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### Gtpal questions

1. 1. GTPAL GRAVIDITY =NUMBER OF TOTAL PREGNANCIESG TERM =TERM DELIVERIES [FULL] BIRTHS (38 WEEKS OR MORE)T BIRTHS PRETERM =PRETERM DELIVERIES (FROM VIABILITY UP TO 37 WEEKS)P BIRTHS ABORTIONS/MISCARRIAGES =ABORTIONS (BOTH SURGICAL ABORTIONS AND MISCARRIAGES)A LIVING =LIVING CHILDRENL CHILDREN A. May is 6 weeks pregnant. Her previous two pregnancies ended in a live birth at 41 weeks. G T P A L 3 1 0 0 1 B. Susan is experiencing her fourth pregnancy. Her first pregnancy ended in a spontaneous abortion at 8 weeks, the second resulted in the live birth of twin boys at 38 weeks, and the third resulted in the live birth of a daughter at 34 weeks. G T P A L 4 2 1 1 3 1. Using Nagele’s rule, calculate the expected date of delivery (EDD) for each of the following pregnant women: The rule estimates the expected date of delivery (EDD) (also called EDC, for estimated date of confinement) from the first day of the womans LMP by adding 1 year, subtracting three months and adding seven days to that date. The result is approximately 280 days (40 weeks) from the LMP. Example: LMP = 8 May 2009 +1 year = 8 May 2010 -3 months = 8 February 2010 +7 days = 15 February 2010 A. Susan had intercourse on February 12, 2006. She has not had a menstrual period since the one that began on January 24, 2006, and ended 5 days later. LMP = February 12, 2006 +1 year = February 12, 2007 -3 months = NOVEMBER 12, 2006 +7 days = (EDD) NOVEMBER 19, 2006
2. 2. B. Dawn has regular 32-day cycles. Her last period began September 4, 2006 and ended September 8, 2006. LMP = September 4, 2006 +1 year = September 4, 2007 -3 months = July 4, 2007 +7 days = (EDD) July 11, 2007Student Review Questions, Ricci-KyleChapter 12: Nursing Management During Pregnancy1.MULTIPLE CHOICEA pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeksand gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document thiswoman’s obstetric history as:31021*301112121220111The woman’s obstetric history would be documented as 30111, G (gravida) = 3 (current pregnancy), T (termpregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeksviability) = 1, and L (number of living children) = 1.2.MULTIPLE CHOICEA woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which of the following locations?Symphysis pubisBetween the symphysis and umbilicus*At the umbilicusJust below the ensiform cartilageAt 20 weeks’ gestation, the fundus can be palpated at the umbilicus. A fundus of 12 weeks’ gestation is palpated atthe symphysis pubis. At 16 weeks’ gestation, the fundus is midway between the symphysis pubis and umbilicus. At36 weeks’ gestation, the fundus can be palpated just below the ensiform cartilage.3.MULTIPLE CHOICEThe diagonal conjugate of a pregnant woman’s pelvis is measured. Which measurement would suggest a potentialproblem?*12.0 cm12.5 cm
3. 3. 13.0 cm13.5 cmThe diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. Thediagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal headoccurs if it is too small.4.MULTIPLE CHOICEA woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:*4 weeks3 weeks2 weeks1 weekThe recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks,and then every week from 37 weeks to birth.5.MULTIPLE CHOICEAfter teaching a pregnant woman how to count fetal movements, the nurse determines that the teaching wassuccessful when the client states which of the following?“I’ll do the count once a week on a morning that I’m not rushed for work.”*“I’ll sit comfortably in a recliner or lie on my side when I do the counts.”“I won’t expect more than three movements to happen in an hour.”“I’ll do the counts while I’m sitting and watching my son’s basketball game.”The client should perform the counts in a relaxed environment and a comfortable position, such as a semi-Fowler’sor side-lying position. The woman needs to do fetal movement counts consistently, at approximately the sametime each day. A woman should report a count of less than three fetal movements in an hour. A relaxedenvironment, a comfortable position, and consistency in performing the counts are important to identify changes.6.MULTIPLE CHOICEA pregnant woman who is 26 weeks pregnant arrives for a follow-up visit. Which of the following assessments, inaddition to measuring fundal height and fetal heart rate, would the nurse expect to complete? Select all that apply.*Blood pressure*WeightEdema
