By the end of pregnancy how much of mom's blood volume is in the uterus?

A. 1/2

B. 1/8

C. 1/6

D. 2/3

E. 1/4

Identify the hormone that influences a pregnancy test.

A. Estrogen

B. hCG

C. Oxytocin

D. FSH

B.hCG

Expected weight gain per week in 1st trimester?

A. 1/2 lb

B. 1-2 lb

C. 4-5 lb

D. 2-4 lb

Weight gain per week in 2nd and 3rd trimester?

A. 1 lb

B. 2 lb

C. 1/2 lb

D. 1 1/2 lb

E. no desired goal

Urinary output increases in which trimesters due to growing uterus and fetus?

A. All three

B. 1st and 2nd

C. 2nd and 3rd

D. none

E. 1st and 3rd

Folic Acid is important prior to conception to prevent what?

A. Maternal Infection

B. Fetal Infection

C. Miscarrage

D. Preterm Labor

E. Spina Bifida

F. Low Birth Weight

Cardiovascular changes in pregnancy include: select all that apply

A. Blood volume increase 50% or appr 1500mL

B. Increased volume elevates Hct

C. Cardiac output decreases 30-50%

D. The liver has an increase if blood flow

E. HR can increase 10-15 BPM

F. BP increases 5-10 systolic and diastolic

A,E

Increased volume causes psuedoanemia

Cardiac output increases 30-50%

The kidneys and uterus experience an increase in blood flow but the liver's remains the same

BP drops 5-10 systolic and diastolic

Respiratory Changes in pregnancy. Select all that apply:

A. Diaphram moves up 4cm or 1 1/2 inches

B. Oxygen consumption increases 15-20%

C. RR increase by 2 per min

D. AP diameter increases 2-3 inches

A,B,C,D

Growing uterus pushes the diaphram up

Oxygen consumption increases due to an increase in the maternal Basal Metabolic Rate

This increase in RR can lead to hyperventilation causing respiratory alkalosis and mom's body compensates, this is a normal variation

What causes the maternal nausea and vomiting?

A. the fetus absorbing all the nutrients

B. increased β-hCG

C. intestines being moved by the uterus

D. the sight of herself in the mirror (ouch!)

relieves pressure off the inferior vena cava if lying supine

promotes circulation to the fetus

When during pregnancy do we begin to see  movement of the fetus? (appr)

A. 18 wks

B. 6 wks

C. 28 wks

D. 32 wks

What hormones cause the changes to the uterus?

Select all that apply

A. Oxytocin

B. LH

C. Estrogen

D. Progesterone

The uterus increases in size by _______ times its prepregnancy size.

A. 20

B. 50

C. 100

D. 200

E. 500

The uterus goes from being able to hold ____mL to being able to hold ____mL.

A. 10-1500

B. 50-2500

C. 75-2750

D.10-5000

E. 250-7500

Precolostrum begins to come in when?

A. conception

B. 6wk gestation

C. 36 wks gestation

D. immediately after delivery

E. 2-3 days after delivery

F. Women are always making precolostrum

Drop in what hormones following delivery may suppress milk production? Select all that apply

A. Estrogen

B. hCG

C. FSH

D. Progesterone

A,D

Cervical changes begin when?

A. Conception

B. 2-4 wks

C. 6-8 wks

D. 12-14 wks

Chloasma, the mask of pregnancy, is made worse by

A. sun exposure

B. caffeine

C. hormones released during intercourse

D. physical exertion

E. progression of pregnancy

Hemolysis (H)

Elevated Liver enzymes (EL)

Low Platelet count (LP)

Breast Changes: ______ causes growth of mammary ductal tissue.  ______ causes growth of lobes, lobules, and alveoli.

A. Estrogen, Progesterone

B. Progesterone, Estrogen

C. Estrogen, Estrogen

D. Progesterone, Progesterone

Pertaining to pregnancy, which gland does Prolactin production take place?

