lOMoAR cPSD| 22896205
lOMoAR cPSD| 22896
ATI MATERNAL NEWBORN 2024 study guide
Chapter 1- contraception
• Contraception refers to strategies or devices used to reduce the risk of
fertilization or implantation in an attempt to prevent pregnancy
• Natural family planning: behavioral methods o Abstinence – no
gentialia contact o Withdrawal (coitus interruptus)
▪ The choice for the monogamous couple
▪ Least effective methods
▪ Risk for Pregnancy o Calendar methods
▪ ovulation occurs about 14 days before the onset of her next menstrual cycle,
and avoid intercourse during that period
▪ count at least 6 cycles o basal body temperature
▪ body temperature can drop slightly at the time of ovulation
▪ measure the oral temperature before getting out of bed each morning to
monitor ovulation
▪ inexpensive, convenient, and with no adverse effects
▪ Basal body temperature and the symptothermal method are fertility
awareness methods.
o Lactational amenorrhea method
• Barrier
o Condoms
▪ Only water-soluble lubricants should be used with latex condoms to avoid
condom breakage o Diaphragm
▪ Dome-shaped cup with a flexible rim made of silicon that fits snugly over the
cervix with spermicidal cream or gel placed into the dome and around the
rim
▪ The client should be properly fitted with a diaphragm by a provider
▪ Replaced every 2 years and refitted for a 20% weight fluctuation, after
abdominal or pelvic surgery, and after every pregnancy
▪ Before coitus, the diaphragm is inserted vaginally over the cervix with
spermicidal jelly or cream that is applied to the cervical side of the dome and
around the rim
▪ The diaphragm can be inserted up to 6 hours before intercourse and must
stay in place 6 hours after intercourse but for no more than 24 hrs.
▪ Spermicide must be reapplied with each act of coitus
▪ The patient should empty the bladder before insertion
▪ Wash with soap and water after use o Cervical cap o Contraceptive
sponge o Question
pg. 1
, lOMoAR cPSD| 22896205
▪ Which method would the nurse identify as a barrier method of
contraception?
a. Basal body temperature
b. Transdermal patch
c. Diaphragm
d. Symptothermal method Hormonal
o Oral contraceptives
▪ Adverse effect
Chest pain, shortness of breath, leg pain from a possible clot,
headache, eye problems from a stroke, hypertension, breast
tenderness, nausea, breakthrough bleeding (common adverse effects
of estrogen component and progestin component)
▪ Can increase the risk of thromboembolism, stroke, heart attack, hypertension,
gallbladder disease, liver tumor
▪ Effectiveness decrease when taking medications that affect liver enzymes, such as
anticonvulsants and some antibiotics
o Injectable contraceptives
▪ Medroxyprogesterone is an IM or SQ injection given to a female client every
11 to 13 weeks
• The first injection should be during the first 5 days of period
• In postpartum, 5 days after delivery
▪ Maintain adequate intake of calcium and vitamin D
▪ Very effective and require only 4 injections per year
▪ Adverse effects
Decrease in bone mineral density, weight gain, increase depression, and
irregular vaginal spotting or bleeding
▪ Contraindicated for osteoporosis patient
▪ Return to fertility can be as long as 18 months after discontinuation o Transdermal
patches o Vaginal rings
o Implantable progestin
▪ A minor surgical procedure to subdermally implant and remove a single rod
containing etonogestrel on the inner side of the upper arm
▪ Disadvantage
Etonogestrel can cause irregular menstrual bleeding
▪ Adverse effects
• Irregular and unpredictable menstruation (most common)
• Mood changes, headache, acne, depression, decreased bone density,
and weight gain
o Intrauterine contraceptives (IUD)
▪ A chemically active T-shaped device that is inserted through the cervix and placed in
the uterus by the provider
▪ The device must be monitored monthly by clients after menstruation to ensure the
presence of a small string that hangs from the device into the upper part of the vagina
to rule out migration or expulsion of the device
Hasan Chowdhury - 2
pg. 2
, lOMoAR cPSD| 22896205
▪ IUDs can maintain effectiveness for 1 to 10 years
▪ Contraception can be reversed
▪ Can increase the risk of pelvic inflammatory disease, uterine perforation, or
ectopic pregnancy and can be expelled
