Maternity wk 2
The LPN/LVN is reinforcing teaching by the RN to a patient diagnosed with gestational diabetes. Which statement made by the LPN/LVN would be correct?
"Your baby may be much larger than expected."
The LPN/LVN is using Naegele's rule to determine the estimated date of delivery for a patient whose last menstrual period was September 15, 2019. Which estimated due date would be determined?
062220*
The HCP would be concerned if a heart rate wasn't detected with a Doppler at how many weeks
10-12
When does a woman notice quickening for the first time
16-20wks
Pt at 8wks most likely her next visit will be in
4 weeks
A female patient is providing a history about her reproductive events. The patient states, "I have four living children who are between the ages of 10 and 16 years, one of whom was delivered at 34 weeks. I delivered one child at term who died at 6 months of age. I also experienced a miscarriage at 16 weeks." Which number does the nurse assign to the "T" portion of the patient's GTPAL history?
5*
Abdominal US
6-8wk, must have a full bladder and remain still for several minutes
The LPN/LVN is working in a clinic that follows a teamwork approach to prenatal patient care. Which patient assessment finding would the LPN/LVN anticipate initiating the addition of another team member?
A certified dietitian if a patient's weight gain is lower than average
Understanding of the amniocentesis procedure
A long needle is placed through my abdomen to obtain amniotic fluid
The LPN/LVN assists the RN in providing care to a patient diagnosed with gestational diabetes. The patient asks how her blood glucose levels go up and down. Which information would the LPN/LVN expect the RN to provide? Place the options in the correct order.
A meal is eaten and blood glucose levels rise. Glucose stimulates the release of insulin. Glucose is facilitated into the cell by insulin. Blood glucose levels are lowered. A decreased amount of insulin is secreted.
The LPN/LVN in a prenatal clinic assists in screening patients in their second trimester of pregnancy for gestational diabetes. Which patients would the LPN/LVN identify as being at greater risk? Select all that apply.
A patient who previously delivered a baby who was over 9 lb A patient who is Korean American
Signs that something is wrong and needs to be reported
Abdominal pain Vaginal bleeding Infection Severe HA Swelling or hands/face Premature rupture of membranes or labor Absence of fetal movement
The LPN/LVN is assisting in the care of an adolescent patient who is in the first trimester of pregnancy. The RN asks the LPN/LVN to assist with providing the patient physical and emotional support. Which action by the LPN/LVN would best demonstrate patient support?
Acting on opportunities to focus the patient on her health and fetal health
With lesbian patients you should:
Advocate for a change in the clinic and hospital forms to be inclusive
Nonstress test (NST)
After 28wks, for a fetus >32wks it is considered reactive when the FHR increases 15 beats above baseline for 15sec twice in 20min
Which medical intervention would aid in managing gestational diabetes?
All patients receive an oral glucose tolerance test (GTT) between the 24th and 28th week of pregnancy.
A patient has just learned she is pregnant. The LPN/LVN informs the patient that the health care provider will be prescribing laboratory tests to determine the health of the patient and the fetus. Which tests would be focused on preventing fetal/newborn complications? Select all that apply.
Antibody screen HIV and sexually transmitted infection (STI) screen
The LPN/LVN is assisting in the care of a patient admitted for hyperemesis gravidarum. When the LPN/LVN suggests frequent sips of fluids, the patient states, "You don't understand how sick I am!" Which information would the LPN/LVN share to promote patient adherence with the care plan?
Dehydration needs to be avoided for the well-being of the fetus.
The LPN/LVN is assisting in the care of a patient who experienced a missed abortion at 10 weeks' gestation. The patient reports, "I received confirmation via ultrasound 3 days ago, but I haven't had any bleeding. " Which treatments would the LPN/LVN expect to be initiated for this patient? Select all that apply.
Dilation and curettage (D&C) Misoprostol prescription Administration of oxytocin
Fundal height
Distance between the top of the pubic bone and the top of the uterus Reaches the level of the umbilicus at 20wks 20cm
The LPN/LVN is reinforcing teaching by the RN to a patient with chronic hypertension who is planning to become pregnant. Which information would be most important to reinforce regarding management of the patient's condition?