A. posterier pituitary

B. adrenal

C. thyroid

D. anterior pituitary

During pregnancy, Oxytocin is stimulated by the posterior pituitary.  What direct effects does this have on the body? Select all that apply

A. milk ejection

B. cervical thinning

C. peripheral edema

D. fetal station

E. uterine ctx

Blood glucose levels fall during pregnancy by:

A. 20-30%

B. 10-20%

C. 25-35%

D. they actually rise

Roles of the placenta in pregnancy: Select all

A. provides nutrition to fetus

B. provides O₂, removes CO₂, and filters waste

C. protects fetus from chemical exposure

D. helps regulate pregnancy hormones

E. is made of vascular tissue and functional by 12wk

hCG production stimulates the ________ to produce estrogen and progesterone until the placenta is sufficiently developed.

A. thyroid

B. corpus luteum

C. adrenal gland

D. medulla oblongata

Roles of estrogen in pregnancy: Select all

A. stimulates uterine growth

B. relaxes smooth muscle

C. softens the cervix

D. increases blood supply to uterine vessels

E. aids in preparing the breasts ductal system

F. causes hyperpigmentation/vascular changes of skin

A,D,E,F

B. Progesterone relaxes smooth muscle

C. Relaxin softens the cervix

Roles of progesterone in pregnancy: Select all

A. causes fatty acid absorbtion

B. maintains endometrial layer for ovum implantation

C. prevents tissue rejection of the fetus

D. prevents spontaneous abortion

E. stimulates lobes and lobules in breast

F. stimulates increases respirations in mom

G. relaxes bladder increasing capacity

B,C,D,E,F,G

A. fatty acid absorbtion done by human placental lactogen

Matching pregnancy hormone to roles:

A. human placental lactogen

B. relaxin

1. inhibits uterine activity, softens cervix, relaxes pelvic joints

2. decreases maternal metabolism of glucose to free transport of extra to fetus, causes fatty acids to be metabolized for moms energy

A and 2

B and 1

During pregnancy, at its lowest Hct should never fall below?

A. 12%

B. 25%

C. 32%

D. 16%

During pregnancy, at its lowest Hgb should never fall below?

A. 8.5

B. 32

C. 22

D. 10.5

Pregnant moms are at an increased risk for DVT due to a 50% increase in? Select all

A. platelets

B. RBCs

C. stress

D. fibrin

E. fibrinogen

In pregnancy BP is lower due to decreased ______ and _______ vessels.

A. fibrin, dilated

B. volume, lengthened

C. estrogen, dilated

D. POP, dilated

In pregnancy nausea and vomiting usually begins around the ___wk and ends between ______wks.

A. 1st, 36-38th

B. 12th, 20-22nd

C. 6th, 14-16th

D. 4th, 30-32nd

Select all presumptive signs of pregnancy:

A. nausea/vomiting

B. prenancy test

C. urinary frequency

D. cervical thinning

E. vaginal/cervical color change

F. palpable fetal movements

G. breast changes

A, C, E, G

also amenorrhea, fatigue, quickening

(all symptoms of pregnancy but are subjective, less reliable and can be caused by other things)

Select all probable signs of pregnancy:

A. abd/uterine enlargement

B. cervical softening

C. braxton hicks ctx

D. cervical color change

E. changes of the breasts

F. quickening

A,B,C

D,E,F are all presumptive

other probable signs are: ballottement, palpation of the fetal outline, fundal palpation, uterine souffle, pregnancy test

Select the three positive signs of pregnancy:

A. positive pregnancy test

B. cervical thinning

C. auscltation of fetal heart sounds

D. fetal movement felt by the examiner

E. ballottement

F. visualization of the fetus

Excessive maternal weight gain in pregnancy can lead to: Select all that apply

A. preterm labor

B. macrosomia

C. prolonged labor

D. birth trauma

E. asphyxia

F. C/S birth

Which would be the BEST meal choice for a mom suffering from hyperemisis gravidarum?

