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Ch. 4 Davis Advantage Maternal
Nursing LATEST 2025 UPDATE
EXAM!!!
Which of the following statements best describes Naegele's rule? It determines the due date based on ultrasound findings and is the most accurate dating method. It determines the due date based on maternal approximation of sexual activity and is correct within a week before or after. It is based on the date of the last menstrual period (LMP) and should be used with caution in women with irregular menses or who were on hormonal contraception. It is based on HCG levels assessed through a blood or urine sample at the beginning of pregnancy. HCG levels spike at a specific time and then decline, determining the gestational age of the pregnancy. - It is based on the date of the last menstrual period (LMP) and should be used with caution in women with irregular menses or who were on hormonal contraception. A transvaginal ultrasound can be used for which of the following? Select all that apply. To diagnose pregnancy. To perform a PAP smear. To obtain an estimated due date (EDD). To rule out abnormalities in the pregnancy. To identify STIs or other infections. - To diagnose pregnancy. To obtain an estimated due date (EDD). To rule out abnormalities in the pregnancy. When discussing personal comfort with pregnant patients, which of the following should be discouraged? Douching External genital cleansing Wearing loose, cotton clothing Resting in a side-lying position - Douching Maria is 32 weeks pregnant and complaining of varicosities in her legs. What should be included in her routine assessments due to this complication? Nothing should change with her assessments; this is a normal part of pregnancy. A recommendation to the provider for physical therapy. Education on prevention and checking peripheral pulses. Assessments for pregnancy-induced hypertension. - Education on prevention and checking peripheral pulses. Krystin is 38 weeks pregnant and in the office today complaining of shortness of breath. What is the first nursing action you should take as her nurse today?
Reassure her this is a normal part of pregnancy, and she should simply raise her arms over her head and breathe slow and deep when it happens. Call 911 and have her transferred to the emergency room. Put her on a rebreather mask with oxygen running at 10 L/min. Obtain a full set of vital signs and ask Krystin to tell you more about the shortness of breath she is having. - Obtain a full set of vital signs and ask Krystin to tell you more about the shortness of breath she is having. Since discovering she was pregnant 6 weeks ago, Martina has called her OB office several times a week for numerous complaints and concerns, all of which were normal or unfounded. Now in her 15th week of pregnancy, she insists on being seen for an ultrasound because she is worried the baby has something wrong with it. What is Martina suffering from? This is a normal response to pregnancy in some women and is not concerning. She is suffering from post-traumatic stress disorder (PTSD) and should be referred to counseling. She is experiencing pregnancy-related anxiety and should be referred to counseling. She is at increased risk for postpartum depression and may harm herself. - She is experiencing pregnancy-related anxiety and should be referred to counseling. Juanita is 11 weeks pregnant with an unintended pregnancy with her life partner Joel. They've begun discussing where the baby will sleep and are making plans for Juanita to stay home for the first few years and not work. What maternal process of pregnancy is Juanita displaying? Binding-in Fetal embodiment Seeking safe passage Nesting - Binding-in Tina is 6 weeks pregnant and at the OB office for her initial OB visit. She is in a committed relationship and the pregnancy is not unwelcome though it was unplanned. She states, "I'm just not sure how I feel about being pregnant, it's not real to me yet." What is your best therapeutic response to Tina? "We need to get you to a counselor as soon as possible to make sure you don't harm yourself or your baby." "Have you talked to your partner about your feelings so you can decide if you'd rather terminate the pregnancy?" "Being ambivalent to your pregnancy is a normal response. Do you have any questions or concerns I can answer for you about your pregnancy?" "Being ambivalent to your pregnancy is a normal response. You shouldn't worry about anything right now though, as the baby is fine and so are you." - Being ambivalent to your pregnancy is a normal response. Do you have any questions or concerns I can answer for you about your pregnancy? Which of the following are expected responses from an adolescent upon becoming pregnant? Select all that apply.
