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PRNU 129 Review Questions

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RN examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's priority would be to
Massage the fundus
A woman gave birth vaginally to a 9-pound, 12 ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders?
She has an episiotomy
The laboratory results for a postpartum woman are as follows; blood type A; Rh status positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret these data:
Rubella vaccine should be given
Part of the health assessment of newborn is observing the infant's breathing pattern. A full-term newborn's breathing pattern is predominantly
Abdominal with synchronous chest
A first time father is changing the diaper of his 1 day old daughter. He asks the nurse, "What is this black sticky stuff in her diaper?
Meconium
An African-American woman noticed some bruises on her newborn girl's buttocks. She asked the nurse who spanked her daughter the nurse explains that it is
Mongolian Spot
The parents of a newborn ask the nurse how much the newborn can see the parents specifically want to know what type of visual stimuli they should provide for their newborn the nurse responds to the parents by telling them
The infant can track their parent's eyes and distinguish patterns, they prefer complex patterns
An infant body was just born a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. The apgar assessment is performed
at least twice, 1 minute and 5 minutes after birth
The normal term infant has little difficulty clearing its airway at birth. Most secretions are brought up to the oropharynx by the cough reflex. However, if the infant has excess secretion, the mouth and nasal passages can be cleared easily with a bulb syringe. When instructing the parents on the correct use of the piece of equipment it is important to teach the parents to suction
mouth first
A new father wants to know what medication was put into his infants eyes and why it was needed. The nurse explains to the father that the purpose of the ophthalmic ointment is to
prevent gonorrhea and chlamydia infection of the infant's eyes potentially from the birth canal
In the classification of newborns by gestational age and birth weight, the appropriate gestation age (AGA) weight would
fall between the 10th and 90th percentiles for the infant's age
A newborn is jaundices and receiving phototherapy via ultraviolet bank lights. An appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy by this method would be to
place eye shields over the newborn's eyes
A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home?
Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change
With regard to fetal positioning during labor, nurses should be away that: birth is imminent at
4+ or 5+
With regard to primary and secondary powers, the maternity nurse should know that:
Primary powers are responsible for effacement and dilation of the cervix
To adequately care for a laboring woman, the nurse should know which state of labor varies the most in length
First stage
How do you assess cervical change
Vaginal Exam
The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are caused by
uteroplacental insufficiency
The nurse providing care for the laboring woman should understand that variable fetal heart rate (FHR) decelerations are caused by
umbilical cord compression
A nurse might be called on to stimulate the fetal scalp
to elicit an acceleration in FHR
When using intermittent auscultation IA for fetal heart rate nurses should be aware that:
you can order an ultrasound and look for the best place to listen for FHR
According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR):
In the active phase of the first stage of labor, the FHR should be auscultated every 30 min if no risk factors are involved
To help patients manage discomfort and pain during labor, nurses should be aware
the predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen- this pain comes from cervical changes, distention of the lower uterine segment, and uterine ischemia
Referred pain occurs when
the pain that originates in the uterus radiates into the abdomen
Nursing care measures are commonly offered to women labor, which nursing measure reflects application of the gate-control theory
massaging the women's back
A first-time mother is concerned about the type of medications she will received during labor she is in a fair amount of pain
sedatives can be used to reduce the n/v that often accompany opioid use in addition some ataractics reduce anxiety and apprehension and potentiate the opioid analgesic affects
A woman in labor has just received spinal anesthesia. The most important nursing intervention is to:
Monitor the maternal blood pressure for possible hypotension
A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's IV fluid for a preprocedural bolus. She reviews her lab values and noes her hemoglobin is 12 g/dl hematocrit is 38% and platelets are 67,000 and white
thrombocytopenia
Several changes in the integumentary system that appear during pregnancy disappear after birth, although not always completely. What change is almost certain to be completely reversed?
