maternity exam 2

The use of what during pregnancy is potentially most harmful to the fetus?

alcohol

complete spontaneous abortion

all products of conception expelled

moderate baseline variability

amplitude range 6-25 bpm

marked baseline variability

amplitude range >25 bpm

absent baseline variability:

amplitude range undetectable

why is amniocentesis done?

detect abnormalities, evaluate fetal condition, determine fetal lung maturing

alpha fetoprotein analysis:

detect risk of neural tube defects and down syndrome

marker screeing tests:

detect trisomies, neural tube defects, and other abnormalities for further examination

two main functions of contractions:

dilate cervix push fetus through birth canal

nuchal translucency screening:

early detection and diagnosis of some fetal chromosomal and structural abnormalities

the three embryonic layers of the pre-embryonic cell are:

ectoderm mesoderm endoderm

Lower levels of hCG are associated with:

ectopic (abnormal placement) pregnancy

The nurse is reviewing the laboratory test results of a pregnant client. Which finding would alert the nurse to the development of HELLP syndrome?

elevated liver enzymes

fetal membranes form the amniotic sac during which stage?

embryonic

which stage has the highest mortality rate?

embryonic stage. Pregnancy doesn't take due to genetic defects, poor maternal health, teratogens, etc.

what happens at the first prenatal visit?

establish trusting relationship focus on education for wellness detection and prevention of potential problems comprehensive health history, physical exam, and lab test

chorionic villus sampling (CVS):

evaluation of chromosomal disorders, to determine the SEX and sex-linked disorders

from weeks 29 - 36, how many prenatal visits will the mother have?

every 2 weeks

up to 28 weeks, how often will the mother have a prenatal visit?

every 4 weeks

pelvic examination:

examine of external/internal genitalia bimanual exam pelvic shape: GYNECOID, android, anthropoid, platypelloid pelvic measurements: diagonal conjugate, true (obstetric) conjugate, and ischial tuberosity

T/F CVS can detect neural tube defects.

false

sex of baby is determined by: (mother or father?)

father; X or Y chromosome

Presumptive s/s (and weeks):

fatigue (12) breast tenderness (3-4) nausea/vomiting (4-14) amenorrhea (absence of menstruation) (4) urinary frequency (6-12) hyperpigmentation of skin (16) fetal movement (quickening; 16-20) uterine enlargement (7-12) breast enlargement (6)

A primapara woman, 30 weeks' gestation, has no family support and frequently calls the health care provider's office with questions. Which report by the woman would alert the nurse that she may be having a complication related to the pregnancy and needs to come to the clinic today for further assessment?

feeling of achy, cramping in vaginal area accompanied by bleeding that has saturated 1 pad/hour

what occurs during preembryonic stage?

fertilization cleavage morula blastocyst and trophoblast implantation

preembryonic stage time span:

fertilization through 2nd week

A nurse is caring for an antenatal mother diagnosed with umbilical cord prolapse. For which should the nurse monitor the fetus?

fetal hypoxia

The maternal serum alpha fetoprotein blood test is performed on pregnant women to screen for which condition?

fetal neural tube defects

pica:

an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month

shiny Schultz:

fetal side of placenta

what is amniotic fluid made of?

fluid transported from maternal blood across the amnion fetal urine (98% water, 2% organic matter)

One vitamin has been identified as helping to prevent neural tube defects when consumed in adequate amounts before conception through the early weeks of pregnancy. Which vitamin is it?

folic acid

A woman asks the nurse if she can take an over-the-counter vitamin during pregnancy rather than her prescription prenatal vitamin. A chief ingredient in prenatal vitamins that makes them important for pregnancy nutrition is:

folic acid.