A. chicken broth, crackers, water

B. grilled chicken, potato chips, soda

C. eggs, bacon, coffee

D. pasta, rice, yogurt

A pregnant mom presents on the unit with hyeremisis gravidarum.  She has lost weight daily since arriving on the unit and is not tolerating PO food at all.  Her VS were BP 110/73, HR 84, RR 22, O₂ 95%.  What should the nurse expect will be needed?

A. Admin O₂ @ 2L via nasal canula

B. Recheck BP

C. Start TPN via MD order

D. Perform vag exam to check labor status

What is the recommended schedule for meals with hyperemisis gravidarum?

A. when the mother asks

B. none, she has to be on TPN

C. three meals a day

D. provide meals every 2-3 hours

A 23yr old woman presents to the ER having suffered a spontaneous abortion.  The fetus has been passed but the uterus won't contract completely and the woman is continues to bleed. She is 12 wks gestation.  What can the nurse expect to be the priority action taken?

A. MD perform D&C

B. get type and cross and start 18g IV

C. vag exam by speculam

D. admin oxytocin to contract uterus

A 32yr old woman presents to the ER having suffered an incomplete abortion.  She is 18 wks gestation and bleeding.  A type and cross has been performed and ordered fluids hung and running.  What can the RN expect will be ordered next?

A. get consent for emergency C/S delivery

B. assist MD with D&C

C. assist pt with ambulation

D. admin Pitocin

What is the priority intervention with a pt experiencing Disseminated Intravascular Coagulation?

A. admin Vitamin K

B. admin Novolog

C. deliver fetus and placenta

D. frequent ambulation

Recurrent spontaneous abortion is defined as how many consecutive lost pregnancies?

A. 2

B. 3

C. 4

D. 5

You are a nurse on the Labor and Delivery unit working with a student nurse.  A pregnant mom had a prophalactic cerclage performed at 14wks gestation for an incompetent cervix.  She is at 39wks gestation and is in having the sutures clipped.  The student nurse is freaking out that the baby is coming and you're not ready how do you handle the student nurse?

A. ask the student if she wants to watch you perform the manual exam

B. hurry and get a delivery room ready

C. start Pitocin running IV

D. explain that clipping the sutures does not instantly start active labor

Which one of these is NOT a cause of preterm labor?

A. low maternal height or weight

B. obesity

C. uterine or cervical anomalies

D. chronic illness

E. multi-fetal gestation

F. vegitarianism

F. Vegitarianism

other causes include: previous preterm labor, incompetent cervix, dehydration, infection, anemia, preeclampsia, poor nutrition, age <18yr and >40yr, low economic status, smoking, standing for long periods (job), chronic stress, domestic violence, substance abuse

Signs and symptoms of preterm labor:

-routine ultrasound showing cervical change

-women feels "something is different"

-ctx that may or may not be felt

-sensation the baby is balling up

-cramps similar to menstrual cramps

-constant low backache

-pelvic pressure like the baby is pressing down

-increase or change in vaginal discharge

What is the loading dose of Magnesium Sulfate when used for preterm labor?

A. 0.5-1g

B. 2-4g

C. 6-10g

D. 15-25g

During the loading dose of Magnesium Sulfate for preterm labor you want to monitor BP every ___mins and also check ___________.

A. 15, HR

B. 30, RR

C. 15, level of conciousness

D. 5, reflexes

Maintenance dose of magnesium sulfate for preterm labor is _____g/hr for 12 hours or until ctx are 1 every ____mins.