Nail brittleness disappears
Excessive blood loss after child birth can have several causes, the most common is:
Failure of the uterine muscle to contract firmly-atony
With regard to the newborn's developing cardiovascular system, nurses should be aware that:
The point of maximal impulse (PMI) often is visible on the chest wall
At 1 min after birth the nurse assesses the infant and notes: a HR of 80 beats/min, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. The nurse would calculate and Apgar score of:
5
• When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for ___ has increased
Intrauterine Infection
After an emergency birth (birth may be unexpected place, not in typical facility with things you would normally have to deal with the birth) , the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to:
Stimulate the uterus to contract
In helping the breastfeeding mother position the baby, nurses should keep in mind that:
Whatever the position used, the infant is "belly to belly" with the mother/Don't want to have the baby's head turned, this can cause latching problems
Which description of the phases of the second stage of labor is accurate:
Descent phase: Significant increase in contractions, Ferguson reflex activated, average duration varies
While evaluating an external monitor tracing of a woman in active labor who is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should:
Document the finding in the patients records
The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat:
o Variable decelerations- caused by cord pressure, used to help when there is no amniotic fluid to relieve that pressure
After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, and buttocks and down her thighs. Before implementing a plan of care the nurse should understand that this type of pain is
Referred
As part of standard precautions, nurses wear gloves when handling the newborn, The chief reason is:
To protect the nurse from contamination by the newborn
A woman arrives at the clinic seeking confirmation that she is pregnant. The following info is obtained; 24 years old, BMI-17.5, she admits to having used cocaine several times during the past year and drinks alcohol occasionally. BP 108/70, pulse 72 bpm, resp. 16 bpm, family history diabetes mellitus and cancer. her sister recently gave birth to an infant with neural tube defect NTD Which characteristics place her at a high risk category
Family history of NTD, low BMI, and substance abuse are all high risk factors
When nurses help their expectant mother assess the daily fetal movement counts, they should be aware that:
the fetal alarm signal should go off when the fetal movements stop entirely for 12 hours
In 1st trimesters ultrasonography can be used to gain information on
Uterine Abnormalities
A 39 year old primagravida thinks she is about 8 weeks pregnant although she has had irregular menstrual periods her life history of smoking approx. one pack of cigarette a day tell you she trying to cut down, lab within normal limits
Ultrasound
41 week pregnant multigravida present in labor and delivery unit after a non-stress test indicated that her fetus could be experiencing some difficulties in utero, which diagnostic tool would yield more detailed info about the fetus:
Biophysical Profile
Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with
congenital anomalies in the fetus
In assessing knowledge of pregestational woman with type I diabetes concerning changing insulin needs during pregnancy the nurse recognizes that further teaching is warranted when the woman states
I will need to increase my insulin dosage during the first 3 months of pregnancy
Screening at 24 weeks of gestation reveals that a normal weight pregnant woman has gestational diabetes mellitus (GDM) in planning her care nurse and woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM the nurse identifies that the fetus is at greatest risk for
Macrosomia
• A 26 year old primigravida comes to clinic for regular prenatal visit at 12 weeks appears thin nervous, reports eats well balanced diet, although her weight is 5 pounds less than it was at her last visit, lab studies confirm she has a hyperthyroid condition, based on data from the nurse formulate a plan of care, what nursing diagnosis is most appropriate for the woman at this time
Imbalanced nutrition: less than body
In caring for a pregnant women with sickle cell crisis, the nurse understands that management of this patient includes all except
Antibiotics
Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women the 4 P's plus is a screening tool designed specifically or identify when there is a need of a more in depth assessment the 4 Ps include all except:
Present
A primigravida is being monitored in her prenatal clinic for preeclampsia, which finding should concern her nurse
A dipstick value of 3+ for protein in her urine
A pregnant woman has been receiving magnesium sulfate infusion for tx. of preeclampsia for 24 hr., on assessment temp 37.3 degree c, pulse rate 88 bpm respiratory rate of 10 breaths/min blood pressure of 128/90 mm hg absent deep tendon reflexes and no ankle clonus the pt. complains I'm so thirsty and warm"
Discontinue the magnesium sulfate infusion
The perinatal nurse is giving instructions to a woman, stay she must take two post-suction curettage secondary to a hydatidiform mole, the woman asks why she must take oral contraceptives for 12 months the best response
