growing throughout pregnancy The fetus gets nutrients from the amniotic fluid The fetus may be underweight if it's exposed to smoke The fetus gets oxygen from blood coming through the placenta

The fetus gets nutrients from the amniotic fluid

In which circumstance would newborn blood incompatibility be most likely to occur if the mother has blood type O and Rh factor positive? The newborn has type A or B blood The newborn is born preterm The newborn has type O, Rh-positive blood The mother has diabetes

The newborn has type A or B blood

Which instruction would the nurse give to the pregnant client with a positive group B streptococcus (GBS) result at 36 weeks' gestation? Go straight to the outpatient area of the maternity unit for a nonstress test You'll need to schedule visits twice a week with your health care provider until you deliver Your baby will have to spend at least 3 days in the neonatal intensive care unit because of this infection This information will be in your prenatal record; however, please remind your labor and delivery nurse of this finding

This information will be in your prenatal record; however, please remind your labor and delivery nurse of this finding

Why is Magnesium Sulfate used?

To prevent eclampsia - Reduce CNS irritability caused by cerebral edema - Protects fetal brain - Given during labor and at least 24 hours postpartum

The client at 8 weeks' gestation requests information from the nurse regarding abortion. Which action would be the nurse's responsibility? To share her own thoughts on abortion with the client To provide the client with correct, unbiased information To ask why the client wants information about abortion To notify the primary health care provider because this is beyond the scope of nursing practice

To provide the client with correct, unbiased information

How do you diagnose an ectopic pregnancy?

Ultrasound - Pregnancy that occurs outside of the uterus

What tests determine an established due date? How do you calculate this?

Ultrasound: - Done within the first 13 6/7 weeks gestation for the most accurate reading - Done if patient is unsure of the date of their last menstrual period - Transabdominal and transvaginal approach may be used Naegele's rule (pregnancy wheel): - First day of last menstrual period - Subtract 3 months - Add 7 days Pelvic exam: - Determines pelvic size to check if consistent with dates provided

What is the recommended weight gain?

Underweight women, BMI < 18.5 = 12.5-18 kg (28-40 lbs) Normal weight women, BMI 18.5-24.9 = 11.5-16 kg (25-35 lbs) Overweight women, BMI 25-29.9 = 7-11.5 kg (15-25 lbs) Obese women, BMI > 30 = 5-9.1 kg (11-20 lbs)

Signs and symptoms of hyperemesis gravidarum

Usually acute nausea and vomiting - Dehydration (dry mucosa, tenting of skin) - Malnutrition (ketonuria and weight loss) - ECG changes due to electrolyte imbalance - Tachycardia and hypotension

What is a GBS screening?

Vaginal swab that checks for GBS bacteria (normal flora of the vagina) Performed as a precaution to protect the baby from getting an infection during delivery Test performed at 35-37 weeks gestation

How do you diagnose a spontaneous abortion?

- Ultrasound or a pelvic exam - Pregnancy lost before 20 weeks - Usually occurs between 5-8th week of gestation

How do you diagnose hyperemesis gravidarum?

Diagnosed in the first trimester of pregnancy and can lead throughout the entire course or end by week 20 - Diagnosed with kidney labs, electrolyte imbalance, weight loss, and ketonuria

Nursing implications with Magnesium Sulfate

Dim the lights Seizure precautions (seizure pads, suction, O2) Reduce environmental stimuli

Which topics would the nurse include in the teaching session for a pregnant client regarding common discomforts caused by fetal growth and hormonal changes? Select all that apply. Emesis Nausea Diarrhea Backache Dyspepsia

Emesis Nausea Backache Dyspepsia (indigestion)

Which expected date of birth (EDB) would the nurse, using Naegele's rule, provide to the pregnant client who states her last normal menstrual period was April 5?

January 12th

According to Naegele rule, which is the expected date of delivery (EDD) of a client whose last menstrual period began on April 15?

