MatAdap, PregComp

Question 1

Indications of pregnancy but no definite diagnosis can be made.

Answer 1

Presumptive/subjective signs

Amenorrhea, nausea, vomiting, frequent urination, fatigue, fetal movement, breast changes.

Question 2

Strong evidence of pregnancy but no definite diagnosis can be made.

Answer 2

Probable/objective signs

Hager’s sign, Chadwick sign, ballottement of head, home pregnancy test

Question 3

Signs only caused by the developing fetus

Answer 3

Positive signs.

Hearing the fetal heart rate, palpation of the fetus, ultrasounds.

Question 4

Changes in the uterus during pregnancy?

Answer 4

Braxton hick’s contractions, hager’s sign. Increases in strength and elasticity. Gradual growth (enters the abdomen at about 13 weeks). Reaches the xyphoid process at term.

Question 5

Changes in the cervix during pregnancy?

Answer 5

Softens to allow expulsion of the uterus. Goodell’s and Chadwick’s signs. Mucus plug prevents entry of pathogens.

Question 6

GI changes?

Answer 6

Appetire increase due to increased metabolic demands. Relaxation and slower emptying of the stomach and intestines. Gums are hyperemic with increased dental plaque. Constipation.

Question 7

Cardio changes?

Answer 7

50% increase over pre-pregnancy blood volume (the plasma). Physiologic anemia of pregnancy. Supine and orthostatic hypotension. Increased clotting factors.

Question 8

Respiratory changes?

Answer 8

Pressure on the diaphragm with the growing uterus. History of asthma and there respiratory problems can decompensated more quickly. Increased cardio congestion (nasal congestion-epistaxis)

Question 9

Urinary changes?

Answer 9

Increased glomerular filtration rate (more blood flow and volume, accumulation of glucose and protein). Increased risk for UTI’s.

Question 10

Musculoskeletal changes?

Answer 10

Lordosis. Pressure on the ligaments that support the uterus. Release of relaxin.

Question 11

Expected weight gain during pregnancy?

Answer 11

1st trimester gains 5 pounds total. Then, 1 pound per week. Based on BMI. Needs to gain different amounts of weight based on starting BMI.
Under: 28-40 pounds
Normal: 25-30 pounds
Overweight: 15-25 pounds

Question 12

Calories, protein, iron, and folic acid while pregnant? Vitamins?

Answer 12

Additional 300 calories. Protein intake needs to increase by 30%. Iron by 30%. Folic acid 25%. Vitamins A and C have smaller required doses, with a prenatal vitamin daily.

Question 13

What can cause bleeding during pregnancy?

Answer 13

Abortion, ectopic pregnancy, cervical insufficient, placenta previa, abrupto placentae

Question 14

What should be done in a nursing assessment for an abortion?

Answer 14

Description and duration of bleeding and clots. Evaluate the intensity of abdominal pain. Vital signs and the level of pain. Support in the grieving process with reassurance. Possible medications.

Question 15

Fertilized ovum implants outside the uterine cavity. Possibly cause by the zygote being unable to travel along the Fallopian tube.

Answer 15

Ectopic pregnancy. Ad it grows, it draws blood supply from the site. No site other than the uterus can support placental implantation or growth of the embryo. A ruptured pregnancy is a medical emergency.

Question 16

Nursing assessment for an ectopic pregnancy?

Answer 16

Health history. 6-8 weeks after missed period, spotting, ab pain. Risk factors. S/s of internal bleeding if ruptured. Diagnostic testing: beta-hCG levels are too low for the length of the pregnancy, visualization of a mass outside the uterus. Education.

Question 17

Non-painful, rapid dilation and effacement, minimal bleeding. Structurally defective cervix.

Answer 17

Cervical insufficiency (CI). 2nd or 3rd trimester of pregnancy. Management includes bed rest or pelvic rest. Avoidance of heavy lifting. Placement of a cerclage as late as 28 weeks,

Question 18

Nursing assessment for CI?

Answer 18

History of cervical trauma or surgery, preterm labor, fetal loss in the second trimester, often around 20 weeks. Complaints of pelvic pressure or pink tinged discharge to bleeding. Loss of amniotic fluid.

Question 19

Implantation of the placenta in the lower uterus.

Answer 19

Placenta previa. “Afterbirth first”
Total, partial, marginal, low-lying. Bleeding in the 2 or 3 trimester. Painless, bright red, comes and goes. Secondary to thinning of the uterus for labor. Lower uterus cannot contract well to stop the bleeding.

