VN 34 S.G Test 2

Question 1

1. Hyperemesis gravidarum nursing Interventions (PP slide 6)

Answer 1

 Medications as ordered (B6, Phenergan, Reglan, Zofran)
 Decreasing trigger factors
 Carbohydrates can decrease nausea (crackers in the AM)
 Assist the woman w/regaining fluid balance.
 If admitted priority will be IV fluids & electrolyte replacement

Question 2

2. Ectopic pregnancy manifestations and risks (pp slide 8)

Answer 2

Manifestations:
 Missed menstrual period
 N/V
 Pelvic pain
 Shoulder pain
 Vaginal spotting/light bleeding

Risks:
 STI’s
 Tubal Ligation
 IUD

Question 3

3. MMR vaccine nursing considerations (PP slide 27, pg.259)

Answer 3

 Not safe during pregnancy but will need before discharge
 The woman should not get pregnant for 28 days after MMR vaccination (could be teratogenic to the fetus)

Question 4

4. Placenta previa manifestations (pp slide 8)

Answer 4

 Painless, bright red bleeding during pregnancy (due to an abnormally implanted placenta that is too close to or covers the cervix)
-Monitor in 3rd trimester for painless bright red bleeding

Question 5

5. Abruption placenta manifestations (pp slide 9)

Answer 5

 Dark red painful bleeding (caused by the premature separation of the placenta from the wall of the uterus at any time before the end of labor.
 Rigid abdomen
 This is an emergency!

Question 6

6. Amniocentesis reason for having and considerations (pp slide 17)

Answer 6

INDICATIONS:
 Can be done for preterm labor to establish lung maturity.
 Advanced maternal age (generally accepted as older than 35)
 Previous offspring w/chromosomal anomalies
 Hx of recurrent pregnancy loss
 Ultrasound diagnosis of fetal anomalies
 Abnormal MSAFP, triple-marker screen, or multiple – marker screen
 Previous offspring w/neural tube defect
 Both parents known carriers of a recessive genetic trait (cystic fibrosis, sickle cell anemia, or Tay-Sachs disease)

CONSIDERATIONS: (flashcard 23)
 Give RhoGAM to an RH negative mother
>can be done at 15-20 weeks

Question 7

7. Teratogens risk (PG.97)

Answer 7

 Weeks 2-8 pose the most risk
 Can cause birth defects in the developing fetus
 Alcohol, oral contraceptives, cat litter, certain drugs like phenytoin, varicella, CMV, rubella, zika virus, X-rays

Question 8

8. Preeclampsia manifestations (PP slides 16, 17)

Answer 8

 BP at or greater than 140/90
 Edema (pitting)
 Epigastric pain
 Proteinuria -2+ or higher on dipstick
 Visual changes including floaters
 Nausea
 Headaches
 Fear of impending doom (FOID)

Question 9

8. Preeclampsia nursing interventions(PP slides 16, 17)

Answer 9

 Accurate BP
 Daily weights
 Bed rest: side lying
 Output
 Seizure precautions
 Monitor RR (PRIORITY)
 Monitor neuro status
 Pharmacology administration as ordered (magnesium sulfate)
 Only cure is delivery
 Pre-eclampsia (mild) at home perform daily kick counts & report change of symptoms

Question 10

9. Iron, folic acid, nutrition during pregnancy (PP slide 22-24, flashcard 36)

Answer 10

 Increased caloric intake of 300 cal/day
 Increase folic acid (vitamin B9) : eggs, nuts, legumes, meat, dark green leafy veggies
 Diet should include @ least 400 mcg of folic acid per/day
 Too much vitamin A can be toxic to fetus, too little can stunt fetal grown & cause impaired adaptation.
 Iron: 1st line of treatment for anemia
 Increase iron supplementation & diet high in iron rich foods for anemia: egg yolks, spinach, Red meats, dried fruit, lentils and beans)

Question 11

10. GTPAL (pp slide 14)

Answer 11

 Gravida: total # of pregnancies
 Term: # of pregnancies that ended @ term (at or beyond 38 wks)
 Preterm: # of pregnancies that ended after 20 wks & before the end of 37 wks
 Abortions: # of pregnancies that ended before 20 wks gestation
 Living: # of children delivered who are alive when HX is taken

Question 12

11. Gestational diabetes nursing interventions (pp slide 18)

Answer 12

 If pregestational good blood glucose control can help prevent progression
 Start w/diet, move to insulin if not controlled
 Screening at 24-28 weeks 1 hr GTT, followed by 3hr GTT
 Occurs only in pregnancy & disappears at delivery
 About a 30% risk of developing diabetes

Question 13

12. GDM complications (pp slide 18, flashcard 38)

Answer 13

 Hypoglycemia to newborn
 Polyhydramnios (too much amniotic fluid)
 LGA (large for gestational age)
 Increased risk of spontaneous abortion (SAB)
 Mother is more likely to develop type 2 diabetes
 Preeclampsia
 Birth trauma
 Macrosomia (baby who is larger than 90-95th percentile at birth)