A. 1-2, 5

B. 2-4, 20

C. 1-4, 10

D. 1-4, 5

E. 1-2, 10

Risk factors of ectopic pregnancy: Select all

A. history of STD's

B. preeclampsia

C. obesity

D. pelvic inflammatory disease

E. previous ectopic pregnancy

F. smoking/drug abuse

A,D,E

also: failed tubal ligation, intrauterine device, multiple induced abortions, maternal age >35yrs

Symptoms of ectopic pregnancy: Select all that apply

A. severe bilateral pelvic/abd pain

B. tender abd mass

C. possible vaginal spotting

D. hypertension

E. fever

Ectopic pregnancy is diagnosed via:

A. ultrasound

B. manual exam

C. β-hCG testing

D. x-ray

E. CBC

Treatment of ectopic pregnancy is surgery.  _______ is the drug used to dissolve the tissue, and if the tube is still intact a _____________ is performed. 

A. spironalactone, salpingostomy

B. Celestone, tubal ligation

C. methotrexate, linear salpingostomy

D. Decadron, linear salpingostomy

C. If the tube is intact a fine incision is made and the contents are removed, the tube is not sutured and is left to heal to reduce scar tissue with could cause problems with future pregnancies.  

A woman diagnosed with an ectopic pregnancy has her fallopian tube rupture and has an emergency salpingostomy.  Following she asks if she will ever be able to get pregnant again. Your best response is:

A. you have the same chances as before

B. unfortunetly you will not be able to have children

C. you have a 50% less chance than before

D. there is no way to tell due to the scar tissue left in the fallopian tube from the surgery

Hydatidiform mole is diagnosed by an ultrasound that reveals a ________ appearence.

A. snow storm

B. whirlwind

C. polkadot

D. blank

Before a vacuum aspiration of a hydatidiform mole can be performed the woman must have what tests performed:  Select all that apply

A. pregnancy test

B. chest imaging

C. metabolic and blood chemistry test

D. CBC

E. urinalysis

F. assess clotting factors/type and cross

A 31 yr old woman at 24 wks gestation presents to the ER with painless bright red vaginal bleeding.  The charge nurse should intervene in the nurse starts to do what?

A. start an 18g IV

B. perform a manual vaginal exam

C. places the woman on bed rest

D. obtains the patients pregnancy history

The MAIN cause of placental abruption is:

A. hypertension

B. smoking

C. multigravida

D. short umbilical cord

E. abd trauma

F. cocaine use

Pregnancy induced hypertension is a systolic >140 or diastolic >90 that develops after ___wks gestation but returns to normal within ___wks of delivery.

A. 20, 6

B. 12, 4

C. 32, 8

D. 8, 2

Mild preeclampsia has only the elevated BP >140/>90, and what one other lab value?

A. elevated liver enzymes

B. serum creatinine >1.2mg/dL

C. severe mental confusion, HA

D. proteinuria 0.3-2g (24hr specimen)

Aside from the elevated BP, which are symptoms of severe preeclampsia? Select all that apply

A. proteinuria >5g (24hr) or 3+ or >(random dipstick)

B. decreased creatinine

C. elevated platelets

D. elevated liver enzymes

E. increased UOP

A,D

creatinine is elevated >1.2mg/dL

Platelets are decreased <100,000

also: severe HA, mental confusion, RUQ or epigastric pain, nausea, vomiting, visual disturbances, fetal growth restriction

A female patient is 28 wks gestation and presents on the unit with severe preeclampsia.  What interventions can the nurse expect to perform? Select all that apply

A. frequent ambulation

B. reduce external stimuli

C. pad bed rails

D. admin Apresoline

E. admin 1 unit packed RBCs

F. restrict fluids

B,C,D

A. is incorrect because the pt will be on bed rest with seizure precautions.  Apresoline is an antihypertensive.  Magnesium sulfate will also be used to prevent seizures.

During an eclampsia seizure the FHR does what?

A. massive shifts from high to low HR

B. variability increases drastically

C. flat lines

D. bradycardia with loss of variability

During an eclampsia seizure the mom should be placed on her side to prevent ______ and improve _____________.

A. supine hypotension, maternal circulation

B. aspiration, fetal circulation

C. contact injury, maternal oxygenation

D. headache, cranial bloodflow

Following an eclampsia seizure the RN anticipate orders for which two things?