A nurse is caring for a pregnant client whose fetus has been diagnosed with macrosomia. When reviewing the client's history, which information would the nurse expect to find?

gestational diabetes

GI changes during pregnancy:

gums become hypermic, swollen, and friable; bleed easily acidic saliva ptyalism (excessive salivation) dental plaque, calculus, and debris deposits increase (leads to gingivitis and periodontists) smooth muscle relaxation decreases peristalsis (progesterone), so, slower digestion times hypercholesterolemia, increasing gallstone risk, gallbladder disease, obesity, etc.\\morning sickness acid reflux

Ideal for pelvis shape for vaginal delivery:

gynecoid

Hormone used to detect pregnancy in pregnancy test:

hCG (human chorionic gonadotropin)

HELLP syndrome

hemolysis, elevated liver enzymes, low platelet count

what sex-linked disorders can CVS detect?

hemophilia, sickle cell anemia, Tay-Sachs disease

Pregnancy tests (both urine and blood) measure levels of which hormone to validate the existence of pregnancy?

human chorionic gonadotropin (hCG)

integumentary system changes:

hyperpigmentation on nipples, areolas, umbilicus, perineum, and axilla (some temporary, some permanent) stretch marks (striae gravidarum) hair loss "mask of pregnancy" (facial melasma) linea nigra (middle of abdomen)

ectopic pregnancy

implantation of the fertilized egg in any site other than the normal uterine location

nutritional guidelines for pregnancy:

increase fruits/vegetables (half the plate) replace saturated with unsaturated fats whole grains as opposed to refined grains lots of fiber no alcohol reduced-fat spreads/dairy 2 servings of fish weekly; one oily 2 quarts of water daily

maternal physiologic responses to labor:

increased HR, cardiac output, BP (during contractions) increased WBCs increased respiratory rate and O2 consumption decreased gastric motility and food absorption decreased emptying and gastric pH increased temp muscle aches/cramps increased BMR decreased glucose levels

Which condition is the most common cause of anemia in pregnancy?

iron-deficiency anemia

at 36 weeks, where should the fundus be?

just below xiphoid process

3 phases of first stage:

latent (0-3 cm) active (4-7 cm) transition (8-10 cm)

what is the normal amount of glucose in a fetus?

less than 45 mg/dL

at 20 weeks, where should the fundus be?

level of umbilicus

musculoskeletal system changes:

ligaments that hold scroiliac joints and pubis symphysis soften and stretch articulations between joints widen/become movable these changes increase pelvic cavity size and make delivery easier lordosis (spine curve) "waddle" gait

Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen. The nurse documents this as which finding?

linea nigra

When teaching a class of pregnant women about the effects of substance use during pregnancy, the nurse would include which effect?

low-birthweight infants

What terminology would the nurse use to document a newborn who weighs 4,000 grams (8.13 lb) or more at birth?

macrosomia

what is amniotic fluid used for?

maintains constant body temp for baby permits symmetric growth/development cushion baby from trauma allows umbilical cord to be relatively free from compression promotes fetal movement to enhance musculoskelatal development

polyhydramnios is associated with:

maternal diabetes neural tube defects chromosomal deviations malformations of CNS/GI tract threatens premature rupture of membranes due to uterine overdistension umbilical cord wrapped around neck

Dirty Duncan:

maternal side of placenta

doppler flow studies:

measures velocity of blood flow

After teaching a group of adolescent girls about female reproductive development, the nurse determines that teaching was successful when the girls state that menarche is defined as a woman's first:

menstrual period

A nurse strongly encourages a pregnant client to avoid eating swordfish and tile fish because these fish contain which component?

mercury, which could harm the developing fetus if eaten in large amounts

16 weeks, where should the fundus be?

midway between symphysis pubis and umbilicus

generally the first presumptive sign of pregnancy:

missing first menstrual period

higher levels of hCG are associated with:

molar pregnancy or multiple-gestational pregnancies

what is the normal amount of creatinine in a fetus?

more than 2 mg/dL in a mature fetus

A client has asked that an opioid be kept on standby in case she needs it for pain control. As a precaution, the nurse will also have which of medication readily available to reverse the effects of that opioid?

