Maternity exam 1
Primary Goal of Maternal and Child Health Nursing
The promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing.
Absence of menses during the reproductive years
amennorhea
study of male repro system
andrology
what vax should pregnant women avoid?
any live vax--big ones being VAR and MMR
what is the narrow pelvis called?
arthopoid--"ape-like"
provider touches the cervix and feels the fetus' head rise and fall
ballottement
why is a heart murmur present in early life?
because the foramen ovale, ductus venosis, and ductus arteriosis never close
wrongful birth
birth of a child w/ a disability that the parent may not have birthed if they had known that the child was going to have a disability
Remarriage where both parties have preextisting kids
blended fam
Type of "practice contractions" that do not lead to cervical dilitation
braxton hicks
grand multipara
carried 5+ pregnancies to viability
developmental pattern that proceeds from head to tail
cephalocaudal
Observed as round and small in a nulligravida client
cervical os
what differentiates real and false labor?
change in cervix
chadwicks sign
change in cervix and vagina to a purplish color d/t inc. bloodflow in early pregnancy
what is the first step to addressing subfertility and why
check the sperm because its easier, less invasive, etc.
Billing's method
checking cervical mucus to determine fertility--if its thin, stretchy, and in copius amounts then ovulation is occurring
what posn can be used to relieve LBP?
child pose/puppy pose--basically on knees w/ butt up head down
Two people living together without children
childless/childfree fam
what diagnostic test involves takign a small pieve of the placenta for testing?
chorionic villi sampling
characteristics of children w/ Turner's syndrome
cognitively challenged, heart disorders, ambiguous genitalia, micropthalmus
Couples (typically with children) that live together but adults are not married
cohabitation family
a limited geographic area in which residents relate to and interact among themselves
community
wrongful conception
contraceptive failed and became pregnant—ex: IUD failed
what is percutaneous umbilical blood sampling also called?
cordiocentesis--take a blood sample from the UC to test
3 parts of the uterus
corpus, isthmus, and cervix
Term when a father has pregnancy symptoms such as nausea, weight gain and cravings
couvade syndrome
Preferred ways of acting based on cultural traditions
cultural values
study of chromosomes by light microscopy
cytogenetics
why is there an increased sex drive in pregnant or menstruating women?
d/t inc. vasocongestion, inc. blood flow to the area
why are pregnant women always anemic?
d/t major inc. in blood volume w/o a corresponding inc. in iron levels
why does renal fxn inc?
d/t waste from woman and fetus
when does rudimentary placental circulation begin?
day 12
oligohydramnios and cause
dec. amniotic fluid d/t dec. kidney fxn
how does libido change during 1st, 2nd, and 3rd tri?
dec. in 1st b/c of NV, inc in 2nd and 3rd d/t inc. bloodflow
what is expected in pregnancy re: peripheral blood flow? what is not expected?
dec. venous return leading to hemorrhoids; inc. risk of DVT also possible--unexpected findings that indicate DVT is warmth, redness, rope-y texture, tenderness in LE
measurement from the anterior aspect of sacral prominence to symphysis pubic that usually measures 10.5-11 cm
diagonal conjugate
what does decreased maternal alpha fetoprotein possibly indicate?
down syndrome
what is trisomy 21
down syndrome
what is the growing ball of cells called 15 days after conception until week 8?
embryo
Stage that begins 15 days after conception and continues through week 8
embryonic
when do bones begin to ossify, sex becomes discernible, and heartbeat is discernible w/ Doppler in fetus?
end of week 12
when is lanugo formed?
end of week 16
when does "fluttering" occur? (when does the fetus start moving around)
end of week 20
when does a fetus demonstrate PERRL? when does its eyes open?
end of week 24
when does lung surfactant before present in fetus?
end of week 24
when are reflexes seen in fetus?
end of week 32
when does iron storage occur in fetus?
end of week 32
when does lanugo disappear?
end of week 36
when does the fetus have good stores of iron, glycogen, carbs, and calcium?
end of week 36
when does the fetus' head flip down to prepare for birth?
end of week 36
when is primary organ development complete in fetus?
end of week 8
what are some characteristics of children w/ down syndrome?
epicanthal eye fold, simian hand crease, low set ears, protruding tongue, splayed big toet, thick neck skin fold
cultural group someone is born into
ethnicity
Individual perception that one's own cultural is superior to all others
ethnocentrism
Nuclear family + extended family (cousins, grandparents, etc) that all live together
extended/multigenerational fam
Structure that contains the ampulla where fertilization occurs
fallopian tubes
true or false: fetal circulation is the same as extrauterine circulation?
false. fetal circulation is different than extrauterine circulation as it is shunted away from the lungs
what family is considered in the "launching" developmental stage?
family w/ late adolescent
quickening/fluttering
fetal movement
what is "quickening"? when does it first occur?
fetal movement--occurs around week 16-20
what does a biophysical profile assess? (5)
fetal reactivity, breathing mvmt, body mvmt, muscle tone (bringing arms and legs up or not), and amniotic fluid level
Behavior a person exhibits which may or may not align with gender identity
gender expression
inner sense someone has of being male or female (or genderqueer or nonbinary)
gender identity
study of the way in which disorders of genes or chromosome structures occur
genetics
what is McDonald's rule?
gestational weeks correlates to the number of cm between the fundus and symphysis pubis
maternal infxn w/ birth implications (5)
gonorrhea, candidiasis, chlamydia, GABHS, HepB
GTPAL
gravida, term, preterm, abortion, living
what are some common emotional responses to pregnancy? (9)
grief, narcissism, introversion, inc. boundaries, inc. concern of body image, stress (r/t finances and preparation), depression, emotional lability and libido changes
what is the ideal pelvis type for pregnancy?
