Ch. 21 Prenatal Period

Question 1

A nulligravida is a woman who has

Answer 1

been pregnant

Question 2

Gravidity refers to a

Answer 2

pregnant woman
# of times woman has been pregnant (current pregnancy)

Question 3

Gravidity refers to the

Answer 3

number of pregnancies

Question 4

A primigravida is a woman who is

Answer 4

pregnant for the first time

Question 5

A multigravida is a woman in at

Answer 5

least her second pregnancy

Question 6

What is gestation?

Answer 6

Time from fertilization of the ovum until the date of delivery

Question 7

Gestation is about

Answer 7

280 days

Question 8

+++++++Naegele rule is

Answer 8

isestimation the date of delivery

Question 9

Parity is the

Answer 9

number of births (not the number of fetuses, e.g., twins)
carried past 20 weeks of gestation
whether or not the fetus was born alive

Question 10

Nullipara is

Answer 10

a woman who has not had a birth at more that 20 weeks of gestation

Question 11

primipara is

Answer 11

a woman who has had 1 birth that occurred after the 20th weeks of gestation

Question 12

multipara is

Answer 12

woman who has had 2 or more pregnancies to the stage of fetal viability

Question 13

++++++++GTPAL stand for

Answer 13

Gravidity - # of pregnancy even the current
Term births - # born > 37 weeks
Preterm births - # births, < 37 weeks
Abortions or miscarriages - include gravida before 20 weeks
Current living children - living children

Question 14

Nulli means
Primi means
Multi means

Answer 14

Nulli - none
Primi - one
Multi - multiple

Question 15

Gravida
nulligravida -
primigravida -
multigravida -

Answer 15

Gravida
nulligravida - never been pregnant
primigravida - pregnant once or current pregnancy
multigravida - 2 or more times

Question 16

Para
nullipara
primipara
multipara

Answer 16

Para
nullipara - no birth or completed a 20 week pregnancy
primipara - completed one pregnancy at 20 weeks or greater
multipara -completed two pregnancy at 20 weeks or greater

Question 17

3 Pregnancy - 3 x’s
1 birth - 39 wks
= G P

Answer 17

G 3, P 1

Question 18

Pregnant w/ twins @ 30 wks, 1st pregnancy

G? P?

Answer 18

G 1, P 0

Question 19

Delivered twins at 37 weeks, not pregnant

G? P?

Answer 19

G1, P2

Question 20

8 Pregnancy signs

Answer 20

1. Amenorrhea - absence of monthly menstrual period
2. N/v
3. increase in size
4. Pronounced nipples
5. Urinary frequency
6. Quickening
7. Fatigue
8. Discoloration of vaginal mucosa

Question 21

Probable Signs of pregnancy

Answer 21

1. Uterine enlargement
2. Hegar’s sign:
3. Goodell’s sign
4. Chadwick’s sign
5. Ballottement
6. Braxton Hicks contractions
7. Positive pregnancy test

Question 22

Positive signs (diagnostic) pregnancy

Answer 22

1. FHT rate
2. Active fetal movements
3. Outline of fetus via radiography or ultrasonography

Question 23

Fundal Height is measured to

Answer 23

evaluate the gestational age of the fetus

Question 24

+++++During the second and third

Answer 24

During the second and third trimesters ( wk 18 to 30), fundal height in centimeters approximately equals fetal age in weeks +/- 2cm

Question 25

Steps for Measuring Fundal Height

Answer 25

1. Place the client in the supine position
2. Place the end of the tape measure at the level of the symphysis pubis
3. Stretch the tape to the top of the uterine fundus
4. Note and record the measurement

Question 26

!!! When assessing fundal heigh, monitor the client closely for

Answer 26

supine hypotension when placed in the supine position

Question 27

!!!! Cardiovascular System -
During pregnancy a woman’s pulse may _________
B/P may _____ in the _____ trimester
B/P may ______ in the _____ trimester by not ____ pre-pregnancy B/P
Respiratory rate will ?

Answer 27

pulse rate may increase 10-15 bpm
b/p slightly decreases in the second trimester
b/p increases in the third trimester
RR remains unchanged or slightly increases.

Question 28

The nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. What instruction should the nurse provide?

Answer 28

An informed consent needs to be signed before the procedure.

Question 29

The nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. What instruction should the nurse provide?

1. Strict bed rest is required after the procedure.
2. Hospitalization is necessary for 24 hours after the procedure.
3. An informed consent needs to be signed before the procedure.
4. A fever is expected after the procedure because of the trauma to the abdomen.

Answer 29

An informed consent needs to be signed before the procedure.