Question 20

Nursing assessment and management of placenta previa?

Answer 20

Health history, risks, education. May be treated with bed rest.
When actively bleeding: pad count, V/S, FHTs, abdomen. No vaginal exams. Oxygen at the bed side.

Question 21

Separation of the normally located placenta at greater than 20 weeks. Bleeding behind the placenta causes this.

Answer 21

Abruptio placentae.
Fetal blood supply is compromised which leads to fetal distress.
History: 80% have vaginal bleeding that is dark red. 20% have no overt signs of bleeding. “Knife-like” abdominal pain that can be rigid.

Question 22

Assessment and management of abruptio placentae?

Answer 22

Bed rest on the left lateral position. Frequent vitals, fundal height checks, peri pad count. Foley and large-bore IV insertion. Fetal and contraction monitoring. Watch for unusual bleeding and report gums, oozing from the IV site.

Question 23

Persistent, uncontrollable nausea and vomiting.

Answer 23

Hyperemesis gravidarum.

Dehydration, greater than or equal to 5% of body weight loss. Electrolyte imbalance. Hospitalization.

Question 24

History, labs, diagnostic for hyperemesis gravidarum?

Answer 24

History of risk factors. Physical exam. Liver enzymes, CBC, TSH/T4, urine specific gravity, electrolytes, ultrasound

Question 25

Nursing management of hyperemesis gravidarum?

Answer 25

NPO 24-36 hours. IV fluids with normal saline with electrolytes and vitamins added. IV or IM anti-emetics until able to eat. G-tube if oral intake is unsuccessful.

Question 26

140/90 prior to the 20th week of pregnancy?

Answer 26

Chronic HTN. No proteinuria. Increased risk for the development of preeclampsia.

Question 27

Systolic is greater than 140 and/or diastolic is greater than 90.

Answer 27

Gestational HTN. At least twice, taken at least 6 hours apart after the 20th week in a woman known to be normotensive prior to that. No proteinuria. Increased risk for the development of preeclampsia.

Question 28

Nursing assessment of preeclampsia?

Answer 28

Accurate measurement of maternal BP, with same device and same position. Frequent weights. Subjective complaints: visual changes, worsening headaches, bleeding or nursing, epigastric pain, rings feeling small

Question 29

What can be used to prevent seizures in preeclampsia? It also blocks neuromuscular transmutation and is a vasodilator. Management?

Answer 29

Magnesium sulfate.
Monitor magnesium levels closely. Assess DTRs and check ankle clonus. Calcium gluconate available to toxicity (CNS depression, hypotension, decreased DTRs and RR)

Question 30

Nursing considerations for magnesium sulfate?

Answer 30

Loading dose, then 1-4gm/hr. Continuous monitoring of fetal heart tones. Monitor and report: hypotension and/or dperessed DTRs, LOC, blurred vision, headache. U/o less than 30mL/hr, I/O hourly. RR less than 12 breaths per minute.

Question 31

Nursing management of eclampsia?

Answer 31

Generalized, begin with facial twitching.
Alternating contraction and relaxation of the muscles. Turn to side lying and stay with pt. Raise bed rails with padding. Dim lights and quiet environment. Document time of seizure, oxygen after cessation of seizure. Continue mag sulf and electronic fetal monitoring. Prepare for delivery

Question 32

HELLP for severe pre-eclampsia signs?

Answer 32

Hemolysis
Elevated
Liver function tests
Low 
Platelet count

Question 33

Occurs when a pregnant woman’s blood type is O, which contains naturally occurring antibodies against type A and B blood (anti-A and anti-B).

Answer 33

ABO incompatibility.
If pregnant with a fetus with non-O blood (A, B, or AB), her anti-A or anti-B antibodies can cross the placenta and cause hemolysis of fetal red blood cells.

Question 34

Pregnant women with Rh(-) factor becomes pregnant with a fetus that has an Rh(+) factor. Mother has no symptoms but it adversely affects fetal health.

Answer 34

Rh incompatibility. Erythrocytes from the fetal circulation leak into the maternal circulation causing maternal antibodies to be made against the fetus’ Rh(-) anti-D antigen. They cross the placenta and destroy fetal RBCs resulting in hemolytic disease of the newborn.

Question 35

Risks for Rh incompatibility?

