The Pregnant Patient

Question 1

What should be commented on in the documentation of the breast exam (for all women)?

Answer 1

Symmetry
Tenderness
Masses
Skin Changes
Nipple Changes
Axillary lymph nodes

Question 2

In the documentation for a pelvic exam what is a critical part to document?

Answer 2

Name and role of chaperone for pelvic exam

(for example: Assistant: Jane Smith, RN)

Question 3

What is gravida?

Answer 3

A woman who is or has been pregnant (regardless of the outcome of the pregnancy)

Question 4

What is nulligravida?

Answer 4

A woman who has never been pregnant and is not currently pregnant

Question 5

What is primigravida?

Answer 5

A woman who is pregnant for the first time or has been pregnant once

Question 6

What is multigravida?

Answer 6

An woman who has been pregnant more than once

Question 7

What is nullipara?

Answer 7

A woman who has never given birth or never had a pregnancy beyond 20 weeks

Question 8

What is primipara?

Answer 8

A woman who has given birth only 1 time (been delivered only once of a fetus/fetuses born alive or dead with a gestation of 20 or more weeks)

Question 9

What is multipara?

Answer 9

A woman who has given birth 2 or more times (past 20 weeks)

Question 10

What are some presumptive signs of pregnancy?

Answer 10

• Missed period or unusual bleeding pattern
• Nausea/vomiting
• Breast changes, size, tenderness, increased sensations
• Increased urinary frequency

Question 11

What is Hegar’s sign?

Answer 11

Softening of uterine isthmus

Question 12

What is Chadwick’s sign?

Answer 12

Bluish or cyanotic appearing cervix and upper vagina due to increased vascularity

Question 13

What is Goodell’s sign?

Answer 13

Softening of cervix due to increased vascularity

Question 14

What is Piskacek’s sign?

Answer 14

Asymmetric bulge or soft prominence of uterus caused by placental development

Question 15

What are positive signs of pregnancy?

Answer 15

• Fetus identified by ultrasound
• Fetal heartbeat detected by doppler or ausculatation
• Objective detection of fetal movement
• Delivery of baby

Question 16

What are some symptoms of early pregnancy?

Answer 16

Amenorrhea
Nausea/vomiting
Breast enlargement/tenderness
Fatigue
Urinary frequency
Pelvic discomfort/pressure

Question 17

What will be seen on the uterus and cervix PE at 6+ weeks gestation?

Answer 17

Enlargement and softening of uterus

Question 18

What will be seen on the uterus and cervix PE at 12 weeks gestation?

Answer 18

Uterus palpable above symphysis pubis in lower abdomen

Question 19

What are some pregnancy skin findings typically seen in later pregnancy?

Answer 19

Melasma or Linea Nigra

Question 20

What is the qualitative test to confirm pregnancy?

Answer 20

hCG

Question 21

Does hCG (urine) have a high false negative rate?

Answer 21

Yes, usually due to testing too early

Question 22

When is the best time to perform a hCG?

Answer 22

Early morning

Question 23

Is serum hCG more sensitive than urine?

Answer 23

Yes

Question 24

In typical pregnancies, what is the progression of hCG levels?

Answer 24

hCG levels double every 48-72 hours; increases every 96 hours as get further along

Question 25

When do hCG levels usually peak?

Answer 25

8-11 weeks, then declines

Question 26

What is the average pregnancy duration from first day of LMP?

Answer 26

280 days

Question 27

What is Naegele's rule in calculating due date?

Answer 27

Add 7 days to first day of LMP, then subtract 3 months, then add a year

Question 28

When should the first prenatal visit be done, ideally?

Answer 28

First trimester, 8 to 10 weeks gestation

Question 29

What should be done at the first prenatal visit?

Answer 29

- Confirm the pregnancy - Determine estimated due date - Desire for the pregnancy/attitude toward pregnancy

Question 30

What is the recommended frequency of normal pregnancy prenatal care visits?

Answer 30

- Office visit at 8-10 weeks of pregnancy - Every 4 weeks for first 28 weeks - Every 2-3 weeks until 36 weeks - Every week after 36 weeks

Question 31

Should depression screening be completed at the first prenatal visit?

Answer 31

Yes, and almost every visit

Question 32

What is the most important and critical vital sign during pregnancy?

Answer 32

Blood pressure, you can't take it enough times

Question 33

At 12 weeks the size of the uterus at what level of the abdomen?

Answer 33

Symphysis pubis

Question 34

At 16 weeks the size of the uterus is at what level of the abdomen?

Answer 34

Halfway between pubis and umbilicus

Question 35

At 20 weeks the size of the uterus is at what level of the abdomen?

Answer 35

Umbilicus

Question 36

What is the single best prevention for neural tube defects?

Answer 36

Folic acid

Question 37

What vaccines are indicated during pregnancy?

Answer 37

Tdap (every pregnancy) Inactivated flu vaccine

Question 38

What vaccines are contraindicated during pregnancy?

Answer 38

Live attenuated vaccines MMR, Varicella, Zostavax, live attenuated flu

Question 39

What vaccines should be delayed until after pregnancy?

Answer 39

Shingrix, HPV

Question 40

A urine dip should be done at each visit to assess for what?

Answer 40

Protein and glucose Infection (WBCs, nitrates)

Question 41

After 36 weeks, the fetus moves into the pelvis, making what exam less reliable?

Answer 41

Fundal heights become less reliable after 36 weeks

Question 42

When should screening for gestational diabetes occur?

Answer 42

Between 24 and 28 weeks

Question 43

If the one hour glucose challenge test (1hr GTT) is positive what should be the next step to confirm the diagnosis of gestational diabetes?

Answer 43

3-hour glucose tolerance test (3hr GTT)

Question 44

When should screening for group B beta-hemolytic streptococcus (GBS) be completed?

Answer 44

35-37 weeks