NRS 125 EXAM AND Verifird Anwers
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NRS 125 EXAM AND VERIFIRD ANWERS A client enters your clinic to discuss fertility based awareness. What are some education topics you would discuss with the patient? Fertility window open between days 8 to 19 of cycle. Requires abstinence during fertile window. Free, safe, acceptable to many religions, promotes self awareness. Virtually impossible for women who are irregular. A client enters your clinic to discuss the calendar rhythm method. What are some education topics you would discuss with the patient? Least reliable form of FBA. Record for 6 months, observe longest and shortest cycles. Fertile phase 18 days before end of shortest cycle and 11 days before end of longest cycle. Requires abstinence during fertile window. A client enters your clinic to discuss basal body temperature method. What are some education topics you would discuss with the patient? Take and record basal temp every morning. Use a specific thermometer with at least 3 hours sleep. Record temperature drop for 3-4 months, and start abstaining day of and 3 days after temp drop. Describe the Billing's Ovulation Method. Assess the amount and character of cervical mucus. Thicc and sticky gets the dicky; stretchy and clear put it in her rear (; Describe the primary symptothermal method. Couple records cycle day, coitus, and cervical mucus changes. Describe the secondary symptothermal method. Couple records increased libido, abdominal bloating, midcycle abdominal pain, and basal body temp. How does an IUD work? Triggers body's natural response to not allow sperm to reach the ovum. How effective is the plan B pill? 75-95% After a vasectomy, a man is not sterile until He has busted 20 nutzz What pharmacological intervention would the physician prescribe to a pregnant woman at <7 weeks gestation who wishes to pursue the clinical interruption of her pregnancy? Mifepristone
NRS 125 EXAM AND VERIFIRD ANWERS What invasive procedure is available to pregnant women in their first trimester who wish to pursue clinical interruption of their pregnancy? D&C (1st trimester), D&E (2nd and 3rd trimesters) Describe therapeutic insemination. Turkey baste that beotch Describe in vitro fertilization. A ripe ova is removed from mother or donor. The egg is then mixed with fresh semen in a petri dish. After fertilization, several ova are implanted in the woman's uterus. How many haploid chromosomes does a human have? 23 Describe monosomy When a cell has 1 copy of a chromosome What are the most common sex chromosome alterations? Turner syndrome (girls) and Klinefelter syndrome What are the 2 major modes of genetic inheritance? Mendelian (single gene) and Non-Mendelian (multifactorial) What diseases are common autosomal dominant inheritance? Huntington disease, mutation HHT gene What percentage chance does a person affected with an autosomal dominant inheritance have of passing that gene down? 50% What diseases are common autosomal recessive inheritance? Sickle cell, Tay Sachs, Cystic Fibrosis, Phenylketonuria, and metabolic disorders Define perinatal loss Death of an infant or fetus up to 28 days after birth What are some factors that can cause perinatal loss? Biological conditions, fetal abnormalities, or environmental factors such as abuse, accidents (MVA's, slips, trips, and falls) What are some factors that can cause a miscarriage? Blighted ovum, chromosomal abnormalities, and health conditions of mother
NRS 125 EXAM AND VERIFIRD ANWERS What are some factors that can cause fetal demise? Chromosomal abnormalities, placental issues, or umbilical cord complications What does prolonged retention of the fetus put the mother at risk for? Clotting; bleeding risk when factors are consumed What are some clinical manifestations of perinatal loss? Spotting, severe lower back pain, cramping, changes in fetal movement What kind of grief is manifested by perinatal loss? Disenfranchised grief What are some risk factors for ectopic pregnancy? - PID (pelvic inflammatory disease) - tubal surgery - endometriosis - ovulation induction - previous ectopic - use an IUD - in utero exposure to diethylstilbestrol What are some religious beliefs about perinatal loss? Jewish: No mourning a child alive less than 30 days Islam: Child is instantly admitted into heaven Buddhism/Hinduism: Child is reincarnated Define gravida number of pregnancies Define para number of viable deliveries (over 20 weeks' gestation) Define nulligravida a woman who has never been pregnant Define nulliparous never carried fetus to viability Define primigravida a woman who is pregnant for the first time Define primipara
NRS 125 EXAM AND VERIFIRD ANWERS delivered one viable fetus Define multigravida been pregnant more than one time Define multipara given birth to two or more viable children Define grand multipara Given birth to 5 or more viable children A pregnancy is considered viable when it reaches ________________. 20 weeks' gestation Define Postterm labor labor that occurs after 42 weeks' gestation Describe the functions of amniotic fluid? Cushions embryo Regulates embryotic temp. Permits symmetrical growth Prevents adherence of embryo-fetus to amnion Allows umbilical cord to be free of compression Acts as extension of fetal extracellular space Acts as wedge during labor Provides fluid for analysis What's the amniotic fluid volume expected to be at 10 weeks? 30 mL What's the amniotic fluid volume expected to be past 20 weeks? 700-1000 mL Describe where the yolk sac can be found Incorporated into umbilical cord Define nuchal cord umbilical cord wrapped around fetal neck at least once The umbilical cord contains how many veins and arteries? One large vein and two smaller arteries Is a fetus in the womb susceptible to bacterial infections?
