Ch 4 Davis Advantage Maternal Nursing

A new patient to the OB clinic tells you that her last menstrual period (LMP) was 09/14. What is her due date using Naegele's rule? The answer should be written as MMDD (for example 09/14 should be written as 0914). Enter the numeral only.

0621

Misty is 28 years old and 15 weeks pregnant with her first baby. As you perform her OB assessment in the office, she starts to cry. She tells you she doesn't know what she was thinking becoming pregnant. She says she loves the idea of being a mom but didn't realize how much she would have to give up and change. What is your best therapeutic response? "That's very selfish of you. Maybe you should give the baby up for adoption if you aren't going to be able to be a good mom." "I understand that you feel sad that you can't do the same things any longer. Would you like me to give you the number to a good therapist?" "I understand that you feel sad that you can't do the same things any longer. Grieving the loss of things you won't be able to do any longer is a normal response to pregnancy. Do you want to tell me more about how you're feeling?" "I understand that you feel sad that you can't do the same things any longer. Grieving the loss of things you won't be able to do any longer could cause you to develop anxiety and depression. It's important that you get over those feelings and start enjoying your pregnancy."

"I understand that you feel sad that you can't do the same things any longer. Grieving the loss of things you won't be able to do any longer is a normal response to pregnancy. Do you want to tell me more about how you're feeling?"

Monique, who is 18 weeks pregnant, has called the office complaining of a sharp, quick pain on her left side that goes away when she leans to the left. What would be your recommendation? "Move slowly when standing and sitting and continue to lean toward the pain when it occurs. If that doesn't help, it continues, or you have other symptoms, be sure to come in and be seen." "You are probably having an appendicitis attack; you need to go to the hospital right away." "You could be going into labor. Go to OB triage at the hospital right away." "Move slowly when standing and sitting to be sure you don't fall. Your center of gravity will be shifting, and you may feel off balance at times."

"Move slowly when standing and sitting and continue to lean toward the pain when it occurs. If that doesn't help, it continues, or you have other symptoms, be sure to come in and be seen."

Sarenti is in the office for a routine OB check, and you are measuring her fundus at 26 cm. What is Sarenti's probable gestational age in weeks?

26

Chloasma

pigmentary skin discoloration usually occurring in yellowish brown patches or spots "mask of pregnancy"

What is the difference between a diagnostic test and a screening test? A diagnostic test confirms the presence of a disorder or disease. A screening test indicates a patient at increased risk for a disorder or disease and identifies those who need diagnostic testing. A diagnostic test identifies those at risk for developing a disorder or disease. A screening test confirms the presence of specific types of disorders and diseases. A diagnostic test and a screening test are only different based on the type of body fluid used for testing and time of gestation. A diagnostic test can only be done on maternal blood, and a screening test can only be done on maternal blood drawn from the chorionic villi.

A diagnostic test confirms the presence of a disorder or disease. A screening test indicates a patient at increased risk for a disorder or disease and identifies those who need diagnostic testing.

What best describes a presumptive sign of pregnancy? A sign that can be confirmed by diagnostic tools such as US or blood test A sign that usually ends up having a different medical explanation A sign that patient experiences and reports A sign that can be objectively identified by the examiner

A sign that patient experiences and reports

"Do you feel safe at home?" is a question that should be asked at what time? At every intake or initial appointment and as needed thereafter if there are signs of concern. If the patient appears unhappy in her relationship. If the patient is recently divorced and you feel the relationship was abusive. At the first visit while the partner is in the room so that you can note their response as well.

At every intake or initial appointment and as needed thereafter if there are signs of concern.

Changes to the vagina during pregnancy

Area becomes more edematous from poor venous return and more rigged as pregnancy continues Operculum and Leukorrhea occur The vagina be comes more acidic

Which of the following medical concerns can cause or increase the likelihood of supine hypotension in a pregnant patient? Select all that apply. Asthma Hyperemesis gravidarum Goodell's sign Ptyalism Pregnancy-related anxiety

Asthma Hyperemesis gravidarum Pregnancy-related anxiety

Changes in blood volume and hematocrit in pregnancy

BV grows 40-50% over pregnancy and peaks at term BV to kidneys increases -> more peeing Hematocrit low because of increase in BV (7%) so tell pt to stay hydrated The increase BV also causes edema

Braxton Hicks contractions (occurence and relief)

