Exam 1: PRN 1831/ PRN1831 (Latest 2024/ 2025 Update) Principles of Maternal Child Health Nursing Review| Questions and Verified Answers|100% Correct| Grade A- Rasmussen
Exam 1: PRN 1831/ PRN1831 (Latest 2023/
2024 Update) Principles of Maternal Child
Health Nursing Review| Questions and
Verified Answers|100% Correct| Grade ARasmussen
Q: What treatment options are available for pelvic floor disorder?
Answer:
Pelvic floor dysfunction is treated without surgery. Non-surgical treatments include:
Biofeedback: This is the most common treatment, done with the help of a physical therapist.
Biofeedback is not painful, and helps over 75% of people with pelvic floor dysfunction.
Q: What hormone is detected in pregnancy testing?
Answer:
Human chorionic gonadortropin (HCG)
Q: What is amenorrhea?
Answer:
absence of menstruation
Q: Where does fertilization typically occur?
Answer:
Outer third of the fallopian tube near the ovary
Q: Where does the genetic material determining gender come from?
Answer:
Sperm (X= Female or Y= Male- this determines gender) The Ovum is X
Q: Naegel’s rule- be able to calculate due date from LMP
Answer:
Last menstrual period – 3 months + 7 days + 12 months • Ex: A woman presents to the clinic
reporting an LMP of 10/01/2019. What is her EDD? Oct 1 minus 3 months is July 1…add 7 days
and you get July 8…adjust the year and: EDD= July 8, 2021
Q: Gravida
Answer:
total number of pregnancies
Q: FPAL
Answer:
Full term: total number of live births after 38 weeks Preterm: total number of live births between
20 and 37 weeks
Abortions: total number of pregnancy losses/elective terminations prior to 20 weeks
Living Children: total number of living children
Q: Frequency of prenatal visits
Answer:
monthly unitl 28wks (3rd trimester)
-28: q2wks until 36
-36: every week until delivery or week 42
Q: Group Beta Strep
Answer:
A bacteria that can be part of the normal flora in the rectovaginal area of pregnant women. It can
cause potentially life-threatening infection in the neonate. Cultures are collected f/ the
rectovaginal area at 36 weeks gestation and if POSITIVE, mom will be given antibiotics during
her labor for the purpose of crossing the placenta to offer protection to the neonate. Meds are
usually Penicillin if no allergy and if so, Clindamycin is given)
Q: monozygotic twins
Answer:
identical twins formed when one zygote splits into two separate masses of cells, each of which
develops into a separate embryo
Q: dizygotic twins
Answer:
twins who are produced when two separate ova are fertilized by two separate sperm at roughly
the same time
Q: Labs in pregnancy
Answer:
Blood type + Rh, Antibody screen, CBC, RPR, Hep B and C, HIV, GC/CT, Urine drug screen, 1
hour Glucose Tolerance Test, and GBS.
Q: What is GBS? When do we test for it? How do we protect the baby?
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Who defines and regulates nursing scope of practice?
Defines scope: State Nurse Practice Act
Regulates: State Board of Nursing
What is evidence based practice?
It is the nursing care in which all nursing interventions are based on current valid research evidence. It takes nursing research and puts it into practice at the pts. Bedside. Incorporated into policies, procedures, and nursing practice.
Autonomy
Pt making own choices; function independently
Beneficence
To benefit the patient; To do good
Nonmaleficence
do no harm
Justice
being fair
Which nurses are prescribers?
APRN-Nurse Practitioner CNM-Certified Nurse Midwives CNS- Clinical Nurse Specialist
Nursing care of the client with gonorrhea
NAAT testing, dirty urine specimen Treatment ceftriaxone 250mg IM X 1with Zithromax 1g po x1 Ask how many partners do they have? Pain during sex? Any pregnancy?
Recommendations on Pap smears for cervical cancer
Start at 21 years and should be done every 3 years
Contraindications for contraceptive methods: IUD
Liver disease, uterine abnormalities, smoker, heart disease
Hormonal vs nonhormonal contraceptive options
Hormonal: progestin pill, Levonorgestril IUD, nuvaring, nexplanon, depo provera, transdermal patch Nonhormonal: Copper IUD, Abstinence, barrier methods
Combination oral contraceptives in adolescence- be able to provide teaching
Estrogen can stop from growing
Use of hormonal contraceptives in adolescents
Estrogen can cause a halt in the expected growth spurt in adolescents. Adolescents should have period for at least 2 years prior to starting oral contraceptives.