The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produced during pregnancy, if you were to get pregnant it would make the diagnosis of this cancer more difficult
The most prevalent clinical manifestation of abruptio placenta as opposed to placenta previa is
Abdominal pain
In caring for the woman with disseminated intravascular coagulation (DIC) what order should the nurse anticipate
Administration of blood
In planning for home care of a woman with preterm labor, the nurse needs to address what concern:
prolonged bed rest may cause negative physiological effects
A woman in preterm labor at 30 weeks of gestation receives 2 12 mg doses of betamethasone intramuscularly, The purpose of this pharmacologic treatment is to:
antenatal glucocorticoids given as intramuscular injections to the mother to stimulates fetal lung maturation (surfactant)
A primigravida 40 weeks gestational is having uterine contractions every 1 ½ to 2 minutes and says that they are very painful, her cervix is dilated 2 cm and has not changes in 3 hours. The woman is crying and wants an epidural what is likely status of this woman's labor
hypertonic
A woman is having her first child. She has been in labor for 15 hours, 2 hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0, 5 mins ago her vaginal examination indicated that there had been no change what abnormal labor pattern is associated with this description
Secondary arrest
A pregnant woman's amniotic membranes have ruptured prolapsed cord is suspected. What intervention would be the top priority
Placing the woman in knee to chest position
Premature infants who exhibit 5-10 seconds of resp. pauses followed by 10-15 seconds of compensatory rapid respiration are:
breathing in a respiratory pattern common to premature infants
An infant is to receive gastronomy feeding what intervention should the nurse institute to prevent bloating, GI reflux into the esophagus. Vomiting, and respiratory compromise
slow small warm bolus feedings over 20-30 mins
NEC inflammatory disease of the GI mucosa, the signs of NEC are nonspecific some generalized signs are:
abdominal distention, temp instability and grossly bloody stools
Nurse practicing in perinatal setting should promote kangaroo care regardless of infants gestational age, this intervention should
help infants to interact directly with their parents and enhances their temperature regulation
A woman arrives at the clinic for a pregnancy test, Last Menstrual period was Feb 14, 2012, her expected date of birth would be
Nov 21
Which blood pressure finding during 2nd trimester indicates risk for pregnancy induced hypertension
100/70 --> 130/85
Prenatal testing for the human immunodeficiency virus HIV is recommended for which women
all women regardless of risk factors
With regard to work and travel during pregnancy nurses should be aware that: while working or traveling in a car or on a plane
women should arranged to walk around at least every hour or so
A woman is recovering at the gynecologists office following a late first trimester spontaneous abortion, at this time it is essential for the nurse too check which of the following:
Maternal blood type
A newborn admitted to nursery has a positive direct Coomb's test. Which of the following is an appropriate action by the nurse?
Monitor baby for jaundice
A 36-week gestation woman lies flat on her back. Which of the following maternal signs/ symptoms would not be unanticipated?
Diziness
A baby was just born to a mother who had positive vaginal cultures for group B strep. The mother was admitted to labor 2 hours before the birth. Which of the following should the nurse closely observe for in this baby
Hypothermia
4 babies are in the newborn nursery. The nurse pages the neonatologist to see that baby who exhibits what?
o Intercostal retractions
o Erythema toxicum
o Pseudostrabismus
o Vernix caseousa
Intercostal retractions
A pregnant woman informs the nurse that her last normal menstrual period was on Sep 20, 2012, using Nagele's rule the nurse calculates the clients EDD as:
June 27, 2013
A nurse suspects that a client has been physically abused. The woman refuses to report the abuse to the police. Which statement by the client suggests to the nurse that the relationship may be in the "honeymoon phase'
My partner said that he will never hurt me again
Four 38 gestation woman have just deliver. Which of the babies should be monitored closely for respiratory distress
o Baby whose mother has DM (diabetes mellitus)
o Baby whose mother has lung cancer
o Baby whose mother has hyperthyroidism
o Baby whose mother has asthma
Baby whose mother has DM (diabetes mellitus)
A patient has been diagnoses with gestational diabetes! I will never be able to give myself shots!" Which response by the nurse is most appropriate?
If you exercise and follow your diet your will probably not need insulin
A 24 week pregnant client is being seeing the prenatal client. She states, "I've had a terrible headache for the past few days, Which is the priority assessment
Take her BP
A pregnant woman, 36 weeks gestation with DM 1 has just had a BPP (biophysical profile). Which of the following results should be reported?
One fetal heart acceleration in 20 mins
A gravid woman with sickle cell anemia is admitted in vaso-occlusive crisis. Which of the following is the priority intervention that the nurse must perform
Infuse IV hydration
A lecithin; sphignomyelin (L/S) ratio has been ordered, What will be learned from the test?