Begin as early as 16th week and are relived with hydration and walking

Tina is 6 weeks pregnant and at the OB office for her initial OB visit. She is in a committed relationship and the pregnancy is not unwelcome though it was unplanned. She states, "I'm just not sure how I feel about being pregnant, it's not real to me yet." What is your best therapeutic response to Tina? "We need to get you to a counselor as soon as possible to make sure you don't harm yourself or your baby." "Have you talked to your partner about your feelings so you can decide if you'd rather terminate the pregnancy?" "Being ambivalent to your pregnancy is a normal response. Do you have any questions or concerns I can answer for you about your pregnancy?" "Being ambivalent to your pregnancy is a normal response. You shouldn't worry about anything right now though, as the baby is fine and so are you."

Being ambivalent to your pregnancy is a normal response. Do you have any questions or concerns I can answer for you about your pregnancy?

Juanita is 11 weeks pregnant with an unintended pregnancy with her life partner Joel. They've begun discussing where the baby will sleep and are making plans for Juanita to stay home for the first few years and not work. What maternal process of pregnancy is Juanita displaying? Binding-in Fetal embodiment Seeking safe passage Nesting

Binding-in

Changes in uterus during pregnancy

Blood flow increases due to progesterone Estrogen and progesterone cause the uterus to enlarge and stretch as fetus grows Uterus goes from lightbulb shape at the pubis to globular structure in the pelvis and abdominal cavity Fundus reaches the umbilicus by term and uterus is below the xiphoid Lightening occurs By term the muscles stretch and thin and weight increases Estrogen causes muscles to contract

Chadwick's sign

Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion. Occurs around 6-8 week of pregnancy

Changes in eyes and nose during pregnancy

Blurred vision is common and only temporary Nasal stuffiness and congestion can be relieves with increase in fluids Nosebleeds become more common

Pruritus gravidarum

severe itching in pregnancy from stasis of liver bile

Hyperemesis gravidarum

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

Goodell's sign

softening of the cervix from estrogen and progesterone

Prolactin

stimulates milk production

Probable signs of pregnancy (PROBABLE)

Positive pregnancy test Returing of fetus when uterus is pushed (Ballottement's sign) Outline of fetus palpated Braxton hicks contractions A softening of the cervix (Goodell's sign) Blueish color (Chadwick's sign) Lower uterine segment soft (Hega's sign) Enlarged uterus Also Piskack's sign which is uterine asymmetry to implantation side

vena caval syndrome

symptoms of dizziness, pallor, and clamminess that result from lowered bp when a pregnant woman lies supine and the enlarged uterus presses on the vena cava. (aka supine hypotensive syndrome)

CO changes during pregnancy

CO increases and peaks 20-24th weeks and remains there for the rest of pregnancy BP stays same in first trimester and decreases in second trimester

Danielle is 12 weeks pregnant, and her husband Chris is having a difficult time adjusting. He's been experiencing insomnia, weight gain, food aversion, and nausea. What is Chris experiencing? Couvade syndrome Moratorium phase Ambivalence Dyspepsia

Couvade syndrome

Supine hypotensive syndrome

Dizziness and a drop in blood pressure caused when the mother is in a supine position and the weight of the uterus, infant, placenta, and amniotic fluid compress the inferior vena cava, reducing return of blood to the heart and cardiac output.

When discussing personal comfort with pregnant patients, which of the following should be discouraged? Douching External genital cleansing Wearing loose, cotton clothing Resting in a side-lying position

Douching

Let-down reflex

the reflex that forces milk to the front of the breast when the infant begins to nurse Oxytocin

Changes with mouth during pregnancy

Gingivitis from an increase in blood supply/edema Ptyalism gravidarum is increase saliva and lasts from 1st trimester to after birth Pyrosis (heartburn) is common at the end of the third trimester

Changes with the heart during pregnancy

Heart shifts upwards and to the left Av HR increases 10-15 Normal cardiac hypertrophy from increase blood volume and work First and third HS exaggerated and systolic mumurs are common

Palmar erythema

unusual spidery redness of the neck, thorax, face, and arms From increase estrogen

You are working in an OB office on June 9 and gathering assessment data on Sophia. Sophia's due date is June 25. Using Naegele's rule, determine if Sophia's current gestational age is preterm, full term, early term, or postterm. Postterm Full term Early term Preterm

Early term

Maria is 32 weeks pregnant and complaining of varicosities in her legs. What should be included in her routine assessments due to this complication? Nothing should change with her assessments; this is a normal part of pregnancy. A recommendation to the provider for physical therapy. Education on prevention and checking peripheral pulses. Assessments for pregnancy-induced hypertension.