naloxone

amniocentesis:

needle puncture of the amniotic sac to withdraw amniotic fluid for analysis

gravida:

number of pregnancies. i.e., gravida II = second pregnancy

para:

number of viable offspring carrying 20+ weeks

primipara:

one birth after a pregnancy of 20+ weeks

after 37 weeks, how many prenatal visits will the mother have?

one per week

danger signs second trimester:

pain in calf leakage of fluid absence of fetal movement for more than 12 hours

As a result of loss of estrogen, perimenopausal women have decreased vaginal lubrication. What may occur as a result?

painful intercourse

A woman suspecting she is pregnant asks the nurse about which signs would confirm her pregnancy. The nurse would explain that which sign would confirm the pregnancy?

palpable fetal movement

On a routine hematocrit screen during a prenatal visit, the nurse notices that the client is mildly anemic. When discussing this with the couple, the husband hints that she might be eating unusual things. The nurse recognizes the need for the woman to be evaluated for which condition?

pica

What is the organ with a rich blood supply that supplies the developing organism with food and oxygen and carries away waste for excretion by the mother?

placenta

confirmation of pregnancy can only be determined by what kinds of signs?

positive signs

The nursing student doing a clinical obstetrics rotation correctly picks which term to label a pregnancy that continues past the end of the 42nd week of gestation?

post-term pregnancy

A nurse is reviewing the medical record of a pregnant woman and notes that she is gravid II. The nurse interprets this to indicate the number of:

pregnancies.

incomplete spontaneous abortion

pregnancy loss with products of conception remaining in the uterus

A nursing instructor identifies which factor as increasing the chances of infection when coupled with prolonged labor?

premature rupture of membranes

PROM

premature rupture of membranes (37+ weeks)

abruptio placentae

premature separation of the placenta from the uterine wall

A pregnant client in her second trimester visits a health care center. She informs the nurse that at times she experiences difficulty breathing. What would the nurse identify as the most likely cause of the client's report?

pressure on the diaphragm by the growing fetus

A woman having contractions comes to the emergency department. She tells the nurse that she is at 34 weeks' gestation. The nurse examines her and finds that she is already effaced and dilated 2 cm. What is this woman demonstrating?

preterm labor

PPROM

preterm premature rupture of membranes (<37 weeks)

A client comes to the emergency department reporting strong contractions that have lasted for the past 2 hours. Which assessment will indicate to the nurse that the client is in true labor?

progressive cervical dilatation and effacement

recommended amount of protein, iron, and folic acid per day:

protein: 80 g/day iron: 27 g/day folic acid: 800 mcg/day

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence?

quickening

A pregnant client is excited that she is beginning to feel her baby move within her. The nurse explains that these first fetal movements are known as:

quickening.

A nursing student correctly identifies which action to be the best way to prevent complications of pregnancy?

receiving prenatal care

The injection of a local anesthetic to block specific nerve pathways is referred to as:

regional block

contraction timing, t/f labor:

regular is true irregular is fals

endoerm forms:

respiratory system, liver, pancreas, and digestive system

Which assessment finding in a client reporting uterine contractions would be most consistent as an indicator of approaching labor?

rupture of amniotic membranes

criteria for continuous internal monitoring of FHR:

ruptured membranes dilated 2 cm fetal head low enough to attach electrode skilled practitioner only

mesoderm forms:

skeletal, urinary, circulatory, and reporductive organs

Threatened spontaneous abortion

slight bleeding; no cervical changes; no tissue passed

Goodell's sign:

softening of the cervix

Hegar's sign:

softening of the lower uterine segment

danger signs of first trimester:

spotting/bleeding painful urination sever persistent vomiting fever lower abdominal pain/dizziness and shoulder pain (ruptured ectopic pregnancy)

fetal scalp sampling/stimulation conducted in order to:

stimulate fetal movment

contraction strength t/f labor:

strong is true weak is false

danger signs third trimester:

sudden weight gain edema sever upper abdominal pain headache with visual changes decreased fetal movment

until week 36, how can you approximate where the fundus should be?

the number of weeks should equal the number of cm moving up from pubic bone.