Contraception in breastfeeding- what is safe? Know appropriate use of progestin only pill
Breastfeeding: Progestin only methods or nonhormonal methods (estradiol interferes with milk production).
Nuvaring
insert ring and leave in place x 3 weeks, then d/c x 1 weekinsert new ring
COC and POP
take 1 pill each day at the same time (COC increases risk for Thrombosis/Progestin only Pill causes irregular menses)
Depo provera
IM injection x 1 every 3 months (Causes weight gain, amenorrhea/irregular menses)
IUD
inserted by provider… leave in place x 3, 5, or 10 years depending on device (Levonorgestril IUD (Mirena) {cause irregular bleeding/amenorrhea}
Nexplanon
inserted under the skin of the upper inner arm by provider, remains in place x 3 years (Cause weight gain, acne, menstrual irregularities, and mood changes)
Patch
{cause increased risk for Thrombosis}
What treatment options are available for pelvic floor disorder?
Pelvic floor dysfunction is treated without surgery. Non-surgical treatments include: Biofeedback: This is the most common treatment, done with the help of a physical therapist. Biofeedback is not painful, and helps over 75% of people with pelvic floor dysfunction.
What hormone is detected in pregnancy testing?
Human chorionic gonadortropin (HCG)
What is amenorrhea?
absence of menstruation
Where does fertilization typically occur?
Outer third of the fallopian tube near the ovary
Where does the genetic material determining gender come from?
Sperm (X= Female or Y= Male- this determines gender) The Ovum is X
Naegel’s rule- be able to calculate due date from LMP
Last menstrual period – 3 months + 7 days + 12 months • Ex: A woman presents to the clinic reporting an LMP of 10/01/2019. What is her EDD? Oct 1 minus 3 months is July 1…add 7 days and you get July 8…adjust the year and: EDD= July 8, 2021
Gravida
total number of pregnancies
FPAL
Full term: total number of live births after 38 weeks Preterm: total number of live births between 20 and 37 weeks
Abortions: total number of pregnancy losses/elective terminations prior to 20 weeks
Living Children: total number of living children
Frequency of prenatal visits
monthly unitl 28wks (3rd trimester)
-28: q2wks until 36
-36: every week until delivery or week 42
Group Beta Strep
A bacteria that can be part of the normal flora in the rectovaginal area of pregnant women. It can cause potentially life-threatening infection in the neonate. Cultures are collected f/ the rectovaginal area at 36 weeks gestation and if POSITIVE, mom will be given antibiotics during her labor for the purpose of crossing the placenta to offer protection to the neonate. Meds are usually Penicillin if no allergy and if so, Clindamycin is given)
monozygotic twins
identical twins formed when one zygote splits into two separate masses of cells, each of which develops into a separate embryo
dizygotic twins
twins who are produced when two separate ova are fertilized by two separate sperm at roughly the same time
Labs in pregnancy
Blood type + Rh, Antibody screen, CBC, RPR, Hep B and C, HIV, GC/CT, Urine drug screen, 1 hour Glucose Tolerance Test, and GBS.
What is GBS? When do we test for it? How do we protect the baby?
Group Beta Strep rectovaginal culture at 36 weeks. Give mom antibiotics during labor
What is MSAFP?
Maternal Serum Alpha Feta Protein, Test for down syndrome
When is the MSAFP test done?
(trisomy 21,18) and open neural tube defects. Collected between 14 weeks and 22 weeks.
Recommended weight gain in pregnancy: One Child:
Normal weight 25-35lb 11.4 to 15.9kg
Underweight 28-40lb 12.7 to 18.2kg
Overweight 15-25lb 6.8 to 11.3kg
Obese 11-20lb 5 to 9.1kg
Recommended weight gain in pregnancy: Twins
Normal weight 37-53lb 16.8 to 24.5kg
Overweight 31-50lb 14.1 to 22.7kg
Obese 25-42lb 11.3 to 19.1kg
Dietary sources of iron
Dried fruit, green leafy vegetables, dried beans and lentils, meat, chicken, fish, liver, legumes, whole or enriched grain products, nuts, blackstrap molasses, tofu, eggs, kale
What are presumptive signs of pregnancy?
