EAQ Womens Health and Childbearing Health Promotion Flashcards
A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How does the nurse, using the GTPAL format, document the client’s obstetric history?
• A G4 T3 P2 A1 L4
• B G5 T2 P2 A1L4
• C G5 T2 PI A1 L4
• D G4 T3 PI A1 L4
• C G5 T2 PI AL L4
Rationale
The acronym GTPAL stands for gravidity, term births, preterm births, abortions, and living children; G5 T2 Pl Al L4 indicates that the client has had five pregnancies (twins count as one pregnancy, and the current pregnancy counts as one), two term births, one preterm birth (the twins), one abortion, and four living children. G4 T3 P2 Al L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one, not two, preterm birth; one abortion; and four living children.
A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, how would the nurse document theclient’s obstetric history?
• A G4 T3 P2 A1 L4
• B G5 T2 P2 A1 L4
• C G5 T2 Pl A1 L4
• D G4 T3 PI A1 L4
• C G5 T2 Pl Al L4
Rationale
The acronym GTPAL represents gravidity, term births, preterm births, abortions, and living children; G5 T2 PI Al L4 indicates that the client has had five pregnancies (twins count as one pregnancy and the current pregnancy counts as one); two term births; one preterm birth (the twins); one abortion; and four living children. G4 T3 P2 Al L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins count as one, not two, preterm birth; one abortion; and four living children. G5 T2 P2 Al L4 indicates that there were five pregnancies; two term births; twins count as one, not two, preterm births; one abortion; and four living children.
Which action will the nurse take when a client’s prenatal record indicates they are G2 PO, but the client denies having a previous pregnancy in the presence of her current partner?
• A Confirm the obstetric history when the client is alone.
• B Adjust documentation to indicate that the client is a G1 PO.
• C Explain the importance of accurate information to the client and her partner.
• D Ask the client and her partner about a previous miscarriage or abortion.
• A Confirm the obstetric history when the client is alone.
Rationale
The nurse should be cautious when discussing obstetric history with a client in front of the partner or family. The nurse should not assume that others have knowledge of the client’s past pregnancies. If there is a discrepancy between what the client discloses in the interview and the medical record, the information should be clarified when the client is alone to maintain confidentiality.
A pregnant client has two children at home, one born at 38 weeks’ gestation and the second born at 34 weeks’ gestation. She has also had one miscarriage at 18 weeks and an elective abortion. Using the GTPAL system, which is the client’s obstetrical record?
• A G5 T1 P1 A2 L2
• B G4 T2 P2 Al L4
• C G2 T3 P3 A2 LI
• D G3 T2 PI A3 L3
• A G5 T1 P1 A2 L2
Rationale
G (gravida) stands for the total number of pregnancies a client has had. Gravida 5 indicates that this is the client’s fifth pregnancy. T (term) stands for the number of neonates born at the expected date of birth. The neonate born at 38 weeks’ gestation was born at term. P (preterm) stands for the number of neonates born before the expected date of birth. The neonate born at 34 weeks’ gestation was born preterm. An abortion or miscarriage describes the birth of a fetus before 20 weeks’ gestation.
Both the miscarriage and elective abortion are considered abortions. L living) stands for the number of living children at the time of assessment. The client has two living children.
Using the GTPAL system, determine the obstetric history in this example. The client is 38 weeks into her fourth pregnancy. Her third pregnancy, a twin gestation, ended at 32 weeks with a live birth, her second pregnancy ended at 38 weeks with a live birth, and her first pregnancy ended at 18 weeks.
• A G4, T2, P1, A1, L2
• B G4, T1, P2, Al, LI
• C G4, T1, PI, Al, L3
• D G4, T2, P1, A1, LI
• C G4, T1, PI, Al, L3
Rationale
Four pregnancies = G (gravida) 4. One pregnancy that
ended at 38 weeks = T (term) I. One pregnancy that
ended at 32 weeks = P (preterm) 1. One pregnancy that
ended at 18 weeks = A (abortion) 1. One set of twins and a
singleton = L (living) 3.
Using the GTPAL system, determine the obstetric history for this client: She has just delivered at 38 weeks’ gestation. Her third pregnancy, a twin gestation, ended at 32 weeks with a live birth, her second pregnancy ended at 32 weeks with a live birth, and her first pregnancy ended at 18 weeks.
• A G4, T2, PI, AI, L2
• B G4, T1, P2, A1, LI
• C G4, T1, P1, AI, L3
• D G4, 12, P1, AI, LI
• C G4, T1, P1, AI, L3
Rationale
Four pregnancies = G (gravida) 4. One pregnancy that
ended at 38 weeks = T (term) 1. One pregnancy that
ended at 32 weeks = P (preterm) 1. One pregnancy that
ended at 18 weeks = A (abortion) 1. One set of twins and a
singleton = L (living) 3.
Which assessment would the nurse anticipate for a 24-year-old female client who tells the nurse that she has missed her last three menstrual cycles? Select all that apply. One, some, or all responses may be correct.
• A Endocrine testing
• B PregnancyResting
• C Height and weight
• D Medication history
• E Pelvic examination
• A Endocrine testing
• B PregnancyResting
• C Height and weight
• D Medication history
• E Pelvic examination
Rationale
Hypo- and hyperthyroidism are some of the endocrine diseases associated with secondary amenorrhea.
Pregnancy also results in secondary amenorrhea. Obesity and anorexia can cause secondary amenorrhea.
Medications such as antileptics, oral contraceptives or other hormonal therapies, cocaine, and opioid use can result in secondary amenorrhea.
Which finding is most indicative of pregnancy in a client presenting to the clinic with complaints of nausea and amenorrhea and reporting that she obtained a positive result on a home pregnancy test?