Because amniocentesis is an invasive procedure, informed consent needs to be obtained before the procedure. After the procedure, the client is instructed to rest, but may resume light activity after the cramping subsides. The client is instructed to keep the puncture site clean and to report any complications, such as chills, fever, bleeding, leakage of fluid at the needle insertion site, decreased fetal movement, uterine contractions, or cramping. Amniocentesis is an outpatient procedure and may be done in the health care provider’s office or in a special prenatal testing unit. Hospitalization is not necessary after the procedure.

Question 30

A pregnant client in the first trimester calls the nurse at a health care clinic and reports that she has noticed a thin, colorless vaginal drainage. The nurse should make which statement to the client?

1.
“Come to the clinic immediately.”
2.
“The vaginal discharge may be bothersome, but is a normal occurrence.”
3.
“Report to the emergency department at the maternity center immediately.”
4.
“Use tampons if the discharge is bothersome, but be sure to change the tampons every 2 hours.”

Answer 30

“The vaginal discharge may be bothersome, but is a normal occurrence.”

Leukorrhea begins during the first trimester. Many clients notice a thin, colorless or yellow vaginal discharge throughout pregnancy. Some clients become distressed about this condition, but it does not require that the client report to the health care clinic or emergency department immediately. If vaginal discharge is profuse, the client may use panty liners, but she should not wear tampons because of the risk of infection. If the client uses panty liners, she should change them frequently.

Question 31

A nonstress test is performed on a client who is pregnant, and the results of the test indicate nonreactive findings. The health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this finding?

Answer 31

A normal test result

Contraction stress test results may be interpreted as negative (normal), positive (abnormal), or equivocal. A negative test result indicates that no late decelerations occurred in the fetal heart rate, although the fetus was stressed by 3 contractions of at least 40 seconds’ duration in a 10-minute period. Options 2, 3, and 4 are incorrect interpretations.

Question 32

A rubella titer result of a 1-day postpartum client is less than 1:8, and a rubella virus vaccine is prescribed to be administered before discharge. The nurse provides which information to the client about the vaccine? Select all that apply.

1.
Breast-feeding needs to be stopped for 3 months.
2.
Pregnancy needs to be avoided for 1 to 3 months.
3.
The vaccine is administered by the subcutaneous route.
4.
Exposure to immunosuppressed individuals needs to be avoided.
5.
A hypersensitivity reaction can occur if the client has an allergy to eggs.
6.
The area of the injection needs to be covered with a sterile gauze for 1 week

Answer 32

2.
Pregnancy needs to be avoided for 1 to 3 months.
3.
The vaccine is administered by the subcutaneous route.
4.
Exposure to immunosuppressed individuals needs to be avoided.
5.
A hypersensitivity reaction can occur if the client has an allergy to eggs.

Rubella vaccine is administered to women who have not had rubella or women who are not serologically immune. The vaccine may be administered in the immediate postpartum period to prevent the possibility of contracting rubella in future pregnancies. The live attenuated rubella virus is not communicable in breast milk; breast-feeding does not need to be stopped. The client is counseled not to become pregnant for 1 to 3 months after immunization or as specified by the health care provider because of a possible risk to a fetus from the live virus vaccine; the client must be using effective birth control at the time of the immunization. The client should avoid contact with immunosuppressed individuals because of their low immunity toward live viruses and because the virus is shed in the urine and other body fluids. The vaccine is administered by the subcutaneous route. A hypersensitivity reaction can occur if the client has an allergy to eggs because the vaccine is made from duck eggs. There is no useful or necessary reason for covering the area of the injection with a sterile gauze.

Question 33

The nurse in a health care clinic is instructing a pregnant client how to perform “kick counts.” Which statement by the client indicates a need for further instruction?

1.
“I will record the number of movements or kicks.”
2.
“I need to lie flat on my back to perform the procedure.”
3.
“If I count fewer than 10 kicks in a 2-hour period, I should count the kicks again over the next 2 hours.”
4.
“I should place my hands on the largest part of my abdomen and concentrate on the fetal movements to count the kicks.”

Answer 33

“I need to lie flat on my back to perform the procedure.”

The client should sit or lie quietly on her side to perform kick counts. Lying flat on the back is not necessary to perform this procedure, can cause discomfort, and presents a risk of vena cava (supine hypotensive) syndrome. The client is instructed to place her hands on the largest part of the abdomen and concentrate on the fetal movements. The client records the number of movements felt during a specified time period. The client needs to notify the health care provider (HCP) if she feels fewer than 10 kicks over two consecutive 2-hour intervals or as instructed by the HCP.

Question 34

The nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the fundal height in centimeters and notes that the fundal height is 30 cm. How should the nurse interpret this finding?

