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NCC Board Prep > NPWH > Flashcards

NPWH Flashcards

1
Q

PRESUMPTIVE signs of preganancy

A

Subjective symptoms reported by the patient

  • amenorrhea
  • breast tenderness, tingling, or enlargement
  • areolar color changes
  • fatigue
  • urinary frequency
  • n/v
  • maternal perception of fetal movement
  • skin changes such as linea nigra and straie
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2
Q

PROBABLE signs of pregnancy

A

Objective signs observed by the provider

  • positive pregnancy test
  • palpation of Braxton Hicks contractions
  • increase in uterine size
  • increase in abdominal
    circumference
  • Hegar’s sign
  • Goodell’s sign
  • Chadwick’s sign
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3
Q

Hegar’s sign

A

softening of the lower uterine segment and cervical isthmus

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4
Q

Goodell’s sign

A

softening of the cervix

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5
Q

Chadwick’s sign

A

blue discoloration of the cervix and vagina

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6
Q

What are Braxton-Hick’s contractions

A

painless irregular contractions that do not cause cervical dilation

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7
Q

POSITIVE signs of pregnancy

A

those that confirm a pregnancy

  • auscultation of fetal heart tones
  • palpation of the ENTIRE fetal body by a healthcare provider
  • palpation of fetal movements by the healthcare provider
  • visualization on US of the gestational sac, embryo/fetus
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8
Q

____ sign of pregnancy: palpation of the ENTIRE fetal body by a healthcare provider

A

positive

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9
Q

Average length of gestation per Nagele’s rule

A

280 days

= 9 calendar months

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10
Q

____ sign of pregnancy: provider palpation of fetal movement

A

positive

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11
Q

Nagele’s rule

A

utilizing LMP
subtract 3 months
add 7 days
add 1 year

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12
Q

____ sign of pregnancy: patient perception of fetal movement

A

presumptive

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13
Q

____ sign of pregnancy: auscultation of fetal heart tones

A

positive

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14
Q

____ sign of pregnancy: amenorrhea

A

presumptive

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15
Q

____ sign of pregnancy: positive pregnancy test

A

probable

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16
Q

____ sign of pregnancy: provider palpation of increased uterine size

A

probable

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17
Q

____ sign of pregnancy: provider palpation of Braxton Hick’s contractions

A

probable

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18
Q

Between _____ to ____ weeks, the gestational age correlates with the measurement of fundal height in centimeters, within + or - _____cm

A

16-38 weeks

+ or - 3cm

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19
Q

Fetal heart sounds can be detected as early as _____ using a handheld doppler

A

10 weeks

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20
Q

Initial maternal perception of fetal movement within the uterus usually occurs between _____ weeks (quickening)

A

16-22 weeks

typically earlier for those who have been pregnant before

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21
Q

GTPAL: Gravida

A

number of pregnancies, regardless of outcome

if a woman is pregnant for the first time but carrying twins, she is still G1 because there are 2 fetuses but it is only 1 pregnancy

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22
Q

GTPAL: Term

A

number of pregnancies delivered at term > or = 37 weeks or weighing > or = 2500g

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23
Q

GTPAL: Preterm

A

number of pregnancies prematurely born between 20-36 weeks or weighing between 500-2499g

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24
Q

GTPAL: Abortion

A

number of spontaneous abortions, miscarriages, or terminations at <20 weeks or <500g

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25
Q

GTPAL: Living

A

number of current living children

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26
Q

GP: Gravidity

A

The total number of times a woman has been pregnant (including the current one), same as for GTPAL

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27
Q

GP: Parity

A

the number of pregnancies carried to the 20th week gestation or the delivery of an infant weighing >500g regardless of the outcome of the pregnancy

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28
Q

Nulligravida

A

never been pregnant

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29
Q

Nullipara

A

never carried a pregnancy past 20 weeks or delivered a baby >500g

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30
Q

Primigravida

A

first pregnancy

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31
Q

Primipara

A

has been or is currently pregnant for the first time past 20 weeks gestation

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32
Q

Multigravida

A

has been pregnant 2 or more times

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33
Q

Multipara

A

has carried 2 or more pregnancies past 20 weeks gestation or delivered an infant >500g more than once

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34
Q

Grand multipara

A

give birth five or more times

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35
Q

_____ sign of pregnancy: Hegar’s, Chadwick’s, and Goodell’s signs

A

probable

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36
Q

_____ sign of pregnancy: palpation of fetal movements by the healthcare provider

A

positive

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37
Q

Multiple gestations (e.g., twins) only counts as 1 in every GTPAL category except….