4. 4. *Urine testing*Blood glucose levelUp to 28 weeks’ gestation, follow-up visits involve assessment of the client’s blood pressure and weight, urinetesting for protein and glucose, along with fundal height and fetal heart rate. Between weeks 24 and 28, a bloodglucose level is obtained. Assessment for edema is typically done between 29 and 36 weeks’ gestation.7.MULTIPLE CHOICEThe nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reportedimmediately to her health care provider. Which of the following would the nurse include? Select all that apply.*Headache with visual changes in the third trimesterUrinary frequency in the third trimester*Sudden leakage of fluid during the second trimesterNausea with vomiting during the first trimester*Lower abdominal pain with shoulder pain in the first trimesterBackache during the second trimesterDanger signs and symptoms that need to be reported immediately include headache with visual changes andsudden leakage of fluid in the third trimester, and lower abdominal pain accompanied by shoulder pain in the firsttrimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backacheduring the second trimester are common discomforts of pregnancy.8.MULTIPLE CHOICEWhen providing preconception care to a client, which medication would the nurse identify as being safe tocontinue during pregnancy?AccutaneLithiumWarfarin*FamotidineFamotidine is a category B drug that has been used frequently during pregnancy and does not appear to causemajor birth defects or other fetal problems. Accutane and warfarin are category X drugs and should never be takenduring pregnancy. Lithium is a category D drug with clear health risks for the fetus and should be avoided duringpregnancy.9.MULTIPLE CHOICEAfter teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, whichstatement indicates the need for additional teaching?
5. 5. “I’ll try to drink more fluids to help move things along.”*“I’ll switch to chewing gum instead of using mints.”“I’ll stay away from foods like cabbage and brussels sprouts.”“I’ll increase my time spent on walking each day.”Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gasbuild-up. Increasing fluid intake helps to reduce flatus. Gas-forming foods such as beans, cabbage, and onionsshould be avoided. Increasing physical exercise, such as walking, aids in reducing flatus.10.MULTIPLE CHOICEWhen describing the role of a doula to a group of pregnant women, which of the following would the nurseinclude?The doula is a professionally trained nurse hired to provide physical and emotional support.The doula can perform any necessary clinical procedures.*The doula primarily focuses on providing continuous labor support.The doula is capable of handling high-risk births and emergencies.Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to providewomen and families with encouragement, emotional and physical support, and information through latepregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-riskbirths and emergencies.Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 018 (edited file)—"Obstetrical Assessment"10/14/08, Page 1 of 6, 0 Figure(s), 0 Table(s), 3 Box(es) 21: Obstetrical AssessmentPRACTICE QUESTIONS1. A client arrives at the prenatal clinic for the first prenatal assessment. The client tells thenurse that the first day of her last menstrual period was September 19, 2007. Using Nägele’srule, the nurse determines the estimated date of confinement as:1. July 26, 20082. June 12, 20083. June 26, 20084. July 12, 2008Answer: 3Rationale: Accurate use of Nägele’s rule requires that the woman have a regular 28-daymenstrual cycle. Add 7 days to the first day of the last menstrual period (LMP), subtract 3months, and then add 1 year to that date. First day of the LMP: September 19, 2007; add 7 days:September 26, 2007; subtract 3 months: June 26, 2007; add 1 year: June 26, 2008.Test-Taking Strategy: Knowledge regarding the use of Nägele’s rule is required to answer thisquestion. Read all of the options carefully, noting the dates and years in the options, beforeselecting an answer. Review Nägele’s rule if you had difficulty with this question.
