Nurs 371 Exam 1

What is the most significant barrier for access to care?

Inability to pay

How long does postpartum last?

4-6 weeks

What are the trimesters?

First: weeks 1-13

Second: weeks 14-26

Third: weeks 27-40

Define gravida.

a woman who is pregnant

Define gravidity.

pregnancy

Define primigravida.

a woman who is pregnant for the first time

Define nulligravida.

a woman who has never been pregnant

Define parity.

The number of times a pregnancy reached 20 weeks gestation or more

Define para.

Deliveries after 20 weeks

Define nullipara.

woman who has not completed pregnancy with a fetus or fetuses who have reached the stage of fetal viability (20 weeks)

Define primipara.

a woman who has delivered one pregnancy of at least 20 weeks

What is the difference between stillborn and abortion?

What is the range of "preterm"?

20 weeks - 36 weeks and 6 days

What is defined as late preterm?

Pregnancy between 34 weeks and 36 weeks 6 days

What is defined as a term pregnancy?

It has reached 37 weeks

What are the different types of term pregnancies?

Early: 37 weeks - 38 weeks 6 days

Full: 39 weeks - 40 weeks 6 days

Late: 41 weeks - 41 weeks 6 days

Post: 42 weeks and beyond

What is the most accurate and in depth way to document gravidity and parity?

The GTPAL method

G: gravida

T: term

P: preterm

A: abortion

L: living children

A client is pregnant for a 4th time. She has a child born at 35 weeks at home. She lost one pregnancy at 10 weeks gestation and gave birth to another infant stillborn at term. Determine the gravida and para.

GP: G4 P2

GTPAL: G4, T1, P1, A1, L1

A client is pregnant for the 5th time. She has a 7 and 5 year old son and daughter at home who were both born at term. Her 3rd pregnancy ended at 16 weeks gestation. For her 4th pregnancy, she gave birth to twin girls at 35 weeks, with one twin dying soon after birth. What is her gravida/para and TPAL?

GP: G5 P3

GTPAL: G5, T2, P1, A1, L3

What is the earliest biochemical marker for pregnancy?

Human chorionic gonadotropin (hCG)

When is can hCG start to be detected and when does it peak?

hCG can be detected in urine at 7-8 days before expected period.

hCG peaks around 2 months

What medications may cause false positive pregnancy tests?

Tranquilizers or anticonvulsants

What medications may cause false negative pregnancy tests?

Promethazine and diuretics

How can LH affect the results of a pregnancy test?

hCG and LH are very similar, therefore when there is an increase in LH related to conditions, there may be a false positive pregnancy test

In order for Naegele's rule to be used to calculate estimated date of birth (EDB), what is needed?

The woman's menses needs to be normal to determine

What is Naegele's rule?

Add 7 days to the first day of the LMP and subtract 3 months to estimate a woman's EDC

LMP: March 15, 2023

What is EDB using Naegele's Rule?

12/22/23

What are presumptive signs of pregnancy?

Subjective signs perceived by the woman

- Signs: amenorrhea, breast changes & tenderness, nausea

- Symptoms: N/V, urinary freq, weight gain, fatigue, quickening (fetal movement)

What are probable signs of pregnancy?

Objective changes observed by an examiner

-S/s: uterine enlargement, braxton hicks, placental/uterine souffle, ballottement, + preg test, Hegar sign, Goodell's signs, chadwick's signs

What is Hegar sign?

Softening of the isthmus (lower uterine segment)

What is Goodell's sign?

softening of vaginal portion of cervix

What is Chadwick's sign?

bluish discoloration of cervix

What are positive signs of pregnancy?

fetal heart sounds, visualization of fetus ultrasound, fetal movement palpated by hcp.

What is are the mnemonics to remember the different types of signs/indicators of pregnancy?

PRESUME: period absent, really tired, enlarged breasts, sore breasts, urination inc, movement perceived, emesis/ nausea

PROBABLE: positive preg test, return of fetus against finger, outline of fetus detected, braxton hicks, softening of cervix, bluish color to cervix, lower uterine segment softening, enlarged uterus

FETUS: Fetal movement felt, electronic device detects heart tones, the delivery, ultrasound detects baby, see visible movement

At 13 weeks, which presumptive s/s of pregnancy should the nurse anticipate?

a) Hegar's sign and quickening

b) Chadwicks sign and uterine souffle

c) Ballottement and a postive pregnancy test

d) excessive fatigue and urinary frequency

D: excessive fatigue and urinary frequency

High levels of what hormones stimulate uterine growth in the 1st semester?

