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NRSG 206: OB > [Exam 1] Chapter 12 - Nursing Management During Pregnancy > Flashcards

[Exam 1] Chapter 12 - Nursing Management During Pregnancy Flashcards

1
Q

Preconception Care: What is this?

A

Promotion of the health and well-being of a woman and her partner before pregnancy. Goal is to identify and modify biomedical, behavioral, and social risks to a womens health

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2
Q

Preconception Care: Primary care for all womens of childbearing age by nurses should include what?

A

A routine assessment of a womans reproductive goals and planning

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3
Q

Preconception Care: For women not intending a pregnancy soon, preconception care should focus on

A

contraception counseling

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4
Q

Preconception Care: Folic Acid should be at how much per day?

A

400-800 mcg per day

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5
Q

Preconception Care: What vaccines should a women get?

A

Influenza if during flu season

Rubella and Varicella Vaccines if no evidence of immunity

TDaP if missing

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6
Q

Preconception Care: New insight reveal that early embryo is extremely sensitive to signals from

A

gametes, trophoblastic tissue, and periconception maternal lifestyles

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7
Q

Preconception Care and RF for Adverse Pregnancy Outcomes: Preconception care can reduce what outcomes?

A

Maternal and infant mortality, preterm briths, and low-birth-weight infants

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8
Q

Preconception Care and RF for Adverse Pregnancy Outcomes: What percentage of women do not take folic supplements?

A

70%

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9
Q

Preconception Care and RF for Adverse Pregnancy Outcomes: Period of greatest environmental sensitivity is between what days?

A

17-56 days

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10
Q

Preconception Care and Nursing Management: How can Isotretinoins affect fetus?

A

Accutane, high risk of congenital malformations which may include craniofacial, cardiac, and CNS injuries

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11
Q

Preconception Care and Nursing Management: How can Alcohol Misuse affect fetus?

A

Fetal alcohool syndrome and other alcohol related birth defects

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12
Q

Preconception Care and Nursing Management: How can Antiepileptic drugs affect fetus?

A

(Valporic Acid). if prescribed, should be prescribed to a lower dose

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13
Q

Preconception Care and Nursing Management: Key areas of complete health history and physical examination include what?

A

Immunizations

Underlying medical conditions

Reproductive health data

Sex practices

Lifestyle practices

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14
Q

First Prenatal Visit: What occurs in the initial visit?

A

Idel time to screen for factors that might place the woman and her fetus at risk for problems such as preterm delivery

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15
Q

First Prenatal Visit: What two ways can prenatal care be delievered?

A

Individually or in a group format termed centering.

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16
Q

First Prenatal Visit: How does the centering pregnancy model of group prenatal care work?

A

Involves group of up to a dozen women meeting for 10 sessions for 1.5-2 hours each .

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17
Q

First Prenatal Visit: International Association of Diabetes recently issues what recommendation for first prenatal visit?

A

Measure fasting plasma glucose, HbA1c or random plasma glucose. If okay, test again at 24-28 weeks for gestational diabetes with 2 hour 75 g oral glucose tolerance test

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18
Q

First Prenatal Visit: Threshold for fasting plasma glucose?

A

126 mg/dL

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19
Q

First Prenatal Visit: Threshold for Hemoglobin A1c level?

A

6.5%

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20
Q

First Prenatal Visit: Threshold for random plasma glucose?

A

200 mg/dL

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21
Q

First Prenatal Visit and Comprehensive Health Hx: What comprehensive information is obtained?

A

Age, menstrual history, prior obstetric history, past medical and surgical history, psychological screening, genetic screening, and medication or drug use

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22
Q

First Prenatal Visit and Comprehensive Health Hx: Initial health history includes questions about what three major areas?

A

The reason for seeking care,

clients past medical, surgical, and personal history

Clients reproductive history

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23
Q

First Prenatal Visit and Reason for Seeking Care: Urine or blood test is performed to test for what?

A

Evidence of human chorionic gonadotropin (hCG)

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24
Q

First Prenatal Visit and Past History: Why is it important to ask about past history?

A

Because conditions experienced in past may recur or be exacerbated during pregnancy

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25
Q

First Prenatal Visit and Past History: What should you ask about personal history?

A

Her occupation, possible exposure to teratogens, exercise and activity, recreational patterns, and use of different therapies.

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26
Q

First Prenatal Visit and Past History: What changes will smoking cause on fetus?

A

Nicotine causes vasoconstriction in mother, leading to reduced placental perfusion

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27
Q

First Prenatal Visit and Reproductive History: What does this typically include?

A

Menstrual, obstetric, and gynecologic history.

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28
Q

First Prenatal Visit and Reproductive History: History begins with what?

A

Description of womans menstrual cycle, including her age, number of days in cycle, typical flow, adn any discomfort experienced

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29
Q

First Prenatal Visit and Reproductive History: What does the end point date provide?

A

Timing of specific maternal and fetal testing throughout pregnancy, gauges fetal growth parameters, and provides well established timelines

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30
Q

First Prenatal Visit and Reproductive History: What is the Nagele Rule?

A

Used to estimate date of birth.

Subtract 3 months from her LMP and then add 7 days to the first day of the LMP. Then add one year to the date.

Margain of error is plus or minnus two weeks

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31
Q

First Prenatal Visit and Reproductive History: What may cause Nageles rule to be irregular?