A

LIVING

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38
Q

Fertilization occurs in the fallopian tubes during the first _____ after release of the egg from the ovary

A

12 hours

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39
Q

Result of zygote mitotic division

A

blastomere

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40
Q

A 16-cell ball of blastomeres

A

morula

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41
Q

Morula travels into the uterus ____ after conception

A

3 days

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42
Q

Inner cell mass of the blastocyst becomes the….

A

embryo

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43
Q

Outer cell mass of the blastocyst becomes the….

A

trophoblast

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44
Q

The ____ attaches the blastocyst to the uterine wall and differentiates into two layers

A

trophoblast

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45
Q

The trophoblast, once implanted in the uterine wall, differentiates into these (2) layers which later develop into the placenta

A
  1. cytotrophoblast (inner layer)

2. synctiotrophoblast (outer layer)

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46
Q

The developing conceptus before the end of the ____ week after conception is referred to as an EMBRYO

A

8 weeks post-conception (10 weeks LMP)

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47
Q

Implantation occurs when after conception/fertilization

A

6-7 days after conception

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48
Q

Main function of the placenta

A

support normal growth of the fetus by facilitating exchange of nutrients and waste products between the fetal and maternal circulatory systems

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49
Q

Typical size and weight dimensions of a mature placenta

A

weighs 500g
2-3cm thick
20cm in diameter

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50
Q

the placenta and the chorion are both derived from the

A

trophoblast

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51
Q

the _____ establishes connection with the uterine lining, which gives rise to the placenta

A

chorionic villi

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52
Q

decidual tissue that surrounds the chorionic sac

A

decidua capsularis

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53
Q

fetal part of the placenta

A

chorion frondosum

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54
Q

maternal part of the placenta

A

decidua basalis

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55
Q

beta hCG is produced mainly by the ….

A

placenta

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56
Q

beta hCG may be detectable in the plasma as early as ___ days after conception

A

7 days

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57
Q

beta hCG’s main function

A

to maintain the corpus luteum and thus progesterone production

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58
Q

hPL is detectable as early as….

A

2-3 weeks after conception

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59
Q

hPL’s main function

A

acts as a diabetogenic that inhibits maternal insulin activity, influences carbohydrate metabolism, both of which increase maternal sugars for fetal nutrients

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60
Q

(8) placental hormones

A
  • beta hCG
  • hPL
  • ACTH
  • relaxin
  • human placental growth hormone
  • estradiol 17-beta
  • estriol
  • progesterone
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61
Q

ACTH (placental hormone)’s main function

A

may have an impact on fetal lung maturation

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62
Q

relaxin’s main function

A

thought to maintain quietude of the uterus early in pregnancy, and is also secreted by the corpus luteum during this stage

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63
Q

functions of estrogen during pregnancy (3)

A
  • stimulate growth of the endometrium
  • increase blood flow between uterus and placenta
  • prepare breasts for lactation
64
Q

when does placenta take over progesterone production from the corpus luteum

A

around the 9-10th week

65
Q

(2) functions of progesterone in pregnancy

A
  • prepares uterus for implantation

- essential hormone for maintaining pregnancy, quietude of the uterus

66
Q

Maximum amniotic fluid volume occurs at

67
Q

Polyhydramnios AFI

A

24cm or more

68
Q

Polyhydramnios DVP

A

8cm or more

69
Q

50% of polyhydramnios etiology

A

ideopathic

70
Q

Oligohydramnios AFI

71
Q

Oligohydramnios DVP

72
Q

Organogenesis weeks

A

weeks 3-8 after conception (5-10w LMP)

73
Q

Frequency of prenatal visits

A

Q4 weeks until 28w, Q2-3 weeks until 36 weeks, weekly until birth

(7-11 visits total)

74
Q

First prenatal visit typically occurs at ___ weeks

A

8-12 weeks

75
Q

What is Tay-Sachs disease

A

Rare autosomal recessive disease caused by a deficiency in beta-hexosaminidase A. Leads to progressive neurodegeneration due to intracellular accumulation of GM2 gangliosides. Symptoms include developmental delay, “cherry-red” spot on macula, seizures, and hearing impairment. Patients usually die around the age of 4. More prevalent in the Ashkenazi Jewish population.