NRS 125 EXAM AND VERIFIRD ANWERS No. Large particles like bacteria cannot pass through the placenta What is a normal fetal heart rate (FHR) during the first trimester? 160-170 bpm (slows with fetal growth to 110-160 bpm) When helping a female client plan the use of contraceptives, what is the most important consideration? Pt's preference including religious, cultural, or other personal beliefs Define amenorrhea absence of menstruation Define quickening. When does it occur? Quickening is the term used to describe when the mother first detects fetal movements, usually at 18 to 20 weeks of gestation in a primigravida and 16 to 18 weeks of gestation in a multigravida. Define Hegar's Sign softening of the lower uterine segment; occurs at about week 6 Define Goodell's sign softening of the cervix; occurs at about week 8 Define Chadwick's Sign Bluish color of vaginal mucosa and cervix; occurs about week 6 Define Ballottement Rebounding of the fetus against the practitioner's fingers upon palpation. What does a pregnancy test test for? test for the presence of chorionic gonadotropin Why might a pregnant woman experience a poor appetite? Decreased GI motility What are some clinical manifestations of decreased GI motility in pregnant patients? Poor appetite, constipation, flatulence, and heartburn. Oxygen consumption in pregnant patients increases by how much? 15-20% By how much does a pregnant patients blood volume increase? 40-50%
NRS 125 EXAM AND VERIFIRD ANWERS What type of anemia is developed by the plasma increase exceeding the production of red blood cells in pregnant patients? Physiological anemia True or false: Shortness of breath is an unusual finding during pregnancy False. Shortness of breath is a normal finding during pregnancy What are some clinical manifestations of the increase in estrogen levels during pregnancy? Ptyalism (excessive secretion of saliva) and the swelling of gum tissue During what trimester(s) does an increase in frequency of urination occur? 1st and 3rd What happens to a pregnant patient's basal metabolic rate? Increases When do irregular contractions start to begin during pregnancy? 16 weeks gestation What changes to the skin might a pregnant patient expect to experience? Increased pigmentation, linea nigra (dark streak down center of stomach), chloasma (brownish hyperpigmentation of the forehead, cheeks and nose), reddish-purple When would a woman be given a glucose tolerance test? 24-28 weeks gestation Why would a woman be given a 3 hour glucose tolerance test? If she failed the 1 step approach What role does hPL play? It makes the mother more insulin resistant; causes preexisting diabetes to be difficult to manage How many grams of glucose are administered for a 1 step test? 75 How many grams of glucose are administered for the 2 step test 50 and 100 Why is a newborn born to a mother with gestational diabetes likely to present with periods of hypoglycemia post partum? The child has excess insulin reserves secondary to receiving too much glucose from the mother in utero.