A

If woman concieves while breast feeding or before her regular menstrual child is established after childbirth

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32
Q

First Prenatal Visit and Reproductive History: What device is a more accurate way to determine gestational age?

A

Ultrasound

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33
Q

First Prenatal Visit and Reproductive History: What does obstetric history provide?

A

Information about womans poast prenancies, including any problems encountered during pregnancy, labor, birth, and postpartum

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34
Q

First Prenatal Visit and Reproductive History: What is Gravid?

A

state of being prenant

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35
Q

First Prenatal Visit and Reproductive History: What is gravida/gravidity?

A

total number of times a woman has been pregnant, regardless of whether pregnancy resulted in termination

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36
Q

First Prenatal Visit and Reproductive History: What is Nulligravida?

A

Woman who has never experienced pregnancy

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37
Q

First Prenatal Visit and Reproductive History: What is Primigravida?

A

Woman pregnant for the first time

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38
Q

First Prenatal Visit and Reproductive History: What is Secundigravida?

A

Woman pregnant for the second time

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39
Q

First Prenatal Visit and Reproductive History: What is Multigravida?

A

Woman pregnant for at least third time

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40
Q

First Prenatal Visit and Reproductive History: What is Para?

A

Number of times a woman has given birth to a fetus of at least 20 gestational weeks, counting multiple births as one event

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41
Q

First Prenatal Visit and Reproductive History: What is Parity?

A

Refers to the number of pregnancies, not the number of fetuses, carried to the point of viability regardless of outcome

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42
Q

First Prenatal Visit and Reproductive History: What is Nullipara?

A

Woman has not produced viable offspring

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43
Q

First Prenatal Visit and Reproductive History: What is Primipara?

A

Woman who has given birth once after a pregnancy of at least 20 weeks,

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44
Q

First Prenatal Visit and Reproductive History: What is Multipara?

A

Woman who has had two or more pregnancies of at least 20 weeks gestation resulting in viable offspring.

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45
Q

First Prenatal Visit and Reproductive History: What are teh sayings used for Obstetric History terms?

A

GTPAL or TPAL

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46
Q

First Prenatal Visit and Reproductive History: What does GTPAL stand for?

A 
Gravida
Term Births
Preterm Births
Abortions
Living Children
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47
Q

First Prenatal Visit and Reproductive History: Example of GTPAL

Mary Johnson is pregnant for fourth time

She had one abortion at 8 weeks

Has daughter born at 40 weeks and son born at 34 weeks

A

Gravida = 4, Para = 2

TPAL = 1112

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48
Q

First Prenatal Visit and Physical Exam - Preparation: What do you instruct them to do at start?

A

Put on gown. Ask them to empty their bladder. Clean-Catch sent to lab for urinalysis to detect possible UTI

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49
Q

First Prenatal Visit and Physical Exam - Preparation: How do you begin the physical exam?

A

By obtaining VS including BP, RR, Temp, Pulse. Also measure height.

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50
Q

First Prenatal Visit and Physical Exam - Preparation: What may elevated bP suggest?

A

Pregestational hypertension.

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51
Q

First Prenatal Visit and Physical Exam - Head n Neck: What do you check for here?

A

Palpate for enlarged lymph nodes. Note any edema of nasal mucosa or gingivitis. Palpate thyroid gland

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52
Q

First Prenatal Visit and Physical Exam - Chest: Why may murmur be heart?

A

Because of increase in blood volume.

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53
Q

First Prenatal Visit and Physical Exam - Chest: HR change?

A

Change by 10-15 bpm starting at 14-20 weeks.

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54
Q

First Prenatal Visit and Physical Exam - Chest: What does Estrogen affect in chest?

A

Promotes relaxation of ligaments and joints of ribs, resulting increase in anteroposteior chest diameter . Expect increase in RR

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55
Q

First Prenatal Visit and Physical Exam - Chest: What does estrogen and progesterone do to breasts?

A

Make the breasts feel full and more nodular, with increased sensitivty to touch . Blood vessels are more visible.

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56
Q

First Prenatal Visit and Physical Exam - Abdomen: What should you inspect it for?

A

Striae, scars, shape, and size. May reveal striae gravidarum and linea nigra.

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57
Q

First Prenatal Visit and Physical Exam - Abdomen: Where can fundus be palpated at 12 weeks?

A

At the symphysis

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58
Q

First Prenatal Visit and Physical Exam - Abdomen: Where can fundus be palpated at 16 weeks?

A

Midway between symphysis and the umbilicus

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59
Q

First Prenatal Visit and Physical Exam - Abdomen: Where can fundus be palpated at 20 and 36 weeks?

A

20= Palpated at umbilicus

36 = fundus is just below the xiphoid process

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60
Q

First Prenatal Visit and Physical Exam - Extremities: What should you inspect legs for?

A

Palpate for edema, pulses and varicose veins.

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61
Q

First Prenatal Visit and Physical Exam - External Genitalia: They should be free form what?

A

Lesions, discharge, hematomas, varicosities , and inflammation upon inspection

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62
Q

First Prenatal Visit and Physical Exam - Internal Genitalia: How should cervix appear?

A

Should be smooth, ,long, thick, and closed. Cervix will be softened (Goodell) Uterine Isthmus softened (Hegar sign) and Chadwick sign

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63
Q

First Prenatal Visit and Physical Exam - Internal Genitalia: Once examination of internal genitalia complete, spulum removed and what ahppens?