Eat a low-sodium diet.
The LPN/LVN is assisting with the care of a patient during a follow-up visit after the placement of surgical cerclage. Which finding would indicate a possible complication?
Fever and chills
The LPN/LVN is reinforcing teaching by the RN for a patient after diagnosis of an ectopic pregnancy. The health care provider prescribes methotrexate treatment. Which teaching by the RN would the LPN/LVN reinforce?
Foods that are high in folic acid
Emily is pregnant with twins she has a 10yr old born at 30 wks 16yr old born at 40wks had a miscarriage at 8 wks
G 4 (pregnancy) T 1 (term-16yr at 40wks) P1 (preterm 10yr old at 30wks) A1 (miscarriage at 8wks) L2 (living kids)
GTPAL
G: pregnancies T: term infants at 37wks P: preterm 20-37 wks A: abortion L: living children
Types of pica
Geophagy: ingestion of soil, clay Amylophagia: raw starch Pagophagia: ice or freezer frost
The LPN/LVN is caring for a patient who is at 28 weeks' gestation while assisting in a maternal health clinic. Which tests would the nurse expect to be ordered for this patient? Select all that apply.
Glucose challenge test Group B streptococci test (GBS)
Urinalysis
Glucose: gestational diabetes Ketones: when body is breaking down fat for energy Protein: pre-eclampsia sign, kidney damage or urinary infection Nitrates: uti
Which clinical manifestations would the LPN/LVN expect when assisting with a patient who is in the first trimester of a pregnancy with twins? Select all that apply.
Greater maternal weight gain Higher levels of human chorionic gonadotropin (hCG) and alpha-fetoprotein Auscultation of multiple fetal heartbeats Uterine size is larger than anticipated
Bradley method
Husband coaches muscle control
The LPN/LVN is assisting with the care of a patient being treated for eclampsia. The RN is administering magnesium sulfate as prescribed. Which information would the LPN/LVN report to the RN immediately as an indication of toxicity?
Hypotension
Indicates that MORE teaching is needed for pregnancy nutrition
I can drink diet soft drinks because they have no calories
The LPN/LVN who is newly hired in an obstetrical clinic is asked to help estimate a patient's due date by using a pregnancy wheel. Which action would the LPN/LVN perform after placing the wheel on the date of a patient's last menstrual period (LMP)?
Identify the estimated date indicated by the wheel.
Three months after vacuum evacuation of a hydatidiform mole, a patient is diagnosed with uterine choriocarcinoma. Which follow-up instructions would be of greatest priority to reinforce to the patient?
Importance of obtaining the prescribed chest x-ray
Decrease risk of developing hemorrhoids
Increase fiber
A patient in the first trimester of pregnancy states, "My partner just told me that he tested positive for syphilis before my pregnancy." Which consideration would the LPN/LVN anticipate as being most important for this patient?
Inform the patient of the high risk for miscarriage or stillbirth.
The LPN/LVN is aware that the principles of therapeutic communication are applicable to all patients. Which communication principles are specifically important when a patient is being seen for a first obstetrical visit? Select all that apply.
Initial discussions about patient para and gravida status are held in private with the nurse. Health care providers and personnel must remain nonjudgmental. Understand that the patient needs to feel comfortable and safe sharing personal information and/or history.
Why is the quadruple screen test done
It detects Down syndrome, trisomy 18, and neural tube defects
A urinalysis is done at each prenatal visit to scan for
Ketones, glucose, bacteria, and protein
Signs of IVP
Late/absent to prenatal appointments Signs of injuries to face/neck/chest/abdomen Signs of anxiety/self-harm Vaginal bleeding
A patient has been seeing a certified nurse midwife (CNM) before becoming pregnant and plans to have a CNM provide care throughout her pregnancy and for labor and birth. The CNM needs to explain issues that will prompt the patient to be transferred to the care of an obstetrician-gynecologist (OB-GYN) instead. Which situation would most likely initiate a change?
Manifestations occur, indicating a risk for pregnancy complications.