Question 14

13. MSAFP reasons (PG.127, pp slide16)

Answer 14

 (Maternal Serum Alpha Fetal Protein) : Done 15-20 wks gestation PP: 16-18 wks
 To check for neural tube defects (anencephaly: failure of the brain to develop normally, spina bifida: failure of the spine to close completely during development)
 Elevated: could mean neural tube defect, carrying multiple fetus, fetus has died in utero
 Low: may indicate down syndrome

Question 15

14. Early sx of pregnancy (PP slide 2)

Answer 15

Presumptive (possible) signs:
 Breast tenderness
 Missed period
 Frequent urination
 Back pain
 Mood changes
 N/V , fatigue

Probable Signs:
 + pregnancy test either urine or blood

Positive Signs:
 Diagnostic confirmation: ultrasound, fetal heartbeat ect.

Question 16

15. HIV, HSV, and pregnancy nursing considerations (Pg.343, 345)

Answer 16

 HIV: pregnant women is @risk for transmitting infection to newborn during birth or while breastfeeding.
-Receiving antiretroviral treatment during pregnancy & childbirth and avoiding breast feeding newborn will substantially reduce risk of perinatal transmission of HIV to infant.
>HSV: treatment during pregnancy often includes 1-2 week course of therapy w/acyclovir for a 1st episode of HSV.
-Suppressive therapy may be ordered beginning @36 wks gestation because this seems to reduce the risk of an active outbreak @ the time of delivery.

Question 17

16. RhoGAM considerations (PP slide 22)

Answer 17

 Prevents formation of RH antibodies

Question 18

17. NST considerations (PP slide 18, flashcard 25)

Answer 18

 Measures fetal heart rate acceleration patterns
 Reactive indicates fetal well being (2 accelerations in 20 mins)
 Non-reactive requires further evaluation (after 40 mins of no activity a biophysical profile is needed)

Question 19

18. Magnesium sulfate nursing considerations (PP slide 17)

Answer 19

 Altered LOC
 Lowers RR
 High risk of toxicity
 Decreased deep tendon reflexes.
 ANTIDOTE: calcium gluconate

Question 20

19. Exercise, travel, and pregnancy (pg.135

Answer 20

 A woman may generally maintain her normal exercise routine during pregnancy, as long as she does not become overheated or excessively fatigued
 Avoid exercise that can cause trauma to the fetus like kickboxing, horseback riding, scuba diving, bathing in Jacuzzis, jerky bouncing.
 If traveling, make sure to get up and walk every 2hrs to avoid DVT

Question 21

20. Manifestations of each type of abortion (PP slide 11)

Answer 21

Threatened Abortion: pregnancy may progress to term, or threatened abortion can lead to one of the other types
 Vaginal bleeding/spotting
 Possibly cramping
 No cervical dilatation

Inevitable Abortion:
 Cramping & spotting or vaginal bleeding w/cervical dilatation, amniotic fluid may leak

Incomplete Abortion:
 Some but not all the products of conception are expelled. Most commonly, the fetus delivers, and the placenta and membranes are retained

Complete Abortion:
 All of the products of conception (fetus, membranes & placenta) are expelled

Missed Abortion:
 The fetus dies, but remains in utero. Signs of pregnancy ( nausea, breast tenderness) decrease & the fundus doesn’t grow as expected in a normal pregnancy & may regress (get smaller)
 No fetal heart tones are present

Habitual (recurrent) Abortion:
 The loss of 3 or more consecutive pregnancies before the fetus is viable

Question 22

21. Integumentary system changes during pregnancy (PP slide 10)

Answer 22

 Chloasma (mask of pregnancy)
-Brown blotchy areas on the forehead, cheeks & nose
 Linea nigra
 Striae (may develop on abdomen in response to elevated glucocorticoid levels)

Question 23

22. Naegele’s Rule

Answer 23

-3 months, +7 days, +1 year (if applicable)

Question 24

23. Danger Signs in pregnancy (PP slide 21)

Answer 24

Headaches
Epigastric pain
Abnormal vaginal discharge
Pain
Persistent vomiting
Excessive, rapid weight gain
Absence or decrease in fetal movement once felt
Signs of infection – odor
Edema extremities & facial
Vaginal bleeding (avoid coitus while present)
 Visual disturbances/blurred vision

Question 25

25. Infectious Diseases (TORCH) [PP slide 27]

Answer 25

 TORCH: Toxoplasmosis, Other (Hep B, Syphilis, varicella, herpes zoster), Rubella, CMV and HSV
 Prevention is the best treatment strategy because many of the TORCH infections don’t have effective treatment.
 HSV: if active lesion will need cesarean preventative antivirals in 3rd trimester
 Chlamydia (most common STD) & Gonorrhea :increased risk of PTL (preterm labor)
 Trichomoniasis: Flagyl/ PTL (pre
 HIV: causes AIDS, HAART (highly active anti-retroviral treatment)
-Prophylactic medication to keep viral loads down, will need formula teaching.
 Hep B can cause liver disease.
 Hep C is most common w/drug use