Amenorrhea (an abnormal absence of menstruation.)- often the first sign
Nausea- morning sickness
breast tenderness/ enlargement
deepening pigmentation
quickening- fetal movement felt by mother 16-20 wks
What are the probable signs of pregnancy?
Goodwell’s sign- softening of the cervix
Chadwick’s Sign- purplish or bluish discoloration of the cervix, vagina, and vulva caused by increased vascular congestion
Hegar’s sign- softening of the lower uterine segment
Mcdonald’s sign- flex the body of the uterus against the cervix
abdominal enlargement
Braxton HIcks contractions- irregular, painless and begin in 2nd trimester
Ballottement- fetal part is displaced by a light tap of the examining finger
Striae- stretch marks, skin is stretched to its capacity
Positive pregnancy test
What are positive signs of pregnancy?
fetal heart sounds, visualization of fetus ultrasound, fetal movement palpated by hcp.
Understand pregnancy drug categories A
Category A: No risk demonstrated to the fetus in any trimester
Understand pregnancy drug categories B
Category B: No adverse effects in animals; no human studies available
Understand pregnancy drug categories C
Category C: Only prescribed after risks to the fetus are considered. Animal studies have shown adverse reaction; no human studies available
Understand pregnancy drug categories D
Category D: Definite fetal risks, but may be given in spite of risks in life-threatening situations
Understand pregnancy drug categories X
Category X: Absolute fetal abnormalities. Not to be used anytime during pregnancy
when does a fetus have a heartbeat?
FHR audible with a Doppler 10-12 weeks
Understand how to provide safe guidance to pregnant patients regarding prescribed medications
Some medications will cross the placenta and affect the developing fetus all medications should be reviewed by the provider at the start of the pregnancy
Folic Acid teachings
should be started 3 months prior to becoming pregnant in order to have the most preventive effects for ONTD and spina bifida.
What are the functions of the placenta?
Transfer nutrients and oxygen to the fetus and the removal of waste from the fetus.
What protects the vessels in the umbilical cord from compression?
Wharton’s jelly covers and cushions the cord vessels and keeps the three vessels separated
Normal FHR range
110-160bpm
normal physiologic changes in pregnancy
Normal: nausea, vomiting, leaky breast, constipation, stuffy nose, Thick white vaginal secretions, Dependent edema (that usually resolves when off her feet)
abnormal physiologic changes in pregnancy
Abnormal: on going headache during 3rd trimester, edema face and hands, blurred vision, epigastric pain. Bright Red vaginal bleeding, decreased fetal movement.
Hyperemesis Gravidarium: what is it? What symptoms would be associated?
This is persistent vomiting unrelated to other causes, a measure of acute starvation (usually large ketonuria), and some discrete weight loss, most often 5% of the pre-pregnancy weight).
Hyperemesis Gravidarium What symptoms would be associated?
Symptoms that would be associated and often require short term hospitalization for hydration, electrolyte replacement and nutritional supplementation as well as stabilization of the symptoms. DIFFERS F/ THE TYPICAL N&V.
What does ketonuria indicate?
Acute dehydration
Be able to describe symptoms associated with hyperventilation
Anxiety, elevated heart rate, numbness/tingling of fingers, chest tightness, feeling of not getting enough air, and lightheadedness.
Ectopic Pregnancy: what is it? What symptoms would be associated?
Some Vaginal bleeding, shoulder pain
Fundal height
12 weeks symphysis
20 weeks umbilicus
after 20 weeks measure from the symphysis to the fundus
Normal amniotic fluid volume at term?
700-800ml
Polyhydramnios
too much amniotic fluid
Oligohydramnios
not enough amniotic fluid
When does fetal blood circulation begin?
a developing embryo, the heart has developed enough by day 21 post-fertilization to begin beating. Circulation patterns are clearly established by the fourth week of embryonic life.
Amniotic fluid functions
it helps the fetus to maintain a normal body temperature and allows for symmetrical fetal growth. Amniotic fluid is essential for normal fetal lung development.
What is an NST?
non stress test;
done to see if the fetus is in any distress
How do we assess fetal wellbeing?