Leukorrhea

thick, whitish or yellowish vaginal discharge

When caring for a newborn, the nurse observes that the neonate has developed white patches on the mucus membranes of the mouth. Which condition is the newborn most likely experiencing?

thrush

ultrasonography:

to ID complications, establish accurate gestational age

A nurse urges a pregnant client at the first prenatal office visit to begin taking iron supplements immediately. What is the rationale for this intervention?

to avoid anemia

first stage of labor:

to complete cervical dilation of 10 cm longest stage 3 phases (latent, active, transition)

oligohydramnios:

too little amniotic fluid (<500 mL at term)

polyhydramnios:

too much amniotic fluid (>2000 mL at term)

During a follow-up prenatal visit, a pregnant woman asks the nurse, "How long do you think I will be in labor?" Which response by the nurse would be most appropriate?

"It's difficult to predict how your labor will progress, but we'll be there for you the entire time."

The client is anxious about her prolonged pregnancy. She informs the nurse she has been doing research on the Internet and has read about certain herbs that can help to induce labor. Which response from the nurse would be appropriate?

"Please talk to your primary care provider first to ensure it is safe."

A client at 36 weeks' gestation comes in for her weekly primary care provider visit. She tells the nurse, "I am having contractions, but they are irregular and go away when I rest. Do you think I am going into labor?" The best response by the nurse would be:

"These are called Braxton-Hicks contractions and are preparing your body for labor but are not 'true' labor contractions."

During a prenatal visit, a pregnant woman says, "I know the amniotic fluid is important, but can you tell me more about it?" When describing amniotic fluid to a pregnant woman, which description would the nurse most likely include?

"This fluid acts as a cushion to help to protect your baby from injury."

A pregnant woman in the 36th week of gestation reports that her feet are quite swollen at the end of the day. After careful assessment, the nurse determines that this is an expected finding at this stage of pregnancy. Which intervention is appropriate for the nurse to suggest?

"Try elevating your legs when you sit."

5 P's affecting labor:

**1.) Passenger: fetal head, attitude, lie (longitudinal, transverse, oblique), presentation *(cephalic, breech, shoulder), station, engagement 2.) Passageway: birth canal 3.) Powers: contractions 4.) Position: of mother 5.) Psychologic response**

The blood tests for a primigravida client indicate that the client is Rh-negative and her partner is Rh-positive. What is an appropriate nursing intervention for this client?

Arrange for Rho immune globulin at 28 weeks' gestation

The nurse notes uterine atony in the postpartum client. Which assessment is completed next?

Assessment of the perineal pad

A nurse is a caring for a postpartum client. What instruction should the nurse provide to the client as a precautionary measure to prevent thromboembolic complications?

Avoid sitting in one position for long periods of time.

A nurse is performing a nursing assessment on a new client. The woman estimates that she is approximately 16 weeks pregnant. While assessing her the nurse asks her about what appear to be scratch marks on her hands, and she tells the nurse that she has three cats at home. What screening would be prescribed for this woman?

toxoplasmosis

missed spontaneous abortion

Cervix1. is CLOSED 2. No bleeding 3. No products of conception Fetal demise has occurred WITHOUT symptoms

On the first prenatal visit, examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse documents this finding as:

Chadwick's sign.

A nurse is monitoring the FHR of a client in labor using an electronic fetal monitor. The reading shows a late deceleration. Which intervention should the nurse implement?

Change maternal position to an upright or side lying position.

The nurse is caring for a young couple who are expecting their first baby. They are experiencing the phenomenon known as Couvade syndrome. What can the nurse explain to this family to help them understand this syndrome?