gynecoid
study of female repro system
gynecology
Hormone found in the bloodstream shortly after implantation up to the 100th day of pregnancy
hCG
hormone produced by placenta that pregnancy tests pick up on
hCG
what is lanugo?
hair that covers fetus' body that usually disappears by the time the baby is at full term (premies born before week 36 will be born w/ lots of lanugo b/c it hasnt gone away that early)
what role does prolactin play in pregnancy?
helps stim the release of oxytocin which causes contractions and also stims milk let down
direct v indirect care
home care situation in which a nurse remains in continual attendance or visits frequently and actually administers care versus home care situation in which a nurse plans and supervises care given by others (such as home care assistants)
causes for female subfertility (5)
inadequate LH or FSH amennorhea and annovulation problems getting ova thru fallopian tubes structural issues (structural defects in cervix, vagina, or uterus) environmental (poor diet, stress, overweight, lack of TEs)
how does blood comp change?
inc WBCs, inc clotting factors, inc platelets
why does fluid retention occur during pregnancy?
inc aldosterone
why does GU fxn inc?
inc. blood volume and inc pressure on bladder
what happens to resporatory system in pregnancy?
inc. stuffiness d/t estrogen leading to nose bleeds
how to relieve leg cramp in pregnancy and what not to do?
inc. water and K+; maybe stretch by pulling toes towards nose but if DVT is present it could get dislodged
termination of pregnancy performed by a knowledgeable healthcare provider to end a pregnancy before fetal viability
induced abortion
what is a good indication of the overall health of a country
infant mortality rate
couple who has not become pregnant after at least 1 year of unprotected coitus
infertile couple
inability to conceive a child or sustain a pregnancy to birth
infertility
dark line on navel from belly button down
linea nigra
bicornate uterus
looks like there are horns by fallopian tubes
maternal infxns w/ fetal implications (6)
malaria, rubella, toxoplasmosis (CATS :D and uncooked meat), herpes, cytomegalovirus, syph
what must occur following a vasectomy to ensure efficacy?
man must come back to get his sperm count checked to check for failure of the vasectomy
darkening of the skin on the cheeks and nose during pregnancy
melasma/cholasma
operculum
mucus plug at cervix
Term for the mucus that seals out bacteria and prevents infection in the fetus and membranes
mucus plug--operculum
types of BC methods
natural family planning, barrier, hormonal, intrauterine devices, and surgical methods
what is created after a sperm cell reaches and fertilizes an egg?
no other sperm can penetrate the egg b/c a special membrane is formed
primary v secondary subfertility
no previous conceptions (never been pregnant as the couple or in previous relationships) versus having previous pregnancies but being unable to conceive now (previous pregnancies can be together or w/ other people)
Two parents and children
nuclear fam
Turner syndrome
one X chromosome or part of one X chromosome is missing
Mittelschmerz
one-sided, lower abdominal pain associated with ovulation that women who are very intuned with their body can sometimes pick up on
internal female repro structures
ovaries, fallopian tubes, uterus, vagina
hormone produce by hypothalamus and stored/released by pituitary gland. it plays a role in milk letdown reflex as well as stimulating ctx and exogenous form is used to induce labor
oxytocin
Structure that supports and protects the reproductive and pelvic organs
pelvis
Tay sachs is associated with folks from what ethnic group?
people w/ Jewish descent
what is the wide pelvis type called w/ a shallow AP diameter?
platypoid
causes of male subfertility (4)
poor sperm production obstruction that prevents sperm motility (e.g. bloackage in seminiferous tubules) ejaculation probs (inability to ejaculate or could be ejaculating too often so theres not enough sperm in the semen when it comes time to fertilize the egg) environmental factors (e.g. Xray exposure, stress, poor diet)
leading cause of neonatal death
prematurity because it is associated with LBW and congenital defects
Establishes a baseline of present health and minimizes the risk of possible complications
prenatal care
why is folic acid important? how much should a woman take if shes thinking about pregnancy or getting pregnant?
prevent neural defects (e.g. spina bifida); take at least 400 mg
Term noted to describe a woman in her first pregnancy
primagravida
hormone that helps establish placenta and inhibits uterine contractions
progesterone
what is expected to occur in musculoskeletal system? what occurs as a result?
progressive cartilage softening resulting in gait changes and possible LBP
hormone produced by pituitary gland that plays a role in lactation
prolactin
social construct that groups people together on presumed physical similarity
race
what is the difference b/w real ctx and braxton hicks?
real ctx do not improve w/ movement, are more regular, and are painful
hormone that relaxes ligaments in pelvis and softens cervix in preparation for birth
relaxin
an ideal contraceptive should be (6)
safe, effective, compatible w/ religion/culture, convenient, affordable, and have no repercussions for future pregnancies
external repro structures of male
scrotum, testes, penis
hyperemesis gravidarum
severe NV during pregnancy--may not even be able to swallow their own spit
what are some indicators that a baby has FAS? (4)
small head, small/squinty eyes, upward turned nose, thin upper lip
goodell's sign
softening of cervix and vagina
hegar's sign
softening of lower uterine segment--the isthmus
what does elevated maternal alpha fetoprotein possibly indicate?
spina bifida
Expectation of a set of behavioral characteristics without regard to the individual characteristics of group members
stereotyping
inability to conceive d/t known cause (e.g. absence of a uterus)
sterility
name for the atrophy or rupture of connective tissue during pregnancy--"stretch marks"
striae gravidum
term used that denotes that couple has a potential to conceive;Conception is possible in some way
subfertility
couvade syndrome
sympathy syndrome--partner experiences symptoms similar to pregnant woman
what is Nagele's rule?
take first day of most recent period, subtract three months, add 7 days. this is the estimated delivery date (of the following year)
when is the fetus viable?