1.
The client is measuring large for gestational age.
2.
The client is measuring small for gestational age.
3.
The client is measuring normal for gestational age.
4.
More evidence is needed to determine size for gestational age

Answer 34

The client is measuring normal for gestational age.

During the second and third trimesters (weeks 18 to 30), fundal height in centimeters approximately equals the fetus’s age in weeks ± 2 cm. Therefore, if the client is at 28 weeks gestation, a fundal height of 30 cm would indicate that the client is measuring normal for gestational age. At 16 weeks, the fundus can be located halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks, the fundus is at the umbilicus. At 36 weeks, the fundus is at the xiphoid process.

Question 35

The nurse is performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. The nurse should assess for which probable signs of pregnancy? Select all that apply.

1.
Ballottement
2.
Chadwick's sign
3.
Uterine enlargement
4.
Positive pregnancy test
5.
Fetal heart rate detected by a nonelectronic device
6.
Outline of fetus via radiography or ultrasonography

Answer 35

1.
Ballottement
2.
Chadwick's sign
3.
Uterine enlargement
4.
Positive pregnancy test

The probable signs of pregnancy include uterine enlargement, Hegar’s sign (compressibility and softening of the lower uterine segment that occurs at about week 6), Goodell’s sign (softening of the cervix that occurs at the beginning of the second month), Chadwick’s sign (violet coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at about week 4), ballottement (rebounding of the fetus against the examiner’s fingers on palpation), Braxton Hicks contractions, and a positive pregnancy test for the presence of human chorionic gonadotropin. Positive signs of pregnancy include fetal heart rate detected by electronic device (Doppler transducer) at 10 to 12 weeks and by nonelectronic device (fetoscope) at 20 weeks of gestation, active fetal movements palpable by the examiner, and an outline of the fetus by radiography or ultrasonography.

Question 36

A pregnant client is seen for a regular prenatal visit and tells the nurse that she is experiencing irregular contractions. The nurse determines that she is experiencing Braxton Hicks contractions. On the basis of this finding, which nursing action is appropriate?

Answer 36

3.

Inform the client that these contractions are common and may occur throughout the pregnancy.

Question 37

A client arrives at the clinic for the first prenatal assessment. She tells the nurse that the first day of her last normal menstrual period was October 19, 2018. Using Nägele’s rule, which expected date of delivery should the nurse document in the client’s chart?

Answer 37

2.

July 26, 2019

Question 38

The nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child who was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. Using GTPAL, what should the nurse document in the client’s chart?

Answer 38

2.

G = 2, T = 1, P = 0, A = 0, L = 1

Question 39

!! When assessing fundal height, monitor the client closely for ______ ________ when placed in the ______ position.

Answer 39

supine hypotension

supine

Question 40

Fundus by weeks of normal gestation with a single fetus. position week 20 - 22

Answer 40

at the location of the umbilicus

Question 41

Fundus by weeks of normal gestation with a single fetus. position week 36

Answer 41

fundus is at the xiphoid process

Question 42

!! During pregnancy, postural changes occur as the increased weight.
Encourage the client to implement measures that maintain safety and

Answer 42

correct posture to prevent a backache.

Question 43

Nausea and vomiting occurs in the _______ trimester and usually subsides by the 3rd ____

Answer 43

1st

3rd month

Question 44

Nausea and vomiting is caused by elevated levels of human ________ __________ and other pregnancy ________ as well as changes in ___________ metabolism

Answer 44

human chorionic gonadotropin and
other pregnancy hormones as well as
changes in carbohydrate metabolism

Question 45

Interventions for N/V

Answer 45

dry crackers before arising
avoid brushing teeth immediately after arising
eating small meals 
low-fat meals
drink between meals rather than at meals 
Avoid fried and spicy foods
acupressure
herbal remedies 
antiemetic

Question 46

!! What trimester is a woman more at risk for hypotension?

Answer 46

2nd and 3rd

Question 47

!!What position places the woman at risk for hypotension

Answer 47

Supine

Question 48

!! Nurse should instruct pregnant woman to avoid ________ in the __________position to avoid hypotension

Answer 48

lying

supine

Question 49

Maternal age for woman

Answer 49

20-35

Question 50

!!!Folic acid supplement help to prevent

______ ______ ______ and ________ ______ in the fetus

Answer 50

neural tube defects

orofacial clefts

Question 51

Another name for German measles

Answer 51

Rubella

Question 52

!! Antepartum health care visits is every ____ weeks for the first ____ to ____ weeks

Answer 52

28 to 32 weeks

Question 53

!! Antepartum health care visits is every 2 weeks from ___ to ___ weeks, and every week from ____ to ___ weeks.

Answer 53

32 to 36 weeks

36 to 40 weeks