Fetal Heart Rate is to be assessed primarily, NST, biophysical profile, or ultrasound
What is a biophysical profile? Know the components
Fetal Movement, Fetal Tone, Fetal Breathing, Amniotic Fluid, and NST
First stage of Labor
First stage of Labor is the Longest and has 3 phases. (0-10 cm) Latent phase =0.3cm Active phase= Cervical change 0.5-1cm/per and the Transition phase= Rapid cervical changes (1-1.5 cm/hr.) IF pt. IS IN TRANSITION PHASE DO NOT LEAVE HER!!!
risk factors for depression in pregnancy:
Lack of support, hx of abuse, hx of mental illness, unwanted or unplanned pregnancy, stress, and/or pregnancy complications that may be present or in the past.
True labor contractions
Come at regular intervals • Become increasingly more intense as labor progresses • Increase in duration over time • Include discomfort that usually begins in the back and radiates to the front • Cause effacement and dilation to occur • May intensify with walking • Do not diminish with a warm shower or rest
False labor contractions
Are irregular • Do not increase in duration • Do not cause cervical effacement and dilation to occur • May cease with rest or a warm shower • Do not intensify with a walk
What is effacement?
It is the cervix-thinning process that may begin toward the end of pregnancy. (Measured in percentages)
Measuring contraction frequency, duration
One type, Braxton Hicks contractions, begins sometime during the second trimester. They can be uncomfortable but do not produce cervical dilation or effacement. The second type of contraction causes cervical dilation and effacement and indicates true labor.
What is laboring down?
The fetus will move slowly through the birth canal with the pressure from the contractions. This method is commonly called laboring down.
Preparation for cesarean section
Abdomen shave and prepped, IV, make sure there is informed consent.
What is PROM? What does this put the patient at risk for?
Premature Rupture of Membranes.
What does this PROM (Premature Rupture of Membranes) put the patient at risk for?
intra-amniotic infection Pre-term birth, infection, hypertensive disease, and asphyxia
What assessments should be done when ROM is suspected/occurs?
Examine your vagina and cervix.
Take a swab of fluid from the vagina. This is examined for the presence of amniotic fluid.
Do an ultrasound test to measure amniotic fluid in the uterus.
Check your baby’s heart rate.
factors for developing gestational diabetes
Maternal obesity, large baby before, older than 25, hx of Gestational Diabetes, fasting glucose of 126, family Hx of diabetes.
What risks are there to the fetus
congenital abnormalities, birth injury, RDS, hypoglycemia, jaundice
hypoglycemia in neonate s/s
-occurs with levels <45 mg/dl
Sx/Sx: jitteriness, irritability, lethargy
hypoglycemia in neonate
Pregnant women tend to develop hypoglycemia between meals and during sleep because the fetus continues to draw glucose across the placenta from the maternal bloodstream.
Pre-eclampsia is defined as
as hypertension and proteinuria after 20 weeks of gestation. Edema is commonly present also but not necessary for a diagnosis of pre-eclampsia. Pre-eclampsia becomes eclampsia with the onset of a seizure
Medication to prevent seizures is
Magnesium Sulfate
HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome
is a life-threatening pregnancy complication
- Caucasian • Age greater than 25 years • History of hypertension • Previous history of HELLP syndrome
RAPID WEIGHT GAIN CAN INDICATE
FLUID RETENTION
How do we assess vaginal bleeding in pregnancy?
If a laboring patient is experiencing vaginal bleeding, the examiner should not perform a vaginal cervical exam. The bleeding could indicate a placenta previa
What is placenta previa? How would we evaluate for this?
This is an abnormal implantation of the placenta in the lower uterus. Usually, there is BRIGHT red blood present. Must deliver if close to term, bed rest until bleeding stops, or pelvic rest until previa resolves or delivery.
What is placental abruption?
A serious pregnancy complication in which the placenta detaches from the womb (uterus). DARK RED BLOOD/ FETAL DISTRESS.
Difference between eclampsia and preeclampsia
Preeclampsia can become Eclampsia if the patient has a seizure.
What are the uses of magnesium sulfate in OB?
Relax uterus during preterm labor, seizure prophylaxis in preeclampsia
What is cold stress?
When baby gets cold oxygen, level goes down
What potential problem could develop from excessive postpartum bleeding?
Losing lots of blood quickly can cause a severe drop in your blood pressure. It may lead to shock and death if not treated.