Which facts would the LPN/LVN identify as being correct in regard to placental bleeding? Select all that apply
May require performance of a hysterectomy Can result in a change of management during labor Can be the cause of uterine rupture May result from the use of cocaine
Risks of pregnant woman over 35yr
Miscarriage, twins, gestational diabetes, c section
subsequent prenatal visits
Monthly for first 28wks Every 2wks until 36wks Weekly after 36 weeks until birth Monitor urinalysis & fundal ht everytime
The LPN/LVN is reviewing admission notes for a patient who is at 8 weeks' gestation in her third pregnancy. The patient's reproductive history is G3, T0, P0, A2, L0. Which medical management would the LPN/LVN expect for this patient?
Placement of a cerclage
placenta previa
Placenta implanted near opening of the cervix Marginal: next to but doesn't cover Partial: covers part Complete: covers all of the opening Avoid vaginal cervical exams
placenta abruptio
Premature separation of the placenta from the wall of the uterus #1 risk factor is HTN
The LPN/LVN is instructed by the RN not to place a patient in the third trimester of pregnancy on her back in order to avoid supine hypotensive syndrome. Which concern would be the greatest regarding the development of this condition?
Pressure from the uterus can cause a drop in blood pressure and cardiac output.
Para
Refers to a woman who has produced a viable infant, regardless if the fetus was alive at birth Viability is the point when a fetus could theoretically survive outside the womb
Gravida
Refers to the number of times a woman has been pregnant
The LPN/LVN is assisting with caring for a patient at 34 weeks' gestation who has gestational diabetes. The patient has gained more weight than is expected. Which nursing care would the LPN/LVN provide?
Reinforce the dietary plan from the patient's dietitian.
Which information about Rh incompatibility between a mother and a fetus would be accurate? Select all that apply.
RhoGAM is given at 28 weeks' gestation for a positive indirect Coombs' test. A rise of bilirubin in amniotic fluid can indicate fetal distress. All pregnant women need testing for Rh factor and blood type.
The LPN/LVN is providing care to a pregnant patient diagnosed with gestational diabetes. The health care provider has just increased her insulin dose. Which teaching initially provided by the RN would the LPN/LVN reinforce with the patient?
Signs of low blood sugar
The LPN/LVN is reinforcing prenatal teaching provided by the RN for a patient who is pregnant. The patient asks about how she should clean crusting from her nipples. Which information from the LPN/LVN would be correct?
Soak the nipples with a warm, wet washcloth.
Foods to increase iron levels
Spinach, beef steak, kale
The LPN/LVN is discussing childbirth classes with a patient who is at 30 weeks' gestation. The patient shares that she hopes to deliver a baby who is awake and alert. The LPN/LVN is aware of Lamaze and Bradley classes being offered. For which reasons would the LPN/LVN recommend Bradley classes to this patient? Select all that apply.
The Bradley method prepares the woman to deliver without medications or medical interventions. The Bradley method focuses on muscle control because muscle tension increases the pain of labor.
A patient who is Rh-negative is pregnant with her second child. The patient states, "My first child was Rh-negative, so I am not worried that this baby is Rh-positive." Which information would the LPN/LVN expect the RN to teach the patient to explain the need for close monitoring? Select all that apply.
The formation of antibodies can occur during a pregnancy. Fetal blood can be transferred during this pregnancy to the mother from trauma. Any invasive procedure to the uterus can result in blood transfer. With an early spontaneous abortion, blood of unidentified Rh factor may transfer.
The LPN/LVN reviews a patient's urinalysis results at 35 weeks' gestation. Which result would the LPN/LVN associate with the presence of infection?
high levels of protein
Naegele's Rule
subtract 3 months from the first day of the LMP then add 7 days
A patient in her second trimester asks why prenatal visits must occur every 2 weeks instead of monthly. Which statement made by the LPN/LVN would be accurate?
"Frequent visits allow us to closely monitor you and your baby. "
The LPN/LVN is assisting with care for a patient admitted for hyperemesis gravidarum. The patient begins to cry and states, "I can't be here. I have two preschool children at home." Which comment would be most appropriate by the nurse?
"I can ask the hospital social worker to come and talk with you."
