Week 1 Material

Question 1

What is a pap smear

Answer 1

Procedure done as part of what is typically called an Annual exam. It is a physical exam that screens for cervical cancer

Question 2

Pap Smear Screening Intervals

Answer 2

> 21 y/o age No screening
21-24 y/o age Pap smear every 3 years
25-29 y/o age pap smear every 3 years
30-65 y/o age 3 options: Pap smear with HPV every 3 years; Pap smear only every 3 years, or HPV every 5 years
65+ No screening needed if no hx of abnl cervical changes and either three negative pap test results in a row, two negative HPV tests in a row or two negative co-test results in a row withing the past 10 years. The most recent test should have been performed within the past 3-5 years
Post-Hysterectomy-If no hx of cervical CA or cervical changes No screening
If hx of cervical cancer or moderate to severe cervical changes-Continue to have screening for 20 years after your surgery

Question 3

HPV vaccine

Answer 3

9-12 y/o 1 dose
2nd dose 6-12months after
> 15 y/o at initial dose, 3 doses needed

Question 4

What does HPV vaccine prevent?

Answer 4

Prevents cancer and pre-cancer of cervix, vagina, vulva, penis, anus, throat, tongue , and tonsils

Question 5

What age/population is HPV vaccine indicated for?

Answer 5

Men and women up to age 45

Question 6

What are the guidelines for mammograms

Answer 6

Age 40-annually or every other year. Screen early if high risk.
Age 50-Annually or every other year
Age 75 stop screening

Question 7

Chlamydia Screening

Answer 7

Start screening at 25 years of age if sexually active
After age 25, test prn or with new partners/multiple partners
May need every 3-6 months testing for VERY HIGH RISK clients.

Question 8

What population are at increased risk for Intimate Partner Violence?

Answer 8

Pregnant women

Question 9

At what stage of fetal development is death of embryo and spontaneous abortion common?

Answer 9

1-2 weeks of pregnancy.

Question 10

At what stage of fetal development are developing baby more susceptible to teratogens?

Answer 10

3-8 weeks during organogenesis phase

Question 11

When is organogenesis complete?

Answer 11

By the end of Week 8

Question 12

At the end of week 8 of fetal development, what is occurring?

Answer 12

Fine tunning

Question 13

What are the periods of fetal developments?

Answer 13

Zygote- 1-2 weeks
Embryo- 2-8 weeks
Fetus 8-40 weeks

Question 14

Important Developmental Events (Gestational weeks)

Answer 14

The developing baby resembles a human-12 weeks
Primigravida should be able to feel her baby moving-20 weeks
Multigravida should be able to feel her baby moving-16 weeks
Developing baby fairly well-formed body and internal organs have developed-8 weeks
Alveolar ducts and sacs are present and lecithin begins to appear in the amniotic fluid. BABY IS VIABLE- 24 weeks

Question 15

What is amniotic fluid?

Answer 15

Fluid created via fluid from fetal lungs and urine that helps maintain body temperature, fluid and electrolyte balance. It is reabsorbed when baby swallows and by amnion and chorion membranes.

Question 16

What Oligohydramnios?

Answer 16

<300 ml of amniotic fluid caused by fetal renal anomalies

Question 17

What is Polyhydramnios?

Answer 17

> 2L of amniotic fluid caused by fetal GI and other anomalies.

Question 18

Describe the umbilical cord?

Answer 18

Surrounded by Wharton’s Jelly, 2 Arteries and 1 vein (Remember AVA) 2 A at the top and V at the bottom.

Question 19

Name and define the 4 hormones produced by placenta.

Answer 19

Human Chorionic Gonadotropin (hCG)-detectable in maternal serum 8-10 days after conception. It preserves the function of the corpus luteum).
Human placental lactogen (hPL)- increase insulin resistance and facilitates glucose transport across the placenta.
Progesterone- Maintains endometrium, decreases uterine contractility, stimulates breast development and maternal metabolism
Estrogen-increases towards end of pregnancy, stimulates uterine growth, utero-placental blood flow; breast growth, and contractility of uterus.