A

Bimanual exam of uterus to confirm size of uterus and to palpate of ovaries, they should be small and nontender

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64
Q

First Prenatal Visit and Physical Exam - Pelvic Size, Shape, Measurement: Size and shpe divided into what four types?

A

Gynecoid, Android, Anthropoid, an dPlatypelloid

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65
Q

First Prenatal Visit and Physical Exam - Pelvic Size, Shape, Measurement: Why are internal pelvic measurements important?

A

Determines the actual diameters of the inlet and outlet through which the fetus will pass.

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66
Q

First Prenatal Visit and Physical Exam - Pelvic Size, Shape, Measurement: What three measurements are assessed?

A

Diagonal conjugate, true conjugate, and ischial tuberosity.

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67
Q

First Prenatal Visit and Physical Exam - Pelvic Size, Shape, Measurement: What is the diagonal conjugate?

A

Distance between anterior surface of sacral prominence and the anterior surface of inferior margin of the symphysis ubis. Measurement usually 12.5 cm or greater represents anteroposterior diameter of pelvic inlet.

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68
Q

First Prenatal Visit and Physical Exam - Pelvic Size, Shape, Measurement: What is the true conjugate?

A

Measurement form anterior surface of the sacral prominence to the posterior surface of the inferior margin of the symphysis pubis

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69
Q

First Prenatal Visit and Physical Exam - Lab Test: What is urine analyzed for?

A

Albumin, glucose, ketones, and bacteria casts

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70
Q

First Prenatal Visit and Physical Exam - Lab Test: What do blood studies include

A

Hgb, Hct, RBC, WBC, Blood Typing, Rh Factor, glucose screening, and sti

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71
Q

First Prenatal Visit and Physical Exam - Lab Test:

Levels of Hgb, Hct, RBC, WBC, and platelet count

A

Hgb is 12-14
Hct is 42%
RBC is 4.2-5.4 million
WBC is 150,000-450000

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72
Q

Follow-Up Visits: How often must they come in for checkup?

A

Every 4 weeks up to 28 weeks

Every 2 weeks from 29-36 weeks

Every week from 37 weeks to birth

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73
Q

Follow-Up Visits: What assessments occurs at each follow up?

A

Weight and BP

Urine testing for protein, glucose, ketones

Fundal height

Assessment for quickening/fetal movement

Assessment of fetal HR

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74
Q

Follow-Up Visit Intervals and Assessments: How should they screen and test for gestational diabetes?

A

Oral glucose test. Disagreement is wih how many grams of glucose ingested and how long afterward blood drawn.

Use oral 50g glucose following by 1 hour-plasma glucose determination

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75
Q

Follow-Up Visit Intervals and Assessments: When is screening for gestational diabetes done?

A

Between 24-28 weeks unles screening warranted for first trimester (obesity, >25 years old, family hx of diabetes)

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76
Q

Follow-Up Visit Intervals and Assessments: What happens if results from glucose is more than 130-140 ?

A

Further testing, such as 3=hour 100-g glucose tolerance test

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77
Q

Follow-Up Visit Intervals and Assessments: Edema in what parts of the body could be signs of gestational hypertension?

A

Pertibial edema, periorbital edema, edema of hands

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78
Q

Follow-Up Visit Intervals and Assessments: What to do if mother Rh negative

A

Antibody titer evaluated. RhoGAM is given. It is used to prevent development of antibodies to Rh+ red cells whenever fetal cells are known or suspected of entering maternal circulation

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79
Q

Follow-Up Visit Intervals and Assessments: What to ask at 28 weeks for preterm labor risk?

A

Ask if experiencing signs of uterine contractions, dullbackache, feeling of pressure in pelvic area, increased vaginal discharge, and vaginal bleeding

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80
Q

Follow-Up Visit and Fundal Height Measurement: What is the McDonald method?

A

Distance measured with tape measure from top of pubic bone to the top of the uterus with client lying on her back

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81
Q

Follow-Up Visit and Fundal Height Measurement: When does fundus reach umbilicus?

A

20 weeks

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82
Q

Follow-Up Visit and Fundal Height Measurement: Fundal measurement should equal number of weeks of gestation until week what

A

36

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83
Q

Follow-Up Visit and Fetal Movement Determination: Mothers first perception of fetal movement occurs when and is termed what?

A

In 2nd trimester, and is termed “quickening”, described as gentle fluttering

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84
Q

Follow-Up Visit and Fetal Movement Determination: Decreased Fetal movement may indicate what?

A

Asphyxia and FGR

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85
Q

Follow-Up Visit and Fetal Movement Determination: What is the fetal movement counting method?

A

Used by mother to quantify her fetus movement. Should be performed in side lying method

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86
Q

Follow-Up Visit and Fetal Movement Determination: Wha tis the Count to 10 method?

A

Woman focuses of fetus movement and records how long it takes to document 10 movements. If longer than 2 hours, contact health care provider

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87
Q

Follow-Up Visit and Fetal Movement Determination: Normal fetal heart rate range ?

A

110 to 160 bpm

88
Q

Follow-Up Visit and Danger Sign of Pregnancy: Contact provider if what occurs during first trimester?

A

Spotting/Bleeding, Painful Urination, Vomiting, Fever >100 and lower abdominal pain

89
Q

Follow-Up Visit and Danger Sign of Pregnancy: Contact provider if what occurs during second trimester?