A. chest radiography

B. ABG's

C. auscultation of lungs

D. clear diet

A,B

You don't need an order to auscltate lung sounds, diet is irrelevant.  Fluid shifts from intravascular to interstitual space possibly causing pulmonary edema or heart failure.  Renal failure is possible due to poor renal perfusion.  Cerebral hemorrhage is possible due to extreme hypertension.  You will also need to admin oxygen at 8-10L, monitor UOP hourly, auscultate lungs at least hourly, and use continuous pulse ox

Warning signs of eclampsia seizure include headache, blurry vision, delayed fetal growth, low amniotic fluid and what else?

A. rapid increase in BP

B. sudden drop in BP

C. UTI

D. depression

Oral Glucose Tolerance Test is the gold standard for diagnosing gestational diabetes.  What are the levels that indicate GDM at fasting, 1hr, 2hr, and 3hr?

A. >120, >250, >175, >140

B. >95, >180> 150, >95

C. >95, >180, >155, >140

D. >180, >155, >140, >95

C. Fasting >95

1 hr >180

2 hr >155

3 hr >140

Terbutaline Sulfate is a bronchodialator used for asthma.  What unlabeled use does it have in pregnancy?

A. lowers pregnancy induced hypertension

B. increases fetal oxygenation

C. reduces nausea and vomiting

D. delays uterine ctx in preterm labor

A pregnant woman should increase her caloric intake by ______/day.

A. 200

B. 300

C. 500

D. 1000

The umbilical cord contains three vessels, what are they?

A. 1 vein, 2 arteries

B. 2 veins, 1 artery

The student nurse is looking over a pt chart and sees the results of a Lecithin/Sphingomyelin ratio.  What is this test used to determine?

A. gestational age

B. neuro tube defects

C. genetic abnormalities

D. fetal lung maturity

________ insulin is required as pregnancy progresses.

A. More

B. Less

A. More

The amount of insulin you take is likely to increase as you go through pregnancy because your body becomes less able to respond to the action of insulin, a condition called insulin resistance. Your insulin needs may double or even triple as you get closer to your delivery date.

Gestational diabetes is a result of the maternal body producing _______ insulin during pregnancy.
A. too much

B. not enough

Ketones are produced from the breakdown of ____, when your blood glucose is too high or if you are not eating enough.

A. fat

B. protein

C. tissue

D. RBC's

A. fat

Ketones can be harmful if passed to the fetus.  Ketosis can develop and quickly turn into diabetic ketoacidosis.

Physical exercise can lead to ___________ in the diabetic patient and they will require more __________ before starting to exercise.

A. hyperglycemia, insulin

B. hyperglycemia, carbs

C. hypoglycemia, insulin

D. hypoglycemia, carbs

Breastfeeding _______ blood glucose.

A. raises

B. lowers

B. lowers

You might need to have a snack before or after you breastfeed your baby.

After giving birth you may need ________ insulin.

A. more

B. less

B. less

After you've given birth, you might need less insulin than usual for several days. Breastfeeding can also lower the amount of insulin you need. Diabetes pills are not recommended during breastfeeding.

Illness can ______ your blood glucose.

A. raise

B. lower

A. raise

Having a cold, the flu, or an infection can raise your blood glucose levels. You can have serious health problems leading to a coma if your blood glucose levels are very high.

A diabetic pt calls the clinic and says he is sick and has been throwing up and wonders if he should still take his insulin.  The RN should answer:

A. yes you should continue taking your insulin

B. no you should stop until the vomiting has stopped

A.yes you should continue taking your insulin

Take your insulin, even if you are sick and have been throwing up. Ask your doctor about how to adjust your insulin dose based on your blood glucose test results.