technically questionable at week 20-22 but preferably week 23-24 for lung maturity purposes
what happens to basal body temp around ovulation
temp dec/ half a degree the day before ovulation and then inc. half a degree above baseline during ovulation
wrongful life
test comes back saying that child will be fine but then they have a disability and the parent would have aborted had they known but now they have a child w/ a disability
where does egg get fertilized?
the ampulla (outer 1/3 of the fallopian tube)
what is emotional lability?
the drastic changes in emotions d/t fluctuations in hormones
abortions must be legal in all 50 states during what part of pregnancy?
the first trimester--first 12 weeks. states have differing policies re: 2nd and 3rd tri
where is the egg implanted?
the uterus
why is it painless when a woman's water breaks?
there is no nerve supply to the amnion and chorion
what is cervical mucus like when estrogen levels are low?
thick and not good for fertilization
what is Wharton's jelly?
thick, sticky mucus that surround the two arteries and one vein in the umbilical cord to prevent cord compression/pressure on the vasculature
Spinnbarkeit
thin, stretchy cervical mucus that is prime for fertilization--occurs during ovulation
What endocrine gland is important to check in a woman during matters of subfertility?
thyroid--hyper and hypothyroidism can cause difficulties d/t hormonal effects
ante/retroversion of the uterus ante/retroflexion of the uterus
tipped fwd/bkwd bent fwd/bkwd
how is a US used PP?
to check if all the placenta has been delivered
Talking to pts about what care can be included in their care to be in line with their culture
transcultural nursing
The care of patients that is guided by cultural aspects and respects individual differences
transcultural nursing
sometimes this disorder is incompatible w/ life b/c of anencephaly and if the child survives they are often in a vegetative state
trisomy 13 and 18
what disorders are associated with plasma protein A?
trisomy 13, 18, and 21
tue or false: maternal stress is a teratogen
true
true or false: The fetus' GI tract is sterile
true--this is why vitamin K shot is given because the GI tract hasn't had the chance to begin producing vitamin K yet
Transports oxygen and nutrients to the fetus from the placenta and returns waste products to the placenta
umbilical cord
how long before labor/delivery can a mucus plug be released?
up to 2 weeks
where should implantation occur?
upper uterus b/c if its too low the placenta will end up covering the cervix (placenta previa)
what is an important consideration when prescribing an ABX to a woman on oral contraceptives?
use an alternative/barrier method because ABX interfere with oral BCs
Structure that accommodates the growing fetus
uterus
Surgical procedure eliminate male fertility
vasectomy
when is fundus at umbilicus?
week 20
when is meconium produced?
week 24
A gelatinous mucopoly-saccharide that gives the umbilical cord body and prevents pressure on the vein and arteries
wharton's jelly
when should a mother receive Rhogam?
when she is Rh- and baby could be Rh+
what is lightening?
when the fundus lowers as the uterus moves into position to give birth
gravida
woman who is or has been pregnant
after the sperm enters the egg it undergoes its first cell division and divides into two--what is the structure now called?
zygote
what is/how long is the epididymis?
20 ft long coiled tube that stores sperm for maturation
how long is the umbilical cord and what is the diameter?
21 inch long, 2 cm diameter
avg weight gain during pregnancy for a person w/ normal prepregnancy weight
25-35lbs
para
# of pregnancies that reached viability
how much does temp inc. during pregnancy?
1 degree
3 definitions of family
1. "A group of people related by blood, marriage, or adoption living together." 2. "Two or more people who live in the same household (usually), share a common emotional bond, and perform certain interrelated social tasks." 3.Family is who you say it is
ex of presumptive signs of pregnancy (10)
1. Breast changes 2. Nausea, vomiting 3. Amenorrhea 4. Frequent urination 5. Fatigue 6. Uterine enlargement 7. Quickening 8. Linea nigra (brown line from belly button to symphysis pubis) 9. Melasma 10. Striae gravidarum
Two Pillars of the 2020 National Health Goals
1. Increase quality and years of healthy life 2. Eliminate health disparities
ex of probable indicators (7)
1. Maternal serum test 2. Chadwick's sign 3. Hegar's sign 4. Sonographic evidence of gestational sac 5. Ballottement (internal exam and they touch cervix and can feel something move up and back down) 6. Braxton Hicks contractions (tightening around uterus but no cervical change) 7. Fetal outline felt by examiner
1. birth rate 2. fertility rate 3. fetal death rate 4. nenoatal death rate 5. perinatal death rate
1.# of births per 1000 2.# of pregnancies per 1000 childbearing women 3. # of fetal deaths (fetus >500g) per 1000 4.# of deaths per 1000 live births 5. sum of fetal and neonatal death rate
4 phases of health care
1. health promotion 2. health maintenance 3. health restoration 4. health rehabilitation
presumptive v probable v positive signs of pregnancy
1. indications that could occur at the beginning of pregnancy or d/t other things 2. signs that begin to look more like pregnancy--they are objective signs 3. only absolute definitive indicator of pregnancy
3 basic Qs for subfertility analysis
1. is there sperm and is it good quality, in good number, and have good motility? 2. are there ova? 3. can the sperm and ova meet up to live happily ever after?
1. maternal mortality rate 2. infant mortality rate 3. childhood mortality rate
1. maternal deaths per 100,000 2. infant death per 1000 (occur w/in first year) 3. 1-14 year old deaths per 1000
ex of positive indicator
1. sonogram w/ fetal outline 2. audible fetal heart 3. fetal mvmt felt by examiner
how many fetal movements should be felt in an hour if the etus is not sleeping?
10
avg diagonal conjugate measurement
10.5-11 cm
how big does the pelvic outlet (ischial tuberosity diameter) need to be in order to get fetal head through?
11 cm
how many add'l cals does a woman need during pregnancy
300
when does implantation occur?
8-10 days after fertilization
normal pregnancy has how much amniotic fluid?
800-1000mL
polyhydramnios, possible cause, and sign its occurring
>2000mL of amniotic fluid d/t fetus' inability to swallow, GDM in mom; s/s is a leaking of alkaline fluid
what is considered an advanced maternal age?