▪ A client should report to the provider later abnormal spotting or bleeding,
abdominal pain or pain with intercourse, abnormal foul-smelling vaginal
discharge, fever, chills, a change in string length, or if the IUD cannot be
located
▪ IUD can cause irregular menstrual bleeding
▪ Must be removed in the event of pregnancy o Emergency contraception
▪ A morning-after pill that prevents fertilization from taking place
▪ The pill is taken within 72 hr after unprotected coitus
• Surgical methods o Tubal ligation
▪ Sterilization for women
▪ A laparoscope is inserted; fallopian tubes are grasped and sealed
o Vasectomy
▪ Sterilization for men
▪ Usually performed under local anesthesia ▪ Involves cutting the vas
deferens, which carries the sperm
Chapter 3 – Expected physiological changes during pregnancy
• Signs of Pregnancy o Presumptive, probable, positive
• Presumptive: those changes felt by the woman o e.g., breast changes
(darkened areolae, enlarged Montgomery’s glands), uterine enlarged,
quickening (slight fluttering movements of the fetus felt by a woman,
usually between 16 to 20 weeks of gestation)
o A skipping period is not a reliable sign of pregnancy by itself but if it is accompanied
by nausea, fatigue, breast tenderness, and urinary frequency, pregnancy would see
very likely
• Probable: those changes observed by an examiner o Hegar’s sign –
softening and compressibility of lower uterine segment or isthmus o
Ballottement
▪ examiner pushes against the
woman's cervix during a pelvic exam
and feels a rebound from the floating
fetus
▪ a rebound of the unengaged
fetus o abdominal enlargement
o Chadwick’s sign – deepened the violet-bluish color of the cervix and vaginal mucosa
o Broxton Hicks contractions – falls contractions that are painless, irregular, and
usually relieved by walking
o Positive pregnancy test
pg. 3
, lOMoAR cPSD| 22896205
▪ Human chorionic gonadotropin (HCG) is the earliest biochemical
marker for pregnancy
▪ Production begins as early as the day of implantation
▪ Can be detected in maternal serum or urine as soon as 7 to 8 days
before the expected menses
▪ The urine sample should be first-voided morning specimens and follow
the direction for accuracy
o Fetal outline felt by the examiner
Positive: those signs attributed only to the presence of the fetus
o Confirm that fetus is growing in the uterus o Fetal heart
sound - hearing fetal heart tones (via Doppler) o visualizing
the fetus by ultrasound o palpating fetal movements (20
weeks) by the examiner
o Pulse sock on mom to get mom’s HR to ensure it’s not baby’s heart sound
pg. 4
lOMoAR cPSD| 22896
ATI MATERNAL NEWBORN 2024 study guide
Chapter 1- contraception
• Contraception refers to strategies or devices used to reduce the risk of
fertilization or implantation in an attempt to prevent pregnancy
• Natural family planning: behavioral methods o Abstinence – no
gentialia contact o Withdrawal (coitus interruptus)
▪ The choice for the monogamous couple
▪ Least effective methods
▪ Risk for Pregnancy o Calendar methods
▪ ovulation occurs about 14 days before the onset of her next menstrual cycle,
and avoid intercourse during that period
▪ count at least 6 cycles o basal body temperature
▪ body temperature can drop slightly at the time of ovulation
▪ measure the oral temperature before getting out of bed each morning to
monitor ovulation
▪ inexpensive, convenient, and with no adverse effects
▪ Basal body temperature and the symptothermal method are fertility
awareness methods.
o Lactational amenorrhea method
• Barrier
o Condoms
▪ Only water-soluble lubricants should be used with latex condoms to avoid
condom breakage o Diaphragm
▪ Dome-shaped cup with a flexible rim made of silicon that fits snugly over the
cervix with spermicidal cream or gel placed into the dome and around the
rim
▪ The client should be properly fitted with a diaphragm by a provider
▪ Replaced every 2 years and refitted for a 20% weight fluctuation, after
abdominal or pelvic surgery, and after every pregnancy
▪ Before coitus, the diaphragm is inserted vaginally over the cervix with
spermicidal jelly or cream that is applied to the cervical side of the dome and
around the rim
▪ The diaphragm can be inserted up to 6 hours before intercourse and must
stay in place 6 hours after intercourse but for no more than 24 hrs.