76
Q

Piskacek’s sign

A

uterus enlarges asymmetrically usually over the site of the implantation (~6 weeks)

77
Q

Anthropod pelvis

A

adequate for vaginal birth due to large size

78
Q

Android pelvic

A

“male pelvis”

heart shaped and may lead to more dystocia and operative births

79
Q

Gynecoid pelvis

A

“female pelvis”

best suited for childbirth

80
Q

Platypelloid pelvis

A

rare, <3%

poor prognosis for vaginal birth

81
Q

Ptyalism

A

increased salivation

82
Q

Etiology for physiologic dyspnea in pregnancy

A

increased tidal volume and lower PCO2

83
Q

Pituitary enlargement by ___% in pregnnacy

84
Q

Supplements for leg cramps in pregnancy

A

calcium and/or magnesium tablets

85
Q

The uterus is back to pre-pregnancy size by ____ weeks post partum

86
Q

lochia rubra days

A

delivery - 3 or 4 days

87
Q

lochia serosa

A

3-4 days until 2 weeks

88
Q

lochia alba

A

2 weeks until 6 weeks

89
Q

By ___ weeks post partum, the cervix is almost closed and is about back to normal size and shape

90
Q

By ____ weeks postpartum, the vagina is expected to be healed and tone close to pre-pregnancy

91
Q

average time to ovulation for lactating women

92
Q

average time to ovulation for non-lactating women

A

70% by 12 weeks

2.5-3 months

93
Q

GFR returns to normal by ____ weeks postpartum

A

8 weeks (2 months)

94
Q

Each nipple contains ____ lactiferous ducts

95
Q

Sebaceous glands that lubricate the nipple and areaola

A

montgomery’s tubercles/glands

96
Q

Lactogenesis I

A

mid-pregnancy to 2nd day postpartum

alveolar cells differentiate into secretory cells

97
Q

Lactogenesis II

A

“milk coming in”, pp day 3-8 triggered by decreasing progesterone (10-fold decline)

characterized by copious milk production

98
Q

Lactogenesis III

A

established mature milk supply, >8 days postpartum

99
Q

Amount of milk typically made on Day 1 post partum

100
Q

Sensitive period for bonding post-partum

A

30-60 minutes after birth

101
Q

Bonding is ___directional

A

unidirectional (mother to infant)

102
Q

Attachment is ___directional

A

bidirectional (interactive)

103
Q

Under the influence of estrogen during pregnancy, thyroid function changes include an increase in:

A

thyroxine binding globulin

104
Q

Lab test used to diagnose rubella

A

HAI titer

1:10 - 1:64 is immunity
>1:64 is active infection

105
Q

HAI titer 1:6 for rubella indicates…

A

not immune

106
Q

HAI titer 1:10 for rubella indicates….

107
Q

HAI titer 1:65 for rubella indicates….

A

active infection

108
Q

effect of pregnancy on cholesterol and triglcyeride levels

A

may increase

109
Q

What happens to treponemal and non-treponemal tests after infection with, and then treatment for, syphilis

A

non-treponemal (RPR, VDRL) should become nonreactive after treatment

treponemal tests (FTA-ABS, TPI) usually remain positive indefinitely after treatment

110
Q

Heart sound best heard at the BASE of the heart

A

S2

base = top

111
Q

What are somatic mutations

A

can occur any time in one’s life after conception, acquired

112
Q

Renal function tests should be completed every _____ for someone on PrEP

113
Q

Most opportunistic infections occur in folks with HIV and a CD4+ count less than….

A

<200 cells/mm3

114
Q

Classic triad for mono

A
  • fever
  • sore throat
  • swollen lymph nodes
115
Q

most common reason for painless BRBPR

A

internal hemorrhoids

116
Q

First line treatment for otherwise healthy <65yo with CAP

A

azithromycin (advanced gen macrolide)

117
Q

First line treatment for >65yo and/or comorbidities with CAP

A

levofloxacin (respiratory fluoroquinolones)

118
Q

Expected findings in IDA: ferritin

A

low ferritin <10 mg/L

119
Q

How is estrone made after menopause

A

estrone is converted from androstenedione from the ovarian stroma and adrenal gland

120
Q

What is a benefit of continuous-combined HT over cyclic-combined HT

A

there is overall less progesterone in continuous-combined

continuous-cyclic is every day estrogen with only some days progesterone

121
Q

Considerations for choosing DMPA injection site in someone who is obese

A

IM injection requires deep muscle penetration, deltoid may be a better site than the glutes

122
Q

major MOA of POP pills

A

thickening cervical mucus

123
Q

If you are more than _____ late taking a POP pill, use backup for _____

A

> 3 hours, use backup for 48 hours

124
Q

Does pre-ejaculatory semen contain sperm?