The LPN/LVN is reinforcing prenatal teaching provided by the RN with a patient who is 22 weeks' gestation with triplets. Which comment by the patient would initiate additional reinforcement by the LPN/LVN is needed?
"I feel so full that I can hardly force myself to eat a meal."
The LPN/LVN is assisting the RN with a patient who is newly diagnosed with gestational diabetes. The patient states, "I don't understand. Why am I suddenly diabetic?" Which explanation would the LPN/LVN expect the RN to provide?
The hormones of pregnancy block the effects of insulin.
The LPN/LVN is caring for a patient in her second trimester. Which factors would lead the LPN/LVN to expect the patient to undergo a cordocentesis? Select all that apply.
The mother's family has a history of bleeding disorders in male offspring. The fetus's size is small for gestational age.
The LPN/LVN is assisting with the care of a patient who just underwent a salpingectomy because of a ruptured ectopic pregnancy. Which finding on the patient's medical record would alert the LPN/LVN to a time-sensitive intervention?
The patient has a negative Rh factor.
The LPN/LVN is obtaining the vital signs of a patient during her first prenatal visit. The patient has missed her first menstrual cycle and reports mild morning sickness 4 to 5 days a week. Which condition would the LPN/LVN suspect if the patient's blood pressure is 160/88 mm Hg?
The patient has undiagnosed chronic hypertension.
The LPN/LVN is assisting with the care of a patient being treated for eclampsia. The patient has received the loading dose of magnesium sulfate and one maintenance dose. The LPN/LVN observes that the patient is in a darkened room and appears to be sleeping. Which additional observation would cause the LPN/LVN to alert the RN immediately?
The patient is drowsy and difficult to arouse.
The LPN/LVN is assisting with a patient who was admitted because of threatened abortion after 16 weeks' gestation. Which events would prompt the LPN/LVN to notify the RN immediately? Select all that apply.
The patient reports a gush of fluid. The LPN/LVN notices foul-smelling vaginal discharge. The patient asks the LPN/LVN for a perineal pad.
A 20-year-old patient visits a clinic because she has missed two periods and suspects she is pregnant. The patient shares that she is sexually active. The pregnancy test is negative. Which additional patient factor would the LPN/LVN suspect as the cause of the patient's amenorrhea?
The patient's body mass index (BMI) is 17.2.
The LPN/LVN is assisting with the care of a patient at 30 weeks' gestation who was just informed that she is positive for placenta previa. Which factor would lead the LPN/LVN to reinforce teaching made by the RN?
The risks related to sexual intercourse
The LPN/LVN is preparing a patient for her initial pelvic examination before becoming pregnant. After placing the patient in lithotomy position, in which order would the LPN/LVN explain the steps of the procedure? Place each option in the correct order.
The speculum will be inserted into the vaginal canal. The speculum will be opened. The cervix is visualized. The Pap test is performed.
Which manifestations would alert the LPN/LVN to the possibility of placenta abruptio? Select all that apply.
There is an absence of vaginal bleeding. The abdominal wall feels hard when palpated. Patient reports uterine tenderness with touch. Maternal blood pressure (BP) is low and heart rate (HR) is elevated.
Types of abortions
Threatened: vaginal bleeding/abdominal cramping occurs, may or may not loss fetus Inevitable: cervix dilates and amniotic membrane ruptured fetus/placenta are expelled Incomplete: some of the uterine contents are expelled not all Complete: all uterine contents are expelled Missed: fetus dies during first half of pregnancy not expelled and still carried
The LPN/LVN is assisting with care of a patient who is 37 years of age and at 32 weeks' gestation with her second child. The patient's first child was born 11 months ago by cesarean delivery. Based upon this objective data, the LPN/LVN would expect the health care provider to schedule an ultrasound for which reason?
To assess for placenta accreta
Why is uterine fundies measured
To determine appropriate fetal growth
A patient calls the health clinic and indicates that she just received a positive home pregnancy test result. For which reasons would the LPN/LVN recommend the patient make an appointment with a health care professional as soon as possible? Select all that apply.