Answer 35

Being pregnant, invasive procedures, trauma.

Question 36

Rh(-) mothers who are pregnant with an Rh(+) infant get what medication at 28 weeks?

Answer 36

Rhogam (blood product). Within 72 hours post part, after miscarriage or abortion, after amniocentesis or chorionic villi sampling to prevent sensitization to the D antigen of the Rh(+) fetus.

Question 37

Binds fetal red blood cells with the D antigen before the mother is able to produce an immune response and form anti-D antibodies.

Answer 37

Rhogam (blood product)

Question 38

Dominance and recessiveness of blood types?

Answer 38

Type A and B are dominant over O.
Type A and B are considered co-dominant.
Type O is recessive.

Question 39

Which blood types come together to make what other ones?

Answer 39

AO=type A
BO=type B
OO=type O
AB=type AB

Question 40

Greater than 2000mL of amniotic fluid between 32-36 weeks. Causes, risk, and signs?

Answer 40

Amniotic fluid imbalance, or hydramnios.
Causes: gestational diabetes and upper GI problems of the fetus, fetal anomalies.
Risks: PROM, preterm delivery, prolapsed cord
Signs: dyspnea, fundal height greater than dates

Question 41

Less than 500mL amniotic fluid between 32-36 weeks. Causes and signs?

Answer 41

Amniotic fluid imbalance, or oligohydramnios.
Causes: conditions that do not allow the fetus to make to excrete urine.
Signs: fundal height < dates. May be unaware of PROM.

Question 42

Rupture of membranes before labor begins in term pregnancy, greater than or equal to 38 weeks.
Rupture before labor beings in preterm pregnancy, less than 38 weeks.
Diagnosis?

Answer 42

PROM
PPROM
Alkalinity of fluid on special “nitrazine” paper, fern appearance on microscope slide or speculum visualization

Question 43

Concerns for the premature rupture of membranes?

Answer 43

Infection, fetal lung maturity, cord compression or prolapse, closely observe in the hospital but some women are managed at home

Question 44

Promotes fetal lung maturity by increasing surfactant. Improvement in lung maturity can be seen after 24 hours.

Answer 44

betamethasone (Celestone)
2 doses Im 24 hours apart. Repeat in 7 days until the lungs are mature or delivery.
Monitor mother for infection, especially in the lungs.

Question 45

What is involved in insulin resistance due to placental hormones?

Answer 45

Gestational diabetes. Remember the importance of preconception counseling. Blood glucose is gone at first prenatal visit if at risk. Normal is fasting <126 mg/dL
Blood glucose challenge at 24-28 weeks. 1 hour test abnormal is >140 mg/dL. If abnormal a 3 hour challenge is done at a later time.

Question 46

What are risks for gestational diabetes?

Answer 46

HTN early pregnancy, recurrent candida infections, BMI>30, infant with congenital abnormality. Infant > or equal to 4,000 grams. Unexplained fetal demise or neonatal death. Age >25 years. Family history of diabetes.

Question 47

What maternal things should be monitored with diabetes?

Answer 47

Urinary protein, ketones, nitrates. Kidney function, creatine clearance and protein levels. Eye exams and HbA1c.

Question 48

What fetal things should be monitored with diabetes?

Answer 48

U/s for growth, activity, and amniotic fluid levels. AFP for congenital anomalies. Weekly NSTs, BPP as needed. Amniocentesis for fetal lung maturity.

Question 49

Medical providers often don’t care for pregnant women with this disease. Disproportionate affect on services for people living with it.

Answer 49

HIV. Pregnant women may not know they have it. 8500 give birth annually. No breastfeeding or pre-chewing infants food if they are HIV+. Vulnerable populations include adolescents, women greater than 35 years of age, and women who abuse substances.

Question 50

These medications before and during pregnancy reduce the risk of the child contracting HIV from 28% to <2%.

Answer 50

Antiretroviral (ART). Taken at the same time every day, missing doses can be very detrimental. Infant must be treated for 4-6 weeks after birth to reduce risk.

Question 51

What effects can smoking and alcohol have on the baby?

Answer 51

Smoking: heart, cleft and placental problems, preterm births, LBW
Fetal alcohol syndrome

Question 52

What effects can caffeine and tobacco, marijuana, stimulants have on the baby>

Answer 52

Caffeine: LBW, irritability in large amounts

T,M,S: Can double or triple the rate of the stillborn