Couvade syndrome is when the partner begins to experience the same physical symptoms as the pregnant woman experiences.

fourth stage:

Delivery of placenta and ends with maternal stabilization of vital signs 1-4 hours after delivery fundus firm, located midline, slowly rising to umbilicus during first hour

Gestational Trophoblastic Disease (GTD)

Disorder classified into two types: benign or partial (hydatidiform mole) and malignant or whole (choriocarcinoma)

Which medical pair is the highest concern if reported during a pregnant client's medical history?

Heart disease and diabetes

A pregnant woman who had stress incontinence during a previous pregnancy asks the nurse what could be done to manage this in her current pregnancy. What should the nurse recommend to the client?

Kegel exercises

A pregnant client in her third trimester is diagnosed with supine hypotension syndrome. What would the nurse instruct the client to do?

Lie laterally, preferably on the left side.

A client is preparing to leave the clinic after her first prenatal visit. What is important for the woman to do before she leaves the office?

Make a follow-up appointment.

Inevitable spontaneous abortion

Moderate cramps, mild to severe bleeding, no tissue passed, Cervical opening dilated with membranes or tissue bulging at cervix.

how do you determine the pH of the fluid in the event of a ruptured membrane?

Nitrazine yellow dye swab

A group of nursing students are preparing a presentation which will illustrate various components of the birthing process. When presenting the pelvis, the students should point out that it is often referred to as which term?

Passageway

A client asks why she should learn breathing patterns for labor. After instruction is given, the nurse determines teaching has been effective when the client states:

"Breathing patterns are distraction techniques taught to decrease pain in labor."

A client who has been in prolonged labor reports extreme back pain. She asks why her back hurts so much. What would be the best response by the nurse?

"Different fetal positions can cause prolonged labor and back pain."

A pregnant woman is flying across the country to visit her family. After teaching the woman about traveling during pregnancy, which statement indicates that the teaching was successful?

"I'll get up and walk around the airplane about every 2 hours."

A client arrives at a health care facility in the latent phase of the first stage of labor. Which intervention should the nurse implement?

Provide emotional and physical support.

A nurse is coaching a woman during the second stage of labor. Which action should the nurse encourage the client to do at this time?

Push with contractions and rest between them.

habitual spontaneous abortion

Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.

Which neonatal assessment is the highest priority if the mother received meperidine during labor?

Respiratory rate

functions of placenta:

Serving as the interface between the mother and fetus Making hormones to control the physiology of the mother Protecting the fetus from immune attack by the mother Removing waste products from the fetus Inducing the mother to bring more food to the placenta Producing hormones that mature into fetal organs

A woman has heard that hypotension can be a problem during pregnancy, but she is not sure what it is or what causes it. The nurse explains that it is simply a temporary bout of low blood pressure due to impaired blood return to the heart. It is commonly caused by sleeping in a position that causes compression of the vena cava blood vessel. To avoid this condition, which suggestion should the nurse make?

Sleep on your side.

A prenatal client who is 6 weeks' gestation calls the clinic to report vaginal bleeding. For what concern will the nurse further assess the client?

Spontaneous abortion

A client has been informed that the result of her pregnancy test indicates that she is 3 weeks' pregnant. Which instructions should the nurse give the client in regard to her condition?

Stop using drugs, alcohol, and tobacco.

what is amniotic fluid?

The fluid surrounding the embryo/fetus that protects the unborn baby

fetal stage of pregnancy:

The third stage of pregnancy, weeks 8-38 (until birth). Growth of fetus and organ refinement.

A nurse is caring for a client who has given birth. The client reports that her breast milk is dark yellow. Which information should the nurse give to the client regarding the situation?

The yellow fluid is colostrum and is rich in maternal antibodies.

TORCH:

Toxoplasmosis Other (syphilis, HIV, Hepatitis, varicella) Rubella Cytomegalovirus Herpes

Pre-eclampsia

When a pregnant woman develops high blood pressure and protein in the urine after the 20th week (late 2nd or 3rd trimester) of pregnancy.