NRS 125 EXAM AND VERIFIRD ANWERS At what time during gestation can a fetal heart rate be observed through a doppler? 10-12 weeks gestation Which contraceptives are classified as estrogen-progestin combinations? Ortho-novum, ortho tri-cycline, triphasal, alessa, nuvaring, and orth evra Which contraceptives are classified as progestin only? Micronor, ovretta, depo-provera, mirenra (IUD), implanon (SQ rod) What are some risk factors associated with oral contraceptives? Thrombophlebitis, use alternative method (condom) if pt is on antiseizure or antibiotics. Amenorrhea, N&V (morning/all day sickness), excessive fatigue, urinary frequency, breast changes, quickening, linea nigra, and chloasma are all ___________ signs of pregnancy? Presumptive Goodell's sign, chadwick's sign, hegar's sign, McDonald's sign, abdominal/uterine excitement, braxton hicks, ballottement, positive pregnancy tests, and striae gravidarum (white/silver stretch marks) are all __________ signs of pregnancy? Probable What are considered positive signs of pregnancy? Fetal HR (doppler fetoscope), fetal movement, ultrasound What changes in the uterus occur during pregnancy? Increase in size by 20 x, hyperplasia, hypertrophy, walls thin for symmetrical growth of fetus, increase in volume (< 10mL to 5 L) What changes in the cervix occur during pregnancy? Endocervical glands secrete thick mucus; mucus plug formed, becomes shortened and more elastic, Goodell and Chadwick sign (increased vascularity) What are the TORCH infections? Toxoplasmosis Other (syphilis, chicken pox, HIV) Rubella CMV Herpes What's the difference between fetal demise and a spontaneous abortion? Spontaneous abortion refers to the death of a fetus prior to 20 weeks gestation, and fetal demise (also known as still birth) occurs after 20 weeks
NRS 125 EXAM AND VERIFIRD ANWERS Insulin allows what to enter the cell? Glucose and potassium What modifiable risk factors are associated with Type I diabetes? None. Type I diabetes is genetic DKA is associated with which type of diabetes? Type 1 HHS is associated with which type of diabetes? Type 2 Which has a faster onset. DKA or HHS? DKA What's the number 1 leading cause of DKA? Infection What clinical manifestations sperate DKA from HHS? Pt's with HHS have higher sugar, higher fluid loss, and confusion. DKA presents with a dry body, lower sugar (still high 250-500+), abdominal pain, ketones, and kussmaul respirations. What are your priority interventions when treating a pt with DKA? Dehydration- Run 0.9% NS Kill sugar slowly (>250 BG, IV regular Insulin; <200 SQ insulin with d5W 1/2 NS IV) Add Potassium during IV insulin, not after When treating pts with DKA or HHS, how often should you recheck blood glucose? Hourly What is considered deadly hypoglycemia? Blood glucose <70 Which types of insulin cannot be mixed? Long acting What can cause a pt to go into hypoglycemia? Exercise, alcohol, and insulin peak times What affect does alcohol have on blood sugar? Lowers it
NRS 125 EXAM AND VERIFIRD ANWERS What drugs can increase blood sugar? Steroids ending in -sone Pts with chronic hyperglycemia are at risk for what type of infections? Bacterial At what age is a mother at risk for gestational diabetes? 25 years What's the fastest way to kill a diabetic pt? Not giving food during the insulin's peak What should be avoided for pts using oral diabetic medications? Alcohol; contraindicated in pts with liver disease What drug is classified as a biguanide? Metformin What does metformin do? Reduces glucose production by the liver, improves insulin sensitivity (must be held for 48 hours prior to contrast dye and surgical procedures) What drug is classified as incretin enhancer? Sitagliptin What does sitagliptin do? Prevents the breakdown of incretins, allowing levels to rise. What does incretin do? stimulate insulin release; inhibits glucagon release What drug is classified as a sulfonylureas? Limepiride What does limepiride do? Stimulates the release of insulin from islet cells Which types of insulin are rapid acting? Aspart and lispro (novolog and humalog) What's the peak time for rapid acting insulin? 60-90 minutes
NRS 125 EXAM AND VERIFIRD ANWERS Which types of insulin are short acting? Regular (Humalin-R, Novolin-R) What's the peak time for short acting insuiln? 2-4 hours Which types of insulin are intermediate acting? NPH, isophane (Humalin-N, Novolin- N) What is the peak time for intermediate acting insulin? 6-8 hours What type of insulin is long acting? Detemir and Glargine (Levemir and Lantus) What's the peak time for long acting insulin? 16-20 hours What type of footwear would you advise a diabetic pt to wear? Close-toed, comfortable, supportive, leather footwear. How would you advise a pt with diabetic neuropathy to care for their toes? Use a soft, dry cloth to dry in between toes; never use OTC lotions or ointments not prescribed by the physician; avoid heat and friction What's the normal range for fasting blood glucose? 70-105 What is the normal range for blood glucose 2 hours after a meal? <155 What percentage on an A1c test is indicative of diabetes? 6.5 or greater What role does progesterone play in pregnancy? Smooth muscle relaxant, maintains uterine lining, aids in implantation, inhibits uterine contraction, helps prepare breasts for lactation. What role does estrogen play in pregnany? Helps prepare for delivery by increasing the amount of oxytocin receptors in the uterus, simulates uterine development to provide suitable environment for fetus.