A

Uterine contrctions, pain in calf, often increased with foot flexion , sudden gush or leakage of fluid, and absence of fetal movement more than 12 hours

90
Q

Follow-Up Visit and Danger Sign of Pregnancy: Contact provider if what occurs during third trimester?

A

Sudden weight gain, edema, upper abdominal pain, headache with visual changes, and decrease in fetal daily movement for 24 hours

91
Q

Follow-Up Visit and Early Contractions: Different between this and Braxton Hicks contractions?

A

They are not true labor pains because they go away when walking or resting. Often go away when woman sleeps

92
Q

Follow-Up Visit and Early Contractions: Where are Braxton Hicks contractions felt versus normal?

A

Felt in abdomen versus the lower back with true preterm labor contractions

93
Q

Follow-Up Visit and Early Contractions: Signs of preterm labor?

A

Include contractions every 10 minutes, change in vaginal discharge, pelvic pressure, low, dull backache, pelvic cramps

94
Q

Follow-Up Visit and Early Contractions: What week is considered preterm labor?

A

37 weeks gestation

95
Q

Follow-Up Visit and Early Contractions: What should woman do if she experiences menstrual-like cramps occuring every 10 minutes accompanied by a low dull backache?

A

Stop what she is doing and lie down on her left side for 1 hour and drink two to three glasses of water. If do not subside after 1 hour, contact health care provider

96
Q

Assessment of Fetal Well-Being and Ultrasonography: How does this work?

A

Transmits high-frequency sound waves and is placed on mothers abdomen and moved to visualize the fetus

97
Q

Assessment of Fetal Well-Being and Ultrasonography: Why would a transvaginal ultrasound be performed?

A

In first trimester to confirm pregnancy, excluude ectopic or molar pregnancy (mole, a benign tumor that develops in the uterus)

98
Q

Assessment of Fetal Well-Being and Ultrasonography: 2nd scan at 18-20 weeks looks for what?

A

Congenital malformations, excludes multifetal pregnancies, adn verify dates and growth

99
Q

Assessment of Fetal Well-Being and Ultrasonography: 3rd abdominal scan performed around 34 weeks for what?

A

evaluate fetal size, assess fetal growth, and verify placental position

100
Q

Assessment of Fetal Well-Being and Doppler Flow Studies: Can be used to measure what?

A

Measure the velocity of blood flow via ultrasound. An detect fetal compromise in high-risk pregnancies. Uses color.

101
Q

Assessment of Fetal Well-Being and Alpha-Fetoprotein Analysis: What is Alpha-Fetoprotein?

A

Glycoprotein produced initially by the yolk sac and fetal gut and later predominately by the fetal liver

102
Q

Assessment of Fetal Well-Being and Alpha-Fetoprotein Analysis: This increases until what week

A

Weeks 14-15 . Present in amniotic fluid in low concentrations

103
Q

Assessment of Fetal Well-Being and Alpha-Fetoprotein Analysis: When developmental defect present, waht happens to AFP?

A

Escapes into amniotic fluid fromt he fetus. Then enters maternal circulation by crossing the placenta

104
Q

Assessment of Fetal Well-Being and Alpha-Fetoprotein Analysis: Variety of siutations can lead to elevation of MSAFP including what

A

open neural tube defect, underestimation of gestational age, presence of multiple fetuses, GI defects, low birth weight

105
Q

Assessment of Fetal Well-Being and Alpha-Fetoprotein Analysis: Lower-than-expected MSAFP levels are seen when?

A

fetal gestational age is overestimated or in cases of fetal death, increased maternal weight, or type 1 diabetes

106
Q

Assessment of Fetal Well-Being and Marker Screening Tests: Maternal serum is effective for identifying what?

A

Fetal risk for trisomies 13, 18, 21 and neural tueb defects.

107
Q

Assessment of Fetal Well-Being and Marker Screening Tests: What is Pregnancy-Associated Plasma Protein A (PAPP-A)

A

Key regulator of insulin-like growth factor essential for normal fetal development . Increases with gestational age. Used for down syndrome screening

108
Q

Assessment of Fetal Well-Being and Marker Screening Tests: Low PAPP-A at 11-13 weeks is associated with

A

stillbirth, infant death, preterm birth, preeclampsia, and chromosomal abnormalities

109
Q

Assessment of Fetal Well-Being and Marker Screening Tests: Whaat do low Inhibin A levels indicate

A

possibilitiy of down syndrome

110
Q

Assessment of Fetal Well-Being and Nuchal Translucency Screening: What is this?

A

Allows for early detection and diagnosis of some fetal chromomal and structural abnormalities.

111
Q

Assessment of Fetal Well-Being and Amniocentesis: What is this?

A

Transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis . Contains fetal cells. Used to confirm a fetal abnormality when other screening tests detect a possible problem

112
Q

Assessment of Fetal Well-Being and Amniocentesis: Why should you be careful of this in first trimester?

A

High risk of spontaneous miscarriage and postprocedural amniotic fluid leakage

113
Q

Assessment of Fetal Well-Being and Amniocentesis: Why is this performed in 2nd trimester?

A

TO detect chromosomal abnormalities, evaluate fetal condition when woman is sensitized to Rh-+ blood, and diagnose intrauterine infections

114
Q

Assessment of Fetal Well-Being and Amniocentesis: What does abnormal bilirubin indicate?

A

High levels indicate hemolytic disease of the neonate in isoimmunized pregnancy

115
Q

Assessment of Fetal Well-Being and Amniocentesis: What does presence of meconium indicate?

