CARDIOVASCULAR CHANGES IN PREGNANCYAlthough cardiac output increases by 30%–40%, blood pressure is normally lower during pregnancy due to a 15% decrease in systemic vascular resistance. Furthermore, in the supine position, venous return decreases and cardiac output can be significantly affected with a drop of 25%–30% in the latter half of pregnancy (>20 weeks) when aortocaval compression is at its greatest. This compression of the aorta and the inferior vena cava against the lumbar vertebral bodies results in decreased venous return from the lower extremities, thereby decreasing preload, stroke volume and cardiac output. Hypotension in the supine position usually does not occur due to a compensatory rise in peripheral vascular resistance. However, up to 15% of women at term can demonstrate supine hypotensive syndrome of pregnancy, defined as a decrease in systolic blood pressure of at least 15–30 mmHg. The syndrome has been demonstrated in pregnant females from the middle of the second trimester onward. Cardiac output can decrease by 30%–40% in patients with this syndrome. Pregnant patients in the supine position have compression of the inferior vena cava and aorta by the gravid uterus, which leads to decreased venous return and thus hypoperfusion. Symptoms include tachycardia, diaphoresis, nausea, vomiting, pallor, weakness, lightheadedness, and dizziness. Women can lose consciousness and even maternal and/or fetal death can occur. Symptoms usually occur within 3–10 minutes after lying down. Inadequacy of paravertebral collateral blood supply is one etiology behind this hypotension. Women who do not develop supine hypotensive syndrome of pregnancy demonstrate compensatory mechanisms including increased collateral venous flow through the paravertebral and azygous system leading to increased cardiac preload and reflex increases in systemic vascular resistance to maintain hemodynamic stability. Risk factors include size, shape, and weight of the uterus. These risk factors are more common with multiple pregnancies and obese parturients. In addition, the syndrome is exacerbated by neuraxial blocks due to the cofounding sympathectomy. PREVENTION AND TREATMENTSymptoms are usually transient and resolve with change in positioning, specifically left lateral position. With minimal compression of the vena cava by the gravid uterus, hemodynamic changes resulting in hypotension are mostly avoided. Studies have shown radiographic and physiologic improvement in aortocaval compression in the lateral compared to supine position. Pregnant women at more than 20 weeks gestation should be placed in the full left lateral position when recumbent. Left lateral position is preferred, but other options include left lateral tilt and manual displacement of the gravid uterus. Left lateral tilt to 15°–30° is achieved by placing a wedge under the right hip and is used in practice for labor and delivery as well as nonobstetric surgery in pregnant patients undergoing anesthesia to prevent supine hypotensive syndrome. Left uterine displacement is performed by manually moving the uterus away from the midline to the left side when the patient is supine. ... 1. You performed the leopold’s maneuver and found the following: breech presentation, fetal back at the right side of the mother. Based on these findings, you can hear the fetal heart beat (PMI) BEST in which location?
2. In Leopold’s maneuver step #1, you palpated a soft broad mass that moves with the rest of the mass. The correct interpretation of this finding is:
3. In Leopold’s maneuver step # 3 you palpated a hard round movable mass at the supra pubic area. The correct interpretation is that the mass palpated is:
4. The hormone responsible for a positive pregnancy test is:
5. The hormone responsible for the maturation of the graafian follicle is:
6. The most common normal position of the fetus in utero is:
7. In the later part of the 3rd trimester, the mother may experience shortness of breath. This complaint maybe explained as:
8. Which of the following findings in a woman would be consistent with a pregnancy of two months duration?
9. Which of the following is a positive sign of pregnancy?
10. What event occurring in the second trimester helps the expectant mother to accept the pregnancy?
11. Shoes with low, broad heels, plus a good posture will prevent which prenatal discomfort?
12. When a pregnant woman experiences leg cramps, the correct nursing intervention to relieve the muscle cramps is:
13. From the 33rd week of gestation till full term, a healthy mother should have prenatal check up every:
14. The expected weight gain in a normal pregnancy during the 3rd trimester is
15. In the Batholonew’s rule of 4, when the level of the fundus is midway between the umbilicus and xyphoid process the estimated age of gestation (AOG) is:
16. The following are ways of determining expected date of delivery (EDD) when the LMP is unknown EXCEPT:
17. If the LMP is Jan. 30, the expected date of delivery (EDD) is
18. Kegel’s exercise is done in pregnancy in order to:
19. Pelvic rocking is an appropriate exercise in pregnancy to relieve which discomfort?
20. The main reason for an expected increased need for iron in pregnancy is:
21. The diet that is appropriate in normal pregnancy should be high in
22. Which of the following signs will require a mother to seek immediate medical attention?
23. You want to perform a pelvic examination on one of your pregnant clients. You prepare your client for the procedure by:
24. When preparing the mother who is on her 4th month of pregnancy for abdominal ultrasound, the nurse should instruct her to:
25. The nursing intervention to relieve “morning sickness” in a pregnant woman is by giving
26. The common normal site of nidation/implantation in the uterus is
27. Mrs. Santos is on her 5th pregnancy and has a history of abortion in the 4th pregnancy and the first pregnancy was a twin. She is considered to be
28. The following are skin changes in pregnancy EXCEPT:
29. Which of the following statements is TRUE of conception?
30. Which of the following are the functions of amniotic fluid? 1.Cushions the fetus from abdominal trauma 2.Serves as the fluid for the fetus 3.Maintains the internal temperature 4.Facilitates fetal movement
31. You are performing abdominal exam on a 9th month pregnant woman. While lying supine, she felt breathless, had pallor, tachycardia, and cold clammy skin. The correct assessment of the woman’s condition is that she is:
32. Smoking is contraindicated in pregnancy because
33. Which of the following is the most likely effect on the fetus if the woman is severely anemic during pregnancy?
34. Which of the following signs and symptoms will most likely make the nurse suspect that the patient is having hydatidiform mole?
35. Upon assessment the nurse found the following: fundus at 2 fingerbreadths above the umbilicus, last menstrual period (LMP) 5 months ago, fetal heart beat (FHB) not appreciated. Which of the following is the most possible diagnosis of this condition?
36. When a pregnant woman goes into a convulsive seizure, the MOST immediate action of the nurse to ensure safety of the patient is:
37. A gravido-cardiac mother is advised to observe bedrest primarily to
38. A pregnant mother is admitted to the hospital with the chief complaint of profuse vaginal bleeding, AOG 36 wks, not in labor. The nurse must always consider which of the following precautions:
39. Which of the following signs will distinguish threatened abortion from imminent abortion?
40. The nursing measure to relieve fetal distress due to maternal supine hypotension is:
41. To prevent preterm labor from progressing, drugs are usually prescribed to halt the labor. The drugs commonly given are:
42. In placenta praevia marginalis, the placenta is found at the:
43. In which of the following conditions can the causative agent pass through the placenta and affect the fetus in utero?
44. Which of the following can lead to infertility in adult males?
45. Papanicolaou smear is usually done to determine cancer of
46. Which of the following causes of infertility in the female is primarily psychological in origin?
47. Before giving a repeat dose of magnesium sulfate to a pre-eclamptic patient, the nurse should assess the patient’s condition. Which of the following conditions will require the nurse to temporarily suspend a repeat dose of magnesium sulfate?
48. Which of the following is TRUE in Rh incompatibility?
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