January 22nd

Nursing education for gestational diabetes

- Monitor carbs - Daily blood sugar checks - Diet (3 meals, 3 snacks) - Exercise (3 days a week, 30 mins each)

Nursing education for hyperemesis gravidarum

- Non pharmacological: acupuncture, ginger, vitamin B6 - Pharmacological: reglan, phenergan (zofran safety in pregnancy hasn't been proven)

Which time during the menstrual cycle would the nurse stress as the optimal time to achieve pregnancy? Midway between periods Immediately after a period ends 14 days before the next period is expected 14 days after the beginning of the last period

14 days before the next period is expected

During a prenatal education class, the nurse discusses the importance of fetal movement awareness. Why is this an important concept to teach? An increase in fetal movement indicates the onset of labor is near A decrease in fetal movement necessitates an evaluation of fetal well-being Fetal movement awareness increases the emotional bond of mother to fetus A perceived decrease in fetal movement is a symptom of preeclampsia

A decrease in fetal movement necessitates an evaluation of fetal well-being

Which are the medical concerns in adolescent pregnancies? Select all that apply. Anemia Macrosomia Gestational diabetes Poor maternal weight gain Pregnancy-induced hypertension

Anemia Poor maternal weight gain Pregnancy-induced hypertension

What are the multiple hematological changes that occur during pregnancy? (BP, HR, blood volume, etc) How does this vary throughout pregnancy?

Anemia - higher blood volume

Which hormone would the nurse explain as stimulating the release of estrogen and progesterone after fertilization? Inhibin Testosterone Follicle-stimulating (FSH) Human chorionic gonadotropin (hCG)

Human chorionic gonadotropin (hCG)

Which blood test will be prescribed for a client who fears pregnancy despite the use of oral contraceptives? Prolactin test Testosterone test Progesterone test Human chorionic gonadotropin (hCG) test

Human chorionic gonadotropin (hCG) test

After a speculum examination in the first trimester of pregnancy, the nurse states that the client's cervix is bluish purple, which is known as the Chadwick sign. Which explanation of this sign would the nurse provide? It helps confirm your pregnancy It is not unusual, even in women who are not pregnant It occurs because the blood is trapped by the pregnant uterus It is caused by increased blood flow to the uterus during pregnancy

It is caused by increased blood flow to the uterus during pregnancy

On arriving in the birthing room the nurse finds the client lying on her back with her head on a pillow and the bed in a flat position. The nurse explains that it is important to avoid lying in the supine position because of which reason? It may precipitate a severe headache It can impede the progression of labor It may cause nausea as labor progresses It will prevent adequate blood flow to the fetus

It will prevent adequate blood flow to the fetus

At 12 weeks' gestation a client with a history of several spontaneous abortions says to the nurse, "Every day I wonder whether I'll be able to have this baby." How would the nurse respond? I can understand why you're worried; however, you'll have other chances in the future to get pregnant You're getting the best of care. Please tell me about the problems with your previous pregnancies It's understandable for you to be worried that you won't be able to carry this pregnancy to term. You've had a difficult time Your pregnancy has lasted past the time when most early spontaneous abortions occur. I think you'll be able to continue the pregnancy

It's understandable for you to be worried that you won't be able to carry this pregnancy to term. You've had a difficult time

The nurse is caring for a client receiving magnesium sulfate for treatment of preeclampsia. Which findings alert the nurse to signs of magnesium sulfate toxicity? Select all that apply. Proteinuria Epigastric pain Loss of patellar reflexes Urine output of 40 mL/h Respirations of 10 breaths/min

Loss of patellar reflexes Respirations of 10 breaths/min

Which changes would the nurse include in the childbirth class focusing on the maternal psychologic and physiologic alterations that occur near the end of pregnancy? Select all that apply. Food cravings increase Nesting needs increase Dependency needs decrease Anxiety about childbirth increases Gastrointestinal motility decreases

Nesting needs increase Anxiety about childbirth increases Gastrointestinal motility decreases

Which client would the nurse identify as being at greatest risk for a hypertensive disorder of pregnancy? Obese primigravida 31-year-old multipara Multipara with more than six previous pregnancies Primigravida who took oral contraceptives within 3 months of conception

Obese primigravida

Probable signs of pregnancy

Objective signs and symptoms - Positive pregnancy test - Braxton Hicks - Goodell's sign - Hegar's sign - Chadwick's sign