Antepartum Terms and PQs
c) prevent neural tube defects and anencephaly
Daily intake of folic acid during pregnancy is required for which function in fetal growth and development? a) cover the increased production of RBCs b) improve neurodevelopment of fetal brain and spinal cord c) prevent neural tube defects and anencephaly d) support metabolism, tissue synthesis, and tissue repair
a) pulmonary embolism
Partially obstructed venous blood flow during pregnancy places a client at risk for which complication? a) pulmonary embolism b) decreased iron absorption c) hypertension d) leukocytosis
d) shortness of breath on exertion
The nurse is assessing a pregnant client during the third trimester. Which clinical finding is expected in the later stages of pregnancy? a) tachycardia b) dyspnea at rest c) progressive dependent edema d) shortness of breath on exertion
equivocal
(CST) FHR decelerations lasting longer than 90 seconds
positive
(CST) late decelerations with half of traced contractions
unsatisfactory
(CST) less than three contractions in a 10-minute period
negative
(CST) no significant variable or decelerations
CST interpretations
- negative: no late decelerations - positive: late decelerations present in minimum of 50% of contractions - equivocal-suspicious: intermittent late decelerations or significant variable decelerations - equivocal: FHR decelerations in presence of contractions more frequent than every 2 minutes or lasting longer than 90 seconds - unsatisfactory: fewer than 3 contractions in 10 minutes or a tracing cannot be interpreted
chorionic villus sampling risks
-Rate of pregnancy loss less than 1% if performed by specially trained physician -Reports of limb reduction defects when performed at less than 10 weeks
recommended fruits
1.5-2 c
fetal movement counting
10 kicks in 2 hours or 4 kicks in 1 hour
recommended calcium
1000 mg
Nagele's rule
1st day of last period + 7 days - 3 months
recommended vegetables
2.5-3 c
recommended iodine
220 mcg
2
29 wks to 36 wks: visits every ___ weeks
recommended dairy
3 c
weekly
37 wks to birth: visits ___
recommended whole grains
6-8 oz
recommended vitamin d
600 IU (15 mg)
recommended iron
9 mg
age older than 35 years, the risk for placental insufficiency, a history of stillbirth from her last pregnancy, hypertension, type 1 diabetes
A 37-year-old G3P2001 client with hypertension and type 1 diabetes with good glycemic control is seen in the antepartum testing unit for a nonstress test (NST) at 36 weeks. Her obstetric history includes an intrauterine fetal death at 38 weeks. What risk factors in the client's history indicate the need for an NST? SATA age older than 35 years, the risk for placental insufficiency, a history of stillbirth from her last pregnancy, hypertension, type 1 diabetes
c) place a pillow under one of the client's hips
A client in her late pregnancy must be in the supine position for an examination. Which strategy would the nurse use to prevent fetal hypoxia in this position? a) elevate the clients feet b) keep the head of the bed at a 45-degree elevation c) place a pillow under one of the client's hips d) ask the client to take long, deep breaths
nonstress test
A method for evaluating fetal status during the antepartum period by observing the response of the fetal heart rate to fetal movement. - reactive: 2+ accelerations within 20 minutes - nonreactive: <2 accelerations in 40 minutes
a) first 12 weeks
During which fetal development time period are defects most likely to occur? a) first 12 weeks b) third trimester c) second 16 weeks d) implantation phase
nuchal translucency measurement
Fetus must be in midsagittal plane, neck in neutral position, measure inner to inner
to confirm fetal heart rate, to confirm gestational age, to identify location of uterus, to determine location of placenta
For which reason is ultrasound guidance required when aspirating tissue during first trimester chorionic villus sampling (CVS)? SATA - to confirm fetal heart rate - to confirm gestational age - to avoid transmission of herpes to fetus - to identify location of uterus - to determine location of placenta
b) at the xiphoid process
In which location would the nurse expect to palpate a pregnant client's fundus at 36 weeks gestation? a) above the pubis symphysis b) at the xiphoid process c) at the umbilicus d) midway between the symphysis pubis and umbillicus
calcium, glucose, iron, amino acids
Increase in absorption of which nutrient occurs by delayed intestinal emptying associated with pregnancy? SATA - calcium - glucose - B vitamins - iron - amino acids
suppress uterus contractions, prevent tissue rejection
Progesterone must be present in adequate amounts during pregnancy for which reason? SATA - suppress uterus contractions - prevent tissue rejection - increase lactic acid production - increase milk secretion - increase systemic vascular resistance