T/F volume of amniotic fluid is used to determine fetal well-being.

true

t/f during false labor, irregular uterine contractions are felt, but the cervix is not affected.

true

Positive s/s and weeks:

ultrasound verification (4-6) fetal movement by experienced clinician (20) auscultation of fetal heart tones (10 - 12

Where does the zygote implant in the uterus? Why?

upper portion, or the fundus, due to the rich blood supply

first trimester discomforts:

urinary freqeuncy/incontinence fatigue nausea/vomiting breast tenderness constipation nasal stuffiness/bleeding gums/epistaxis cravings leukorrhea

A nurse is reviewing a journal article on the causes of postpartum hemorrhage. Which condition would the nurse most likely find as the most common cause?

uterine atony

what is oligohydramnios associated with?

uteroplacental insufficiency fetal renal abnormalities higher risk of surgical births/lower birth weight

VBAC (vaginal birth after cesarean)

vaginal birth of an infant to a woman who has had at least one previous cesarean delivery.

how does the pH of amniotic fluid compare to vaginal fluid?

vaginal fluid is acidic amniotic fluid is alkaline

week gender can be determined:

week 12

week that begins development of: brain spine heart GI tract limb buds

week 3

week where stomach, pancreas and liver begin to form:

week 4

week where heart beats at regular rhythm, eyes/ears begin to form, some cranial nerves are visible, muscles innervated:

week 5

week of lung formation begins, primitive skeleton forms, CNS forms, brain waves detectable:

week 6

week that heart development is complete:

week 8

week that lanugo develops, sucking motions, amniotic fluid is swallowed, weight quadruples, QUICKENING is detected by mother:

weeks 13-16

weeks that vernix caseosa cover fetus, eyebrows and head hair appear, brown fat deposited, finger/toe nails.

weeks 17-20

weeks of alveoli formation, lungs producing surfactant, grasp and morrow reflex.

weeks 21-24

when is screening for gestational diabetes usually done?

weeks 24 and 28, unless high risk

week of digestive and urogenital tract activity:

weeks 9-12

assessments done at follow up visits:

weight/BP compared to baseline urine testing for protein, glucose, keytones, and nitrites fundal height quickening/fetal movement; indicator of fetal well being fetal HR (110-160) teaching: danger signs

multipara:

woman who has given birth to two or more children at 20+ weeks

ideal fetal engagement position:

zero station, at Ischial spines

A pregnant client at 32 weeks' gestation calls the clinic and informs the nurse that she thinks her membranes are leaking. She states that some clear fluid has run down her leg. What is the best response by the nurse?

"It is best for you to visit a hospital immediately. They can use a nitrazine strip to determine if it is amniotic fluid."

A woman's primary care provider has told her he wants to use an episiotomy for birth. She asks the nurse what the purpose of this is. Which answer would be best?

"It relieves pressure on the fetal head."

third trimester discomforts:

- Return of first trimester discomforts - Shortness of breath and dyspnea - heartburn and indigestion - Dependent edema - Braxton hicks contractions

how much weight gain should a woman have AFTER the first trimester?

1 lb/week

normal blood loss for c-section:

1000 mL

Fetal heart rate monitoring reveals baseline tachycardia in the fetus. Which rate would be most likely?

164 beats per minute

Timeline of the Embryonic Period

2-8 weeks. This is organogenesis

what is the average size of the umbilical cord at birth?

22 inches long 1 inch wide

a woman who is underweight before pregnancy or who has a low maternal weight gain pattern should increase how much weight during pregnancy?

28 - 40 lbs (more than the normal 25 - 35)

A nurse measures a pregnant woman's fundal height and finds it to be 28 cm. The nurse interprets this to indicate that the client is at how many weeks' gestation?

28 weeks' gestation

how much weight should a woman have during first trimester?

3-5 lbs

approximate total weight gain during pregnancy:

30 lbs (range: 25 - 35 for normal weight)

how many additional calories should a pregnant woman consume v. a non pregnant woman?

300 (2100 - 2500 total)

normal blood loss for vaginal delivery:

500 mL

how long does it take for implantation to occur?