Your health care provider may say you should call right away if

• your blood glucose levels are above 240 even though you've taken your diabetes medicines
• your urine or blood ketone levels are above normal
• you vomit more than once
• you have diarrhea for more than 6 hours
• you have trouble breathing
• you have a high fever
• you can't think clearly or you feel sleepier than usual

Define TORCH

a group of infectious diseases that can cause serious harm to the fetus:

Toxoplasmsis

Other infections

Rubella

Cytomegalovirus

Herpes

Three things that affect the severity of a teratogen: Select three

A. route of exposure

B. timing of exposure

C. maternal age

D. maternal weight

E. amount of exposure

F. avenity of tissue

B,E,F

-4-8 weeks gestation is the most dangerous time for the infant to be exposed to a teratogen

-example of tissue avenity for a teratogen is tetracyclines to bone/teeth (causes permanent discoloration of child's teeth)

Toxoplasmosis is caused by a protozoan and transmitted by:  Select all that apply

A. sun exposure

B. STDs

C. standing water

D. undercooked meat

E. kitty litter

Toxoplasmosis is a presents as a mild infection in the pregnant mother but can cause what in the fetus?  Select all that apply

A. spontaneous abortion

B. stillborn

C. macrosomia

D. hydrocephalus

E. blindness

A,B,D,E

-may also cause prematurity, neonatal death, microcephaly, convulsions, deafness, and mental impairment

False;

-treatment for toxoplasmosis includes spiramychin, pyrimethamine, and sulfadiazine

You are performing teaching to newly expectant mothers.  Included in your teaching is how to prevent toxoplasmosis.  What would you include in your teaching?

Select all that apply

A. cat litter boxes should be cleaned frequently by someone else

B. exposure to the sun should be kept to a minimal

C. avoid sleeping in a lateral position

D. avoid undercooked meats especially pork

E. gloves should be worn when gardening

F. fruits and vegetables should be washed prior to eating

A,D,E,F

-are applicable to preventing toxoplasmosis

Rubella infection in the second trimester is most often associated with what in the infant?

A. permanent hearing loss

B. congenital heart disease

C. mental retardation

D. cerebral palsey

A. permanent hearing loss

-the others are associated with Rubella infection in the first trimester along with spontaneous abortion, intrauterine growth retardation, and cataracts

Signs of rubella infection in the pregnant mother include:  Select all that apply

A. maculopapular rash

B. enlarged lymph nodes

C. muscular achiness

D. joint pain

E. blurred vision

The actual disease that is associated with cytomegalovirus. 

A. cytomegalic inclusion disease

B. cytomegalic retrovirus

C. cytomegalic inversion disease

D. cytomegalic neurotropic disease

Cytomegalic inclusion disease is diagnosed by serologic tests to detect cytomegalovirus.  What treatment would be started upon diagnosis?

A. penicillan

B. sulfadiazine

C. spiramycin

D. none

D. none

-there is no known effective treatment for CID

-CID can cause fetal death, in neonates causes microcephaly, cerebral palsey, mental retardation, hearing problems, and other neurological problems

True

-a C/S delivery is necessary if the mother has active lesions of genital herpes at delivery

Genital herpes can cause spontaneous abortion if active during ____ trimester.

A. 1st

B. 2nd

C. 3rd

A baby born vaginally to a mother with active genital herpes lesions would be at an increased risk for:

Select all that apply

A. stillbirth

B. neonatal death

C. hydrocephalus

D. permanent brain damage

E. respiratory distress syndrome

B,D

-also characteristic skin lesions

Erythromycin oinment is applied to the eyes of infants to prevent conjunctivitis associated with:

A. herpes

B. gonorrhea

C. syphilis

D. chlamydia

D. chlamydia

-nonpregnant women are treated with tetracyclines, but since this would permanently discolor the child's teeth pregnant women are treated with erythromycin ethyl succinate

-erythromycin ointment prevents opthalmia neonatorum in infants of mothers with gonorrhea; this is required by law for every infant

What information would this provide if listed in a mother's chart?

G 4: P 2-1-0-3

She is pregnant with 2 term deliveries, 1 preterm delivery, no abortions, and 3 living children

TPAL:

Term

Preterm

Abortions

Living children