NSG 355 Module Quiz: GTPAL System

Questions and Answers

Postpartum administration of an IV drip of Pitocin is commonly used:

To prevent postpartum fever

To treat excessive postpartum bleeding

To prevent excessive postpartum bleeding from occurring (correct)

To increase the rate of postpartum milk production

Mastitis most commonly affects or occurs:

Right before a woman starts menstruating again

When a woman wears a bra continuously

In the first 3-5 days postpartum

One breast rather than both simultaneously (correct)

The most common causes of postpartum bleeding include all of the following T's except:

Tissue

Thrombin

Thalamus (correct)

Tone

A woman with Von Willebrand's disease is at an increased risk for:

Postpartum hemorrhage Signup and view all the answers

You are making a routine follow-up call to a woman who gave birth 6 days ago. She starts crying and says that she is exhausted, can't stop crying and doesn't want to get dressed. You tell her:

I think you feel this way because of the postpartum blues. Most women have this happen sometime in the first couple of weeks after birth. You should start to feel better in a few days. Who can you ask for help in the meantime? Signup and view all the answers

What defines zero station in childbirth?

Directly in line with the ischial spines Signup and view all the answers

Which of the following should the nurse plan to include in the childbirth preparation class regarding the mechanisms of labor?

Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion Signup and view all the answers

Which indicates that the second stage of labor is over?

The birth of the baby is completed Signup and view all the answers

What will naloxone (Narcan) effectively reverse?

Opiates such as morphine sulfate (MSO4) Signup and view all the answers

What is the most important assessment for the nurse to make immediately after dosing an epidural anesthetic?

Maternal blood pressure Signup and view all the answers

Which nursing action takes priority when a client in active labor spontaneously ruptures membranes?

Assessing the fetal heart rate Signup and view all the answers

To help relieve lower-back pain during contractions, what may the nurse recommend to the husband?

Apply low back counter-pressure during contractions Signup and view all the answers

Why is spinal anesthesia more commonly used for cesarean sections than epidural anesthesia?

Epidural has a slower setup and lasts longer Signup and view all the answers

Use of an upright position for women in labor is associated with which outcome?

Shortened first stage of labor Signup and view all the answers

Which of the following is a sign of impending placental separation during the third stage of labor?

Umbilical cord lengthening Signup and view all the answers

What essential equipment should be ready before administering epidural anesthesia?

BP monitor Signup and view all the answers

When is the best time for a woman to learn about pain relief strategies for labor?

During prenatal visits or classes Signup and view all the answers

What should the nurse closely assess for in a woman with a continuous epidural infusion?

Bladder distention Signup and view all the answers

Which indicates bladder distention after a normal vaginal delivery?

Uterus above umbilicus and deviated to the right of midline Signup and view all the answers

What type of lochia would the nurse expect to find on day one postpartum?

Lochia rubra Signup and view all the answers

When are normal postpartum blues most likely to occur?

About 3-5 days postpartum Signup and view all the answers

In which phase of postpartum psychological adaptation is a woman who feels, 'tired, sore, and hungry'?

Taking in Signup and view all the answers

What is the most likely cause of a severe headache on postoperative day 2 after a cesarean section?

Decreased volume of spinal fluid due to leakage following puncture of the dura Signup and view all the answers

What assessment finding might be of concern 24 hours after a delivery?

Elevated WBC count Signup and view all the answers

Which action should be reported after examination of a woman's bowels 36 hours postpartum?

Lack of bowel sounds Signup and view all the answers

What is a normal finding conducive to breastfeeding on postpartum assessment of the breast?

Everted nipples Signup and view all the answers

The postpartum drop in estrogen is likely to cause what effect?

Vaginal tissue atrophy Signup and view all the answers

Why do levels of human chorionic somatomammotropin decrease after birth?

It was produced by the placenta, which has been delivered Signup and view all the answers

What should a nurse prioritize in a client with abnormal lochia findings after vaginal delivery?

Increased lochia rubra Signup and view all the answers

What is a primary complication to assess for in a multipara client post-delivery?

Uterine atony Signup and view all the answers

What do severe rectal pain and pressure suggest during perineal inspection?

Vaginal hematoma Signup and view all the answers

Which findings indicate potential risks to breastfeeding post-delivery?

Flat nipples Signup and view all the answers

Using the five-digit GTPAL system, select the correct description of her obstetric history.