▪ Spermicide must be reapplied with each act of coitus
▪ The patient should empty the bladder before insertion
▪ Wash with soap and water after use o Cervical cap o Contraceptive
sponge o Question
pg. 1
, lOMoAR cPSD| 22896205
▪ Which method would the nurse identify as a barrier method of
contraception?
a. Basal body temperature
b. Transdermal patch
c. Diaphragm
d. Symptothermal method Hormonal
o Oral contraceptives
▪ Adverse effect
Chest pain, shortness of breath, leg pain from a possible clot,
headache, eye problems from a stroke, hypertension, breast
tenderness, nausea, breakthrough bleeding (common adverse effects
of estrogen component and progestin component)
▪ Can increase the risk of thromboembolism, stroke, heart attack, hypertension,
gallbladder disease, liver tumor
▪ Effectiveness decrease when taking medications that affect liver enzymes, such as
anticonvulsants and some antibiotics
o Injectable contraceptives
▪ Medroxyprogesterone is an IM or SQ injection given to a female client every
11 to 13 weeks
• The first injection should be during the first 5 days of period
• In postpartum, 5 days after delivery
▪ Maintain adequate intake of calcium and vitamin D
▪ Very effective and require only 4 injections per year
▪ Adverse effects
Decrease in bone mineral density, weight gain, increase depression, and
irregular vaginal spotting or bleeding
▪ Contraindicated for osteoporosis patient
▪ Return to fertility can be as long as 18 months after discontinuation o Transdermal
patches o Vaginal rings
o Implantable progestin
▪ A minor surgical procedure to subdermally implant and remove a single rod
containing etonogestrel on the inner side of the upper arm
▪ Disadvantage
Etonogestrel can cause irregular menstrual bleeding
▪ Adverse effects
• Irregular and unpredictable menstruation (most common)
• Mood changes, headache, acne, depression, decreased bone density,
and weight gain
o Intrauterine contraceptives (IUD)
▪ A chemically active T-shaped device that is inserted through the cervix and placed in
the uterus by the provider
▪ The device must be monitored monthly by clients after menstruation to ensure the
presence of a small string that hangs from the device into the upper part of the vagina
to rule out migration or expulsion of the device
Hasan Chowdhury - 2
pg. 2
, lOMoAR cPSD| 22896205
▪ IUDs can maintain effectiveness for 1 to 10 years
▪ Contraception can be reversed
▪ Can increase the risk of pelvic inflammatory disease, uterine perforation, or
ectopic pregnancy and can be expelled
▪ A client should report to the provider later abnormal spotting or bleeding,
abdominal pain or pain with intercourse, abnormal foul-smelling vaginal
discharge, fever, chills, a change in string length, or if the IUD cannot be
located
▪ IUD can cause irregular menstrual bleeding
▪ Must be removed in the event of pregnancy o Emergency contraception
▪ A morning-after pill that prevents fertilization from taking place
▪ The pill is taken within 72 hr after unprotected coitus
• Surgical methods o Tubal ligation
▪ Sterilization for women
▪ A laparoscope is inserted; fallopian tubes are grasped and sealed
o Vasectomy
▪ Sterilization for men
▪ Usually performed under local anesthesia ▪ Involves cutting the vas
deferens, which carries the sperm
Chapter 3 – Expected physiological changes during pregnancy
• Signs of Pregnancy o Presumptive, probable, positive
• Presumptive: those changes felt by the woman o e.g., breast changes
(darkened areolae, enlarged Montgomery’s glands), uterine enlarged,
quickening (slight fluttering movements of the fetus felt by a woman,
usually between 16 to 20 weeks of gestation)
o A skipping period is not a reliable sign of pregnancy by itself but if it is accompanied
by nausea, fatigue, breast tenderness, and urinary frequency, pregnancy would see
very likely
• Probable: those changes observed by an examiner o Hegar’s sign –
softening and compressibility of lower uterine segment or isthmus o
Ballottement
▪ examiner pushes against the
woman's cervix during a pelvic exam
and feels a rebound from the floating
fetus
▪ a rebound of the unengaged
fetus o abdominal enlargement
o Chadwick’s sign – deepened the violet-bluish color of the cervix and vaginal mucosa
o Broxton Hicks contractions – falls contractions that are painless, irregular, and
usually relieved by walking
o Positive pregnancy test
pg. 3
, lOMoAR cPSD| 22896205
▪ Human chorionic gonadotropin (HCG) is the earliest biochemical
marker for pregnancy
▪ Production begins as early as the day of implantation
▪ Can be detected in maternal serum or urine as soon as 7 to 8 days
before the expected menses
▪ The urine sample should be first-voided morning specimens and follow
the direction for accuracy
o Fetal outline felt by the examiner
Positive: those signs attributed only to the presence of the fetus
o Confirm that fetus is growing in the uterus o Fetal heart
sound - hearing fetal heart tones (via Doppler) o visualizing
the fetus by ultrasound o palpating fetal movements (20
weeks) by the examiner
o Pulse sock on mom to get mom’s HR to ensure it’s not baby’s heart sound
pg. 4
