MVU NURS 629 EXAM 1 QUESTIONS AND
ANSWERS
Three trimesters of pregnancy
1st: week 1-13
2nd: weeks 14-27
3rd: weeks 28 to delivery
Naegeles rule of EDB
First day of LMP- subtract 3 months, add 7 days and one year
Ultrasound to determine EDB
1st trimester: accurate within 7 days
2nd trimester: accurate within 10-14 days
The sooner a woman gets an ultrasound the better estimate we
can give for weeks gestation and tracking of fetal growth and
development.
Prenatal visit schedule for low-risk pregnancies
-Preconception visit: up to 1 yr before conception
-1st prenatal visit: 6-8wks after missed menses
Up to 28 weeks- every 4 weeks
28 to 36 weeks - every 2 weeks
36 weeks and on -every week or more as necessary
First prenatal visit should include
· Confirmation of pregnancy
1. Pregnancy test and ultrasound
· History
· Menstrual history (LMP) and obstetric history
· Past medical history
· Nutrition and habits: tobacco, alcohol, drugs
· Genetic history: mom, father and 1st relative
· Social history including work, abuse, coping
· Current symptoms
· Physical exam and labs
1. Pelvic exam and pap smear
,2. Blood type and antibody screen
3. Rubella and hepatitis B titer
4. GC, RPR, HIV, Hep C
5. CBC
6. Urinalysis with culture
7. UDS (?)
Prenatal visits 12-21 weeks
Quad Marker screening, discuss newborn feeding options
Prenatal visit 18-22 weeks
Anatomy OB ultrasound
Prenatal visit 24-28 weeks
1 hour glucose test, RH neg type and screen
Prenatal visit 28-34 weeks
RhoGam administration, STI testing if indicated, review newborn
feeding discussion, administer Tdap, preterm labor assessment
and education at each visit
Prenatal visit 34-36 weeks
Group B strep swab, review s/s of labor and review labor plan
Prenatal visit 36-40+ weeks
fetal position assessment, cervical exam, review s/s of false labor
vs true contractions
Quad screening
Test performed at 16-18 weeks. Tests levels of Inhibin A, MSAFP,
unconjugated estriol, and HCG. Has increased accuracy in
screening for DS for women under 35.
1st trimester typical symptoms
· Breast pain, enlargement, and changes in pigmentation: wear a
supportive bra, avoid caffeine use
· Constipation: large amount of circulating progesterone cause
decreased GI motility - use bulk-forming laxatives or Colace,
, exercise regularly, elevate feet on a stool while defecating to
prevent straining, high fiber foods, increase fluids, drink warm
fluids
· Excessive salivation (ptyalism) and bad taste in mouth: good
oral hygiene, good diet and adequate hydration, suck hard candy,
breath mints, chewing gum
· Fatigue: supplemental iron if anemic (30mg/day if not anemic,
120mg/day if anemic for at least 6 weeks), adequate sleep and
rest, mild exercise
· Flatulence: avoid constipation, avoid smoking, avoid large meals
· Headaches: usually tension, Tylenol, avoid stress, smoking,
blinking lights, sleeping late, neck and shoulder massage, regular
balanced diet, stay hydrated
· Hemorrhoids: OTC topical anesthetics (Preparation H, Anusol),
avoid constipation, warm or cool sitz baths with Epsom salts,
tucks witch hazel pads, ice packs or cool compresses, Kegel
exercises
· Nausea and vomiting: may use Benadryl, Dramamine,
Compazine, Phenergan, reglan, Zofran, avoid triggers (certain
foods), rest, avoid stress, avoid tight clothing, hypnosis,
acupuncture, relaxation techniques, small frequent meals, high
carb, sipping carbonated drinks, eating crackers on arising,
drinking fluids between meals, avoid spicy and fatty foods, sit
upright after eating, adequate hydration, vitamin B6, ginger
· Urinary frequency and incontinence: resting and sleeping in the
lateral recumbent position, kegals, adequate water intake,
decrease water intake 2-3 hours before bed
· Varicosities of vulva and legs: support hose and compression
stockings, lie flat and raise legs to drain veins, avoiding crossing
legs, elevate the legs as much as possible, kegals, mild exercise,
warm tub baths
ANSWERS
Three trimesters of pregnancy
1st: week 1-13
2nd: weeks 14-27
3rd: weeks 28 to delivery
Naegeles rule of EDB
First day of LMP- subtract 3 months, add 7 days and one year
Ultrasound to determine EDB
1st trimester: accurate within 7 days
2nd trimester: accurate within 10-14 days
The sooner a woman gets an ultrasound the better estimate we
can give for weeks gestation and tracking of fetal growth and
development.
