NURS 629 Exam 1 Questions & Answers 100% Correct

Routine office visit times - Answer every 4 weeks until 28 weeks every 2 weeks until 36 weeks every week from 36 to delivery Biweekly after 40 weeks First Trimester Normal findings - Answer breast pain, enlargement, changes in pigmentation, constipation, excessive salivation and bad taste in mouth, fatigue, flatulence, headache, hemorrhoids, nausea and vomiting, urinary frequency and incontinence, varicosities of vulva and legs. Second Trimester Normal findings - Answer backache, dyspnea, epistaxis, leukorrhea, ligament pain, muscle cramps in the calf, thigh, or buttocks, PICA, syncope. Third Trimester Normal findings - Answer Braxton-hick's contractions, discomfort in the upper extremities, edema, heartburn, insomnia, joint pain/ pelvic girdle pain. First Trimester Danger Signs - Answer spotting or bleeding, cramping, painful urination, severe vomiting and/ or diarrhea, fever higher than 100.4F, symptoms of vaginal infection or STIs, persistent or severe low abdominal pain, lightheadedness, dizziness, abdominal trauma. Second Trimester Danger Signs - Answer regular uterine contractions (6 or more per hour), unilateral leg or calf pain, edema, pain with movement, redness, heat, and tenderness or coldness, numbness and paleness to extremity, sudden gush or consistent leaking of fluid, absence of fetal movement for more than 24 hours after quickening, sudden weight gain, significant edema of the face and/ or hands, severe upper abdominal pain, headache with visual changes and/ or photophobia. Third Trimester Danger Signs - Answer decrease in daily fetal movement, after 37 weeks gestation, when contractions are 3-5 minutes apart if a primipara or 5-8 minutes apart if a multipara lasting 45-60 seconds and strong in intensity or with the characteristics of true labor. What oral contraceptive can be given to breast feeding women - Answer Progestin-only pills What immunizations can be given during pregnancy - Answer Hepatitis B, inactivated influenza, Tdap at 27-36 weeks How do we screen for gestational diabetes - Answer 50 gram oral glucose with a blood draw 1 hour later to determine glucose levels. If the glucose level is greater than 130-140 then a 3 hour 100 gram oral glucose tolerance test is performed. When do we screen for gestational diabetes - Answer 24 weeks What plasma glucose levels would indicate gestational diabetes - Answer Fasting >/= 95 1 hour >/= 180 2 hour >/= 155 3 hour > 140 What is the treatment for mild pregnancy induced hypertension? - Answer Lifestyle modification: smoking cessation, healthy diet, regular exercise. Implement close observation Signs and symptoms of mastitis - Answer Flu-like symptoms including malaise, fever, and chills. Tender, hot, red, painful area, or lump in the breast. Fever is often high, tachycardia, breast exam reveals warmth, redness, tenderness, and swelling. Nipple may be cracked or abraded and breast distended with milk. What is the first line therapy for mastitis - Answer Dicloxacillin 250-500mg every 6 hours for 10-14 days. Erythromycin 500mg every 6 hours for 10 days if PCN allergy. Tylenol as needed. Ice or warm packs. Continue to nurse infant on both breasts but begin on unaffected side. Increase fluid intake. What antibiotic cannot be given if an infant is nursing and less than 1 month - Answer Sulfa When should you suspect a breast abscess - Answer If there is no resolution of symptoms after several days of antibiotics. Pitting edema is possible and fluctuation may be felt over the affected area. This usually requires both abx and drainage. Refer to physician. Culture and sensitivity of breast milk. S/S of gestational hypertension - Answer BP greater than 140/90 after mid-pregnancy but no proteinuria Fundal Height at 12 weeks - Answer Symphysis pubis Fundal Height at 16 weeks - Answer between symphysis pubis and umbilicus Fundal height at 20 weeks - Answer umbilicus and measures 20 cm Fundal Height at 36 weeks - Answer just below the xiphoid process and measures 36 cm How does fundal height increase - Answer in a linear fashion at about 1 cm per week What is the variation in fundal height - Answer 1-2 cm. Make sure woman has emptied her bladder as this can elevate the fundus. Positive signs of pregnancy - Answer Auscultation of fetal heart sounds Palpation of fetal movements Radiologic and/or US verification of gestation Fetal development at 4-5 weeks - Answer gestational sac within the decidualized endometrium Fetal development at 5.5 weeks - Answer secondary yolk sac fetal development at 6 weeks - Answer Visible embryo and heart motion fetal development at 7-8 weeks - Answer fetal limbs are identifiable and fetal head is proportionately larger than the body fetal development at 9-12 