N164 Exam 2 With Complete Solution
Smoking Education - Answer Smoking should be avoided in pregnant women due to the
preterm labor and LBW infants, SIDS risk is increased; mother can use nicotine patches
to curb withdrawal effects of nicotine
Alcohol + other teratogens Education - Answer Alcohol is to be avoided, fetal alcohol
syndrome and life-long problems in development
Illicit drugs: prevent teratogenic neonatal abstinence syndrome post birth
Caffeine: prevent spontaneous abortion and/or preterm labor
CBC Values during Pregnancy - Answer Hgb:
-baseline 12-16
-1st trimester: 11.5-14
-2nd trimester: 10-15
-3rd trimester: 9.5-15
Hct:
-baseline: 35-44
-1st trimester: 31-41
-2nd trimester: 30-39
-3rd trimester: 28-40
WBC
-baseline: 4-10
-1st -3rd trimester: 6-16
Plt:
-baseline: 150-400
-1st trimester: 170-390
-2nd trimester: 150-400
,-3rd trimester: 145-400
When would CBCs be ordered? - Answer For females with a history of infection, anemia,
gestational HTN, and other disorders
Breast enlargement and tenderness - Answer Increased levels of progesterone and
estrogen contribute to fullness and tingling sensations
Premenstrual changes, chronic cystic mastitis, hyperestrogenism associated with oral
contraceptives
Changes in the Breast - Answer -Enlargement of size and increased sensitivity
-Skin pigmentation around the areola darkens with the advancement of pregnancy and
with increased production of estrogen
Nipples become more erect and sensitive, colostrum may be present in third trimester
Montgomery glands (small bumps on nipples) become more prominent and may leak a
small amount of breast milk or natural oily substance that cleans and lubricates the
nipple and areola
Breast Changes that impact Breastfeeding - Answer Scars on breast may indicate that a
breast reduction was performed which may impact milk supply
Breast implants can impact effective breastfeeding
-Asymmetrical breasts or tuberous-shaped breasts indicate fewer breast glands and
may be associated with an inadequate milk supply -Flat or inverted nipples can make it
difficult for the baby to attach to the breast
Danger Signs to Watch for in 2nd and 3rd Trimesters - Answer -Persistent, severe
vomiting flu, food poisoning. Sudden discharge of fluid from vagina before 37 weeks
premature rupture of membranes Vaginal bleeding, severe abdominal pain abruption,
placenta previa
Chills, fever, burning on urination, diarrhea-UTI, pyelonephritis Severe backache or
flank pain-UTI, pyelonephritis Change in fetal movements, absence of fetal movements,
any unusual change in fetal movement pattern-risk for intrauterine demise, low amniotic
fluid Uterine contractions, pressure, cramping prior to 37 weeks of gestation-preterm
, labor, dehydration Visual disturbances: blurring vision, double vision, or spots before
eyes-high blood pressure, preeclampsia
Swelling of face or fingers and over sacrum (high blood pressure, preeclampsia)
Headaches: severe, frequent, or continuous (high blood pressure, preeclampsia)
Muscular irritability or convulsions (high blood pressure, eclampsia) Epigastric or
abdominal pain (perceived as heartburn) (preeclampsia, HELLP syndrome [hemolysis of
red blood cells, elevated liver enzymes, low platelet count]) Glycosuria, positive glucose
tolerance test (gestational diabetes)
How to Palpate Fundus - Answer Position woman with knees flexed and head flat. Just
below umbilicus, cup hand and press it firmly against the woman's abdomen. At same
time, stabilize uterus at symphysis with opposite hand.
If fundus is firm (and bladder is empty), with uterus in midline, measure its position
relative to umbilicus. Measure how many fingerbreadths or cm fit between the umbilicus
and top of fundus.
If fundus is not firm, massage it gently to contract and expel any clots before measuring
distance from umbilicus.