Prenatal visit schedule for low-risk pregnancies
-Preconception visit: up to 1 yr before conception
-1st prenatal visit: 6-8wks after missed menses
Up to 28 weeks- every 4 weeks
28 to 36 weeks - every 2 weeks
36 weeks and on -every week or more as necessary
First prenatal visit should include
· Confirmation of pregnancy
1. Pregnancy test and ultrasound
· History
· Menstrual history (LMP) and obstetric history
· Past medical history
· Nutrition and habits: tobacco, alcohol, drugs
· Genetic history: mom, father and 1st relative
· Social history including work, abuse, coping
· Current symptoms
· Physical exam and labs
1. Pelvic exam and pap smear
,2. Blood type and antibody screen
3. Rubella and hepatitis B titer
4. GC, RPR, HIV, Hep C
5. CBC
6. Urinalysis with culture
7. UDS (?)
Prenatal visits 12-21 weeks
Quad Marker screening, discuss newborn feeding options
Prenatal visit 18-22 weeks
Anatomy OB ultrasound
Prenatal visit 24-28 weeks
1 hour glucose test, RH neg type and screen
Prenatal visit 28-34 weeks
RhoGam administration, STI testing if indicated, review newborn
feeding discussion, administer Tdap, preterm labor assessment
and education at each visit
Prenatal visit 34-36 weeks
Group B strep swab, review s/s of labor and review labor plan
Prenatal visit 36-40+ weeks
fetal position assessment, cervical exam, review s/s of false labor
vs true contractions
Quad screening
Test performed at 16-18 weeks. Tests levels of Inhibin A, MSAFP,
unconjugated estriol, and HCG. Has increased accuracy in
screening for DS for women under 35.
1st trimester typical symptoms
· Breast pain, enlargement, and changes in pigmentation: wear a
supportive bra, avoid caffeine use
· Constipation: large amount of circulating progesterone cause
decreased GI motility - use bulk-forming laxatives or Colace,
, exercise regularly, elevate feet on a stool while defecating to
prevent straining, high fiber foods, increase fluids, drink warm
fluids
· Excessive salivation (ptyalism) and bad taste in mouth: good
oral hygiene, good diet and adequate hydration, suck hard candy,
breath mints, chewing gum
· Fatigue: supplemental iron if anemic (30mg/day if not anemic,
120mg/day if anemic for at least 6 weeks), adequate sleep and
rest, mild exercise
· Flatulence: avoid constipation, avoid smoking, avoid large meals
· Headaches: usually tension, Tylenol, avoid stress, smoking,
blinking lights, sleeping late, neck and shoulder massage, regular
balanced diet, stay hydrated
· Hemorrhoids: OTC topical anesthetics (Preparation H, Anusol),
avoid constipation, warm or cool sitz baths with Epsom salts,
tucks witch hazel pads, ice packs or cool compresses, Kegel
exercises
· Nausea and vomiting: may use Benadryl, Dramamine,
Compazine, Phenergan, reglan, Zofran, avoid triggers (certain
foods), rest, avoid stress, avoid tight clothing, hypnosis,
acupuncture, relaxation techniques, small frequent meals, high
carb, sipping carbonated drinks, eating crackers on arising,
drinking fluids between meals, avoid spicy and fatty foods, sit
upright after eating, adequate hydration, vitamin B6, ginger
· Urinary frequency and incontinence: resting and sleeping in the
lateral recumbent position, kegals, adequate water intake,
decrease water intake 2-3 hours before bed
· Varicosities of vulva and legs: support hose and compression
stockings, lie flat and raise legs to drain veins, avoiding crossing
legs, elevate the legs as much as possible, kegals, mild exercise,
warm tub baths
