Module 4 Kelsey Chapter 6 Flashcards
When considering the use of fetal movement counting for a particular patient, it is important to know that:
A) fetuses move constantly, so the counting can be done at any time.
B) fetal movement is strongest at 29–38 weeks.
C) most women do not feel the fetus move before 24 weeks.
D) there is only one way to perform fetal movement counts.
B) fetal movement is strongest at 29–38 weeks.
Fetal movement counting is a safe, simple, no-cost, noninvasive fetal assessment technique. Research has demonstrated that fetal activity is a good predictor of well-being. A dramatic decrease or cessation of such movement is cause for concern.
On physical examination at an initial prenatal visit of a 25-year-old woman who is at 14 weeks’ gestation, you feel a 1-cm, mobile, well-defined, nontender mass in the upper, outer quadrant of her right breast. Your plan is to:
A) explain that this is normal with the hormonal changes of pregnancy.
B) advise the patient that you will watch this mass at each visit to assess for any change.
C) schedule a mammogram to be done in the third trimester.
D) refer the patient for further evaluation with biopsy.
B) advise the patient that you will watch this mass at each visit to assess for any change.
This well-defined, nontender mass has benign characteristics, and watching it would be an acceptable approach. A malignant breast mass is usually nontender, firm, irregularly shaped, and fixed to underlying tissue.
The trophoblast will ultimately become the:
A) placenta.
B) embryo.
C) blastocyst.
D) umbilical cord.
A) placenta.
The trophoblast is an essential component of the placenta.
The effect of pregnancy on the cardiovascular system is most clearly seen in:
A) lower diastolic blood pressure in the third trimester.
B) a 10% cardiac volume increase that peaks in midpregnancy.
C) a resting pulse increase of 10–15 beats in the first trimester.
D) a slight decrease in cardiac output in the second trimester.
B) a 10% cardiac volume increase that peaks in midpregnancy.
Cardiac volume increases by approximately 10% and peaks at about 20 weeks, and resting pulse increases by 10–15 beats per minute, with the peak occurring at 28 weeks.
Pregnant for the third time, the patient has an obstetric history that indicates two miscarriages at 16 and 18 weeks, respectively, and one twin birth at 36 weeks. One twin died, but the other is alive and well. The four-digit descriptor of this history is:
A) 121
B) 221
C) 2021
D) 2201
A) 121
The patient has not had any term pregnancies, which accounts for the first number, 0. She had a preterm delivery at 36 weeks of twins, which accounts for the second number; even though these were twins, they still count as one number—thus, the 1. The patient had two miscarriages at less than 20 weeks, which accounts for the third number, a 2. The fourth number is the total number of living children. One of the patient’s twins died; therefore, she has only one living child.
In an abdominal exam using Leopold’s maneuvers, the first step is to determine fetal:
A) attitude.
B) position.
C) engagement.
D) lie.
D) lie.
The first Leopold’s maneuver palpates for the fetal lie, followed by the presentation, position, and attitude.
Contraindications to the CST include:
A) GA greater than 37 weeks.
B) history of ectopic pregnancy.
C) nonreactive NST.
D) placenta previa.
D) placenta previa.
Contraindications for a CST include previous classic cesarean section or myomectomy, placenta previa, the mother is at risk for preterm labor, gestational age less than 37 weeks, and multiple gestation.
At the 32-week visit, a patient asks you to explain what you are looking for or feeling when doing her abdominal exam with Leopold’s maneuvers. You respond that you are:
A) determining the placement of the placenta.
B) finding the direction in which the fetus is lying.
C) evaluating the size of the uterus.
D) evaluating adequacy of fetal growth.
B) finding the direction in which the fetus is lying.
Leopold’s maneuvers consist of four abdominal palpation maneuvers used to determine the following fetal characteristics: lie, presentation, position, and attitude.
Maternal serum alpha-fetoprotein screening is performed in what time frame during pregnancy?
A) 8–12 weeks
B) 12–15 weeks
C) 15–19 weeks
D) 20–24 weeks
C) 15–19 weeks
Second-trimester screening (also known as multiple marker screening) is performed between 15 and 20 weeks to detect neural tube defects and trisomies 18 and 21. Serologic testing measuring MSAFP, estriol, and hCG is called a triple screen; with the addition of inhibin A, this becomes a quad screen.
A pregnant patient presents for her 24-week visit, at which time she relates that she does not feel very interested in sex anymore. Your response is to:
A) tell the patient that this is common and she should not be concerned.
B) reassure the patient that the interest will return in the third trimester.
C) tell the patient to get more rest and the interest will increase.
D) get the patient to talk about how she is feeling and thinking about sex.
D) get the patient to talk about how she is feeling and thinking about sex.
It is the healthcare provider’s role to listen and facilitate the patient’s expression of feelings and to provide a nonjudgmental environment.