To establish a baseline of the patient's health early in the pregnancy To identify any potential problems that may affect the pregnancy To perform laboratory and diagnostic tests early for later comparison, as needed. To set appointments to monitor maternal and fetal health on a regular basis
Due to the diagnosis of a hydatidiform mole, the nurse visualizes the patient's uterus as pictured. Which clinical manifestation would the LPN/LVN observe as confirmation of the diagnosis?
Uterine size is notably larger than expected for gestational age.
Which type of late pregnancy complication related to hemorrhage would present the greatest risk for loss of maternal and fetal life?
complete placental separation with concealed hemorrhage. This complication causes an interruption in placental perfusion and results in fetal death. The extent of hemorrhage before detection also results in a high risk for maternal death.
The LPN/LVN is assisting in the care of a patient who is in the first trimester of pregnancy. The patient shares that in her culture, pregnant women do not eat meat. Which response by the LPN/LVN is most appropriate?
"Let's talk about other dietary sources of protein besides meat."
The LPN/LVN is assisting with the care of a patient who is at 28 weeks' gestation. The patient expresses concern about seat belt use, stating, "I know I need to wear one, but I worry about injuring the baby." Which statements made by the LPN/LVN reinforce teaching by the RN regarding appropriate seat belt use? Select all that apply.
"Place the seat belt across both of the hip bones." "Move the seat at least 10 inches from thedashboard." "Shoulder straps are positioned between the breasts."
Fetal kick counts
10 movements in 2 hours
Excessive wt gain
Associated with an increased risk for gestational diabetes, HTN, larger babies
Lamaze method
Breathing patterns to conserve energy
To prevent venous thrombosis formation during travel:
Change positions frequently Walk around q2hrs
A patient in the first trimester of pregnancy calls the health care provider's office and reports uterine cramping, bleeding, and passage of "clotlike material." The patient denies continued cramping and bleeding. The LPN/LVN understands that which event most likely would have occurred?
Complete abortion
The LPN/LVN is reinforcing teaching provided by the RN regarding comfort to a patient in the third trimester of pregnancy. Which teachings would the LPN/LVN determine to be appropriate for this patient? Select all that apply.
Decrease oral fluids 2 hours before bedtime. Elevate the head with an extra pillow at night. Rest in a side-lying position.
Ectopic pregnancy
Fertilized ovum implants outside the uterus usually fallopian tubes
A patient who is at 32 weeks' gestation expresses concern about her baby's well-being. The patient's pregnancy has been uneventful. Which method of monitoring would the LPN/LVN reinforce to reduce the patient's concerns?
Fetal kick counts
Conditions a biophysical profile evaluates
Fetal movement, fetal HR, fetal breathing movements, amount of amniotic fluid
What is a sign of psychological stress
Frequently missing prenatal appointments
The health care provider is preparing to perform measurements to determine the presence of cephalopelvic disproportion. Which measurement would be of greatest importance?
Obstetric conjugate (-This diameter extends from the sacral promontory to the upper inner border of the symphysis pubis and measures roughly 11 cm. It is the most important of the pelvic measurements because it is the first boney strait through which the fetus has to pass during the birth process.)
The LPN/LVN is assisting with the care of a patient diagnosed with gestational diabetes. The health care provider has just increased the patient's insulin prescription. When assessing the patient, the LPN/LVN notices sweating and confusion. The patient reports nausea and a headache. Which action would the LPN/LVN take first?
Obtain a capillary blood glucose level immediately.
A patient who is 34 weeks' gestation is admitted for severe pre-eclampsia. The LPN/LVN is informed by the RN that the patient is now considered as having eclampsia. Which nursing intervention would the LPN/LVN initiate?
Pad the side rails and place suction at the bedside.
Seatbelt use
Place the lap portion low across the abdomen and hipbones
Frequency of prenatal visit for a woman at 38wks
Weekly
The LPN/LVN is reinforcing nutritional teaching with an adolescent patient who is at 10 weeks' gestation. Which knowledge about adolescent pregnancy and nutrition would be of greatest concern for the LPN/LVN?
Weight gain is a major concern for the pregnant adolescent.
S/S of hypovolemic shock
decreased bp, increased heart rate, clammy skin, lightheaded, and confusion