NRS 125 EXAM AND VERIFIRD ANWERS What role does oxytocin play in pregnancy? Stimulates contractions What is the average weight gain during the first trimester and remainder of pregnancy? 4.4 lbs in first trimester; 1 lb per week thereafter What's recommended weight of an average weight pregnant pt? 25-35 lbs Is it safe for a pregnant woman to diet? No What physiological changes to the vagina occur during pregnancy? pH is more acidic to protect uterus from microorganisms, Chadwick's sign (increased vascularity), leukorrhea (increase in vaginal discharge), What physiological changes to the ovaries occur during pregnancy? Ovum production stops Define colostrum A thin, yellow watery fluid secreted from the breasts toward the end of pregnancy What happens to the heart during pregnancy? Increases in size; displaced up, forward, and to the left What is considered a normal blood pressure during pregnancy? 140/90 Define epistaxis. nosebleed What intervention would you advise a pregnant client to perform to reduce the effects of N/V? Eat crackers before getting out of bed What role does cortisol play during pregnancy? Stimulates insulin production What is fibrinogen? Clotting protein During which trimesters would a pregnant pt experience fatigue? 1st and 3rd
NRS 125 EXAM AND VERIFIRD ANWERS What's the normal hemoglobin range for a female? 12-15 At what week during pregnancy is fetal movement detectable by the mother? 20 weeks' gestation Does maternal insulin pass through the placenta? No What exercise would you recommend to a pregnant client experiencing mild lower back pain? Pelvic tilt At what time during pregnancy does the placenta become fully functional? 12 weeks' gestation What is Wharton's Jelly? Jelly-like structure that helps protects the umbilical cord from injury Define preterm 20-37 weeks When is a woman's fertility window open? Days 8-19 of cycle What random plasma glucose level would be considered diabetic? >200 mg/dL What is the normal value for serum potassium? 3.5-5 What fasting plasma glucose level is considered diabetic? >126 mg/dL What two hour plasma glucose level is indicative of diabetes? >200 mg/dL How many diabetes diagnostic tests are required to diagnose a pt with diabetes? At least 2 What is the common name for trisomy 21? Down syndrome
NRS 125 EXAM AND VERIFIRD ANWERS What is the common name for trisomy 18? Edward's syndrome What is the common name for chromosomal alteration 5P? Cri du chat What is the common name for trisomy 13? Patau syndrome What is the common name for the XO sex chromosomal alteration? Turner syndrome What is the common name for the XXY sex chromosomal alteration? Klinefelter syndrome Define trisomy Cells with the presence of an additional chromosome Multifactorial inheritance can be described as... The interaction of multiple genetic factors What are the clinical manifestations of Down Syndrome? Flattened occiput, depressed nasal bridge, low set ears, protruding tongue, broad short hands/fingers, congenital heart disease What are some clinical manifestations of Edward's syndrome? Prominent occiput, low set ears, dropping eyelids, 3rd and 4th fingers overlapped by fingers 2 and 5, syndactyly (webbing of fingers), congenital heart defects What are some clinical manifestations of cri du chat? Severe mental retardation, catlike cry, microcephaly, wide spaced eyes (hypertelorism), organ malformations, and failure to thrive What are some clinical manifestations of Patau syndrome? Seizures, microcephaly, coloboma (key shaped pupil), malformed ears, micrognathia (small lower jaw), polydactyly (extra digits), finger abnormalities, congenital heart defects, various malformations of other organs. What major discomforts of pregnancy are experienced during the first trimester only? N/V What major discomforts of pregnancy are experienced during the 3rd trimester only?
NRS 125 EXAM AND VERIFIRD ANWERS Heartburn, hemorrhoids, backache, varicose, leg cramps, supine hypotensive syndrome, vaginal discharge, and dyspnea. What major discomforts of pregnancy are experienced during the 2nd and 3rd trimester only? Flatulence, constipation, and pedal edema. What major discomforts of pregnancy are experienced during all 3 trimesters? Nasal stuffiness and abdominal distress