Erika lost her first pregnancy at 14 weeks approximately a year ago. She is now back for a new OB appointment with her second pregnancy at 8 weeks. As you do your initial assessment, she tells you she's worried that she isn't excited about this new pregnancy and won't be able to bond with the baby when it comes. Which of the following statements is true about Erika's situation? She should have waited longer before becoming pregnant, as it's obvious she's still grieving for her lost pregnancy. She is experiencing the normal psychological responses to becoming pregnant after a loss that will resolve as she moves through the developmental tasks of pregnancy. She is experiencing the normal psychological responses to becoming pregnant after a loss that will only resolve once she receives counseling and possibly medication. She is experiencing depression and should be counseled on what antidepressants are safe to use while - She is experiencing the normal psychological responses to becoming pregnant after a loss that will resolve as she moves through the developmental tasks of pregnancy. Assessment needs and how patients handle the tasks of pregnancy will be different for each person, significantly influenced by their __________ and ___________ information. Age and weight Gravida and para Medical and psychological Relationship and sexual preference - Medical and psychological What is the difference between a diagnostic test and a screening test? A diagnostic test confirms the presence of a disorder or disease. A screening test indicates a patient at increased risk for a disorder or disease and identifies those who need diagnostic testing. A diagnostic test identifies those at risk for developing a disorder or disease. A screening test confirms the presence of specific types of disorders and diseases. A diagnostic test and a screening test are only different based on the type of body fluid used for testing and time of gestation. A diagnostic test can only be done on maternal blood, and a screening test can only be done on maternal blood drawn from the chorionic villi. - A diagnostic test confirms the presence of a disorder or disease. A screening test indicates a patient at increased risk for a disorder or disease and identifies those who need diagnostic testing. A patient is asking you about the pimple-like bumps around her nipples that have appeared since she became pregnant. How would you answer this question? Those are Montgomery tubercles, and they help to keep your nipple soft while breastfeeding. Those are Montgomery tubercles, and they will disappear as your pregnancy progresses in response to decreasing estrogen levels. Those are Montgomery tubercles, and they are a response to the rising progesterone and estrogen levels and will produce colostrum once the baby delivers.
Those are ingrown hairs that require exfoliation to correct. Be sure to check with the doctor if they don't resolve after you shower. - Those are Montgomery tubercles, and they help to keep your nipple soft while breastfeeding. A new nurse on labor and delivery is concerned by her patient's hemoglobin level on the admittance labs, which is 11 g/dL. What should the new nurse be taught about hemoglobin levels? Lab levels in pregnancy are impacted by hemodilution, which will lower the acceptable level of hemoglobin. The patient has lost blood during delivery, making this an expected finding. Anemia in women is normal, particularly when pregnant, though the patient may be symptomatic. The patient should be placed on fall precautions just in case. The patient is losing blood and should be assessed for vaginal bleeding to rule out other concerns. - Lab levels in pregnancy are impacted by hemodilution, which will lower the acceptable level of hemoglobin. Which of the following women is at the greatest risk for maladaptive behaviors during her pregnancy? Ann, 26, a nurse who is 19 weeks into an unintended pregnancy with her partner of 5 years who is complaining of not being able to drink for the next several months. Lee, 17, a fast-food worker, 24 weeks into an unintended pregnancy who has just told her nurse she thinks her boyfriend has gonorrhea and has been seeing another woman. Hillary, 19, an unemployed college student who is 14 weeks pregnant and taking the next year of school off to move home with her parents to have the baby. Leah, 32, an IT worker, 21 weeks pregnant, in a stable marriage for 6 years but with no local girlfriends, recently diagnosed with bipolar disorder. - Lee, 17, a fast-food worker, 24 weeks into an unintended pregnancy who has just told her nurse she thinks her boyfriend has gonorrhea and has been seeing another woman. A new patient to the OB clinic tells you that her last menstrual period (LMP) was 09/14. What is her due date using Naegele's rule? The answer should be written as MMDD (for example 09/14 should be written as 0914). Enter the numeral only. - 0621 Which of the following are reasons to encourage education in prenatal appointments and in childbirth education classes? Select all that apply. To ensure the patient will follow instructions given by the health care team during labor. To correct misinformation from other sources. To assess psychological adaptation to the pregnancy. To offer anticipatory guidance for the time between visits. To formulate nursing diagnosis for the delivery nurses to follow concerning pain control and other patient wishes for delivery. - To correct misinformation from other sources. To assess psychological adaptation to the pregnancy. To offer anticipatory guidance for the time between visits Pregnancy-induced complications in the urinary system can include which of the following? Select all that apply.