G3, T1, P1, A0, L2 Signup and view all the answers

Based on Nagele's rule, when is Ms. Hall's estimated date of delivery (EDD)?

June 27 Signup and view all the answers

Which sign/symptom is called a probable sign of pregnancy?

Chadwick's sign Signup and view all the answers

As her pregnancy progresses, Ms. Thompson develops constipation. This is related to what underlying physiological gastrointestinal change?

Reduced intestinal motility Signup and view all the answers

To screen for neural tube defects in the fetus, Ms. Russell will probably undergo which test?

Maternal Serum Alpha-fetoprotein (MSAFP) Signup and view all the answers

What is the nurse's best response when a patient expresses uncertainty about readiness for a baby during her planned pregnancy?

You may be feeling ambivalence, which is normal in the first trimester. Signup and view all the answers

What maternal changes related to pregnancy are usually called 'stretch marks'?

Striae Gravidarum Signup and view all the answers

What is your first action for a patient who is pale and diaphoretic, feeling dizzy and needing to vomit?

Turn her to a left lateral position with a wedge behind her back. Signup and view all the answers

Which of the following primigravid clients should you have the midwife visit first?

6 weeks' gestation and unable to keep fluid down for the last 48 hours Signup and view all the answers

According to her last menstrual period, a patient is 20 weeks gestation. Her fundal height measures 23 cms. This discrepancy may be accounted for by: (Select all that apply)

Twin pregnancy Signup and view all the answers

Which immunizations can a pregnant woman receive? (Select all that apply)

Recombinant Hep B Signup and view all the answers

For a postpartum patient with blood type A negative, what is the most important information the nurse must obtain regarding Rh immunoglobulin administration?

Newborn's Rh Signup and view all the answers

How long is an ovum considered fertile after ovulation?

24 hours Signup and view all the answers

What hormone does the placenta secrete?

Secretes both estrogen and progesterone Signup and view all the answers

Which statement about multiple births is true?

Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. Signup and view all the answers

Which of the following are known human teratogens? (Select all that apply)

Chemicals Signup and view all the answers

What is the term used to describe the sperm head?

Acrosomal cap Signup and view all the answers

What protects the baby's umbilical cord from being squashed?

Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly. Signup and view all the answers

Which statement demonstrates understanding of teratogens?

Exposure to teratogens poses the greatest risk during the first 8 weeks. Signup and view all the answers

What is it called when the umbilical cord wraps around the fetus's neck?

Nuchal cord Signup and view all the answers

The assessment finding that confirms true labor is:

Her cervical exam has changed from 2/0/-2 to 4/50/-1. Signup and view all the answers

Claire's contractions are coming about every 4 minutes and last about 45 seconds. Further examination shows: FHR 140 bpm; cervix 5 cm dilated; membranes intact. Claire is in what phase of labor?

First stage, active phase Signup and view all the answers

Where is the fetal presenting part in relationship to the laboring woman's ischial spines if determined that the fetus is ROA at -1 station?

The fetal presenting part is 1 cm above the ischial spines. Signup and view all the answers

Study Notes

Obstetric History and Terminology

GTPAL system: used to summarize obstetric history:
- G: Gravida (total pregnancies)
- T: Term deliveries (37 weeks and beyond)
- P: Preterm deliveries (before 37 weeks)
- A: Abortions (spontaneous or elective)
- L: Living children
Ms. Hall's EDD calculated using Nagele's rule results in June 27.

Signs and Symptoms of Pregnancy

Chadwick's sign (probable sign): bluish discoloration of cervix
Presumptive signs (reported by the woman): amenorrhea, breast changes, urinary frequency
Positive signs: fetal heart tones, movements felt by provider, ultrasound confirmation

Physiological Changes in Pregnancy

Constipation occurs due to reduced intestinal motility.
Stretch marks during pregnancy referred to as striae gravidarum.

Patient Assessments and Interventions

Hypotension symptoms should prompt immediate left lateral positioning for patient comfort and safety.
Significant symptoms in early pregnancy, such as inability to keep fluids down, necessitate priority assessment by healthcare provider.

Laboratory and Screening Tests

Maternal Serum Alpha-fetoprotein (MSAFP): primary test to screen for neural tube defects.
Immunizations during pregnancy include inactive flu vaccine, Tdap, and recombinant Hep B.

