Exam #1

Question 1

Gravidity

Answer 1

Pregnancy

Question 2

Parity

Answer 2

The number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation, not the number of fetuses born. The numeric designation is not affected by whether the fetus is born alive or is stillborn.

Question 3

Quickening

Answer 3

Fetal movements first felt by the pregnant woman at 16 to 18 weeks of gestation.

Question 4

Chronic Hypertension

Answer 4

Hypertension present before pregnancy or diagnosed before 20 weeks of gestation

Question 5

Eclampsia

Answer 5

Onset of seizure activity or coma in the woman diagnosed with preeclampsia, with no history of preexisting pathology that can result in seizure activity.

Question 6

Gestational Hypertension

Answer 6

Onset of hypertension during pregnancy or in the first 24 hours after birth without other signs or symptoms of preeclampsia and without preexisting hypertension.

Question 7

HELLP Syndrome

Answer 7

Laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction; it is characterized by hemolysis, elevated liver enzymes, and low platelets.

Question 8

Preeclampsia

Answer 8

Pregnancy-specific syndrome in which hypertension develops after 20 weeks of gestation in a previously normotensive woman. It is a multisystem, vasospastic disease process of reduced organ perfusion characterized by the presence of hypertension and proteinuria with a clinical continuum from mild to severe.

Question 9

Anemia

Answer 9

A hemoglobin level of less than 11g/dL or a hematocrit of less than 33% in the pregnant woman; it is mainly a result of an iron deficiency

Question 10

Maternal Serum Alpha-Fetoprotein (MSAFP)

Answer 10

Test used as a screening tool for neural tube defects in pregnancy. The test is usually performed between 16 and 18 weeks of gestation.

Question 11

Triple Marker

Answer 11

Test used to screen for Down Syndrome. It is performed between 16 and 18 weeks of gestation. The levels of three markers, namely MSAFP, unconjugated estriol, and hCG, in combination with maternal age are used to determine risk.

Question 12

Nonstress Test (NST)

Answer 12

Test based on the fact that the heart rate of a healthy fetus with an intact central nervous system will usually accelerate in response to its own movement.

Question 13

Risk factors for Preterm Labor

Answer 13

Age younger than 16 or older than 35 years, Low socioeconomic status, Maternal weight below 50 kg (110 lb), Poor nutrition, Previous preterm birth, Incompetent cervix, Uterine anomalies, Smoking, Drug addition and alcohol abuse, Pyelonephritis, Pneumonia, Multiple gestation, Anemia, Abnormal fetal presentation, Preterm rupture of membranes, Placental abnormalities, Infection

Question 14

Risk factors for Polyhydraminos

Answer 14

Diabetes mellitus, Multiple gestation, Fetal congenital abnormalities, Isoimmunization (Rh or ABO), Nonimmune hydrops, Abnormal fetal presentation

Question 15

Intrauterine Growth Restriction

Answer 15

Multiple gestation, Poor nutrition, Maternal cyanotic heart disease, Prior pregnancy with intrauterine growth restriction, Maternal collagen diseases, Chronic hypertension, Gestational hypertension, Recurrent antepartum hemorrhage, Smoking, Maternal diabetes with vascular problems, Fetal infections, Fetal cardiovascular anomalies, Drug addiction and alcohol abuse, Fetal congenital anomalies, Hemoglobinopathies

Question 16

Risk factors for Oligohydraminos

Answer 16

Renal agenesis (Potter’s syndrome), Prolonged rupture of membranes, Intrauterine growth restriction, Intrauterine fetal death

Question 17

Risk factors for Postterm Pregnancy

Answer 17

Anencephaly, Placental sulfatase deficiency, Perinatal hypoxia/acidosis, Placental insufficiency

Question 18

Risk factors for Chromosome Abnormalities

Answer 18

Maternal age 35 years or older at birth, Balanced translocation (maternal and paternal)

Question 19

What are some s/s of severe preeclampsia?

Answer 19

Systolic BP > 160mm Hg; Diastolic BP of at least 110mm Hg; Proteinuria of 5g or more per 24hr speciman; Oliguria; Cerebral disturbances: altered LOC, confusion, or HA; Visual disturbances: scotomata or blurred vision; Hepatic involement: epigastric pain, RUQ pain, impaired liver fxn or elevated liver enzymes; Thrombocytopenia with a platelet count < 100,000mm3; Hemolytic anemia; Pulmonary edema; Fetal growth restriction

Question 20

Nursing diagnoses for severe preeclampsia.

Answer 20

Risk for injury to mother and fetus r/t CNS irritability; Ineffective tissue perfusion r/t to preeclampsia secondary to arteriolar vasospasm; Risk for excess fluid volume r/t increased sodium retention secondary to admin of magnesium sulfate; Risk for impaired gas exchange r/t pulmonary edema secondary to increased vascular resistance; Risk for decreased cardiac output r/t use of antihypertensive drugs; Risk for injury to fetus r/t uteroplacental insufficiency secondary to use of antihypertensive medications

Question 21

What are some precautionary measure that should be taken for severe preeclampsia?