A

fetal hypotension or distress

116
Q

Assessment of Fetal Well-Being and Amniocentesis: What does decrease of creatinine indicate?

A

Immature fetus

117
Q

Assessment of Fetal Well-Being and Amniocentesis: What does absence of phosphatidylglycerol indicate?

A

Absence indicates pulmonary immaturity

118
Q

Assessment of Fetal Well-Being and Amniocentesis: What does presence of glucose indicate?

A

Hypertrophied fetal pancreas and subsequent neonatal hypoglycemia

119
Q

Assessment of Fetal Well-Being and Amniocentesis: What does presence of alpha-fetoprotein indicate?

A

Neural tube defects such as spina bifida or anencephaly, impending fetal death congenital nephrosis or contamination of fetal blood

120
Q

Assessment of Fetal Well-Being and Amniocentesis Procedure: Performed after ultrasound indicates what?

A

Adequate pocket of amniotic fluid free of fetal parts, umbilical cord, or placenta

121
Q

Assessment of Fetal Well-Being and Amniocentesis Procedure: What happens when desired fluid has been withdrawn?

A

The needle is removed and slight pressure is applied to the site. If no bleeding, sterile bandage applied to needle site

122
Q

Assessment of Fetal Well-Being and Amniocentesis Procedure: What risk occur with doing this?

A

Lower abdominal discomfort and cramping for 48 hours

Spontaneous abortion

Maternal or fetal infection

Fetal-maternal Hemorrhage

123
Q

Assessment of Fetal Well-Being and Amniocentesis Nursing Management: What should you tell woman?

A

Explain procedure, and encourage to empty bladder. 20 minute electron fetal strip obtained. Obtain and record VS.

124
Q

Assessment of Fetal Well-Being and Amniocentesis Nursing Management: What do you administer to woman after procedure?

A

RhoGAM IM if womann is Rh negative to prevent potential sensitization to fetal blood

125
Q

Assessment of Fetal Well-Being and Chorionic Villus Sampling: What is this?

A

Invasive procedure involving 18-gauge needle stick through abdomen or passage of suction catheter through the cervix. Used to obtain sampl eo f the chorionic villi from the placenta for prenatal evaluation.

126
Q

Assessment of Fetal Well-Being and Chorionic Villus Sampling: What are Chorionic Villi?

A

Finger-like projections that cover the embryo and anchor it to the uterine lining before the placenta is developed

127
Q

Assessment of Fetal Well-Being and Chorionic Villus Sampling Procedure: When is it performed?

A

10-13 weeks after LMP.

128
Q

Assessment of Fetal Well-Being and Chorionic Villus Sampling Procedure: How is transcervical appraoch done?

A

Woman placed in the lithotomy position and a sterile catheter is introduced through cervix and inserted in the placenta. Requires full bladder

129
Q

Assessment of Fetal Well-Being and Chorionic Villus Sampling Procedure: How is transabdominal approach done?

A

18 gauge spinal needle inserted through abdominal wall into placental tisue and sample of villi aspirated

130
Q

Assessment of Fetal Well-Being and Chorionic Villus Sampling Procedure: Potential complications of CVS?

A

postprocedure vaginal bleeding and cramping, hematomas, spontaneous abortion, limb abnormalities, rupture of membranes

131
Q

Assessment of Fetal Well-Being and Chorionic Villus Sampling Management: What should you tell woman?

A

Will last 15 minutes. Ultrasound done first to locate embryo. If transabdominal, advise her bladder must be filled.

132
Q

Assessment of Fetal Well-Being and Chorionic Villus Sampling Management: What should you tell woman about transcervical CVS?

A

Speculum will be placed into the vagina under ultrasound guidance. Then vagina cleaned and a small catheter is inserted through cervix.

133
Q

Assessment of Fetal Well-Being and Nonstress Test: What is this?

A

Most common method of prenatral testing. Provides indirect measurement of uteroplacental function

134
Q

Assessment of Fetal Well-Being and Nonstress Test: Recommended twice weekly for who?

A

clients with diabetes and other high-risk conditions

135
Q

Assessment of Fetal Well-Being and Nonstress Test Procedure: What should woman do ?

A

Eat meal to stimulate activity. Placed on left position. Fetal monitoring attached to abdomen. Handed buton that pushes every time she perceives fetal movement. Strip will identify that movvement has occured

136
Q

Assessment of Fetal Well-Being and Nonstress Test Management: What instructions will you give her?

A

Explain testing and have woman empty bladder. Obtain baseline over 15-30 minutes.

137
Q

Assessment of Fetal Well-Being and Nonstress Test Management: What will you obseerve during test?

A

Signs of fetal activity with concurrent acceleration of fetal heart rate.

138
Q

Assessment of Fetal Well-Being and Nonstress Test Management: What is a reactive NST?

A

Includes at least two fetal heart rate accelerations from baseline of at least 15 bpm for at least 15 seconds

139
Q

Assessment of Fetal Well-Being and Nonstress Test Management: What is a nonreactive NST?

A

Characterized by absence of two fetal heart rate accelerations usig the 15-by-15 criteria in 20 minute time frame. Usually indicates higher incidience of fetal distress during labor

140
Q

Assessment of Fetal Well-Being and Biophysical Profile: What is this?