c) open neural tube defects
The nurse explains to the pregnant client that the serum alpha-fetoprotein test screens for which condition? a) trisomy 21 b) Turner syndrome c) open neural tube defects d) chromosomal aberrations
chloasma, linea nigra
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? SATA - chloasma - linea nigra - effacement - morning sickness - cervical softening - urinary frequency
d) "do not ingest anything before the test"
When teaching a client with type 2 diabetes, which statement by the nurse reflects accurate information about preparing for a serum glucose test? a) "eat your usual breakfast" b) "have clear liquids for breakfast" c) "take your medication before the test" d) "do not ingest anything before the test"
learn about the disorder, recieve referrals to specialists, seek information about future health care, electively end pregnancy
Which action might a client take when prenatal diagnosis testing shows abnormal results? SATA - learn about the disorder - recieve referrals to specialists - request further screening - seek information about future health care - electively end pregnancy
preventing conception, discontinuin teratogenic medications during pregnancy if possible, avoiding use of nonessential medications during pregnancy, discussing pregnancy termination if the medication that causes teratogenicity cannot be witheld, educating the client about the risks associated with teratogenic medication
Which antenatal precaution would be taken to minimize the risk of medication induced teratogenesis? SATA - preventing conception - discontinuin teratogenic medications during pregnancy if possible - avoiding use of nonessential medications during pregnancy - discussing pregnancy termination if the medication that causes teratogenicity cannot be witheld - educating the client about the risks associated with teratogenic medication
amenorrhea, breast changes, urine frequency
Which are presumptive signs of pregnancy that the nurse would expect when assessing a client at 10 weeks? SATA - amenorrhea - breast changes - urinary frequency - abdominal enlargement - positive urine pregnancy test
safe birth for mother and infant, promote health and well-being of mother and infant, satisfaction of mother and family with the birth experience
Which are the primary goals of prenatal nursing care? SATA - safe birth for mother and infant - pregnant woman's self management - promote health and well-being of mother and infant - satisfaction of mother and family with the birth experience - understand psychosocial factors that influence the woman
b) bluish-purple discoloration of the cervix
Which cervical change is considered one of the earliest signs of pregnancy? a) formation of a cervical plug by immunoglobulin-rich mucus b) bluish purple discoloration of the cervix c) increase in water content d) softening of the cervix
fetal growth, stores of protein and other nutrients, enlargement of breast tissue, development of placenta, increase of body fluids
Which change during pregnancy contributes to maternal weight gain? SATA - fetal growth - stores of protein and other nutrients - enlargement of breast tissue - development of placenta - increase of body fluids
evaluate pelvic structures, diagnose multiple gestations, identify severe fetal anomalies, estimate gestational age
Which clinical indication is considered for performing a first-trimester ultrasound on an obstetric client? SATA - evaluate pelvic structures - diagnose multiple gestations - identify severe fetal anomalies - estimate gestational age - quantify amniotic fluid amount
b) nutritional intake affects fetal growth
Which consideration is evaluated when making a diet plan for appropriate weight management of a pregnant client? a) excessive weight gain affects only the mother b) nutrition intake affects fetal growth c) weight loss must occur for patients with a high BMI d) food portions must be reduced
d) two or more accelerations in a 20-minute period
Which criteria would be included in a reactive nonstress test? a) less than two accelerations in a 60-minute period b) recurrent late decelerations in a 20-minute period c) variable decelerations lasting longer than 60 seconds d) two or more accelerations in a 20-minute period
poultry, legumes, eggs
Which food source would assist a patient in meeting the recommended guideline for protein during pregnancy? SATA - orange or dark yellow vegetables - poultry - legumes - eggs - almond milk
b) pasteurized soft cheeses can be safely consumed