CVS has an advantage over amniocentesis because:
A) it can be done 3 to 4 weeks earlier.
B) there is less risk for infection.
C) there is less risk for limb deformities.
D) there is greater specificity in test results.
A) it can be done 3 to 4 weeks earlier.
An advantage of CVS over amniocentesis is that CVS can be performed between 10 and 13 weeks’ gestation, which is 3 to 4 weeks earlier than amniocentesis is feasible.
Antepartal care for the patient who is HIV positive should focus mainly on:
A) ensuring fetal well-being at all cost.
B) frequent drug testing to ensure that the patient is not using IV street drugs.
C) testing the partner and providing treatment if necessary.
D) maintaining the patient’s health and preventing neonatal transmission.
D) maintaining the patient’s health and preventing neonatal transmission.
Maintaining the health of the patient and preventing vertical transmission to the neonate are the priorities when caring for people with HIV.
The CDC recommends screening for GBS:
A) at the first visit.
B) when labor starts.
C) at 20 weeks.
D) at 35–37 weeks.
D) at 35–37 weeks.
GBS screening is performed at 35–37 weeks by swabbing the vaginal introitus and rectal specimens.
During the embryonic stage, all major organ systems are formed except the:
A) heart.
B) reproductive organs.
C) liver.
D) lungs.
D) lungs.
All major organ systems are formed during the embryonic stage except for the lungs.
The RDAs of calories and protein, respectively, during pregnancy are:
A) 3000 kcal and 50 g/day.
B) 3500 kcal and 60 g/day.
C) 3800 kcal and 60 g/day.
D) 2500 kcal and 60 g/day.
D) 2500 kcal and 60 g/day.
The Recommended Dietary Allowances for pregnancy are 2500 kcal/day and 60 g/day of protein.
Exercise guidelines for healthy pregnant people include suggestions to:
A) discontinue exercise at 20 weeks.
B) begin an intense program of exercise, especially if prepregnant weight was high.
C) modify the existing program if symptoms occur.
D) limit fluids before exercising.
C) modify the existing program if symptoms occur.
In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise per day on most, if not all, days of the week is recommended for pregnant women.
Leg cramps during pregnancy may be relieved by:
A) pointing the toes.
B) hot compresses.
C) flexion of the foot.
D) hot tub baths.
C) flexion of the foot.
Leg cramps may be relieved by flexing the ankle to stretch the calf, decreasing phosphate in the diet, drinking no more than two glasses of milk per day, massaging the affected leg, keeping the legs warm, walking, exercising, and taking calcium tablets and magnesium tablets.
Which of the following is an appropriate plan of care for a patient at 40 weeks’ gestation with a BPP score of 8, which includes a score of 2 for AFV?
A) Order a CST.
B) Repeat the BPP in 48 hours.
C) Schedule a return visit after 1 week.
D) Admit for induction of labor and delivery.
C) Schedule a return visit after 1 week.
A BPP score of 8/10 is a reassuring, normal score. BPP scoring interpretation criteria are as follows: 8–10 is normal; 6 is equivocal, repeat testing; 4 or less is considered abnormal and needs further evaluation.
The calculation of EDB by Naegele’s rule is based on a(n):
A) 28-day menstrual cycle.
B) average length of pregnancy of 290 days.
C) 32-day cycle.
D) length of pregnancy of 270 days.
A) 28-day menstrual cycle.
The calculation of EDB by Naegele’s rule is based on a 28-day menstrual cycle, assuming the average length of pregnancy to be 280 days, or 10 lunar months.
A pregnant patient presents at 32 weeks’ gestation with vaginal bleeding for the past 6 hours, back pain, and irregular abdominal cramping pain. Exam reveals diffuse abdominal tenderness and increased uterine tone. You suspect:
A) marginal placenta previa.
B) placental abruption.
C) preterm labor.
D) pyelonephritis.
B) placental abruption.
Placental abruption is premature separation of the placenta from the uterus; it may be partial or complete. Signs of placental abruption include vaginal bleeding, uterine tenderness and rigidity, contractions or uterine irritability and/or tone, and fetal tachycardia or bradycardia.
A patient states that she is trying to get pregnant and had unprotected intercourse on day 14 of her usual 28-day menstrual cycle. However, the pregnancy test was negative 3 days later. Appropriate management would be to:
A) order an ultrasound.
B) prescribe progesterone.
C) repeat the test in a week.
D) order a serum pregnancy test.
C) repeat the test in a week.
The patient performed the test too early, so she needs to repeat the test in 1 week. Sensitive urine pregnancy tests can detect pregnancy approximately 1 week after conception.
An NST containing two fetal heart accelerations lasting 15 seconds that are 15 beats per minute above the baseline is considered:
A) negative.
B) positive.
C) nonreactive.
D) reactive.
D) reactive.