>35
pt experiencing morning sickness, what can nurse advise her to do? A. eat crackers or plain toast before getting out of bed B. awaken during the night to have a snack C. skip breakfast and eat lunch after nausea has subsided D. eat a large dinner
A
which of the following should a pregnant pt prompty reports to HCP? A. vaginal bleeding B. ankle swelling C. heartburn after eating D. lightheadedness when laying on back
A
how do you interpret the following: G3 T1 P0 A1 L1 (SATA) A.pt has delivered 1 newborn at term B. pt has not experience preterm labor C. pt has been through active labor D. pt has had 2 prior pregnancies E. pt has 1 living child
A, D, E, A. T1=1 term delivery not B b/c: P0 indicates the pt has had no preterm deliveries not C b/c: A1=1 miscarriage D. G3=2 prior pregnancies +pregnant now E. L1=one living child
nurse is teaching pt about medroxyprogesterone (Depo Provera). What sohuld she include in the teaching? (SATA) A. weight fluctuations can occur B. you are protected against STIs C. you sohuld inc. Ca+ intake D. avoid taking ABX E. irregular vaginal spotting can occur
A,C,E
Which couple would the nurse least likely refer to genetic counseling? A.A 28-year-old woman and 35-year-old man who have traveled extensively worldwide B.A 38-year-old woman and a 42-year-old man C.A 22-year-old woman and a 22-year-old man; the woman reports that her sister has a child with a "bad heart" and experienced one miscarriage. D.A 32-year-old woman and a 45-year-old man who works for a pest control company
A. A 28-year-old woman and 35-year-old man who have traveled extensively worldwide Rationale: Although global travel may expose individuals to infectious disease, this rarely results in chromosomal damage. Women older than 35 years of age and a family history of congenital disorders need to be explored in more detail. Finally, concern is increasing that some genetic disorders may occur due to occupational hazards, such as being in contact with toxic substances.
Which of the following tasks is the most important task of the first trimester of pregnancy? A.Accepting the pregnancy B.Accepting a coming child C.Making plans for the baby D.Sharing time with a significant other
A. Accepting the pregnancy Rationale: Before a fetus moves, adjusting to pregnancy is a primary task; later, adjusting to having a baby becomes the primary task.
A woman's diagonal conjugate measurement is 10.5 cm. You would interpret that her pelvis is which of the following? A.Adequate for childbearing B.Narrow anterior-posterior C.Narrow transversely D.Larger than normal
A. Adequate for childbearing Rationale: A typical diagonal conjugate measurement is 10.5 to 11 and is an adequate measurement.
Mrs. Smith asks the nurse to compute her expected due date. Based on the fact that her last menstrual flow began on July 20, which due date would the nurse estimate? A.April 27 B.March 13 C.April 13 D.May 20
A. April 27 Rationale: Naegele's rule is to count backward 3 months and add 7 days from the first day of the last menstrual period to determine an expected due date.
During a sports physical, a 17-year-old male adolescent asks the nurse when to begin testicular self-exams. Which is the most appropriate patient teaching? A.In adolescence B.In his early 20s C.In his early 30s D.In middle age
A. In adolescence Rationale: Beginning in adolescence will allow the adolescent to establish a good baseline for later changes and also develop the habit of performing the examination.
Which of the QSEN competencies is best reflected by the act of a nurse promoting the use of electronic health records (EHRs) to track the health histories of families who are mobile because of seasonal employment? A.Informatics B.Quality improvement C.Evidence-based practice D.Safety
A. Informatics Rationale: Although use of EHRs would make the monitoring of outcomes easier (quality improvement), minimize risk through system effectiveness (safety), and allow local data to be collected to better guide practice (evidence-based practice), the competency of informatics, which is the use of information and technology to manage knowledge, prevent error, and support decision making, is the competency most relevant to this example.
When a woman uses a vaginal spermicide, which of the following actions should she be performing? A.Insert the product by applicator no more than 1 hour prior to coitus. B.Use a douche within 6 hours after coitus. C.Keep a feminine hygiene product available to use in case her supply of spermicide runs out. D.Place the product near the vaginal orifice instead of further back for immediate contact with sperm.
A. Insert the product by applicator no more than 1 hour prior to coitus. Rationale: Vaginal spermicides are most effective when placed far back in the vagina where seminal fluid and sperm tend to collect; because spermicides have a short half-life at body temperature, they should not be placed more than 1 hour before sexual relations. Feminine hygiene products are not effective substitutes for spermicides.
A woman during her first trimester questions how much longer she will have urinary frequency. Which should the nurse advise her regarding urinary frequency? A.It is a common complaint during the first trimester and again later in the third trimester. B.It is a common concern reported during the entire pregnancy. C.It will subside after the first trimester. D.It is a concern until the last trimester of pregnancy.
A. It is a common complaint during the first trimester and again later in the third trimester. Rationale: The weight of the growing uterus causes urinary frequency during the first trimester. After lightning occurs in the last trimester, urinary frequency reoccurs.
pt's last menstrual cycle began april 1, using nagele's rule when is her due date? A. Jan 8 B. Jan 15 C. Feb 8 D. Feb 15
A. Jan 8
The majority of genetic disorders are inherited as recessive traits. Which best describes these recessive inheritance? A.Two genes for the disease must be present in an offspring for the disease to occur. B.There is a 50% possibility that a child born to two carriers will have the disease. C.Only one parent must carry the trait for the disease to occur. D.Most recessive disorders are not evident at birth (are recessed).
A. Two genes for the disease must be present in an offspring for the disease to occur. Rationale: In a recessive trait, the offspring must receive one recessive gene from each parent to have the active disease. A child born of two carriers would have a 25% chance of having the disease. Both parents must have be carriers for it to occur in the child.