A

uses a real-time ultrasound and NST to allow assessment of various parameters of fetal-well being . Includes ultrasound m onitoring of fetal movements, tone, and breathing and ultrasound assessment of amniotic fluid volume

141
Q

Assessment of Fetal Well-Being and Biophysical Profile: Why is this performed?

A

To identify infants who may be at risk of poor pregnancy outcome. Primary objective is to reduce sitllbirth and detect hypoxia

142
Q

Assessment of Fetal Well-Being and Biophysical Profile: Tone expected by what week?

143
Q

Assessment of Fetal Well-Being and Biophysical Profile: Movement expected by what week?

144
Q

Assessment of Fetal Well-Being and Biophysical Profile: Breathing expected at what week?

145
Q

Assessment of Fetal Well-Being and Biophysical Profile: Fetal heart rate reactivity expected by what week?

146
Q

Assessment of Fetal Well-Being and Biophysical Profile and Scoring: How is scoring grded?

A

Five compontents, each worth 2 points if present.

147
Q

Assessment of Fetal Well-Being and Biophysical Profile and Scoring: Body Movement criteria?

A

3 or more discrete limb or trunk movements

148
Q

Assessment of Fetal Well-Being and Biophysical Profile and Scoring: Fetal tone criteria?

A

One o rmore instances of full extension and flexion of a limb or trunk

149
Q

Assessment of Fetal Well-Being and Biophysical Profile and Scoring: Fetal breathing criteria?

A

one or more fetal breathing movement of more than 30 seconds

150
Q

Assessment of Fetal Well-Being and Biophysical Profile and Scoring: amniotic fluid volume criteria?

A

one or more pockets measureing 2 cm

151
Q

Assessment of Fetal Well-Being and Biophysical Profile and Scoring: NST criteria?

152
Q

Assessment of Fetal Well-Being and Biophysical Profile and Scoring: What is considered a normal score?

A

8 to 10. Below 6 is susipicious, indicating compromised fetus

153
Q

Nursing Management for Common Discomfort of Preg: How to fix urinary frequency or incontinence

A

Pelfiv floor exercises

Empty bladder with sesnation

Avoid caffeinated drinks

154
Q

Nursing Management for Common Discomfort of Preg: How to fix fatigue?

A

Attempt to get full sleep

Eat healthy balanced diet

Schedule nap

155
Q

Nursing Management for Common Discomfort of Preg: How to fix N/V?

A

Avoid empty stomach

Eat small meals

Avoid brushing teeth after eating

156
Q

Nursing Management for Common Discomfort of Preg: How to fix backache?

A

Avoid standing in one position

Apply heating pad

Support your lower back with pillows when sitting

157
Q

Nursing Management for Common Discomfort of Preg: How to fix leg crmaps

A

Elevate legs about heart

If get cramp, straighten both legs

Ask about calcium supplements

158
Q

Nursing Management for Common Discomfort of Preg: How to fix varicosities?

A

Walk daily to improve circulation

Elevate legs about heart

Don’t wear constrictive stockings

159
Q

Nursing Management for Common Discomfort of Preg: How to fix hemorrhoids

A

Establish regular time for bowel elimination

Avoid constipation and straining

Preventing straining by frinking plenty of fluids

160
Q

Nursing Management for Common Discomfort of Preg: How to fix constipation?

A

Increase intake of fiber

Ingest prune juice

Consume warm tea upon rising

161
Q

Nursing Management for Common Discomfort of Preg: How to fix heartburn

A

Avoid spicy/greasy foods

Sleep on several pillows to head elevated

void lying down for at least 3 hours after meals

162
Q

Nursing Management for Common Discomfort of Preg: How too fix braxton hicks contractions?

A

Contractions normal. Try changing position or engage in mild exercises

163
Q

First-Trimester Discomfort - Fatigue: Fatigue most often related to what?

A

Many physical changes (increased oxygen consumption, increased levels of progesterone and relaxin), and psychosocial changes (mood swings, multiple role demands)

164
Q

First-Trimester Discomfort - N/V: Research suggests that what contributes to this?

A

High levels of estrogen, progesterone, and hCG and Vitamin B6 deficiency

165
Q

First-Trimester Discomfort - N/V: What foods are high in b6 that may help?

A

Meat, poultry, bananas, fish, green leafy vegetables, peanuts, raisins, and walnuts

166
Q

First-Trimester Discomfort - N/V: What pharmacologic tx has been indicated?

A

doxylamine-pyridoxine therapy

167
Q

First-Trimester Discomfort - Breast Tenderness: What causes women to have this?

A

Increased estrogen and progesterone levels, which cause the fat layer of breass ot thicken

168
Q

First-Trimester Discomfort - Constipation: What causes this?

A

Increasing levels of progesterone during pregnancy leads to decreased contractility of the GI tract, slowed movement of substances through colon, and resulting increase in water absorption

169
Q

First-Trimester Discomfort - Nasal Stuffiness: What causese this?

A

Increased levels of estrogen causes edema of mucous membranes.

170
Q

First-Trimester Discomfort - Nasal Stuffiness: How to treat this?

A

Advise women to drink extra water for hydration of the mucous membranes or use a cool mist humidifier in her bedroom at night.

171
Q

First-Trimester Discomfort - Cravings: What foods are the ones often craved?

A

Foods with high sodium or sugar content

172
Q

First-Trimester Discomfort - Cravings: What nonfoods may women crave?

A

clay, cornstarch, laundry detergent, baking soda, soap, paint chips, dirt, ice, or wax

173
Q

First-Trimester Discomfort - Leukorrhea: What is this and why does it occur?