Education on prevention and checking peripheral pulses.

Montgomery tubercles

Enlarged sebaceous glands in areola on both breasts

All of the following are probable signs of pregnancy except Positive pregnancy test Fetal heartbeat felt by Doppler Goodell's sign Braxton-Hicks contractions

Fetal heartbeat felt by Doppler

Which one of the following is only caused by pregnancy? Piskacek's sign Braxton-Hicks contractions Urinary frequency Fetal movement palpated by a midwife or obstetrician.

Fetal movement palpated by a midwife or obstetrician.

Positive signs of pregnancy (FETUS)

Fetal movements felt by healthcare professional Electronic device detects HR The delivery off the baby Ultrasound See visual movement

Changes in breasts during pregnancy

First sign of pregnancy is changes in the breasts Montgomery tubercles enlarge Precolostrum is found during second trimester Colostrum may leak as early as 16 weeks

Maria is in the office today for a routine OB visit at 39 weeks and 4 days. At what stage of pregnancy would she be considered to be in? Early term Full term Postterm Late term

Full

Lightening

Fundal hight decreases by 1-2 cm at end of pregnancy as fetus decends

Which of the following are due to increased estrogen levels after conception takes place? Select all that apply. Gingivitis Pyrosis Palmar erythema Chadwick's sign Braxton-Hicks contractions

Gingivitis Palmar erythema Chadwick's sign Braxton-Hicks contractions

Which of the following statements best describes Naegele's rule? It determines the due date based on ultrasound findings and is the most accurate dating method. It determines the due date based on maternal approximation of sexual activity and is correct within a week before or after. It is based on the date of the last menstrual period (LMP) and should be used with caution in women with irregular menses or who were on hormonal contraception. It is based on HCG levels assessed through a blood or urine sample at the beginning of pregnancy. HCG levels spike at a specific time and then decline, determining the gestational age of the pregnancy.

It is based on the date of the last menstrual period (LMP) and should be used with caution in women with irregular menses or who were on hormonal contraception.

Which of the following women may need a referral for counseling? Amy, newly pregnant and single at 23, who has several aunts and girlfriends who are supportive and has already started working on the nursery. Katie, 29, happily married, though struggling with infertility and trying to get pregnant for 3 years, and now that she is, she is extremely anxious. Melique, 26, mom of two who already was disappointed when she found out she's having another boy, whose husband and family are supportive and excited for another member. Andrea, 38, and happily married to her wife for 6 years, who is newly pregnant by IVF, who continually rubs her belly and asks questions about the best things to do for the baby during her visit.

Katie, 29, happily married, though struggling with infertility and trying to get pregnant for 3 years, and now that she is, she is extremely anxious.

changes in ovaries during pregnancy

LH secreted to stim corpus luteum to produce progesterone till the placenta grows

A new nurse on labor and delivery is concerned by her patient's hemoglobin level on the admittance labs, which is 11 g/dL. What should the new nurse be taught about hemoglobin levels? Lab levels in pregnancy are impacted by hemodilution, which will lower the acceptable level of hemoglobin. The patient has lost blood during delivery, making this an expected finding. Anemia in women is normal, particularly when pregnant, though the patient may be symptomatic. The patient should be placed on fall precautions just in case. The patient is losing blood and should be assessed for vaginal bleeding to rule out other concerns.

Lab levels in pregnancy are impacted by hemodilution, which will lower the acceptable level of hemoglobin.

Which of the following women is at the greatest risk for maladaptive behaviors during her pregnancy? Ann, 26, a nurse who is 19 weeks into an unintended pregnancy with her partner of 5 years who is complaining of not being able to drink for the next several months. Lee, 17, a fast-food worker, 24 weeks into an unintended pregnancy who has just told her nurse she thinks her boyfriend has gonorrhea and has been seeing another woman. Hillary, 19, an unemployed college student who is 14 weeks pregnant and taking the next year of school off to move home with her parents to have the baby. Leah, 32, an IT worker, 21 weeks pregnant, in a stable marriage for 6 years but with no local girlfriends, recently diagnosed with bipolar disorder.