Newborn and Maternal Concerns

Understanding Rh immunoglobulin: critical if the newborn's Rh factor is positive for the mother with Rh-negative blood type.
Teratogenic risks highest in the first 8 weeks of pregnancy, involving various factors including infections and environmental exposures.

Labor and Delivery

Indicators of true labor include cervical dilation changes during assessment; dilation from 2 cm to 4 cm confirms active labor.
Fetal position terminology:
- ROA: right occiput anterior
- Station measures the fetal presenting part’s relationship to the ischial spines.

Mechanisms of Labor

Cardinal movements of labor: engagement, descent, flexion, internal rotation, extension, external rotation, expulsion.
The second stage of labor concludes with the complete birth of the baby.

Fertility Considerations

Ova remain fertile approximately 24 hours post-ovulation, crucial for couples practicing natural family planning.### Naloxone and Maternal Respiratory Depression
Naloxone (Narcan) reverses respiratory depression caused by opiates like morphine sulfate (MSO4) by blocking their effects on the brain.
It is ineffective against anesthetic agents, barbiturates, and tranquilizers.

Epidural Anesthetic Administration

Immediate assessment after epidural administration should focus on maternal blood pressure due to the risk of hypotension.
Maternal perfusion is crucial for both maternal and fetal health.

Spontaneous Rupture of Membranes

The priority nursing action after membranes rupture is to assess the fetal heart rate (FHR).
Monitoring FHR ensures fetal perfusion following the rupture.

Managing Back Pain in Labor

Counterpressure applied to the lower back during contractions offers significant relief for back pain.
Supporting legs or changing positions during labor may not provide immediate pain relief from contractions.

Spinal vs. Epidural Anesthesia

Spinal anesthesia is preferred for cesarean sections as it has a quicker setup compared to epidurals, though it lasts shorter.
An epidural provides longer-lasting pain relief but with a more involved setup.

Labor Positioning

Upright positions during labor are associated with a shortened first stage of labor.
Utilizing gravity may decrease the duration of the third stage of labor.

Signs of Placental Separation

Umbilical cord lengthening is a key sign of impending placental separation.
A small gush of blood can also indicate separation.

Preparation for Epidural Placement

Required equipment before an epidural includes a blood pressure monitor, IV access with fluids, and provisions for oxygen and suction.
Monitoring for hypotension is essential after the procedure.

Learning Pain Relief Strategies

Expectant mothers should learn pain relief strategies during prenatal visits or classes for optimal preparation.
Early education facilitates better retention compared to learning in labor.

Post Epidural Assessment

After a continuous epidural infusion, monitor for bladder distention as patients may lose the urge to urinate.
Signs of fatigue, such as drowsiness, are common but less critical than urinary retention.

Lochia Assessments

Lochia rubra is expected one day postpartum, transitioning to serosa and then alba.
Uterus deviated to the right and above the umbilicus can indicate bladder distention.

Postpartum Psychological Phases

"Taking in" phase focuses on the mother’s personal needs and processing her birth experience.
Postpartum blues typically manifest 3-5 days after delivery.

Maternal Assessment and Complications

A severe headache post-spinal anesthesia suggests potential spinal fluid leakage (postdural puncture headache).
Uterine atony is a primary concern after a complicated delivery.

Postpartum Pain and Complications

Severe rectal pain may indicate a vaginal hematoma, especially if accompanied by perineal pain.
Common causes of postpartum bleeding are the four T's: Tone, Tissue, Thrombin, and Trauma.

Breastfeeding Considerations

Everted nipples are conducive to breastfeeding, while flat or inverted nipples may complicate latching.
Engorgement can be managed by frequent nursing; tight bras or limited nursing time are ineffective.

Hormonal Changes and WBC Count

Decreased estrogen after birth can lead to vaginal tissue atrophy.
Elevated white blood cell counts are expected postpartum due to labor and delivery stressors.

Support and Communication

During follow-up calls, recognizing signs of postpartum blues and reassuring the mother about its normalcy can provide emotional support.
Assessing available help and support networks is crucial for managing postpartum mental health.

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Description

This quiz focuses on the GTPAL obstetric history system used in nursing. It presents a scenario of a patient with a specific pregnancy history, asking to select the correct representation of her obstetric history. Test your understanding of this important nursing concept through practical application.