A

Increased vaginal begins during first trimester. Arise form high levels of estrogen, which causes increased vascularity and hypertrophy of cervical glands.

174
Q

First-Trimester Discomfort - Leukorrhea: How to help with this?

A

Keep the perineal area clean and dry, wash with mild soap. Also recommend avoid wearing pantyhose

175
Q

Second-Trimester Discomfort - Backache: What causes this?

A

Shifting of center of gravity because of enlarged uterus, increased joint laxity, stretching of ligaments, and pregnancy related circulatory changes

176
Q

Second-Trimester Discomfort - Backache: Treatmetn fr this?

A

Heat and ice, acetaminophen, massage, proper posturing, good support shoes, and good exercise program

177
Q

Second-Trimester Discomfort - Backache: What is the pelvic tilt or pelvic rock?

A

Used to alleviate pressure on the lower back during pregnancy by stretching the lower back muscles. They sit or stand on all fours and woman presses up with the lower back

178
Q

Second-Trimester Discomfort - Leg Cramps: What causes this?

A

RElated to the pressure of the gravid uterus on the pelvic nerves and blood vessels

179
Q

Second-Trimester Discomfort - Leg Cramps: What can be done to treat it?

A

Encourage the woman to gently stretch the muscle by dorsiflexing the foot toward body. Wrap moist towel aroun leg. If due to minerals, eat more nutrients

180
Q

Second-Trimester Discomfort - Varicosities of the Vuvle and Legs: What is this associated with?

A

Increased venous stasis caused by pressure of uterus on pelvic vessels and vasodilation from increased progesterone levels

181
Q

Second-Trimester Discomfort - Varicosities of the Vuvle and Legs: What does Progesterone do?

A

Relaxes the vein walls, making it difficult for blood to return to the heart frrom the extremities , pooling can result

182
Q

Second-Trimester Discomfort - Varicosities of the Vuvle and Legs: How to treat this?

A

Encourage to wear support hose and teach how to apply properly. Elevate legs above heart for 10 minutes beofre getting out of bed.

183
Q

Second-Trimester Discomfort - Hemorrhoids: What is this and what causes this?

A

Varicosities of rectum and may be external or internal. Occur as result of progesterone-induced vasodlation and from pressure of enlarged uterus on lower intestine and rectum

184
Q

Second-Trimester Discomfort - Hemorrhoids: How to prevent this?

A

Increasing fiber intake and drinking at least 2L of fluid per day. Warm sitz baths and elevate feet on stool hile straining

185
Q

Second-Trimester Discomfort - Flatulence with Bloating: How to fix this?

A

Add more fiber to diet, increase fluid intake, and increase physical exercise

186
Q

Third-Trimester Discomfort - SOB and Dyspnea: How can a woman help improve her breathing?

A

By lying on her left side because it will displace the uterus off the vena cava and improve her breathing

187
Q

Third-Trimester Discomfort - Heartburn and Indigestion: What causes this?

A

High progesterone levels cause relaxation of cardiac sphincter, allowing food and digestive juices to flow backward into oesophagus

188
Q

Third-Trimester Discomfort - Heartburn and Indigestion: How to prevent this?

A

sit upright for 1-3 hours after eatign to prevent reflux of gastric acids. Consume small, frequent meals.

189
Q

Third-Trimester Discomfort - Dependent Edema: What causes this?

A

Increased capillary permeability caused by elevated hromone levels and increased blood volume.

190
Q

Third-Trimester Discomfort - Dependent Edema: How to fix this?

A

Elevate your feet, wear support hose, change position frequently, walk at a sensible pace, and rock from the ball of the foot to stimulate circulation

191
Q

Nursing Management to Promote Self-Care and Personal Hygiene - Hot Tub: Why should you aovid this?

A

May cause fetal tachycardia as well as raise the maternal temperature.

192
Q

Nursing Management to Promote Self-Care and Personal Hygiene - Perineal Care: How to take care of this?

A

Shower frequently and wear all-cotton underwear. Caution not to douche because it can increase rf infection and not to wear panty liners, which block air circulation

193
Q

Nursing Management to Promote Self-Care and Personal Hygiene - Dental Care: Periodontal disease is a contributing factor to systemic conditions like

A

heart disease, respiraotry disease, diabetes, and preterm births

194
Q

Nursing Management to Promote Self-Care and Personal Hygiene - Dental Care: What is Periodontitis?

A

Characterized by bleeding gums, loss of tooth attachment, loss of supporting bone, and bad breath to pus formation

195
Q

Nursing Management to Promote Self-Care and Personal Hygiene - Breast Care: What education is given here?

A

Avoid soap on nipple because it is drying.

ring nipple area with plain water.

196
Q

Nursing Management to Promote Self-Care and Clothing: What clothes should they not wear?

A

Constricting clothes and girdles that compress the growing abdomen. Avoid knee-high hose

197
Q

Nursing Management to Promote Self-Care and Exercise: Contraindicated in what women?

A

With preterm labor, poor weight gain, anemia, facial and hand edema, pain, and hypertension.

198
Q

Nursing Management to Promote Self-Care and Exercise: How much exercise should they get?

A

150 minutes of moderae intesnsity exercise per week

199
Q

Nursing Management to Promote Self-Care and Sleep/Rest: How to promote sleep

A

Stay on regular schedule

Eat regular meals

Establish bedtime routine

Go to bed when feeling tired

200
Q

Childbirth Education Classes - Lamaze Method: What is this?