125
Q

(2) risk factors for nonpuerperal mastitis

A

smoking, nipple piercing

126
Q

First leopold’s maneuver

A

determine fetal lie (relationship of long axis of the fetus to long axis of the mother - spines)

127
Q

Second leopold’s maneuver

A

determine fetal presentation (presenting part - part of the fetus in the pelvic inlet)

128
Q

Third leopold’s maneuver

A

determine fetal position

129
Q

Fourth leopold’s maneuver

A

determine fetal attitude (flexion of the head if in vertex/cephalic)

130
Q

the fetal system most commonly associated with oligohydramnios

A

fetal kidneys

131
Q

Peak HR increase in pregnancy occurs when

A

10-15 bpm which occurs by 28 weeks (end of second trimester)

132
Q

Peak cardiac volume increase in pregnancy occurs when

A

10% volume increase which occurs by 20 weeks (midpregnancy)

133
Q

Preventing infections in pregnancy include heating meat up to at least _____

A

145F (63C) and 160F if poultry (71C)

134
Q

CMV is usually asymptomatic, but if symptoms they usual resemble what other illness?

A

mono (EBV)

135
Q

ASYMMETRICAL growth restriction is caused by (2) main factors

A
  • uteroplacental perfusion abnormalities

- reduced nutrition to fetus

136
Q

Can you use metronidazole to treat BV in pregnancy

A

Yes, all trimesters ok

metronidazole 500mg PO BID x7 days
metronidazole 250mg PO TID x7 days
clindamycin 300mg PO BID x7 days

137
Q

BV treatment in pregnancy?

A

if asymptomatic and no risk for preterm delivery, dont treat

if asymptomatic and at risk for preterm delivery, treat

if symptomatic, treat

138
Q

Trich treatment regimen in pregnancy

A

metronidazole 2g PO x1 at any time in pregnancy

139
Q

SYMMETRIC growth restriction usually becomes apparent when

A

18-20 weeks EGA

140
Q

(3) causes of symmetric growth restriction

A
  • chromosomal abnormalities
  • maternal drug use
  • congenital infections
141
Q

average Hgb in pregnancy

142
Q

% prevalence of UTIs in pregnancy

A

2-7% of pregnancies

143
Q

% of UTIs in pregnancy that progress to pyelonephritis if untreated

144
Q

(3) criteria for very high risk for TB (>5mm induration is positive)

A
  • recent contact with known infected person
  • abnormal chest radiograph
  • HIV positive
145
Q

% prevalence of breech

A

14% before 32 weeks, and only 3.5% by term

146
Q

Inflammation of PUPPP is characterized by

A

perivasculitis (inflammation)

147
Q

Normal postpartum involution takes ____ to complete

148
Q

max dose acetaminophen per day

A

4g (4000mg)

149
Q

max dose ibuprofen per day

A

3.2g (3200mg)

150
Q

Mife-Miso medical abortion can be safely used up to ______ weeks gestation

A

10 weeks (70 days)

151
Q

What is DIRECT bilirubin

A

conjugated

152
Q

What is INDIRECT bilirubin

A

unconjugated

153
Q

What would you expect in terms of cervical dilation on day 2 pp?

A

normal for the cervix to remain 2-3 cm dilated on pp days 2-3

154
Q

How does a claims made NP insurance policy work?

A

the incident must occur AND be reported when the policy is in effect, i.e., they won’t continue to cover you in the future once you have a different policy for something that occurred during that time

155
Q

most common cause of pathologic nipple discharge in peri-menopause

A

intraductal papilloma (commonly found in perimenopausal 30-50yo age group)

156
Q

Which androgen can be aromatized into ESTRADIOL

A

testosterone

157
Q

Which androgen can be converted into ESTRONE

A

androstenedione

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