Abdominal Girth Assessing Uterine Contractions By Palpation - Answer Mild: Slightly
tense fundus that is easily indented with fingertips (like pressing a finger to the tip of the
nose)
Moderate: Firm fundus that is resistant to indentation with fingertips (like pressing a
finger to the chin)
Good: Rigid board-like fundus that is almost impossible to indent with fingertips-feels
like pressing a finger to the forehead
Positive signs of pregnancy-Answer-Visualization of a fetus by real-time ultrasound
examination (5-6 weeks)
-Fetal heart tones detected by ultrasound (6 weeks)
-Visualization of a fetus by radiographic study (16 weeks)
-Fetal heart tones detected by a -Doppler ultrasound stethoscope (8-17 weeks)
Fetal heart tones detected by a fetal stethoscope (17-19 weeks)
Fetal movements palpated by an examiner (19-22 weeks)
Fetal movements visible to an examiner (Late pregnancy)
Smoking Education - Answer Smoking should be avoided in pregnant women due to the
preterm labor and LBW infants, SIDS risk is increased; mother can use nicotine patches
to curb withdrawal effects of nicotine
Alcohol + other teratogens Education - Answer Alcohol is to be avoided, fetal alcohol
syndrome and life-long problems in development
Illicit drugs: prevent teratogenic neonatal abstinence syndrome post birth
Caffeine: prevent spontaneous abortion and/or preterm labor
CBC Values during Pregnancy - Answer Hgb:
-baseline 12-16
-1st trimester: 11.5-14
-2nd trimester: 10-15
-3rd trimester: 9.5-15
Hct:
-baseline: 35-44
-1st trimester: 31-41
-2nd trimester: 30-39
-3rd trimester: 28-40
WBC
-baseline: 4-10
-1st -3rd trimester: 6-16
Plt:
-baseline: 150-400
-1st trimester: 170-390
-2nd trimester: 150-400
,-3rd trimester: 145-400
When would CBCs be ordered? - Answer For females with a history of infection, anemia,
gestational HTN, and other disorders
Breast enlargement and tenderness - Answer Increased levels of progesterone and
estrogen contribute to fullness and tingling sensations
Premenstrual changes, chronic cystic mastitis, hyperestrogenism associated with oral
contraceptives
Changes in the Breast - Answer -Enlargement of size and increased sensitivity
-Skin pigmentation around the areola darkens with the advancement of pregnancy and
with increased production of estrogen
Nipples become more erect and sensitive, colostrum may be present in third trimester
Montgomery glands (small bumps on nipples) become more prominent and may leak a
small amount of breast milk or natural oily substance that cleans and lubricates the
nipple and areola
Breast Changes that impact Breastfeeding - Answer Scars on breast may indicate that a
breast reduction was performed which may impact milk supply
Breast implants can impact effective breastfeeding
-Asymmetrical breasts or tuberous-shaped breasts indicate fewer breast glands and
may be associated with an inadequate milk supply -Flat or inverted nipples can make it
difficult for the baby to attach to the breast
Danger Signs to Watch for in 2nd and 3rd Trimesters - Answer -Persistent, severe
vomiting flu, food poisoning. Sudden discharge of fluid from vagina before 37 weeks
premature rupture of membranes Vaginal bleeding, severe abdominal pain abruption,
placenta previa
Chills, fever, burning on urination, diarrhea-UTI, pyelonephritis Severe backache or
flank pain-UTI, pyelonephritis Change in fetal movements, absence of fetal movements,
any unusual change in fetal movement pattern-risk for intrauterine demise, low amniotic
fluid Uterine contractions, pressure, cramping prior to 37 weeks of gestation-preterm
, labor, dehydration Visual disturbances: blurring vision, double vision, or spots before
eyes-high blood pressure, preeclampsia
Swelling of face or fingers and over sacrum (high blood pressure, preeclampsia)
Headaches: severe, frequent, or continuous (high blood pressure, preeclampsia)
Muscular irritability or convulsions (high blood pressure, eclampsia) Epigastric or
abdominal pain (perceived as heartburn) (preeclampsia, HELLP syndrome [hemolysis of
red blood cells, elevated liver enzymes, low platelet count]) Glycosuria, positive glucose
tolerance test (gestational diabetes)
How to Palpate Fundus - Answer Position woman with knees flexed and head flat. Just
below umbilicus, cup hand and press it firmly against the woman's abdomen. At same
time, stabilize uterus at symphysis with opposite hand.
If fundus is firm (and bladder is empty), with uterus in midline, measure its position
relative to umbilicus. Measure how many fingerbreadths or cm fit between the umbilicus
and top of fundus.
If fundus is not firm, massage it gently to contract and expel any clots before measuring
distance from umbilicus.
Abdominal Girth Assessing Uterine Contractions By Palpation - Answer Mild: Slightly
tense fundus that is easily indented with fingertips (like pressing a finger to the tip of the
nose)
Moderate: Firm fundus that is resistant to indentation with fingertips (like pressing a
finger to the chin)
Good: Rigid board-like fundus that is almost impossible to indent with fingertips-feels
like pressing a finger to the forehead
Positive signs of pregnancy-Answer-Visualization of a fetus by real-time ultrasound
examination (5-6 weeks)
-Fetal heart tones detected by ultrasound (6 weeks)
-Visualization of a fetus by radiographic study (16 weeks)
-Fetal heart tones detected by a -Doppler ultrasound stethoscope (8-17 weeks)
Fetal heart tones detected by a fetal stethoscope (17-19 weeks)
Fetal movements palpated by an examiner (19-22 weeks)
Fetal movements visible to an examiner (Late pregnancy)