Lee, 17, a fast-food worker, 24 weeks into an unintended pregnancy who has just told her nurse she thinks her boyfriend has gonorrhea and has been seeing another woman.

Assessment needs and how patients handle the tasks of pregnancy will be different for each person, significantly influenced by their __________ and ___________ information. Age and weight Gravida and para Medical and psychological Relationship and sexual preference

Medical and psychological

Operculum

Mucus plug from cervical mucus to protect uterus from bacteria

Establishing estimated date of birth

Naegele's rule, add 7 days and subtract 3 months from the date of last menstration

Pregnancy-induced complications in the urinary system can include which of the following? Select all that apply. Increased peristalsis, leading to urinary frequency and urgency. Nocturia is a common concern in the first and third trimester but not the second trimester. Kidneys will enlarge and the glomerular filtration rate (GFR) will increase. An increase in both glucose and protein excretion is normal in pregnancy. Due to renal vasodilation, infections of the renal and urinary system are less common during pregnancy.

Nocturia is a common concern in the first and third trimester but not the second trimester. Kidneys will enlarge and the glomerular filtration rate (GFR) will increase. An increase in both glucose and protein excretion is normal in pregnancy.

Krystin is 38 weeks pregnant and in the office today complaining of shortness of breath. What is the first nursing action you should take as her nurse today? Reassure her this is a normal part of pregnancy, and she should simply raise her arms over her head and breathe slow and deep when it happens. Call 911 and have her transferred to the emergency room. Put her on a rebreather mask with oxygen running at 10 L/min. Obtain a full set of vital signs and ask Krystin to tell you more about the shortness of breath she is having.

Obtain a full set of vital signs and ask Krystin to tell you more about the shortness of breath she is having.

Persumptive signs of pregnancy (PRESUME)

Period absent (amenorrhea) Really tired Enlarged breasts Sore breasts Urination increase Movement of fetus perceived (quickening) Emesis (morning sickness) Also stretch marks

A previously potty-trained 3-year-old who begins to wet the bed and requests to wear a diaper when a newborn sibling it brought home is experiencing which behavior? Aggression Indifference Anticipation Regression

Regression

Since discovering she was pregnant 6 weeks ago, Martina has called her OB office several times a week for numerous complaints and concerns, all of which were normal or unfounded. Now in her 15th week of pregnancy, she insists on being seen for an ultrasound because she is worried the baby has something wrong with it. What is Martina suffering from? This is a normal response to pregnancy in some women and is not concerning. She is suffering from post-traumatic stress disorder (PTSD) and should be referred to counseling. She is experiencing pregnancy-related anxiety and should be referred to counseling. She is at increased risk for postpartum depression and may harm herself.

She is experiencing pregnancy-related anxiety and should be referred to counseling.

Erika lost her first pregnancy at 14 weeks approximately a year ago. She is now back for a new OB appointment with her second pregnancy at 8 weeks. As you do your initial assessment, she tells you she's worried that she isn't excited about this new pregnancy and won't be able to bond with the baby when it comes. Which of the following statements is true about Erika's situation? She should have waited longer before becoming pregnant, as it's obvious she's still grieving for her lost pregnancy. She is experiencing the normal psychological responses to becoming pregnant after a loss that will resolve as she moves through the developmental tasks of pregnancy. She is experiencing the normal psychological responses to becoming pregnant after a loss that will only resolve once she receives counseling and possibly medication. She is experiencing depression and should be counseled on what antidepressants are safe to use while pregnant.

She is experiencing the normal psychological responses to becoming pregnant after a loss that will resolve as she moves through the developmental tasks of pregnancy.

Misty is a new patient and, during her assessment, she mentions that she's a vegetarian. What would be a priority nutritional recommendation for her? She should begin eating meat as soon as possible to support her pregnancy. She should take a calcium supplement to support her body's increased need for calcium. She should already know her nutritional needs as a vegetarian; no further recommendations should be needed. She should eat large meals with plenty of nuts, seeds, and leafy greens to compensate for not eating meat.

She should take a calcium supplement to support her body's increased need for calcium.

Changes in the cervix during pregnancy

Softens (goodell's sign)

Oxytocin's role during pregnancy is which of the following? Select all that apply. Stimulates uterine contractions. Acts as a fetal growth hormone. Stimulates the let-down reflex in the breasts. Increases at term, helping to soften and dilate the cervix. Can cause palmar erythema.

