Question 1

Which hematological finding for a pregnant woman requires immediate referral for further evaluation?

Accepted Answer

Failure of the normal physiological anemia of pregnancy to occur in the third trimester may be associated with hypertensive disorders of pregnancy (HDP).Complications of HDP may include the HELLP syndrome (hemolysis,elevated liver enzymes,and low platelets).The HELLP syndrome can result in placental abruption,acute renal failure,hepatic rupture,and fetal and maternal death.Immediately refer patients with these symptoms for further evaluation.Increased white blood cell (WBC)count,increased total red blood cell (RBC)volume,increased fibrinogen and clotting factors VII through X,increased plasma volume,and decreased hematocrit are normal findings.

Question 2

Thalassemia is more commonly found in infants with which ethnic backgrounds?

Accepted Answer

Thalassemia is linked to Asian,Asian Indian,or Mediterranean origin (Greece,Italy,Cyprus,Middle Eastern)ethnicity.Ashkenazi Jews are linked to Tay-Sachs and Gaucher's diseases.French Canadians (and possibly Cajuns)are linked to Tay-Sachs disease.Sickle cell disease or trait is linked to African Americans.

Question 3

According to the recommendations of the American College of Obstetricians and Gynecologists,prenatal visits should be scheduled every 2 weeks from

Accepted Answer

The American College of Obstetricians and Gynecologists (ACOG)recommends the following schedule for prenatal visits: every 4 weeks for weeks 6-28 of gestation,every 2 weeks for weeks 28-36 of gestation,and weekly from 36 weeks until delivery.

Question 4

Increased levels of progesterone lead to which change in the lungs and thorax typically occurring during pregnancy?

Accepted Answer

To accommodate the increased oxygen consumption and carbon dioxide excretion,the diaphragm elevates approximately 4 cm,circumference of the thorax expands by 5-7 cm,and tidal volume increases by 30% to 40%.These physiological changes often lead to an increased respiratory rate,hyperventilation,or shortness of breath,especially on exertion.

Question 5

The incidences of small-for-gestational-age infants,preterm labor,spontaneous abortions,and lower Apgar scores are higher than normal among pregnant women who

Accepted Answer

Smoking can lead to a small-for-gestational-age (SGA)infant,preterm labor,spontaneous abortions,and lower Apgar scores.Some providers recommend less vigorous exercise during the first trimester because of the risk of miscarriage.Ingestion of alcohol,even small amounts,can lead to fetal alcohol syndrome (FAS).Coffee is not involved in small-for-gestational-age infant,preterm labor,spontaneous abortions,or lower Apgar scores.

Question 6

Which breast change(s)occurs in the first few weeks of pregnancy?

Accepted Answer

Early breast changes include enlargement,tingling,and tenderness,which are the result of hormonal changes.As pregnancy progresses,the breasts continue to enlarge and prepare for lactation.Later,nodular tissue of the breast becomes more obvious upon palpation as the lactiferous ducts proliferate in preparation for lactation.Colostrum may be secreted as early as the second trimester.

Question 7

Because of its possible teratogenic effect on the fetus,which medication is most likely to be changed during pregnancy?

Accepted Answer

Certain medications for chronic conditions can be continued during pregnancy,such as methyldopa and hydralazine for hypertension.Other medications may be changed because of their teratogenic effect on the fetus; for example,Coumadin would be changed to heparin,and an oral diabetic agent would be changed to insulin.Acetaminophen is considered safe during pregnancy.

Question 8

Primary goals for the health examination of the pregnant patient include all of the following,EXCEPT

Accepted Answer

The goal of the examination is not only to confirm pregnancy and gestational age but also to evaluate general health so you can provide any needed intervention and to educate the patient to maintain and promote her health as well as that of the fetus.

Question 9

Softening of the uterine isthmus occurring at 8 weeks' gestation is called

Accepted Answer

Around 8 weeks,Hegar's sign,the softening of the uterine isthmus,appears.Also at 8 weeks,Chadwick's sign,a bluish hue,is visible on cervical inspections.Goodell's sign,cervical softening,occurs at 6 weeks.McDonald's sign,easy flexion of the fundus on the cervix,occurs at 7 to 8 weeks.

Question 10

Normal changes during pregnancy that affect the heart and peripheral vasculature include

Accepted Answer

Largely the result of an increase in plasma,blood volume increases by 30% to 50% (more with multiple births),thus increasing the cardiac output.Heart rate increases by 10 to 20 beats per minute.Systolic pressure is not significantly different throughout pregnancy,but diastolic pressure may lower by 5 mm Hg in the second trimester,then rise to first trimester levels after midpregnancy.Supine hypotension,resulting from the weight of the uterus on the inferior vena cava,is common.

Question 11

Which notation indicates that a woman has three living children?