A reactive NST constitutes two or more accelerations in FHR of 15 or more beats per minute lasting for 15 seconds or more within a 15- to 20-minute period.
A patient presents for her first antepartal visit. She is 10 weeks pregnant and requests to listen for the FHT. You have a handheld Doppler available. Your response would be which of the following?
A) “No, there is no reason to listen because it cannot be heard until 18 weeks.”
B) “We can try to listen today. But we may not hear the heartbeat yet.”
C) “We can surely listen! We can definitely hear the heartbeat as early as 6.5 weeks.”
D) “We do not usually do that at any visit.”
B) “We can try to listen today. But we may not hear the heartbeat yet.”
FHTs can be auscultated by Doppler as early as 10 weeks, but this is done more commonly at 12 weeks.
A patient presents for her 36-week visit. Abdominal exam reveals a likelihood of polyhydramnios. In response to her question about where the fluid comes from, you answer that it comes from:
A) the pregnant patient’s blood volume.
B) a combination of maternal serum and fetal urination.
C) amniotic epithelium and fetal functions.
D) fluid ingested by the mother.
C) amniotic epithelium and fetal functions.
Amniotic fluid is produced by the amniotic epithelium. Water transfers across the amnion and through the fetal skin. In the second trimester, the fetus starts to swallow, urinate, and inspire amniotic fluid.
On reviewing the record of a currently pregnant patient, you see that she is P1112. What obstetric history can you derive from this information?
A) Two previous pregnancies, of which one infant was term and one was a premature stillbirth
B) You are unable to determine an obstetric history from this information.
C) Three pregnancies with one term birth and premature twins
D) Three pregnancies, of which one was term, one premature, and one an abortion
D) Three pregnancies, of which one was term, one premature, and one an abortion
The numbers represent a patient’s obstetric history, expressed via TPAL: one term delivery, one preterm delivery, one abortion (spontaneous or elective), and two living children.
The drop in diastolic blood pressure that occurs during normal pregnancy is partly the result of:
A) plasma volume expansion.
B) progesterone’s effect on the vessel walls.
C) increased cardiac output.
D) pooling of plasma in the tissues.
B) progesterone’s effect on the vessel walls.
Diastolic blood pressure is lower in the first two trimesters because of the development of new vascular beds and the relaxation of peripheral tone by progesterone, which result in decreased flow resistance.
Pregnancy loss and the patient’s need for appropriate grieving occur across the reproductive spectrum. Maladaptive grief reactions are best addressed by:
A) telling the patient to put the baby’s things away.
B) listening to whatever the patient has to say.
C) encouraging the patient to be strong so she will get past it.
D) making the patient an appointment with a therapist.
B) listening to whatever the patient has to say.
It is the healthcare provider’s role to listen and facilitate the patient’s expression of feelings and to provide a nonjudgmental environment.
Which structure in human reproduction produces the most diverse and greatest quantity of steroid and protein hormones?
A) Trophoblast
B) Blastocyst
C) Chorion laeve
D) Deciduas basalis
A) Trophoblast
Human trophoblasts produce more diverse steroid and protein hormones and in greater amounts than does any endocrine tissue in all of mammalian physiology.
A pregnant patient (G1 P0) comes for the 20-week visit. The abdominal exam shows the uterine fundus to be halfway between the symphysis and the umbilicus. This finding leads you to consider:
A) IUGR.
B) nothing, because it is normal.
C) oligohydramnios.
D) that the patient is not eating and gaining enough weight.
A) IUGR.
The fundus is typically found at the umbilicus at 20 weeks.
A pregnancy is maintained through hormones produced by the:
A) egg sac and placenta.
B) corpus luteum and chorion.
C) corpus luteum and placenta.
D) ovary and placenta.
C) corpus luteum and placenta.
The corpus luteum is responsible for the secretion of progesterone to maintain the endometrium and pregnancy until the placenta takes over production.
The maternal mortality ratio is defined as the number of maternal deaths that result from the reproductive process per:
A) 1000 live births.
B) 100,000 live births.
C) 100,000 pregnant women.
D) 100,000 reproductive-age women.
B) 100,000 live births.
The maternal mortality ratio is the number of maternal deaths that result from the reproductive process per 100,000 live births.
Which of the following statements concerning influenza vaccination for pregnant patient is true?
A) Vaccination is recommended for all women who will be pregnant during the influenza season.
B) Pregnant women with HIV infection should not receive this vaccination.
C) The pregnant patient should be offered the option of either the injection or nasal administration of the vaccine.
D) Vaccination should be given only in the second or third trimester.
A) Vaccination is recommended for all women who will be pregnant during the influenza season.
The TIV is recommended for all pregnant women during influenza season; live attenuated nasal influenza vaccine is contraindicated during pregnancy.
Which of the following is a presumptive sign of pregnancy seen in the vagina?
