NM702- EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
GRADED A++
What is gravida?
-number of pregnancies including current
What is parity?
-indicates outcome
-TPALM system should be used*
What does TPALM stand for?
T--term (delivery 37 weeks and above)
P--preterm (delivery between 20 wks and 36.6 wks)
A--abortion (delivery prior to 20 weeks--spontaneous or induced)
L--current living children
M--multiples (pregnancies not babies)
What does primapara mean?
-has had one delivery after 20 weeks gestation
What is multigravida?
-pregnant more than twice (sometimes it can be used for the second time if secundagravida is omitted)
What is multipara?
,-has delivered two or more babies after 20 weeks
How is uterine size determined in pregnancy 12 weeks or less?
-Bimanual exam can help estimate gestation
When is the best time to use an ultrasound to verify gestation accurately?
-first trimester
Where is the uterus in less than 12 weeks gestation?
-pelvic organ
-below the symphysis pubis
-not palpable unless by bimanual exam
Where is the fundus at 12 weeks gestation?
-just at or right above the symphysis pubis
Where is the fundus at 20 weeks gestation?
-at the umbilicus
How should fundal height be measured in someone between 12 weeks and 20 weeks?
-using finger-breadths to estimate cm
-12 weeks at the symphysis
-16 weeks is midway between symphysis and umbilicus (about 4 finger-breadths above the symphysis)
How should fundal height be measured in someone greater than 20 weeks gestation?
-using a tape measure in cm
,-have patient in supine or semi-recumbent in a position that will allow her to relax her abdominal
muscles
-place the 0 on the symphysis border
-measure from symphysis pubis to anterior top of the uterine fundus
-should correlate to weeks gestation (+/- 2 cm)
-best utilized between 20 weeks and 32 weeks
Why is it important to use fundal height measurements during prenatal visits?
-can help screen for complications ( multiples, fetal growth restrictions, polyhydraminos,
oligohydraminos, fetal growth complications, etc)
What things can impact an accurate fundal height?
-multiple different examiners or methods of measurement
-bladder is full
-maternal habitus
-fetal lie
-fetal engagement
-excess maternal adipose tissue
-->if there is any concern for inadequate fundal height an ultrasound should be utilized
When can fetal heart tones be detected? Where are they found best?
-10-12 weeks
-fetal back closest to the anterior uterine wall (OA)
, How can leopolds maneuvers be helpful during a pregnancy abdominal exam?
-can help determine fetal lie, presentation, position, variety, engagement, estimate fetal weight,
determine where fetal heart tones are found best
-usually used around 30+ weeks
First leopolds maneuver:
-palpate what is in the fundus
-if round, hard, balloted between fingers--most likely head
-if irregular, large, bulky, less firm, not readily balloted--most likely fetal parts
-if neither is felt--could be transverse lie
Second leopolds maneuver:
-using one hand to gently push the fetus to one side of the uterus while gently holding pressure in order
to feel on the opposite side
-use firm rotary movements with the palms
-if firm, convex, continually smooth, resistant--most likely fetal back
-if small, knobby, irregular masses--most likely fetal parts
-if fetal back feels just out of reach and small parts felt everywhere--suggests a posterior position*
Third leopolds maneuver:
-"Pawliks grip"
-using thumb and middle finger spread far apart and gently but firmly grasping the lower abdomen just
above the symphysis pubis
-if kicking is felt in the top of the fundus during this exam--usually means you are palpating the head
-if head is just above the pelvic brim and readily movable and ballotable--not engaged yet*
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
GRADED A++
What is gravida?
-number of pregnancies including current
What is parity?
-indicates outcome
-TPALM system should be used*
What does TPALM stand for?
T--term (delivery 37 weeks and above)
P--preterm (delivery between 20 wks and 36.6 wks)
A--abortion (delivery prior to 20 weeks--spontaneous or induced)
L--current living children
M--multiples (pregnancies not babies)
What does primapara mean?
-has had one delivery after 20 weeks gestation
What is multigravida?
-pregnant more than twice (sometimes it can be used for the second time if secundagravida is omitted)
What is multipara?
,-has delivered two or more babies after 20 weeks
How is uterine size determined in pregnancy 12 weeks or less?
-Bimanual exam can help estimate gestation
When is the best time to use an ultrasound to verify gestation accurately?
-first trimester
Where is the uterus in less than 12 weeks gestation?
-pelvic organ
-below the symphysis pubis
-not palpable unless by bimanual exam
Where is the fundus at 12 weeks gestation?
-just at or right above the symphysis pubis
Where is the fundus at 20 weeks gestation?
-at the umbilicus
How should fundal height be measured in someone between 12 weeks and 20 weeks?
-using finger-breadths to estimate cm
-12 weeks at the symphysis
-16 weeks is midway between symphysis and umbilicus (about 4 finger-breadths above the symphysis)
How should fundal height be measured in someone greater than 20 weeks gestation?
-using a tape measure in cm
,-have patient in supine or semi-recumbent in a position that will allow her to relax her abdominal
muscles
-place the 0 on the symphysis border
-measure from symphysis pubis to anterior top of the uterine fundus
-should correlate to weeks gestation (+/- 2 cm)
-best utilized between 20 weeks and 32 weeks
Why is it important to use fundal height measurements during prenatal visits?
-can help screen for complications ( multiples, fetal growth restrictions, polyhydraminos,
oligohydraminos, fetal growth complications, etc)
What things can impact an accurate fundal height?
-multiple different examiners or methods of measurement
-bladder is full
-maternal habitus
-fetal lie
-fetal engagement
-excess maternal adipose tissue
-->if there is any concern for inadequate fundal height an ultrasound should be utilized
When can fetal heart tones be detected? Where are they found best?
-10-12 weeks
-fetal back closest to the anterior uterine wall (OA)
, How can leopolds maneuvers be helpful during a pregnancy abdominal exam?
-can help determine fetal lie, presentation, position, variety, engagement, estimate fetal weight,
determine where fetal heart tones are found best
-usually used around 30+ weeks
First leopolds maneuver:
-palpate what is in the fundus
-if round, hard, balloted between fingers--most likely head
-if irregular, large, bulky, less firm, not readily balloted--most likely fetal parts
-if neither is felt--could be transverse lie
Second leopolds maneuver:
-using one hand to gently push the fetus to one side of the uterus while gently holding pressure in order
to feel on the opposite side
-use firm rotary movements with the palms
-if firm, convex, continually smooth, resistant--most likely fetal back
-if small, knobby, irregular masses--most likely fetal parts
-if fetal back feels just out of reach and small parts felt everywhere--suggests a posterior position*
Third leopolds maneuver:
-"Pawliks grip"
-using thumb and middle finger spread far apart and gently but firmly grasping the lower abdomen just
above the symphysis pubis
-if kicking is felt in the top of the fundus during this exam--usually means you are palpating the head
-if head is just above the pelvic brim and readily movable and ballotable--not engaged yet*