Accepted Answer

Pregnant patients are classified according to prior obstetric outcomes.The classification and abbreviations are:
 G: gravida (number of pregnancies)
P: para (number of deliveries)
T: term bisth
P: preterm birth
A: abortion
E: ectopic pregnancy
LC: living children In the notation G6 P4,T2 P2,A1 E1 LC3, LC3 indicates a woman has 3 living children.LC2 in options "a" and "b" indicates the woman has two living children.LC4 in option "d" indicates the woman has four living children.

Question 12

Physiological changes during pregnancy affecting the skin and hair include

Accepted Answer

Physiological changes during pregnancy affect every system in the body.These changes protect the health of the mother and assist in producing a healthy baby.Existing pigmentation increases in the nipples,areolae,external genitalia,and the anal region.The linea alba darkens.Sweat and sebaceous gland production increases.Facial hair may increase,but scalp hair may shed and thin,especially in the postpartum period.Scalp hair may become oily.

Question 13

Hypertensive disorders of pregnancy are typically noted during which period of a pregnancy?

Accepted Answer

Hypertension presenting prior to 20 weeks is most likely chronic.Hypertension after 20 weeks signifies a hypertensive disorder of pregnancy.

Question 14

Which of the following are not commonly associated with changes related to pregnancy?

Accepted Answer

Secondary to the increased intravascular volume,the glomerular filtration rate (GFR)increases by approximately 50% and the reabsorption rate of various chemicals,especially sodium and water,changes.Urinary frequency usually increases in the first trimester.Glycosuria,glucose in the urine,is common in pregnancy.There is also an increased loss of amino acids that can show as proteinuria on a urine dipstick.The risk of urinary tract infection rises,and nocturia,excessive nighttime urination,can disrupt the pregnant woman's sleep.

Question 15

At 16 weeks in a pregnancy,the fundus of the uterus is palpated approximately

Accepted Answer

At 16 weeks,the fundus of the uterus is midway between the symphysis pubis and the umbilicus.At 20 weeks,the fundus is typically at the umbilicus.Within 6 to 7 weeks of conception,the enlarging uterus begins as a pelvic organ,and progresses to an abdominal organ at approximately 12 weeks.

Question 16

Throughout pregnancy,vaginal secretions are typically

Accepted Answer

Hormonal changes result in the production of an endocervical protective plug.Throughout pregnancy,the vaginal discharge is white and milky.From 36 weeks on,the discharge becomes noticeably thicker,and clumps appear as the mucous plug is expelled.These changes in the vagina lead to an increased risk of yeast infection.

Question 17

Because of the relaxation of the esophageal sphincter and subsequent reflux,pregnant women commonly complain of

Accepted Answer

Indigestion (heartburn)is often experienced by the pregnant woman because of the relaxation of the esophageal sphincter,subsequent reflux,and slowed gastric emptying.The growing uterus gradually displaces the abdominal contents,leading to decreased tone and motility,decreased bowel sounds,and increased emptying time for the stomach and intestines.These changes often bring about increased flatulence and constipation.Nausea and vomiting are common early in pregnancy and may even lead to a weight loss in the first trimester.Nausea and vomiting early in pregnancy are possibly the result of increasing levels of HCG and altered carbohydrate metabolism.

Question 18

Cocaine use during pregnancy can lead to an addicted newborn and is associated with a higher incidence of

Accepted Answer

Drug effects on the fetus vary with the drug and gestational time at use.Some drugs,such as crack cocaine and heroin,cause addiction in the newborn who must then go through withdrawal at birth.Cocaine use is associated with a high incidence of abruptio placenta and preterm delivery.Rubella is linked to fetal anomalies and complications.Tobacco use is linked to low infant birth weight and stillbirth.Microcephaly and cardiovascular defects are linked to genetic or familial factors.

Question 19

Which notation indicates that a woman has had four previous live births and that two were preterm?

Accepted Answer

Pregnant patients are classified according to prior obstetric outcomes.The classification and abbreviations are:
 G: gravida (number of pregnancies)
P: para (number of deliveries)
T: term bisth
P: preterm birth
A: abortion
E: ectopic pregnancy
LC: living children In the notation of G5 P4,T2 P2,A0 E1 LC4,the P4 indicates four previous live births.The P2 indicates that two were preterm.

Question 20

A pregnant woman must be questioned closely about all of the following,EXCEPT

Accepted Answer

Typically,immunizations should be avoided during pregnancy,especially those containing live viruses (rubella or varicella)and tetanus toxoid.Rubella and varicella immunizations should be given with instructions to avoid pregnancy for 3 months.Exposure to rubella (German measles),especially in the first trimester,can cause anomalies and complications.Existing HIV and hepatitis B are transmitted perinatally.Syphilis is transmitted transplacentally during pregnancy or at the time of delivery.Therefore,the pregnant woman should be asked about these disorders.Childhood immunizations are not critical.

Quiz 24: The Pregnant Patient