Estrogen and progesterone

Around 12-14 weeks of pregnancy, where will the uterus be palpated?

Above the symphysis pubis

Around 20-24 weeks of pregnancy, where will the uterus be palpated?

At the umbilicus

Typically, around how many weeks will quickening be felt?

Around 16-18 weeks

The term "lightening" refers to what?

When the fundal height decreases as the fetus begins to descend into the pelvis in preparation for birth

A woman that is 26 weeks along comes to the doctor for her checkup. When measuring her fundal height, it is found to be 22 cm. What should be done.

An ultrasound needs to be preformed.

What is the average uteroplacental blood flow?

450-650 mL/min

Before measuring the fundal height in a pregnant woman, what should the nurse educate the patient to do prior?

Empty the bladder

What is the operculum in a pregnant woman?

Increased mucus fills the endocervical canal, resulting in formation of the mucus plug

A pregnant woman tells her doctor that she is concerned about a white/gray mucoid discharge with a faint musty odor. What do you expect to be done?

This is leukorrhea. It is a normal response from increased estrogen and progesterone

(*it is never pruritic or blood stained*)

A pregnant woman tells her doctor that she has been experiencing yeast infections recently despite never having them prior to pregnancy. What could be the reasoning behind this?

Bacteriostatic- her pH is more acidic during pregnancy related to lactic acid production

In a pregnant woman, a Hgb of what is considered anemic?

10.5 g/dL

When does cardiac output start to increase in pregnancy?

Around 8 weeks

What happens to the mom's heart rate during pregnancy?

It increases by 10-15 beats per minute. They may also experience some palpitations and dysrhythmias

What happens to the mom's blood pressure during pregnancy?

It usually decreases slightly or remains the same. This is secondary to the vasodilatory effects of progesterone, prostaglandins, and relaxin

Why would Homan's be included in the head to toe assessment of a female patient?

To test for thrombosis because pregnant women are 5-6x more likely to develop thrombolytic disease

A pregnant woman is complaining of feeling dizzy, faint SOB, nausea, and clammy after lying on her back. What do you expect her to be diagnosed with and what interventions will be given?

Vena caval syndrome/ supine hypotension. We will put her on her left side

What type of acid base balance is a pregnant person in?

Respiratory alkalosis

How does a pregnant person's breathing change?

It changes from abdominal to thoracic/diaphragmatic due to the increased diaphragmatic excursion, chest circumference, transverse diameter, and subcostal angle. The RR stays the same or increases. They may experience some congestion of the nasal mucosa.

What is Hegar's sign?

Softening moves from the cervix to the uterus.

Why might a pregnant woman may experience vascular congestion of nasal mucosa?

Increased estrogen

What is melasma (chloasma)?

"mask of pregnancy", brownish pigmentation over the forehead, temples, cheek, upper lip

What is palmar erythema?

a normal symptom of pregnancy ;

red hands

How should pruritic urticarial papules and plaques of pregnancy (PUPPP) be treated?

Oral anti-histamines and topical steroid creams

A pregnant woman with petechia, pallor, or mottling is what?

Abnormal

A pregnant woman that complains of back pain begins to develop a waddling gait. What should she be educated on?

This type of gait, "the strut of pregnancy", will worsen back pain

What hormone increases the mobility of the pelvis joints?

Relaxin

A pregnant woman comes to her doctor complaining of paresthesia and pain in her dominant arm. What do you think she will be diagnosed with?

Carpal tunnel

When a pregnant lady complains of headaches, why are we concerned?

Because this could be a sign of preeclampsia

How is the esophagus, stomach, and intestines affected in pregnancy?

Increases in progesterone and estrogen cause decreased peristalsis and decrease tone and motility. This relaxation can lead to heartburn

Why is appendicitis difficult to diagnose in a pregnant patient?

Because the appendix is displaced upward and laterally away from McBurney's point

What is the hormone of pregnancy?

progesterone

What causes gestational diabetes?

human placental lactogen

Can rubella be given during prenancy?

NO, it is a live virus

What is done at the initial prenatal visit?

Social hx, physical exam, measure fundal height, FHTs, pelvic exam, UA, blood samples, screening for infectious diseases

What should be done at follow-up prenatal visits?

H&P, urine dipstick, VS, fetal assessment

What is a urine dipstick testing for?

protein and glucose

How often are pregnant women seen in the clinic?

Q4 weeks first 28 weeks

Q2 weeks until 36 weeks

Q week after 36 weeks

What are the danger signs of pregnancy?