Answer 21

Environment: quiet, nonstimulating, lighting subdued; Seizure precautions: suction equipment tested and ready to use, oxygen admin equipment tested and ready to use; Call button within easy reach; Emergency medication tray immediately accessible: Hydralazine or other antihypertensive medication and magnesium sulfate immediately available, calcium gluconate immediately available; Emergency birth pack accessible

Question 22

What is the drug of choice in the prevention and treatment of convulsions caused by preeclampsia or eclampsia?

Answer 22

Magnesium Sulfate

Question 23

Is magnesium sulfate infused using a main IV line or as a secondary infusion (“piggyback”)?

Answer 23

It is admin as a secondary infusion (“piggyback”) to the main IV line by volumetric infusion pump.

Question 24

How is the initial loading dose of magnesium sulfate administered?

Answer 24

An initial loading dose of 4-6g diluted in at least 100mL of IV fluid per protocol or physician’s order is infused over 15-30 minutes.

Question 25

How is the maintenance dose of magnesium sulfate administered?

Answer 25

The initial loading dose is followed by a maintenance dosage of magnesium sulfate diluted in an IV solution per physician’s order and administered by infusion pump at 2g/hr.

Question 26

What serum magnesium level needs to be maintained during administration of magnesium sulfate?

Answer 26

The dose of 2g/hr of magnesium sulfate should maintain a therapeutic serum magnesium level of 4-7.5 mEq/L or 5-7 mg/dL.

Question 27

What needs to be monitored during administration of magnesium sulfate?

Answer 27

The woman’s BP, pulse, and respiratory status should be monitored closely while the loading dose is being administered intravenously and every 15-30 minutes at other times, depending on the stability of the woman’s condition.

Question 28

What is the expected therapeutic effect of magnesium sulfate?

Answer 28

Diuresis with 24-48 hours is an excellant prognostic sign. It is considered evidence that perfusion of the kidneys has improved as a result of relaxation of arteriolar spasm. With improved perfusion fluid moves from interstitial spaces to the intravascular bed, and edema is reduced. MGSO4 does not seem to affect the fetal status.

Question 29

What is BPP and why do we do this assessment?

Answer 29

Biophysical Profile is a noninvasive dynamic assessment of the fetus and its environment that is based on acute and chronic markers of fetal disease. BPP is an accurate indicator of impending fetal death. If abnormal scores (

Question 30

What criteria is assessed in the BPP?

Answer 30

It uses both real time ultrasound and external fetal monitoring. This test includes assessment of five variables namely fetal breathing movements, fetal body movements, non stress test, fetal tone, and amniotic fluid volume. Each assessment is worth 2 points. Abnormal scores (

Question 31

What is a Contraction Stress Test (CST) and why is it done?

Answer 31

It is a test used to identify the jeopardized fetus who is stable at rest but shows evidence of compromise when exposed to the stress of uterine contractions. If the resultant hypoxia of the fetus is sufficient, a deceleration of the FHR will result.

Question 32

How is the Contraction Stress Test (CST) done?

Answer 32

Two methods are used for this test: Nipple-stimulated contraction stress test & Oxytocin-stimulated contraction stress test.

Question 33

What is the Nipple-stimulated contraction stress test?

Answer 33

Use a warm wash cloth X 10 min, then massage nipples X 10 min: this stimulates release of oxytocin from the pituitary gland. Stop when adequate contractions occur. Late deceleration in FHR will occur if the fetus is stressed.

Question 34

What is an oxytocin-stimulated contraction stress test?

Answer 34

IV oxytocin is administered in titrated amounts which cause contractions which decrease uterine blood flow and oxygenation to fetus. A late deceleration in FHR will occur if the fetus is stressed.

Question 35

Janet is 10 weeks pregnant. She comes to the clinic and states that she has been experiencing slight bleeding with mild cramping for about 4 hours. No tissue has been passed and pelvic examination reveals that the cervical os is closed. Indicate the most likely basis for Janet’s signs and symptoms.

Answer 35

Threatened miscarriage.

Question 36

What is the expected care management for a threatened miscarriage?

Answer 36

Bed rest, sedation, and avoidance of stress and orgasm usually recommended; further treatment depends on woman’s response to treatment.

Question 37

Explain why women who abuse substances may delay seeking prenatal care.

Answer 37

Women fear losing custody of child and criminal prosecution. Substance-abuse treatment programs do not address issues affecting pregnant women. Long waiting lists for treatment and lack of health insurance present further barriers to treatment. Stigma, shame and guilt lead to high denial of drug/alcohol problems.

Question 38

A patient is in her 2nd month of pregnancy. One minute she is happy and the next minute she is crying for no reason at all. What is a nursing diagnosis and expected outcome that reflects these symptoms?

Answer 38

Interrupted family processes r/t inadequate understanding of physical and emotional changes in pregnancy. Describe improved family dynamics.

Question 39

How would you respond to a husband that doesn’t know how to cope with his wife that is happy one minute and crying the next for no reason at all?

Answer 39

Explain to him that the rapid mood changes, including increased irritability, explosions of tears and anger, are often attributed to the hormonal changes his wife is going through.