She should eat large meals with plenty of nuts, seeds, and leafy greens to compensate for not eating meat. - She should take a calcium supplement to support her body's increased need for calcium. You're creating a handout for newly pregnant patients to the OB office where you work about common discomforts of pregnancy. What anticipatory guidance would you include? Select all that apply. What foods to avoid to prevent nausea. Where to obtain a breast pump. The importance of dental hygiene. Handling urinary frequency. Avoiding Supine Hypotensive Syndrome. - What foods to avoid to prevent nausea. The importance of dental hygiene. Handling urinary frequency. Avoiding Supine Hypotensive Syndrome. Which of the following women may need a referral for counseling? Amy, newly pregnant and single at 23, who has several aunts and girlfriends who are supportive and has already started working on the nursery. Katie, 29, happily married, though struggling with infertility and trying to get pregnant for 3 years, and now that she is, she is extremely anxious. Melique, 26, mom of two who already was disappointed when she found out she's having another boy, whose husband and family are supportive and excited for another member. Andrea, 38, and happily married to her wife for 6 years, who is newly pregnant by IVF, who continually rubs her belly and asks questions about the best things to do for the baby during her visit. - Katie, 29, happily married, though struggling with infertility and trying to get pregnant for 3 years, and now that she is, she is extremely anxious. Which of these commonly develop on the abdomen and breasts during pregnancy, and are caused by increased adrenal activity, in turn causing connective tissue to become weak and fragile? Angioma Chloasma Striae gravidarum Linea nigra - Striae gravidarum Which of the following is true about the immune system in pregnancy? The immune system has a normal physiological decrease. The immune system has a normal physiological increase. The immune system remains unchanged. The immune system is in remission to prevent rejection of the fetus. - The immune system has a normal physiological decrease. Misty is 28 years old and 15 weeks pregnant with her first baby. As you perform her OB assessment in the office, she starts to cry. She tells you she doesn't know what she was
thinking becoming pregnant. She says she loves the idea of being a mom but didn't realize how much she would have to give up and change. What is your best therapeutic response? "That's very selfish of you. Maybe you should give the baby up for adoption if you aren't going to be able to be a good mom." "I understand that you feel sad that you can't do the same things any longer. Would you like me to give you the number to a good therapist?" "I understand that you feel sad that you can't do the same things any longer. Grieving the loss of things you won't be able to do any longer is a normal response to pregnancy. Do you want to tell me more about how you're feeling?" "I understand that you feel sad that you can't do the same things any longer. G - "I understand that you feel sad that you can't do the same things any longer. Grieving the loss of things you won't be able to do any longer is a normal response to pregnancy. Do you want to tell me more about how you're feeling?" Which one of the following is only caused by pregnancy? Piskacek's sign Braxton-Hicks contractions Urinary frequency Fetal movement palpated by a midwife or obstetrician. - Fetal movement palpated by a midwife or obstetrician. Monique, who is 18 weeks pregnant, has called the office complaining of a sharp, quick pain on her left side that goes away when she leans to the left. What would be your recommendation? "Move slowly when standing and sitting and continue to lean toward the pain when it occurs. If that doesn't help, it continues, or you have other symptoms, be sure to come in and be seen." "You are probably having an appendicitis attack; you need to go to the hospital right away." "You could be going into labor. Go to OB triage at the hospital right