-Gush of fluid from vagina

-Vaginal bleeding

-Abdominal pain

-Fever and chills

-Dizziness, blurred vision, spots before eyes

-Persistent vomiting

-severe, continuous HA (think pree?)

-Pretibial Edema

-Muscular irritability or convulsions

-Epigastric pain (RUQ pain)

-Headaches unrelieved by Tylenol

-Oliguria

-Dysuria

-Decrease or absence of fetal movement

What is the first sign of compromised blood flow to the fetus?

Absence or alteration of fetal movement

What is the desired H&H for a pregnant woman?

Hgb 11 and Hct 33

How much Rhogam should you give to a pregnant woman at 28 weeks?

300 mcgs

What is the VDRL/RPR/Serology test?

Screens for syphilis

Done in the first trimester and repeated in the third

If the Elisa/Western blot comes out to be seronegative, what does this mean?

Negative for HIV

When will you see a 3 hour GTT performed?

A 3 hour GTT is performed when the 1 hour glucose test is failed. This test is used to test for gestational diabetes. Normal is 130-140

What is the biggest concern with a GBS positive mom?

Baby during birth - can lead to respiratory distress

Treat during labor with abx

What could an abnormal maternal serum alpha fetal protein (MSAFP) indicate?

increased could indicate neural tube defects

decreased could mean down syndrome

Around how many weeks of gestation does the mucus begin to form?

12 weeks

Where is the uterus at 12 weeks?

symphysis pubis

What are some symptoms that occur at 12 weeks of pregnancy?

Areolar become darker, fatigue, and NV symptoms alleviate

If the uterus is being palpated at the umbilicus, around how far along can you expect the mother to be?

20 weeks

What symptoms are associated with 20 weeks of pregnancy?

A pooch forms, quickening is felt, FHTs heard

What will you see with 28 weeks of pregnancy?

Heartburn, constipation, more fatigue, and pressure on the back

Where is the fundus located at 36 weeks?

xiphoid process

What are 5 s/s seen with 20 wks of pregnancy?

FHR audible with fetoscope, ballottement, fundus at or just below the umbilicus, quickening, Goodell's, Hegar's, and Chadwick's signs

The nurse is assessing the fundal height of a client at 26 weeks gestation. The nurse should expect the fundus to be...

1. Level with the umbilicus

2. Halfway btwn symphysis and umbilicus

3. slightly below ensiform cartilage

4. At 26 cm

4. At 26 cm

An antepartum client tells the nurse her last period was May 18. The nurse uses Naegele's rule to compute the client's expected date of birth, and tells the client that the correct date of birth will be:

a. February 28 (of the next year).

b. February 11 (of the next year).

c. February 25 (of the next year).

d. February 18 (of the next year).

c. Feb 25 next year

A nurse assesses four clients in the prenatal clinic. Which client will present with the most accurate fundal height related to gestational age?

1. The client who develops polyhydramnios

2. The client with obesity

3. The client who develops HTN

4. The client with a 70 pound weight gain

3. The client who develops HTN

True or False

A woman who is 24 weeks pregnant would arrange for a follow-up visit every 2 weeks

False

While assessing a woman at 24 weeks' gestation, which of the following would the nurse report as unusual?

A.Urinary frequency

B.Backache

C.Leukorrhea

D.Flatulence with bloating

C. Leukorrhea

A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks and gave birth to twin boys at 32 weeks, now 3 years old, Using the GTPAL system, the nurse would document this woman's obstetric history as:

30112

A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which of the following locations?

A. Symphysis pubis

B. Between the symphysis and umbilicus

C. At the umbilicus

D. Just below the ensiform cartilage

C. At the umbilicus

The nurse in the prenatal clinic assesses a 26-year-old client at 13 weeks' gestation. Which presumptive (subjective) signs and symptoms of pregnancy should the nurse anticipate?

1.Hegar's sign and quickening

2.Ballottement and positive pregnancy test

3.Chadwick's sign and uterine soufflé

4.Excessive fatigue and urinary frequency

4. Excessive fatigue and urinary frequency

A nurse is assessing a prenatal client's cardiovascular function. When should the nurse expect this client's cardiac output (CO) to begin rising?

1.8-10 weeks

2.12-18 weeks

3.20-24 weeks

4.31-38 weeks

1. 8-10 wks

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be:

A. Constipation

B. Alteration in the pattern of fetal movement

C. Heart palpitations

D. Edema in the ankles and feet at the end of the day

B. Alteration in the pattern of fetal movement