Question 20

What three shunts allow for oxygenated/deoxygenated in fetal circulation to occur?

Answer 20

Ductus Venosus-
Ductus arteriosus
Foramen ovale-

Question 21

When is embryo NOT Susceptible to teratogens?

Answer 21

During the first 2 weeks of gestation because it is just a ball of cells or zygote and there is no maternal blood flow.

Question 22

When is the embryo most susceptible to neural tube defects like spina bifida and anencephaly?

Answer 22

Weeks 3-16, especially weeks 3-7.

Question 23

Who should take 400 mcg of folic acid daily?

Answer 23

All women of childbearing age to prevent neural tube defects.

Question 24

Embryo and Fetus Congenital

Answer 24

Congenital condition present at birth. It is important to know that baby can be born with congenital defects.

Question 25

Types or pregnancy test (Serum)

Answer 25

Serum
Qualitative-positive or negative results (Over the counter pregnancy test)
Quantitative-providers # indicating units of beta hCG present. Beta hCG doubles every 48 hours in first 4 weeks. If abnormally high can indicate abnormal gestation (Down Syndrome, Gestational Trophoblastic Disease) while abnormally low levels may indicate impending miscarriage.

Question 26

Types or pregnancy test (Urine)

Answer 26

Based on monoclonal antibody immunoassay testing; accuracy depends on how well directions are followed and making sure test is not done too early in pregnancy. If patient has amenorrhea, repeat test in one week.

Question 27

What is GTPAL

Answer 27

G-Gravida-the number of times a woman is or has been pregnant
T-Term-Pregnancies >37 weeks gestation (Multiples count as one)
P-Preterm-20-36 weeks gestation (alive or stillborn) Multiples count as one)
A-Abortion-<19 6/7 weeks (Multiples count as one)
L-Living-living children (Count multiples individually).

Question 28

What is GP Notation

Answer 28

G-Gravida-the number of times a woman is or has been pregnant
P-Parity-all completed pregnancies >20 weeks gestation (including live births and stillbirths) Multiples count as one)

Question 29

What is Goodell sign?

Answer 29

Softening of the tip cervix that occurs at about 6 weeks gestation.

Question 30

What is Chadwick’s sign?

Answer 30

bluish discoloration of the cervix/vagina

Question 31

Hegar’s sign

Answer 31

softening/Compressibility of the lower uterine segment/uterine isthmus that occurs at about 6 weeks gestation.

Question 32

What is Lightening?

Answer 32

Fundal height decreases between 38-40 weeks gestation as the fetus begins to descend into the pelvis before the onset of labor.

Question 33

Measuring fundal height

Answer 33

12 weeks fundus just above pubic bone. Until 12 weeks the uterus cannot be felt abdominally.
20 weeks- fundus at height of belly button.
Fundal height increases by 1 cm/per week. Will correspond with gestational age +/- cms Ex: 32 weeks pregnant (30-34 weeks)
36-38 weeks-underneath sternum
After 38 weeks fundus begins to lower down as baby descends.
Any decrease in fundal height before lightening occurs is considered abnormal, even if the measurement is still within normal range.

Question 34

What is Ballottement

Answer 34

The rebound motion of the fetus. Shows that fetus is not engaged into the bony part of the pelvis.

Question 35

What is Vena Cava Syndrome?

Answer 35

Supine Hypotension. Nursing intervention: Have patient turn on left side. Left lateral decubitus recumbent position

Question 36

Immunizations that are contraindicated in pregnant women

Answer 36

Live vaccine: Measle, Mumps, Chicken pox, oral polio or attenuated live viruses (intranasal flu mist)

Question 37

Immunizations recommended/safe in pregnant women

Answer 37

Tdap (Pertussis for whooping cough), administer at 27-36 weeks gestation to provide pertussis immunity for the newborn, inactivated flu; COVID 19

Question 38

Naegele’s Rule to determine EDD?