away." "Move slowly when standing and sitting to be sure you don't fall. Your center of gravity will be shifting, and you may feel off balance at times." - "Move slowly when standing and sitting and continue to lean toward the pain when it occurs. If that doesn't help, it continues, or you have other symptoms, be sure to come in and be seen." All of the following are probable signs of pregnancy except Positive pregnancy test Fetal heartbeat felt by Doppler Goodell's sign Braxton-Hicks contractions - Fetal heartbeat felt by Doppler Which of the following are due to increased estrogen levels after conception takes place? Select all that apply. Gingivitis Pyrosis
amniotic fluid compress the inferior vena cava, reducing return of blood to the heart and cardiac output. vena caval syndrome - symptoms of dizziness, pallor, and clamminess that result from lowered bp when a pregnant woman lies supine and the enlarged uterus presses on the vena cava. (aka supine hypotensive syndrome) Ptyalism gravidarum - excess saliva Hyperemesis gravidarum - severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus Pyrosis - heartburn Pruritus gravidarum - severe itching in pregnancy from stasis of liver bile Prolactin - stimulates milk production Let-down reflex - the reflex that forces milk to the front of the breast when the infant begins to nurse Oxytocin Diastasis recti - midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles Chloasma - pigmentary skin discoloration usually occurring in yellowish brown patches or spots "mask of pregnancy" Palmar erythema - unusual spidery redness of the neck, thorax, face, and arms From increase estrogen Dyspepsia - indigestion Changes in uterus during pregnancy - Blood flow increases due to progesterone Estrogen and progesterone cause the uterus to enlarge and stretch as fetus grows Uterus goes from lightbulb shape at the pubis to globular structure in the pelvis and abdominal cavity Fundus reaches the umbilicus by term and uterus is below the xiphoid Lightening occurs By term the muscles stretch and thin and weight increases Estrogen causes muscles to contract Lightening - Fundal hight decreases by 1-2 cm at end of pregnancy as fetus decends
Braxton Hicks contractions (occurence and relief) - Begin as early as 16th week and are relived with hydration and walking Changes in the cervix during pregnancy - Softens (goodell's sign) Changes to the vagina during pregnancy - Area becomes more edematous from poor venous return and more rigged as pregnancy continues Operculum and Leukorrhea occur The vagina be comes more acidic Operculum - Mucus plug from cervical mucus to protect uterus from bacteria changes in ovaries during pregnancy - LH secreted to stim corpus luteum to produce progesterone till the placenta grows Changes in breasts during pregnancy - First sign of pregnancy is changes in the breasts Montgomery tubercles enlarge Precolostrum is found during second trimester Colostrum may leak as early as 16 weeks Changes with the heart during pregnancy - Heart shifts upwards and to the left Av HR increases 10- Normal cardiac hypertrophy from increase blood volume and work First and third HS exaggerated and systolic mumurs are common CO changes during pregnancy - CO increases and peaks 20-24th weeks and remains there for the rest of pregnancy BP stays same in first trimester and decreases in second trimester Changes in blood volume and hematocrit in pregnancy - BV grows 40-50% over pregnancy and peaks at term BV to kidneys increases -> more peeing Hematocrit low because of increase in BV (7%) so tell pt to stay hydrated The increase BV also causes edema Changes in resp system during pregnacy - Tidal volume increases 30-40% Progestrerone causes chronic hyperventilation Nurses should tell pts to rest with head elevated and take slow deep breaths Changes in eyes and nose during pregnancy - Blurred vision is common and only temporary Nasal stuffiness and congestion can be relieves with increase in fluids Nosebleeds become more common Changes with mouth during pregnancy - Gingivitis from an increase in blood supply/edema