7-10 days

normal pH of umbilical cord blood:

7.2 - 7.3

what is the normal range of amniotic fluid by week 28?

700 - 1000 mL

Minimal baseline variability

> undetectable but <or= 5bpm

Leopold's maneuvers:

A series of four maneuvers designed to provide a systematic approach whereby the examiner may determine fetal presentation and position.

A client in the latent phase of the first stage of labor is noted to be uncomfortable with intact membranes and mild contractions on assessment. The nurse should encourage the client to pursue which action?

Ambulation ad lib

A pregnant client in her second trimester reports feeling tired all the time. The nurse notes pale skin and low normal hemoglobin on assessment. Which recommendation should the nurse prioritize for this client?

An iron supplement

The nurse is preparing discharge instructions for a postpartum woman who has developed DVT after a long and difficult birthing process. The nurse will include instruction on which medication for this client?

Anticoagulants

Chadwick's sign:

Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion.

ectoderm forms:

CNS, special senses, skin, and glands

A newly pregnant 41-year-old woman is requesting genetic testing of the baby. She is concerned that due to her age the baby has an increased risk for which condition?

Down syndrome

A woman in her third trimester is suffering from heartburn. What should the nurse advise her to do?

Eat small meals frequently rather than large meals.

in the event that the membranes rupture, what is the priority?

FHR; monitor for infection

When describing the process of fertilization, the nurse would explain that it normally occurs in which structure?

Fallopian tube

second stage:

Full dilation and ends with birth (intense contractions every 1-2 minutes) (spinal block, pudendal, and local infiltration)

Toxoplasmosis

a parasite that is most commonly transmitted from pets to humans by contact with contaminated animal feces

ballottment:

a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus

nullipara:

a woman who has never borne a viable child

hallmark sign of ectopic pregnancy:

abdominal pain with spotting within 6 to 8 weeks after missed menses

12-14 weeks, where should the fundus be?

above the symphysis pubis

four categories of baseline variability:

absent minimal moderate marked

when is amniocentesis done?

after first trimester to decrease risk of spontaneous miscarriage (results may take up to 3 weeks)

contraction discomfort t/f labor:

back and abdomen is true just abdomen is false

second trimester discomfort:

backache varicosities of vulva and legs (due to increased blood flow) hemorrhoids flatulence with bloating

what occurs during the embryonic stage?

basic structures of major body organs main external features

A couple is discussing starting a family with the nurse. When should the nurse suggest genetic counseling?

before they conceive

Which feature would alert the nurse that the client is in the transition phase of labor?

beginning urge to bear down

A nurse is assigned to care for a client with lacerations. The nurse knows that which factor would be the most likely cause of lacerations of the genital tract?

birth of a large newborn

third stage:

birth of infant to placental separation (placental expulsion is 2-30 minutes later)

probable s/s and weeks:

braxton hicks (16 - 28) positive pregnancy test (4-12) abdominal enlargement (14) ballottment (16-18) Goodell's sign Chadwick's sign Hegar's sign (6-12)

lightening:

by 40 weeks, the fetal head begins to descend and engage in the pelvis

A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn?

cephalhematoma

Nuchal cord:

cord around neck; must be removed prior to birth

When assessing cervical effacement of a client in labor, the nurse assesses which characteristic?

degree of thinning

Sources of folic acid

dark green vegetables, black eyed peas, liver, baked beans, fruits

esophagus changes (GI):

decreased lower esophageal sphincter pressure and tone, which increases risk of heartburn

Stomach changes (GI):

decreased tone and mobility with delayed gastric emptying time, which increases risk of gastroesophageal reflux and vomiting; decreased gastric acidity and histamine output, which improves symptoms of peptic ulcer disease

A pregnant client in her first trimester visits the health care facility for regular checkups. The nurse instructs the client to increase her dietary intake of folic acid based on the understanding that folic acid is important for which action?

decreasing incidence of birth defects