Pregnancy.

PregnancyB. Abuse can worsen during pregnancy The incidence of abuse during pregnancy ranges between 7-20% and is higher when pregnancies are unplanned. This percentage is higher than gestational diabetes or pre-eclampsia. Screening is routinely performed for these two conditions. Domestic violence often begins during pregnancy and can accelerate when it has existed prior to pregnancy. Therefore, it is important to screen. Unfortunately, this is not reportable in all 50 states. -answer The NP suggests that a pregnant patient may have been physically abused by a domestic partner. The NP knows that: A. Abuse often ends in homicide by the abuser B. Abuse can worsen during pregnancy C. This is reportable in all 50 states D. This will usually end when the pregnancy ends C. Takes place at about 24-28 weeks This is the ideal time b/c the patient is more likely to exhibit elevations in glucose at 24-28 weeks due to placental hormones that increase insulin sensitivity. This is also a good time to initiate interventions that will decrease complications in the fetus associated with glucose elevations. If the patient has risk factors, she can be screened early. -answer Routine screening for gestational diabetes: A. Takes place only if the mother is symptomatic B. Takes place at about 16-20 weeks C. Takes place at about 24-28 weeks D. Takes place routinely in each trimester D. This may increase the risk of preterm labor. This can occur b/c the lower uterine segment may be physically stimulated. Additionally, oxytocin is released, which may precipitate preterm labor. However, in the absence of complications associated with the pregnancy, sexual activity is not contraindicated. If vaginal discharge or bleeding occurs, or rupture of membranes occurs, sexual intercourse should be avoided until assessed by the patient's provider. -answer A pregnant patient asks if engaging in sexual activity will place her fetus at increased risk. The nurse practitioner responds: A. There is absolutely no increased risk to the fetus. B. There is a slight cardiovascular risk to the fetus C. This may stimulate labor and so should be avoided. D. This may increase the risk of preterm labor. C. FHT are audible at about 9-12 weeks Doppler can be used at 9-12 weeks. Transvaginal ultrasound can identify movement of the heart at 5-6 weeks. -answer In a viable pregnancy: A. FHT can be heard at 4-6 weeks B. Heart rates can exceed 240 bpm C. FHT are audible at about 9-12 weeks D. The fetus begins to respire at 6-8 weeks A. She should be treated now and rescreened later in pregnancy. Treat with azithromycin 1 gm po x 1 and ceftriaxone 250 mg IM x 1. Since the percentage of patients who become reinfected with an STD later in pregnancy (even after being treated and educated) is great, this patient should be rescreened later in pregnancy regardless of whether symptoms emerge. Deleterious effects can occur if she is infected and left untreated. -answer A patient in her first trimester of pregnancy is found to be infected with chlamydia and gonorrhea. Which statement below is true? A. She should be treated now and rescreened later in pregnancy. B. She should be treated in the second trimester C. She should be screened for other STDs later in pregnancy D. She should be treated now and rescreened in symptoms reappear A. Order urine culture and begin antibiotics The positive findings with the patient complaints are consistent with a UTI. Empiric antibiotic therapy should be initiated and a urine culture should be ordered. Pregnant females are at high risk of developing pyelonephritis if a UTI is left untreated or undertreated. -answer A pregnant patient complains of urinary frequency and dysuria. A urinalysis was obtained. What course of action is most appropriate? (+ nitrites, + bacteria, + leukocyte esterase) A. Order urine culture and begin antibiotics B. Repeat the UA C. Prescribe an antibiotic only D. Order urine culture only B. Inactive influenza Live and attenuated immunizations should not be given during pregnancy. The CDC recommends pneumococcal, hepatitis A, and hepatitis B vaccines during pregnancy only if a risk factor is present; otherwise, these should be delayed until after pregnancy. -answer Which of the following immunizations may be safely .