Which instruction would a nurse provide to a pregnant patient to avoid foodborne illness? a) lunch meat can be consumed in quantitites of 12 oz or less b) pasteurized soft cheeses can be safely consumed c) pate, meat spreads, or smoke seafood can be consumed if they are refrigerated d) consuming all types of fish is an excellent source of nutrients
c) hypertension
Which maternal disorder during pregnancy places the fetus at risk for hypoxia? a) diabetes b) asthma c) hypertension d) hypothyroidism
multiple gestation, advanced maternal age, previous fetal demise, maternal obesity
Which piece of client information would warrant antepartum fetal testing (APFT)? SATA - multiple gestation - multiparity - advanced maternal age - previous fetal demise - maternal obesity
a) ensure rest the day of the procedure
Which piece of information would the nurse relay to the patient following an amniocentesis? a) ensure rest the day of the procedure b) limit intake of fluids c) hold all oral medications d) maintain left side-lying position
a) fetal chromosomal and genetic testing
Which prenatal service is routinely offered to all pregnant clients? a) fetal chromosmal and genetic testing b) in utero surgical repair of identified disorders c) financial assistance for pregnancy d) 3D and 4D ultrasound for identification of fetal sex
a) false reassurance for obstetrical clients
Which problem could be a result of non-clinically indicated ultrasounds? a) false reassurance for obstetrical clients b) financial exploitation of clients c) evidence of casual relationship between sonography and fetal harm d) inaccuracy of fetal sex identification
c) prevents compression of the maternal aorta
Which reason is attributed for placing the pregnant client in a side-lying position for a nonstress test? a) provides comfort for advanced gestation b) allows the fetus to shift into a position for accurate monitoring c) prevents compression of the maternal aorta d) allow for complete assessment of uterine activity
GFR, creatinine clearance, glucose excretion
Which renal function measure increases during pregnancy? SATA - serum creatinine - GFR - BUN - creatinine clearance - glucose excretion
a) alpha-fetoprotein levels (AFP)
Which serum analyte, obtained during second-trimester screening, shows risk of neural tube defects (NTDs) if elevated? a) alpha-fetoprotein levels (AFP) b) inhibin-A c) uE3 d) hCG
a) "using supplements can meet all of my nutrient needs during pregnancy"
Which statement by a patient regarding nutritional requirements during pregnancy would require further education? a) "using supplements can meet all of my nutrient needs during pregnancy" b) "the best source for me of vitamin k is through dark green, leafy vegetables" c) "I should avoid high sodium foods such as canned soups or vegetables" d) "my calcium intake during pregnancy will be the same as before I was pregnant"
"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"
Which statement would the nurse include in a teaching session for pregnant clients regarding fetal growth and development? SATA - "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"
d) opioids
Which substance use during pregnancy would result in decreased fetal movement and bradycardia? a) alcohol b) caffeine c) decongestants d) opioids
d) burning sensation
Which symptom would prompt the nurse to assess for a UTI in a pregnant client? a) frequency b) urgency c) stress incontinence d) burning sensation
c) Sequential Stepwise Screening
Which type of combined sample prenatal screening provides screening and risk results as they become available? a) serum integrated screening b) integrated screening c) sequential stepwise screening d) preimplantation genetic diagnosis (PGD)
d) inappropriate weight gain in teens is linked to preterm delivery
Which weight gain consideration is suggested for adolescent pregnancies? a) weight should be gained according to pediatric BMI categories b) total weight gained for teens should be higher than adult pregnancies c) weight gain during each semester should total around 0.5-2 kg (1.1-4.4 lb) d) inappropriate weight gain in teens is linked to preterm delivery
progesterone
___ promotes the growth of the lobes, lobules, and alveoli
estrogen
_____ stimulates the growth of mammary ductal tissue
linea nigra
a dark line appearing on the abdomen and extending from the pubis toward the umbilicus
cell-free DNA
a newer measurement of fetal genetic material in the maternal blood supply, used to assess the risk of fetal genetic conditions with potentially greater accuracy
probable indicators of pregnancy
abdominal enlargement, cervical softening, changes in uterine consistency, ballottement, braxton hicks contractions, palpation of fetal outline, uterine souffle, pregnancy tests
second/third ultrasounds
abdominal; confirm fetal viability, evaluate anatomy, age, serial fetal growth, compare growth of each fetus, evaluate 4/5 markers of biophysical profile, locate placenta when placenta previa is suspected