6. 6. Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: Maternity/AntepartumReference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 34.2. A nurse is collecting data during an admission assessment of a client who is pregnant withtwins. The client has a healthy 5-year-old child who was delivered at 38 weeks, and tells thenurse that she does not have a history of any type of abortion or fetal demise. The nurse woulddocument the GTPAL for this client as:1. G = 3, T = 2, P = 0, A = 0, L = 12. G = 2, T = 0, P = 1, A = 0, L = 13. G = 1, T = 1, P = 1, A = 0, L = 14. G = 2, T= 0, P = 0, A = 0, L = 1Answer: 2Rationale: Pregnancy outcomes can be described with the GTPAL acronym: G=gravidity =number of pregnancies; T=term births = number born at term (40 weeks); P=preterm births =number born before 40 weeks’ gestation; A=abortions/miscarriages = number ofabortions/miscarriages (included in gravida if before 20 weeks’ gestation; included in para if past20 weeks’ gestation); L=live births = number of live births or living children. Therefore, awoman who is pregnant with twins and has a child has a gravida of 2. Because the child wasdelivered at 38 weeks, the number of preterm births is 1 and number of term births is 0. Thenumber of abortions is 0 and number of live births is 1.Test-Taking Strategy: Knowledge and understanding of the GTPAL acronym will direct youto option 2. If you had difficulty answering this question, review this method of describingpregnancy outcomes.
7. 7. Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 018 (edited file)—"Obstetrical Assessment"10/14/08, Page 2 of 6, 0 Figure(s), 0 Table(s), 3 Box(es)Level of Cognitive Ability: ApplicationClient Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process/Data CollectionContent Area: Maternity/AntepartumReference: Wong, D., Perry, S., & Hockenberry, M. (2002). Maternal child nursing care (2nd).St. Louis: Mosby, p. 168.3. A nurse is collecting data during an admission assessment on a client who is pregnant withtwins. The client also has a 5-year-old child. The nurse would document which gravida and parastatus on this client?1. Gravida III, para II2. Gravida II, para II3. Gravida I, para I4. Gravida II, para IAnswer: 4Rationale: Gravida is a term that refers to a woman who is or has been pregnant, regardless ofthe duration of the pregnancy. Para is a term that means the number of pregnancies that haveprogressed past 20 weeks’ gestation. Parity does not reflect the number of fetuses or infants.Option 1, 2, and 3 are incorrect based on the above definition.Test-Taking Strategy: Knowledge of the terms gravida and para is necessary to answer thisquestion correctly. Review the description of these terms if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Communication and DocumentationContent Area: Maternity/AntepartumReference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, pp. 33-34.4. A primipara is being evaluated in the clinic during her second trimester of pregnancy. Whichof the following would indicate an abnormal physical finding necessitating further testing?1. Consistent increase in fundal height2. Fetal heart rate of 180 beats per minute3. Braxton Hicks contractions4. QuickeningAnswer: 2Rationale: The fetal heart rate depends on gestational age. It is 160 to 170 beats per minute inthe first trimester and slows with fetal growth to approximately 110 or 120 to 160 beats perminute. Options 1, 3, and 4 are normal expected findings.Test-Taking Strategy: Use the process of elimination. Note the key words, indicates anabnormal physical finding. Recalling the normal fetal heart rate will direct you to option 2.Review normal assessment findings in pregnancy if you had difficulty with this question.Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: Maternity/AntepartumReference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 78.