Pt is post op after a salpingectomy d/t ectopic pregnancy. What statement by client req's further clarification? A. "Its good to know I won't havea tubal pregnancy ever again" B. "The doc said the surgery can affect my ability to get pregnant in the future" C. "I understand one of my fallopian tubes was removed" D. "ovulation can still occur b/c my ovaries were unaffected"
A. risk of recurrence of an ectopic pregnancy are inc. following an ectopic pregnancy
A woman calls into the ambulatory care center. She reports that her at-home ovulation predictor test strip results were "positive." She asks what this means. Which should the nurse explain? A."The kit has detected an increased presence of luteinizing hormone (LH) in the urine." B."The kit has determined that your cervical mucus is receptive to sperm." C."The kit has detected an increase in free estrogen in the urine." D."The kit has detected that ovulation will take place within the next 6 to 8 days."
A."The kit has detected an increased presence of luteinizing hormone (LH) in the urine." Rationale: The kit has detected in the urine the hormone that surges prior to ovulation, indicating that the woman is approaching ovulation. Usually, a positive test will indicate that an ovum will be released within the next few days, indicating the most fertile period during the menstrual cycle. The kit does not test for presence of estrogen in the urine or the condition of the cervical mucus.
In performing a family assessment, what is the best way to handle the situation of an English-speaking healthcare provider and parents who do not speak English? A.Assure that a translator from the healthcare organization is present. B.Enlist the help of a neighbor visiting the home who speaks English. C.Ask the oldest child in the family who has learned English to translate. D.Ask the family to bring a friend who speaks English with them for the next visit.
A.Assure that a translator from the healthcare organization is present. Rationale: It is the healthcare organization's responsibility to provide translation resources when the healthcare provider and the clients do not speak the same language. Asking a child in the family, a friend, or a neighbor is not appropriate (except in case of extreme emergency) because this could lead to the child needing to make age-inappropriate judgments or could easily result in a "third-party" health history from nonfamily members.
nurse in health clinic is reviewing contraceptive use w/ group of clients--which statement demonstrates understanding? A. "a water soluble lube sohuld be used w/ condoms" B. "a diaphragm should be removed 2 hr after sex" C. "Oral BC can worse acne" D. "a BC patch is replaced 1x/month
A> Condoms are used w/ water soluble lube
Couple has been unable to conceive for 18 months--what should the nurse assess? (SATA) A. occupation B. menstrual Hx C. childhood infectious illnesses D. Hx of falls E. recent blood transfusions
ABC
what are common discomforts of pregnancy? SATA A. breat tenderness B. urinary frequency C. epistaxis D. dysuria E. epigastric pain
ABC
If constipation is a problem for a woman during pregnancy, which of the following measures would be best to recommend? A.Mineral oil B.Increasing fluid intake C.Reducing her iron supplement D.Increasing intake of meat in her diet to provide fiber
B. Increasing fluid intake Rationale: Increasing fluid content helps relieve constipation in both pregnant and nonpregnant women. Reducing an iron supplement could lead to anemia; mineral oil can reduce absorption of fat-soluble vitamins. Meat does not contain fiber.
External structures of female repro system (9)
Mons veneris, Labia minora, Labia majora, Vestibule, Clitoris, Skene glands, Bartholin glands, Fourchette, Hymen
Pt tells nurse "I am not sure I am happy about being pregnant" what can nurse say in response? A. "I'll tell the HCP you're having these feelings" B. "Its normal to have these feelings during the first few months of pregnancy" C. "you should be happy you're bringing a new life into the world!" D. "I'm going to make you an appt w/ the counselor to discuss these thoughts"
B
nurse is assessing several pts being evaled for infertility, which pt should she anticipate the HCP will refer to genetic counseling? A. Pt w/ sister w/ alopecia B. Pt w/ partner w/ von Willebrand disease C. Pt w/ allergy to sulfa D. Pt who had rubella 3 months ago
B
nurse is reviewing med record of a pt about to undergo a hysterosalpingography. What section alerts nurse to a risk for a complication? A. VS: temp 97, HR 60bpm B. H&P: employed as radiology tech, allergy to shrimp, tonsillectomy at age 18 C. Lab results: BG 103, Hgb 13.1, cholesterol 265 D. meds: rosuvastatin, magnesium oxide, mafenide acetate
B H&P b/c allergy to seafood is a contra d/t dye used in procedure
Which of the following nursing interventions is appropriate when preparing a woman for an amniocentesis? A.Inform her that a narcotic premedication will be given to prevent pain during needle insertion. B.Be certain she knows that there is a slight risk of complication, such as premature labor, from amniocentesis. C.Instruct her not to empty her bladder prior to the procedure. D.Suggest that she take a deep breath and hold it during needle insertion.
B. Be certain she knows that there is a slight risk of complication, such as premature labor, from amniocentesis. Rationale: Amniocentesis carries a slight risk of beginning labor. The woman should not hold her breath because that depresses the diaphragm, shifts the contour of the uterus, and may shift the location of the placenta to the chosen needle insertion site. The bladder should be emptied to avoid accidental puncture.
A woman who is 3 months pregnant enjoys a slow, long walk daily. Which of the following would be most appropriate for her concerning this for the remainder of her pregnancy? A.Reduce walking to half a block daily. B.Continue this as long as she enjoys it. C.Stop and rest every block. D.Engage in aerobics for greater benefits.
B. Continue this as long as she enjoys it. Rationale: Walking is an excellent exercise during pregnancy because it is low impact and increases venous circulation.