weeks - Answer fetal movement, the stomach, bladder, umbilical cord, and spine can be seen fetal development at 11-14 weeks - Answer most normal fetal anatomic features can be identifiable by sonography fetal development at 13-16 weeks - Answer External sex organs are formed. The outer ear begins to develop. The fetus can swallow and hear. The neck is formed. Kidneys are functioning and begin to produce urine. fetal development at 17-20 weeks - Answer The sucking reflex develops. The skin is wrinkled, and the body is covered with vernix and lanugo. You may be able to feel him or her move. The fetus sleeps and wakes regularly. The gallbladder begins producing bile, which is needed to digest nutrients. In female fetuses, the eggs have formed in the ovaries. In male fetuses, the testes have begun to descend. It may be possible to tell the sex of the fetus on an ultrasound exam fetal development at 21-24 weeks - Answer The fetus may hiccup. The brain is rapidly developing. Tear ducts are developing. Finger and toe prints can be seen. The lungs are fully formed but not yet ready to function outside of the uterus. fetal development at 25-28 weeks - Answer The eyes can open and close and sense changes in light. The fetus kicks and stretches. The fetus can make grasping motions and responds to sound. Lung cells begin to make a substance that will enable breathing. fetal development at 29-32 weeks - Answer With its major development finished, the fetus gains weight very quickly. Bones harden, but the skull remains soft and flexible for delivery. The different regions of the brain continue to form. Hair on the head starts to grow. Lanugo begins to disappear. fetal development at 33-36 weeks - Answer The fetus usually turns into a head-down position for birth. The brain continues to develop. The skin is less wrinkled. The lungs are maturing and getting ready to function outside of the uterus. Sleeping patterns develop. fetal development at 37-40 weeks - Answer The fetus drops lower into the pelvis. More fat accumulates, especially around the elbows, knees, and shoulders. The fetus gains about half a pound per week during this last month of pregnancy. When can the fetal heart tones be doppled - Answer week 10-12 Treatment for N/V in pregnancy - Answer Vitamin B6 with Doxylamine combination 10mg/ 10mg (A) 2 tabs at HS and 1 tab in morning or midday if needed. Diphenhydramine 25-50mg (B) every 4-6 hours. -Dimenhydrinate (Dramamine) 25-50mg (B) every 4-6 hours. Prochlorperazine 5-10mg (C) every 4-6 hours or 25mg rectal BID. Promethazine 12.5-25 mg (C) every 4-6 hours. Metoclopramide 5-10 mg (B) PO or IM every 6-8 hours. Zofran 4mg (B) TID. Avoid clothing that is tight and constricting, hypnosis, acupuncture, relaxation techniques, acupressure, autogenic training, meditation, visual imagery, massage, eat small, frequent meals, eat crackers on arising, adequate hydration, ginger maxing 1 gm per day. What OTC medications cannot be given during pregnancy - Answer NSAIDs, aspirin, cimetidine, iodine Large doses of which vitamins can be harmful to mom and baby - Answer A and D Recommended weight gain during pregnancy - Answer Underweight: 28-40lb Normal weight: 25-35lb Overweight: 15-25lb Obese: 11-20lb Initial visit blood testing - Answer ABO blood group/ Rh factor, CBC, rubella titer, Syphilis screening, hepatitis B surface antigen, urinalysis and culture, chlamydia screening, gonorrhea screening, cervical cytology, HIV antibody screening. Second Trimester blood testing - Answer Genetic and congenital screening tests. Quad screening. If Rh negative re-do antibody titer, glucose screening for gestational diabetes, H&H. Third Trimester blood testing - Answer retest for chlamydia, gonorrhea, syphilis, and/ or HIV if needed How to improve breast pain - Answer Avoid use of caffeine, sleeping in a bra, pain often improves in the second trimester. How to improve constipation - Answer Bulk-forming nonnutritive laxatives such as Metamucil, Docusate sodium 50-100mg (C) daily to BID, eat foods high in bulk, increase water intake, decrease refined carbohydrates, drink warm fluids on arising to stimulate bowel motility, prune juice. How to improve bad taste in mouth - Answer Condition will resolve after pregnancy, maintain good oral hygiene, avoid excessive starch intake, adequate hydration, sucking on hard candy or breath mints, chewing gum. How to improve fatigue - Answer Avoid major life stresses, supplement iron if anemic, encourage adequate sleep and rest periods, correct nutritional inadequacies How to improve flatulence - Answer Avoid gum chewing, large meals, smoking. Knee-chest position may help expel gas, limit gas forming foods such as carbonated beverages, reheating food increases gas-producing substances