• A Her menses is a week late.
• B Her urine immunoassay test is positive.
• C She reports that she has urinary frequency.
• D She complains that she has nausea every morning
• B Her urine immunoassay test is positive.
Rationale
A positive result on a urine pregnancy test is a probable sign of pregnancy because the test is based on the presence of human chorionic gonadotropin (hCG) in the urine and is 95% accurate in detecting pregnancy.
Menses a week late is a presumptive sign of pregnancy, but there are many other causes of amenorrhea. Urinary frequency is a presumptive sign of pregnancy.
Which sign would the nurse document when the client’s vaginal mucosa is noted to have a purplish discoloration?
• A Hegar
• B Goodell
• C Chadwick
• D Braxton Hicks
• C Chadwick
Rationale
A purplish coloration, called the Chadwick sign, results from the increased vascularity and blood vessel engorgement of the vagina. The Hegar sign is softening of the lower uterine segment. The Goodell sign is softening of the cervix. After the fourth month of pregnancy, irregular, painless uterine contractions, called Braxton Hicks contractions, can be felt through the abdominal wall.
Which presumptive sign of pregnancy at 10 weeks of gestation may the nurse expect? Select all that apply. One, some, or all responses may be correct.
• A Amenorri
• B Breast changes
• C Urinary frequency
• D Abdominal enlargement
• E Positive urine pregnancy test
• A Amenorri
• B Breast changes
• C Urinary frequency
Rationale
The absence of menstruation (amenorrhea is a presumptive sign of pregnancy that is recognized at 4 weeks of gestation. Breast changes, caused by increased levels of estrogen and progesterone, are a presumptive sign of pregnancy that is recognized at 3 to 4 weeks of gestation. Urinary frequency, caused by pressure of the enlarging uterus on the urinary bladder, is a presumptive sign of pregnancy that is recognized at 6 to 12 weeks of gestation.
A small-for-gestational-age (SGA) newborn who has just been admitted to the nursery has a high-pitched cry, appears jittery, and exhibits irregular respirations. What complication does the nurse suspect?
• A Hypovolemia
• B Hypoglycemia
• C Hypercalcemia
• D Hypothyroidism
• B Hypoglycemia
Rationale
SGA infants may exhibit signs of hypoglycemia, especially during the first 2 days of life, because of depleted glycogen stores and inhibited gluconeogenesis.
Decreased blood pressure, pallor with cyanosis, tachycardia, retractions, lethargy, and a weak cry are signs of hypovolemia. Hypercalcemia is uncommon in newborns. These signs are unrelated to hypothyroidism; signs of hypothyroidism are difficult to identify in the newborn.
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A client presents with complaints of nausea and amenorrhea and reports that she obtained a positive result on a home pregnancy test. Which component of the history is most indicative of pregnancy?
• A Her menses is l week late.
• B Her urine immunoassay test is positive.
• C She reports that she has urinary frequency.
• D She complains that she has nausea every morning.
• B Her urine immunoassay test is positive.
Rationale
A positive result on a urine pregnancy test is a probable sign of pregnancy because the test, based on the presence of human chorionic gonadotropin (hCG) in the urine, is 95% accurate in detecting pregnancy. Menses 1 week late is a presumptive sign of pregnancy; there are many other causes of amenorrhea. Urinary frequency is a presumptive sign of pregnancy; there are other causes of frequency, such as urinary tract infection.
During a pelvic examination, the nurse midwife finds the client’s cervix is bluish purple-the Chadwick sign. The client is concerned and asks if something is wrong. What response by the nurse midwife is appropriate?
• A “It helps confirm your pregnancy.”
• B “It is not unusual, even in women who are not pregnant.”
• C “It occurs because the blood is trapped by the pregnant uterus.”
• D “It is caused by increased blood flow to the uterus during pregnancy.”
• D “It is caused by increased blood flow to the uterus during pregnancy.”
Rationale
Stating that the Chadwick sign is caused by increased blood flow to the uterus during pregnancy underscores the normalcy of Chadwick sign and provides a simple explanation of the cause; women often need reassurance that the physical changes associated with pregnancy are expected. Stating that the Chadwick sign helps confirm pregnancy answers part of the question but fails to explain why it occurs. The Chadwick sign is a probable sign of pregnancy; it is not seen in nonpregnant women.
No free blood is circulating in the uterus during pregnancy.
A primigravida at 8 weeks’ gestation is visiting the prenatal clinic for the first time. Which sign would an examination reveal at this time?
• A Lightening
• B Quicken
• C Goodell’s sign
• D Braxton Hicks sign
• C Goodell’s sign
Rationale
Goodell’s sign, or softening of the cervix, occurs at 8 to 9 weeks’ gestation. Lightening or settling of the fetal presenting part into the pelvis usually occurs about 2 weeks before the onset of labor in nulliparas. Quickening refers to fetal movement, usually perceived by the mother between the 16th and 20th weeks of gestation. Braxton Hicks (preparatory) contractions consist of intermittent cramplike contractions that start at the 16th week and grow stronger and more frequent as pregnancy progresses.
A pregnant client tells the nurse, “I think I can feel the baby move now. It feels like butterflies in my stomach. My friend calls it feeling life.” Which term would the nurse include when discussing fetal movement with the client?
• A Lightening
• B Quickening
• C Engagement
• D Ballottement
• B Quickening
Rationale
The word quickening originates from the middle English word quik, which means “alive.” Quickening is said to occur when the pregnant woman can feel the fetus moving. Lightening is the descent of the fetus into the birth canal toward the end of pregnancy. Engagement occurs when the presenting part is at the level of the ischial spines. Ballottement refers to the technique that causes the fetus to rebound in the amniotic fluid after pressure has been exerted against the fetus.