During a prephysical interview, a patient reports that she and her husband are using the "rhythm method" of contraception. This method of family planning A.Requires abstinence from sexual intercourse the week after menstruation B.Requires abstinence from sexual intercourse 3 to 4 days before ovulation and 3 to 4 days after ovulation C.Requires close monitoring of temperature and assessment of cervical mucus D.Combines abstinence from sexual intercourse 2 days before ovulation and 2 to 3 days after ovulation in addition to monitoring temperature
B. Requires abstinence from sexual intercourse 3 to 4 days before ovulation and 3 to 4 days after ovulation Rationale: Abstinence during that time period provides some degree of protection during the most fertile days of the cycle. Adding additional ways of determining when ovulation occurs, such as monitoring cervical mucus or basal temperature, would increase the accuracy of predicting ovulation.
Which is an example of a culture-specific value or norm? A.The expectation that communication between the woman and the healthcare provider will be understood by both parties B.The expectation to have only the spouse present during the delivery C.The desire to have healthy family communication D.The desire for the family to have enough basic necessities in life
B. The expectation to have only the spouse present during the delivery Rationale: The expectation of having only the spouse in the delivery room is only one of many cultural values related to expectations about labor and delivery and thus is not a universal one. In contrast, the expectations of clear communication with healthcare providers, having good family communication, and striving for enough resources for the family to flourish are almost universally embraced by all cultures.
A community health nurse is conducting a family assessment of the Robinson family, who are a nuclear family. In the course of the interview, she asks who brings in the bulk of the family's income and is told that it is Ms. Robinson, who works as a business associate. This answer establishes which role for Ms. Robinson in this family? A.The primary decision maker for the family B.The primary provider for the family C.The primary problem solver for the family D.The primary gatekeeper for the family
B. The primary provider for the family Rationale: Whoever brings in the bulk of the family income is considered the primary provider for the family; however, this does not mean that the primary provider is the primary decision maker, problem solver, or gatekeeper. In some cultures, these roles are still maintained by the male member of the nuclear family; therefore, additional information would need to be gathered by the nurse to make these determinations.
The school nurse conducts a sports physical examination on a 14-year-old gymnast, who voices a concern that she has not begun menstruation, even though most of her friends have. Which is the best nursing action? A.Advise her to share her concerns with her family doctor because this certainly is an abnormal occurrence. B.Explain that because of her low body fat, it is not unusual for menstruation not to have begun yet. C.Report these findings immediately to her physician for further evaluation. D.Encourage the use of hormone supplements to promote puberty.
B.Explain that because of her low body fat, it is not unusual for menstruation not to have begun yet. Rationale: Menstruation may begin as late as age 15 years and still be considered within normal limits. Further, body fat and athletic participation may delay the onset. Supplements are not needed or appropriate.
Lactation amenorrhea method (LAM)
BC method that requires breastfeeding every 2-3 hrs w/o supplements, the menses havent returned, and the infant is under 6 mo
which of the following are potential ADEs of implantable progestins (SATA) A. Tinnitus B. irregular vaginal bleeding C. weight gain D. nausea E. gingival hyperplasia
BCD
which of the following are probable signs of pregnancy? SATA. A. montgomery's glands B. goodell's sign C. Ballottement D. chadwick's sign E. quickening
BCD
couple is being evaled for infertility, what statement by the nurse indicates understanding of the assessment process? A. "you will need to see a genetic counselor as part of the assessment" B. "Its usually the woman who has trouble so men don't need to be involved in assessment" C. "the male is easiest to access and the provider will usually begin there" D. "think about adopting first because there are so many babies out there that need good homes"
C
nurse instructing pt on oral BC about things to report to HCP--which does she include? A. reduce mentrual flow B. breast tenderness C. SOB D. inc appetite
C
pt is experiencing maternal hypotension and asks about the cause, what does the nurse say? A. "its d/t the inc. blood volume" B. "its d/t the pressure of the uterus on the diaphragm C. "its d/t weight of uterus on vena cava" D. "its d/t inc. cardiac output"
C
Which of the following suggestions would be the best technique to help a patient relax during a pelvic examination? A."Bear down as if you have to move your bowels." B."Take a deep breath and hold it." C."Count backward from 20 at a steady pace." D."Tense your abdominal muscles so the uterus contracts less."
C. "Count backward from 20 at a steady pace." Rationale: Tensing abdominal muscles can make a pelvic exam painful. Suggesting a method to aid relaxation can reduce discomfort.
Blood volume normally increases during pregnancy. The extent of this increase is what percentage of prepregnancy volume? A.1% to 10% B.20% to 30% C.30% to 50% D.70% to 90%
C. 30% to 50% Rationale: To supply adequate blood for fetal circulation, blood volume increases 30% to 50%.
As a pregnant woman lies on the examining table, she grows very short of breath and dizzy. The nurse recognizes which as the probable cause? A.Her cerebral arteries are growing congested with blood. B.The uterus requires more blood in a supine position. C.Blood is trapped in the vena cava in a supine position. D.Sympathetic nerve responses cause dyspnea when a woman lies supine.
C. Blood is trapped in the vena cava in a supine position. Rationale: Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava.
The term "reproductive life planning" best refers to the counseling of A.Only adult married women B.Couples who are concerned using contraception prior to their first pregnancy C.Couples with concerns related to conceiving, genetic abnormalities, and child-spacing needs D.Only couples who are concerned about genetic defects in future children
C. Couples with concerns related to conceiving, genetic abnormalities, and child-spacing needs. Rationale: Reproductive life planning is pertinent to any woman and man of childbearing age who is in, or is planning to be in, a sexual relationship. It refers to planning for both having and not having children. Although reproductive life planning can encompass preventing pregnancies for genetic reasons, it is not limited to this purpose.
Which of the following is not a nursing responsibility related to care being provided to pregnant women and children in the home? A.Making home visits for assessment and reevaluation purposes B.Supervising home health personnel C.Driving the pregnant woman to her follow-up medical visits D.Providing health teaching to the patient and family
C. Driving the pregnant woman to her follow-up medical visits Rationale: Although nurses may assist in arranging for patient transportation, transporting home care patients to their primary care providers is not a nursing responsibility. All other activities listed are considered appropriate nursing actions.