8. 8. Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 018 (edited file)—"Obstetrical Assessment"10/14/08, Page 3 of 6, 0 Figure(s), 0 Table(s), 3 Box(es)5. A nurse is providing instructions to a pregnant client with genital herpes about the measuresthat need to be implemented to protect the fetus. The nurse tells the client that:1. Daily administration of acyclovir (Zovirax) is necessary during the entire pregnancy.2. Total abstinence from sexual intercourse is necessary during the entire pregnancy.3. Sitz baths need to be taken every 4 hours while awake if vaginal lesions are present.4. A cesarean section will be necessary if vaginal lesions are present at the time oflabor. Answer: 4Rationale: For women with active lesions, either recurrent or primary at the time of labor,delivery should be by cesarean section to prevent the fetus from being in contact with the genitalherpes. The safety of acyclovir has not been established during pregnancy and should be usedonly when a life-threatening infection is present. Clients should be advised to abstain fromsexual contact while the lesions are present. If this is an initial infection, they should continue toabstain until they become culture-negative, because prolonged viral shedding may occur in suchcases. Keeping the genital area clean and dry will promote healing.Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 first becauseof the absolute word “entire” in these options. From the remaining options, recalling that thelesions should be kept clean and dry to promote healing will assist in eliminating option 3. Ifyou had difficulty with this question, review the content related to genital herpes as a maternalrisk factor.Level of Cognitive Ability: ApplicationClient Needs: Safe, Effective Care EnvironmentIntegrated Process: Teaching/LearningContent Area: Maternity/AntepartumReference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 338.6. A nurse is collecting data on a pregnant client who is at 28 weeks of gestation. The nursemeasures the fundal height in centimeters and expects the findings to be which of the following?1. 22 cm2. 28 cm3. 36 cm4. 40 cmAnswer: 2Rationale: During the second and third trimesters (weeks 18 to 30), fundal height in centimetersapproximately equals the fetus’ age in weeks plus or minus 2 cm. At 16 weeks, the fundus canbe located halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks, thefundus is at the umbilicus and, at 36 weeks, the fundus is at the xiphoid process.Test-Taking Strategy: Use the process of elimination. Remember that during the second andthird trimesters (weeks 18 to 30), fundal height in centimeters approximately equals the fetus’age in weeks plus or minus 2 cm. If you are unfamiliar with this data collection technique,review this content area.Level of Cognitive Ability: ComprehensionClient Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process/Data CollectionContent Area: Maternity/AntepartumReferences: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 192.Silvestri, 3/e, ISBN 1-1460-0052-6
9. 9. Chapter 018 (edited file)—"Obstetrical Assessment"10/14/08, Page 4 of 6, 0 Figure(s), 0 Table(s), 3 Box(es)Murray, S., McKinney, E., & Gorrie, T. (2002). Foundations of maternal-newborn nursing(3rd ed.). Philadelphia: W.B. Saunders, p. 425.7. A pregnant client is seen in the health care clinic for a regular prenatal visit. The client tellsthe nurse that she is experiencing irregular contractions. The nurse determines that the client isexperiencing Braxton Hicks contractions. Based on this finding, which nursing action isappropriate?1. Instruct the client to maintain bed rest for the remainder of the pregnancy.2. Instruct the client that these are common and may occur throughout the pregnancy.3. Contact the physician.4. Call the maternity unit and inform them that the client will be admitted in aprelabor condition.Answer: 2Rationale: Braxton Hicks contractions are irregular, painless contractions that may occurintermittently throughout pregnancy. Because Braxton Hicks contractions may occur and arenormal in some pregnant women during pregnancy, options 1, 3, and 4 are unnecessary andinappropriate actions.Test-Taking Strategy: Use the process of elimination. Options 3 and 4 are similar and can beeliminated first. From the remaining options, knowing that Braxton Hicks contractions arecommon and can occur throughout pregnancy will assist in directing you to option 2. If you haddifficulty with this question, review the physiology associated with Braxton Hicks contractions.Level of Cognitive Ability: ApplicationClient Needs: Health Promotion and MaintenanceIntegrated Process: Teaching/LearningContent Area: Maternity/AntepartumReference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 83.8. A nurse is reviewing the record of a client who has just been told that a pregnancy test ispositive. The physician has documented the presence of Goodell’s sign. The nurse determinesthat this sign is indicative of:1. A softening of the cervix2. A soft blowing sound that corresponds to the maternal pulse while auscultating the uterus3. The presence of human chorionic gonadotropin (hCG) in the urine4. The presence of fetal movementAnswer: 1Rationale: In the early weeks of pregnancy, the cervix becomes softer as a result of pelvicvasoconstriction, which causes Goodell’s sign. Cervical softening is noted by the examinerduring pelvic examination. A soft blowing sound that corresponds to the maternal pulse may beauscultated over the uterus and is due to blood circulation through the placenta. hCG is noted inmaternal urine in a positive urine pregnancy test. Goodell’s sign does not indicate the presenceof fetal movement.Test-Taking Strategy: Use the process of elimination and knowledge regarding the physiologicalfindings in Goodell’s sign to answer this question. Remember that Goodell’s sign refers to asoftening of the cervix. If you had difficulty with this question, review the changes in the cervixthat occurs during pregnancy.Level of Cognitive Ability: Comprehension