A) Hegar’s sign
B) Piskacek’s sign
C) Goodell’s sign
D) Chadwick’s sign
D) Chadwick’s sign
Chadwick’s sign is a presumptive sign of pregnancy. Presumptive sign of pregnancy refers to signs and symptoms that may be caused by pregnancy. Amenorrhea may be caused by sickness or stress.
A primigravida at 13.5 weeks states that she is concerned because she has not felt the baby move yet. Your response should be which of the following?
A) “Most pregnant people with their first pregnancy do not feel movement until around 20 weeks.”
B) “You are worrying too much—just relax.”
C) “I will order an ultrasound just to be sure everything is fine.”
D) “I would like you to return in a week so we can recheck it.”
A) “Most pregnant people with their first pregnancy do not feel movement until around 20 weeks.”
Quickening is the maternal perception of fetal movement, which usually occurs between 18 and 20 weeks for primiparas; it occurs earlier for multigravidas, at about 14 to 18 weeks.
The BPP assesses fetal well-being with:
A) a combination of NST and ultrasound evaluation to assess five variables.
B) both a CST and an ultrasound evaluation of AFV.
C) serial ultrasounds to evaluate AFV as well as fetal breathing and body movement and tone.
D) evaluation of fetal movement with kick counts after administration of oxytocin or nipple stimulation.
A) a combination of NST and ultrasound evaluation to assess five variables.
A BPP consists of five parameters: NST, breathing, movement, tone, and AFV.
A patient indicates that she is afraid of oxytocin (Pitocin) because her sister had a uterine rupture when she was induced. Your response would be to:
A) reassure the patient because she will not need induction anyway.
B) discuss how oxytocin (Pitocin) is given, and provide assurance that nothing will go wrong.
C) discuss alternative methods to promote uterine readiness and contractions.
D) say that oxytocin (Pitocin) is the best way to get through labor and it is not a problem.
C) discuss alternative methods to promote uterine readiness and contractions.
Oxytocin (Pitocin) may be utilized to help initiate or facilitate labor by stimulating contraction of the uterine smooth muscle. Other methods may also be employed to promote uterine readiness and contractions, such as nipple stimulation.
A patient comes in for her first antepartal visit. When asked the date of her last menstrual period, she indicates she has not had one since she has been nursing her 6-month-old daughter. You diagnose that she is pregnant. How would you determine EDB?
A) Determine when she expected to get her period and calculate from there.
B) Document quickening and extrapolate from there.
C) Send the patient to the fetal assessment unit for an ultrasound.
D) Get a good sexual history and use the last coitus as the basis for calculation.
C) Send the patient to the fetal assessment unit for an ultrasound.
If the patient is uncertain about the LMP, ultrasound may be used to calculate estimated GA.
The characteristic gait of pregnancy results from:
A) a shift in the center of gravity as the uterus enlarges.
B) the effects of relaxin and estrogen.
C) the effects of relaxin and progesterone.
D) the effects of increasing amounts of estrogen and progesterone.
C) the effects of relaxin and progesterone.
Relaxin and progesterone affect cartilage and connective tissue, resulting in a loosening of the sacroiliac joint and symphysis pubis.
A patient comes in for the first antepartal visit at 8 weeks and tells you that she has nausea every morning but is able to eat and drink in the afternoon. Your first step in management at this point would include:
A) a prescription for antinausea medicine.
B) vitamin B6 50 mg twice a day.
C) advising the patient to eat small, frequent meals.
D) advising the patient to drink a carbonated beverage on rising.
C) advising the patient to eat small, frequent meals.
Nausea and vomiting of pregnancy are most common in the first trimester. It is recommended that patients eat small, frequent meals, with no restriction on the kind of food or how often. Education includes discontinuing prenatal vitamins with iron until nausea and vomiting have resolved, but continuing folic acid. Other recommendations may include consuming raspberry tea, peppermint tea, carbonated beverages, or hard candy; using acupressure, including sea bands for wrists; taking ginger 1 g per day in divided doses, pyridoxine (vitamin B6) 25 mg BID or TID orally, doxylamine 12.5 mg BID or QID with pyridoxine orally, metoclopramide 5 to 10 mg g q6–8h orally, or promethazine 25 mg q4h per rectal suppository.
Which of the elements of clinical pelvimetry defines the midplane?
A) Diagonal conjugate
B) Intertuberous diameter
C) Ischial spines distance and sacrum
D) Pubic arch
C) Ischial spines distance and sacrum
The distance between the ischial spines normally measures 10 cm, is the smallest diameter of the pelvis, and defines the midplane.
The fetal system most closely associated with oligohydramnios is the:
A) GI system.
B) CNS.
C) renal system.
D) cardiovascular system.
C) renal system.
Oligohydramnios is associated with genitourinary abnormalities in the fetus.