A community health nurse is performing a family assessment. He asks questions about how many family members reside in the house and what the relationships are among them. What is the nurse assessing? A.Family member role B.Family function C.Family structure D.Family relation to the community
C. Family structure Rationale: Assessment of family structure targets identification of family members and the relationship among them. Assessment of family member role identifies what primary and secondary roles each member plays within the family. Assessment of family function addresses how well the family as a whole is performing each family function. Finally, assessment of the family in relation to the community is a broader issue in which the relationship of the family to the community at large would be addressed.
A male patient is interested in learning more about having vasectomy. Which of the following would you include in your teaching? A.He will no longer ejaculate. B.He may notice increased scrotal swelling over time. C.He will need to continue to use contraception until at least 10 weeks after the procedure. D.His testes will no longer produce sperm.
C. He will need to continue to use contraception until at least 10 weeks after the procedure. Rationale: Vasectomy does not stop sperm production nor does it affect ejaculation. Usually, there is no swelling of the scrotum, even immediately after the procedure, although occasionally a hematoma may form. Because residual sperm may be present in the vas deferens, birth control should be used until the sperm count is negative.
Which question would be most appropriate to ask in assessing the community in relation to initiating home care for a pregnant woman who needs to be on bed rest? A.Does the caregiver know what steps to take if the pregnant woman's condition suddenly becomes worse? B.Is there adequate electrical wiring in the home? C.Is an emergency response mechanism (e.g., 911) available? D.Are there working smoke detectors in the home?
C. Is an emergency response mechanism (e.g., 911) available? Rationale: Although all of the questions are related to assessing the adequacy of being able to provide home care, the other questions are related to the adequacy of resources available in the individual home rather than in the community. Availability of an emergency response is a community resource.
Which of these actions would be most likely to promote family-centered care? A.Restrict hospital visiting hours so patients can rest. B.Place a limit on the number of visitors per patient to improve patient security. C.Solicit parent's preferences about the way education is delivered. D.Restrict the pediatric play area to specific times.
C. Solicit parent's preferences about the way education is delivered. Rationale: All of the other choices restrict choices that families can make about healthcare services, access to family, and their child's developmental needs.
A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which of the following guidelines should you give her? A.Travel no more than 50 miles daily. B.Do not use a lap seat belt. C.Stop and walk every hour. D.Avoid riding in a pickup truck.
C. Stop and walk every hour. Rationale: The danger of long periods of travel occurs when the woman sits for long periods with her knees sharply bent. Walking increases venous return and reduces the possibility of thrombophlebitis.
Which of the following statements best defines sexual identity? A.The chosen activities a person uses to express masculinity or femininity B.The male or female characteristics determined by genetic factors C.The feeling of being male or female D.The male or female characteristics encouraged by the culture
C. The feeling of being male or female Rationale: Sexual identity refers to whether individuals see themselves as male or female, not to their activity or to the cultural expectation.
A woman is using a basal body temperature (BBT) graph to monitor fertile periods. She calls to report that she did not see any temperature change during her past monthly cycle. To which does the nurse attribute this? A.An elevated estrogen level B.An elevated FSH level C.A failure to ovulate D.An elevated progesterone level
C.A failure to ovulate Rationale: The most likely reason is that the woman probably did not ovulate during this menstrual cycle. During a cycle when ovulation occurs, FSH and estrogen increase near the time of ovulation and progesterone surges within several days after ovulation (also see Fig. 7.1 in the text).
pt is experiencing LBP, what measures can she take to relieve the LBP? SATA. A. avoid any lifting B. perform kegels 2x/day C. perform pelvic rock exercises daily D. use proper body mechanics E. avoid restrictive clothing
CD
A patient is attending her first prenatal appointment and tells the nurse that she has 3 other children...one born at 38 weeks, one born at 39 weeks and the other at 34 weeks gestation. She also had a miscarriage last year...What is her GTPAL?
G5 T2 P1 A1 L3
view of the world and a set of traditions a specific social group uses and transmits to the next generation
Culture
Pt wants to confirm a pregnancy, what should the nurse tell the pt? A. "you should wait until 4 weeks after conception to be tested" B."you should not take any meds 24 hours prior to testing" C. "you should be NPO 8 hrs prior to testing" D. "you should collect urine from first morning void"
D
nurse is teaching pt about IUD. what statement indicates understanding? A. "an IUD sohuld be replaced anually" B. "I cannot get an IUD until I have a child" C. "I should plan on regaining fertility 5 months after the IUD is removed" D. "I will check to make sure the strings of the IUD are still present after my period"
D
The advance practice nurse is conducting health histories and physicals for a local high school football team. Joel Peterson mentions to you that he considers his grandmother as his primary caregiver and wants her as his emergency contact. From this remark, the nurse knows which is his most likely family structure? A.A blended family B.A nuclear family C.A cohabitation family D.An extended family
D. An extended family Rationale: In an extended family, a child's primary caretaker may not be a parent but an extended family member. This is not true in a blended family (in which a divorced or widowed person with children marries someone else with children) or in a nuclear family, which consists only of parents and children. Cohabitational couples are unmarried couples who may or may not have children but usually are the primary caretakers.
In counseling a couple who have experienced subfertility for 14 months, which of the following true statement does the nurse base the initial information given to them? A.Transrectal and scrotal ultrasound testing is routinely performed in the male. B.Semen analysis is usually not performed until all tests in the female partner are negative. C.Testing for tubal patency is performed during the same time period as ovulation monitoring is being done. D.Fertility testing usually begins with ovulation monitoring in the woman.