percutaneous umbillical blood sampling (PUBS)
aka cordocentesis; usually after 18 wks - aspirate fetal blood from umbillicus for diagnosis/therapy
presumptive indicators of pregnancy
amenorrhea, N/V, fatigue, urinary frequency, breast and skin changes, vaginal and cervical color changes, fetal movement
common neural tube defects
anencephaly and spina bifida
biophysical profile (BPP)
assesses FHR, fetal movement, fetal tone, fetal breathing movement, amniotic fluid amount - interpreted from NST and US - 8 to 10: normal oxygenation - 2: normal - 0: abnormal - 6 is equivocal if fluid amount is normal but suspicious if abnormal - 0 to 4 usually acidemia or perinatal asphyxia
positive indicators of pregnancy
auscultation of fetal heart sounds, fetal movements detected by an examiner, visualization of the embryo or fetus
6
blood volume increases by 6 weeks of gestation
30-50%
cardiac output increases ___
modified biophysical profile (MBPP)
combines NST with US measurement of fluid - 4 measurements totaled to get amniotic fluid index (AFI) - measure of 2 cm or less: oligohydramnios - 18 to 20: excess volume or hydramnios
lecithin-to-sphingomyelin ratio
component of surfactant in which value of 2:1 indicates fetal lung maturity
4
conception to 28 wks: visits every ___ weeks
fetal doppler flow ultrasound
condition of placenta, including hemodynamics - detect fetal anemia when Rh alloimmunization is suspected - measures cardiac cycle differences between peak systolic and end diastolic blood flow velocity - normal, decreased, reversed
chadwick's sign
deepened violet-bluish color of cervix and vaginal mucosa
bloody show
dislodging of thick cervical mucus plug at end of pregnancy, which is a sign of beginning of labor
specialized obstetric ultrasound
done when specific fetal structure or system needs precise assessment
Dick-Read childbirth education
fear of childbirth results in tension and pain
antepartum fetal tests
fetal movement counting (FMC), nonstress test (NST), contraction stress test (CST), biophysical profile (BPP), modified biophysical profile (MBPP), doppler flow ultrasound
nonmedical ultrasound
for gender identification, research, or diagnostic purposes
human chorionic gonadotropin (hCG)
hormone produced by the placenta to sustain pregnancy by stimulating the ovaries to produce estrogen and progesterone
para
how many complete pregnancies after 20 weeks
gravida
how many times a woman has been pregnant
Bradley childbirth education
husband-coached birth; avoid medications and interventions
estrogen
increases fascularity of mucous membranes in the upper respiratory tract
progesterone
increases sensitivity of the medulla oblongata to carbon dioxide
preimplantation genetic diagnosis
is a technique used to identify genetic defects in embryos created through in vitro fertilization (IVF) before transferring them into the uterus - looks for sickle cell anemia, Tay-Sachs, etc.
fetal lung maturity
lecithin-sphinomyelin (l/S) ratio of 2:1, surfactant, and Lamellar bodies
amniocentesis
needle puncture of the amniotic sac to withdraw amniotic fluid for analysis - not used very often anymore
limited obstetric ultrasound
offers data about a specific problem that requires further evaluation
first trimester screening
performed between 11 and 13 weeks of pregnancy and involves an ultrasound and a finger stick blood test - NT - hCG - cell-free fetal DNA
6-8; 32
plasma volume increases from ___ weeks until ___ weeks of gestation
amniotic fluid inspection
preliminary information about surfactant levels based on vernix presence
chorionic villus sampling (CVS)
prenatal diagnostic technique that involves taking a sample of tissue from the chorion
basic obstetric ultrasound
provides information about fetal and maternal anatomy and biometry
Lamaze childbirth education
psychoprophylaxis, uses the mind to prevent pain, most popular
contraction stress test and oxytocin challenge
records response of FHR to stress induced by contractions - may be done if NST findings are nonreactive - 3 contractions in 10 minutes
20-30%
red blood cell volume increases by about ____
ROM
rupture of membranes
goodell's sign
softening of the cervix
relaxin
stimulates the ligaments around the ribs to expand
lamellar body count
storage form of surfactant produced by type II pneumocytes
striae gravidarum
stretch marks
melasma
the "mask of pregnancy," a patchy tan-to-dark brown discoloration of the face.
10-15%; first
the muscles of the heart enlarge ____ during the ___ trimester
first trimester ultrasound
transvaginal; to confirm pregnancy, verify location, identify if twins, determine age, identify markers, determine locations of organs
second trimester screens
triple, quad, and penta screens