A

Psychoprophylactic (“mind prevention”), method of preparing for labor that promotes use of specific breathing and relaxation techniques.

201
Q

Childbirth Education Classes - Lamaze Method: Lamaze classes include what?

A

Information on toning exercises, relaxation exercises, and techniques and breathing methods for labor.

202
Q

Childbirth Education Classes - Lamaze Method: What is Paced Breathing?

A

Technique used to decrease stress responses and therefore decrease pain. Implies self-regulation by woman. Starts by taking a cleansing breath at onset and end of each contraction.

203
Q

Childbirth Education Classes - Lamaze Method: What is Slow-Paced Breathing?

A

Associated with relaxation and should be half the normal breathign rate (6-9 bpm). Relaxed and recommended throughout labor. Best to breathe in through the nose and out through nose or mouth

204
Q

Childbirth Education Classes - Lamaze Method: What is Modified-Paced Breathing?

A

Used for increased work or stress during labor to increase alertness or focus attention. RR increases but does not exceed twice her normal rate.

205
Q

Childbirth Education Classes - Lamaze Method: What is Patterned-Paced Breathing?

A

Similar to modified-paced breathing but with rhythmic pattern. Uses variety of patterns, with emphasis of exhlation.

206
Q

Childbirth Education Classes - Bradley (Partner-Coached) Method: How is this done?

A

Conditioned to work in harmony with her body using breath control and deep abdominopelvic breathign to promtoe general body relaxation during labor. Coach educated in massage/comfort techniques

207
Q

Childbirth Education Classes - Dick-Read Method: What does woman do here?

A

Woman achieves relaxation and reduces pain by arming herself with the knowledge of normal childbirth and using abdominal breathing during contractions

208
Q

Childbirth Education Classes - Feeding: How often should you feed infant?

A

Every 3-4 hours

209
Q

Which of the following biophysical profile findings indicate poor oxygenation to the fetus?

Two pockets of amniotic fluid
Well-flexed arms and legs
Nonreactive fetal heart rate
Fetal breathing movements noted
A

Nonreactive fetal heart rate

210
Q

The nurse teaches the pregnant client how to perform Kegel exercises as a way to accomplish which of the following?

Prevent perineal lacerations
Stimulate labor contractions
Increase pelvic muscle tone
Lose pregnancy weight quickly
A

Increase pelvic muscle tone

211
Q

During a clinic visit, a pregnant client at 30 weeks’ gestation tells the nurse, “I’ve had some mild cramps that are pretty irregular. What does this mean?” The cramps are probably:

The beginning of labor in the very early stages
An ominous finding indicating that the client is about to have a miscarriage
Related to over hydration of the woman
Braxton Hicks contractions, which occur throughout pregnancy
A

Braxton hicks contractions, which occur throughout pregnancy

212
Q

The nurse is preparing her teaching plan for a woman who has just had her pregnancy confirmed. Which of the following should be included in it? Select all that apply.

Prevent constipation by taking a daily laxative
Balance your dietary intake by increasing your calories by 300 daily
Continue your daily walking routine just as you did before this pregnancy
Tetanus, measles, mumps, and rubella vaccines will be given to you now
Avoid tub baths now that you are pregnant to prevent vaginal infections
Sexual activity is permitted as long as your membranes are intact
Increase your consumption of milk to meet your iron needs
A

Balance dietary intake

Continue your daily walking routine

Avoid tub b aths now that you are pregnant

Sexual activity is permitted as long as membranes intact

213
Q

A pregnant client’s last normal menstrual period was on August 10. Using Nagele rule, the nurse calculates that her estimated due date (EDD) will be which of the following?

June 23
July 10
July 30
May 17
214
Q

Which of the following is not true about breast-feeding?

Breast-fed infants experience more obesity and allergies
Breast milk is perfectly suited to the infant’s nutritional needs
Breast milk contains maternal antibodies to stimulate infant’s immunity
Breast-feeding enhances maternal bonding and attachment
A

Breast fed infants experience more obesity and allergies

215
Q

Practicing good oral hygiene is important for all women throughout their pregnancy. As a nurse providing anticipatory guidance for pregnant women, what condition can result from periodontal disease if good dental care isn’t practiced?

Post-dates pregnancy
Large for gestational age infant
Advanced reproductive cancer
Preterm or low-birth-weight infant
A

Preterm or low-birth-weight infant

216
Q

Anticipatory guidance regarding sexual activity during pregnancy includes which of the following? Select all that apply:

Sexual activity is contraindicated throughout pregnancy
Most women don’t desire intimacy after the first trimester
Sexual activity may continue up until the end of the second trimester
Sexual intercourse is prohibited if a history of preterm labor exists
Women’s sexual desire may change throughout the pregnancy
Couples can try a variety of positions of comfort during pregnancy
A

Womens sexual desire may change

Couples can try variety of positions

217
Q

Which of the following would be considered risk factors for psychologic well-being in pregnancy? Select all that apply:

Limited support system and network of friends and family
Introverted personality at any point in the pregnancy
Ambivalence any time during the pregnancy
High levels of stress due to family discord
History of previous high-risk pregnancy with complications
Depression prior to pregnancy and on medication
A

Limited support system

High levels of stress

History of previous high risk preg

Depression prior to pregnancy

NRSG 206: OB (42 decks)

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