D. Fertility testing usually begins with ovulation monitoring in the woman. Rationale: Ovulation monitoring in the woman and semen analysis in the man are usually the first steps taken in fertility testing because these are the least invasive of procedures and answers two of three basic questions related to subfertility (sperm quality and available ova). Transrectal and scrotal ultrasound and checking for tubal patency are more invasive procedures and are performed if these initial tests are negative.
The primary focus of which of these phases of health care is that of education related to preventing complications? A.Health promotion B.Health maintenance C.Health restoration D.Health rehabilitation
D. Health rehabilitation Rationale: The goal of health rehabilitation is to prevent complications related to existing illness and to allow clients to achieve an optimum state of wellness. Health promotion is concerned with prevention of disease/illness and promotion of continued good health, health maintenance occurs when the client is at risk for disease/injury, and health restoration is concerned with intervention when disease/injury has occurred.
A fetus is able to maintain blood circulation in utero by the presence of circulatory shunts. The nurse understands this is because the ductus arteriosus in utero shunts blood in which direction? A.Left to right heart atria B.Aorta to the pulmonary veins C.Right ventricle to the aorta D.Pulmonary artery to the aorta
D. Pulmonary artery to the aorta Rationale: Because the fetal lungs are not inflated, blood must be diverted past them. The ductus arteriosus helps to do this by shunting blood from the pulmonary artery to the aorta.
A woman with a history of fetal loss due to genetic disorders is seeking information concerning the use of amniocentesis and chorionic villi sampling (CVS) during her next pregnancy. The nurse understands which to best advise? A.There are no differences in the risk of miscarriage between these tests. B.The loss of pregnancy is reduced in the CVS test because it is done earlier in the gestational period. C.The amniocentesis can safely be done anytime after the 8th week of pregnancy. D.The CVS has a higher risk of both miscarriage and fetal damage.
D. The CVS has a higher risk of miscarriage and fetal damage. Rationale: CVS is performed earlier in the pregnancy than amniocentesis and carries a higher risk of miscarriage. It also carries the risk of limb reduction syndrome in the fetus. Amniocentesis is usually carried out under ultrasound guidance after the 14th week of pregnancy, reducing the risk of miscarriage and fetal injury.
Select the assessment finding that would most likely result in a decision that home care is not an option for a child. A.Smoke detectors with outdated batteries B.The family is unfamiliar with administering total parenteral nutrition needed by the child. C.Three ants were found crawling on a kitchen counter. D.The need for the primary wage earner to become unemployed to become the primary caretaker
D. The need for the primary wage earner to become unemployed to become the primary caretaker Rationale: Loss of family income affects the entire family as well as the child needing home care. Smoke batteries can be replaced, and the family can be educated about the importance of working smoke detectors. Administering total parenteral nutrition is a skill that can be taught to the primary care provider and evaluated. The presence of ants would need to be explored further, but education related to kitchen sanitation would probably remediate the situation.
The nurse is assessing a laboring woman for pain. Which is most important for the nurse to remember? A.Pain threshold sensation can vary widely from one culture to another. B.Communication of pain is acceptable in all cultures, so she will readily tell you if she is in pain. C.Ways of expressing pain is fairly universal. D.Use of a 0 (no pain) to 10 (the most pain) scale is an objective way of assessing pain.
D. Use of a 0 (no pain) to 10 (the most pain) scale is an objective way of assessing pain. Rationale: Use of a numeric pain rating scale is an evidence-based method of objectively assessing pain for most cultures. Although pain threshold and pain tolerance can vary widely across cultures, pain threshold sensation is fairly stable. Ways of expressing pain and the acceptability of expressing pain can also vary widely across cultures.
health promotion
Educating parents, educating children; ex: safe sex ed
internal repro structures of male
Epididymis, Vas deferens, Seminal vesicles, Prostate gland, Bulbourethral glands, Urethra
the family one is born into (e.g., oneself, mother, father, and siblings, if any)
Family of orientation
the family one establishes (e.g., oneself, a spouse or significant other, and children, if any)
Family of procreation
health rehabilitation
Helping prevent complications from illness ex:Encouraging a woman with gestational trophoblastic disease (abnormal placenta growth) to continue therapy
what procedure is most commonly done to check the patency of fallopian tube?
Hysterosalpingogram
what happens to immune system in pregnancy?
IgG decreases, WBCs increase, and competency decreases
what type of immunity does the fetus have? how?
Igs cross from placenta to fetus creating passive immunity
health maintenance
Intervening to maintain health when there is a risk present ex: encouraging women to come for prenatal care
what is the best posn for a pregnant woman to lie in to relieve supine hypotension?
L lateral Sims
what is a result of tobacco use during pregnancy? and why?
SGA d/t restricted placental bloodflow
At the onset of ovulation, cervical mucus that is more abundant, clear, slippery and smooth is called
Spinnbarkeit
health restoration
Using conscientious assessment to ensure that symptoms are identifies early on so interventions can begin immediately ex: Caring for a woman during a complication of pregnancy such as gestational diabetes
who can provide home care?
a certified home healthcare or community healthcare agency
What is the most effective method to prevent sexually transmitted infections (STIs)
abstinence (HAH!)
when should a woman no longer fly on a plane if pregnant?
after 7 mo
when does morning sickness dec. and why?
after about 12 weeks d/t the dec. in hCG levels which is what cause the NV in the first place
when does the zygote become a blastocyst?
after cell division has occured several times and the growing ball of cells enters the uterus to be implanted
what defines the developmental stage of a family?
age of the oldest child
The term used for the transverse diameter of the pelvic outlet
ischial tuberosities
how does the cervix change during pregnancy? the uterus?
it becomes very vascular--almost edematous; gets larger, walls thicken and then thin as they stretch
what happens to insulin during pregnancy?
levels increase d/t the inactivating effects of estrogen and progesterone
Term used when infant "settles" into the pelvis
lightening
what is it called when the uterus moves down into the pelvis in preparation for childbirth thereby reducing the fundal heght
lightening