Stimulates uterine contractions. Stimulates the let-down reflex in the breasts.

Which of these commonly develop on the abdomen and breasts during pregnancy, and are caused by increased adrenal activity, in turn causing connective tissue to become weak and fragile? Angioma Chloasma Striae gravidarum Linea nigra

Striae gravidarum

Which of the following are expected responses from an adolescent upon becoming pregnant? Select all that apply. Telling her peers she's gaining weight because of a diet change. Making her first prenatal appointment at 25 weeks. Making her first prenatal appointment at 8 weeks. Using the pregnancy as an opportunity to gain independence from her parents. Being unwilling to name the infant and referring to the pregnancy as 'it'.

Telling her peers she's gaining weight because of a diet change. Making her first prenatal appointment at 25 weeks. Being unwilling to name the infant and referring to the pregnancy as 'it'.

Which of the following are the most likely to have a hard time adjusting to their new role as grandparents? The Smiths, both 62, expecting their fourth grandchild in the last 3 years, all from their three adult children in stable relationships. The Browns, 40 and 42, whose 22-year-old daughter let them know she was 10 weeks pregnant 6 months after getting married. The Fletches, both 37, whose 17-year-old daughter with mental health concerns is 22 weeks pregnant. Caroline, 49, whose 19-year-old daughter and her boyfriend of 3 years announced she's 7 weeks pregnant and they are getting married at city hall tomorrow.

The Fletches, both 37, whose 17-year-old daughter with mental health concerns is 22 weeks pregnant.

Which of the following is true about the immune system in pregnancy? The immune system has a normal physiological decrease. The immune system has a normal physiological increase. The immune system remains unchanged. The immune system is in remission to prevent rejection of the fetus.

The immune system has a normal physiological decrease.

Which of the following increase the chance of falls for women who are pregnant? Select all that apply. The symphysis pubis widens. The uterus shifts backward. The sacroiliac joint loosens. The round ligaments of the uterus expand downward. The gravid uterus may cause supine hypotension.

The symphysis pubis widens. The sacroiliac joint loosens. The gravid uterus may cause supine hypotension.

A patient is asking you about the pimple-like bumps around her nipples that have appeared since she became pregnant. How would you answer this question? Those are Montgomery tubercles, and they help to keep your nipple soft while breastfeeding. Those are Montgomery tubercles, and they will disappear as your pregnancy progresses in response to decreasing estrogen levels. Those are Montgomery tubercles, and they are a response to the rising progesterone and estrogen levels and will produce colostrum once the baby delivers. Those are ingrown hairs that require exfoliation to correct. Be sure to check with the doctor if they don't resolve after you shower.

Those are Montgomery tubercles, and they help to keep your nipple soft while breastfeeding.

Changes in resp system during pregnacy

Tidal volume increases 30-40% Progestrerone causes chronic hyperventilation Nurses should tell pts to rest with head elevated and take slow deep breaths

Which of the following are reasons to encourage education in prenatal appointments and in childbirth education classes? Select all that apply. To ensure the patient will follow instructions given by the health care team during labor. To correct misinformation from other sources. To assess psychological adaptation to the pregnancy. To offer anticipatory guidance for the time between visits. To formulate nursing diagnosis for the delivery nurses to follow concerning pain control and other patient wishes for delivery.

To correct misinformation from other sources. To assess psychological adaptation to the pregnancy. To offer anticipatory guidance for the time between visits

A transvaginal ultrasound can be used for which of the following? Select all that apply. To diagnose pregnancy. To perform a PAP smear. To obtain an estimated due date (EDD). To rule out abnormalities in the pregnancy. To identify STIs or other infections.

To diagnose pregnancy. To obtain an estimated due date (EDD). To rule out abnormalities in the pregnancy.

You're creating a handout for newly pregnant patients to the OB office where you work about common discomforts of pregnancy. What anticipatory guidance would you include? Select all that apply. What foods to avoid to prevent nausea. Where to obtain a breast pump. The importance of dental hygiene. Handling urinary frequency. Avoiding Supine Hypotensive Syndrome.

What foods to avoid to prevent nausea. The importance of dental hygiene. Handling urinary frequency. Avoiding Supine Hypotensive Syndrome.

Leukorrhea

white discharge from the vagina

Pyrosis

heartburn

Dyspepsia

indigestion

Diastasis recti

midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles

Ptyalism gravidarum

excess saliva