Answer 38

Example: 1st day of LMP 12-10-21. 9/17/22 Subtract 3 from month, Add 7 to day and Add 1 to year.

Question 39

What is a traditional Prenatal Visit Schedule

Answer 39

First visit within first trimester (12 weeks)
Every 4 weeks during 0-28 weeks
Every 2 weeks 29-36 weeks
Weekly from 36 weeks to birth.

Question 40

Embryo and Fetal Developmental Milestones

Answer 40

4 weeks- Heart begins beating
12 weeks-resembles a human with all organs and body structures in place, gender is recognizable
20 weeks-Vernix Caseosa and lanugo (fine hair over body), fetal movements strong enough for mothers to feel.
24 weeks- skin red, wrinkled, body lean, alveolar ducts and sacs appear, lecithin begins to appear in amniotic fluid; can hear, potentially viable
30-31 weeks- Subcutaneous fat forming, Lecithin Sphingomyelin L/S Ratio: 1.2:1
36-40 weeks: Lanugo and vernix disappearing as 40 weeks approaches L/S ratio= 2:1; definite sleep-wake cycles, testes descended, labia majora well developed.

Question 41

What is rubella titer in pregnancy?

Answer 41

A rubella test is usually done for a woman who is or wants to become pregnant to determine whether she is at risk for rubella. Several laboratory methods can be used to detect rubella antibodies in the blood. The most commonly used method is the enzyme-linked immunosorbent assay (ELISA, EIA).

Question 42

What does a rubella titer of 1/8 mean?

Answer 42

An individual with an antibody titer of 1:8 or higher indicates prior infection with rubella virus, and immunity to primary infection. Therefore, a second specimen is not mandatory, but may be of interest in studies of the booster or reinfection phenomenon.

Question 43

What are normal Hgb and Hct levels in pregnancy?

Answer 43

1st Trimester: Hbg: 10.8-14.0 Hct: 31.2-41.2
2nd Trimester: Hgb: 10.0-13.2 Hct: 30.1-38.5
3rd Trimister: Hgb: 10.4-14.0 Hct: 31.7-40.9

Question 44

Why does Hgb change during trimester?

Answer 44

There is a 40-50% above pre-pregnancy levels change in blood level due to increase plasma volume > the increase in RBC’s Relative anemia

Question 45

What is Rhogam. What is it, who do we give it to? Why?

Answer 45

Rhogam is a immune globin given to Rh-mothers to prevent antibody formation. A dose of 300ug is routinely administered at 26-30 weeks gestation in Rh-women without antibodies. If she gives birth to an Rh+ baby, the mother will receive Rhogam again withing 72 hours of birth. She will also receive Rhogam with CVS amniocentesis, spontaneous or therapeutic abortion, ectopic pregnancy, abdominal trauma, or external cephalic version.

Question 46

If you are seeing a vegan, pregnant client, what are some considerations?

Answer 46

Women who are vegans and who do not drink soy milk should supplement their diets with Vitamin B12 4mg, Calcium 1200mg and Vitamin D 10mg. B12 needed for synthesis of DNA and RBC’s

Question 47

List of foods that pregnant women should not eat

Answer 47

Homemade Caesar salad dressing (non pasteurized)
Bologna sandwich (processed)
Brie cheese (non pasteurized)
High mercury fish (Shark, Swordfish, King mackerel, tuna)
Undercooked or Raw fish
Undercooked, Raw and Processed Meat

Question 48

List of foods that pregnant women should not eat

Answer 48

Raw eggs (foods that contain raw eggs, lightly scrambled eggs, poached eggs, hollandaise sauce, homemade mayonnaise, salad dressings, homemade ice cream, cake icing)
Organ meat-limit once a week (too much Vitamin A can cause toxicity.)
Caffeine
Raw sprouts
Unwashed produce
Unpasterized milk, cheese, fruit juice
Alcohol