Maturation of fetal lungs
A 26-week gestation woman is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms
Epigastric pain
Which finding should nurse expect when assessing a client with placenta previa
Painless, vaginal bleeding
A woman has just been admitted to the ER subsequent to head-on automobile accident. Her body appears to be uninjured. The nurse monitor for which complications of pregnancy
Placental Abruption
Type I diabetic is being seen for preconception counseling. The nurse should emphasize that during the first trimester the woman may experience which of the following
Need for less insulin that she normally injects
A nurse is performing an assessment on four 22-week pregnant clients. The nurse reports to the OB that which of the clients may be carrying twins:
Fundal height measurement 26
The perinatal nurse is caring for a woman in the immediate post birth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is
Uterine Atony
The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by
Using proper breastfeeding techniques
The prevalence of urinary incontinence increases as women age, with more than 1/3 of women in the US suffering from some form of this disorder. The symptoms of mild to moderate-to-mild UI can be successfully decreased by a number of strategies, which of these should the nurse instruct the patient to do first
bladder training and pelvic floor exercises
When a woman is diagnosed with PPD with psychotic features, one of the major concerns is that she may
Harm her infant
At 35 weeks of pregnancy a women experiences preterm labor, tocolytics administer, placed on bed rest, experiences regular uterine contractions, her cervix is beginning to dilate and efface, what would be an important test for fetal well- being at this time:
Amniocentesis for L/S ratio to assess fetal lung maturity
A 39 year old primagravida thinks she is about 8 weeks pregnant although she has had irregular MP her entire life, history of smoking one pack of cigarettes a day, she tells you that she is trying to cut down. Her lab data are within normal limits what diagnostic (should be screening) technique could be used with this pregnant woman at this time
Ultrasound
With what heart conditions is pregnancy not usually contraindicated
Heart transplant
When caring for a pregnant woman with cardiac problems the nurse must be alert for s/sx of cardiac decompensation, which are
Dyspnea, crackles, an irregular weak pulse
The nurse providing care for woman with gestational diabetes understands that a lab test for glycosated hemoglobin A1C:
Would be considered evidence of good diabetes control with a result of 2.5%-5.9%
A woman presents to ED complaining of bleeding and cramping, the initial nursing history is significant for a last menstrual period of 6 weeks ago, on sterile speculum examination the primary care provider finds cervix is closed. The anticipated plan of care for this woman is based on probable diagnosis of which of the following types of spontaneous abortion
Threatened
Nurses should be aware chronic hypertension
Can occur simultaneously with gestational hypertension
A PHYSICIAN ORDERED Pitocin for induction of 4 women, in which of the following situations should the nurse refuse to comply with the order
Primigravida with a transverse lie
A woman is 36 weeks gestation, which of the following tests should be done during her next prenatal visit
Vaginal and rectal cultures
Pregnant for the 3rd time, all of her children are living, 1 child born at 39 weeks, twins born at 34 weeks, another child born at 35 weeks of gestation
4-1-2-0-4
A woman is at 14 weeks gestation, the nurse would expect to palpate the fundus at which level
Slightly above pubic symphisis
Cardiovascular system changes in pregnancy, which finding would be normal of a woman in her second trimester
Increased pulse rate
Appendicitis may be difficult to diagnose in pregnancy because the appendix is
Displaced upward and laterally, high and to the right
The nurse must be cognizant that an individual's genetic makeup is known as
Genotype
Regarding the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that
The risk factor remains the same no matter how many affected children are in the family
A father and a mother are carriers of phyneulketonuria (PKU). Their 2 year old daughter has PKU. The couples tell the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby won't be affected what response by the nurse is most accurate
You are both carriers, so each baby has 25% of being affected
A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur. Which response by the nurse is most accurate
They occur between the 3rd and 5th weeks of development
With regard to the structure and function of the placenta the nurse should be aware
As one of its early functions, the placenta acts as an endocrine gland
The nurse is providing genetic counseling to an expectant couples who already gave a child with trisomy 18, the nurse should
Discuss options with the couple, including amniocentesis to determine whether the fetus is affected
The nurse caring for a laboring women should know that meconium is produced by
Fetal intestines
In practical terms regarding genetic health care, nurses should be aware that
The most important of all nursing function is providing support to the family during counseling
With regard to prenatal genetic testing, nurses should be aware
Maternal serum screening can determine whether a pregnant woman is at risk of carrying a fetus with down syndrome
The ___ is/are responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream
Chorionic villi
With regard to follow-up visits for women receiving prenatal care, nurses should be aware that:
During the abdominal examination, the nurse should be alert for supine hypotension
Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnancy woman to her health care provider
Vaginal bleeding
While evaluating an external monitoring tracing and in active labor, the nurse notes that the fetal heart rate (FHR) for 5 sequential contractions begins to decelerate late in the contraction with nadir of the decelerations occurring after the peak of contraction, the nurse's first concern is
Change the women's position
The nurse caring for a laboring women should understand that early decelerations are caused by
Altered fetal cerebral blood flow
During labor a fetus with an average heart rate of 135 beat/min over a 10 min period would be considered to have
A normal baseline heart rate
Nurse teaches pregnancy women about characteristics of true labor contractions, the nurse evaluated the woman understands
True labor contractions will continue and get stronger even if I relax and even if I relax and take a shower
Nulliparous woman telephones the hospital to report that she is in labor, the nurse should initially
Ask the women to describe why she believes she is in labor
A new mother states that her infant must be cold because the baby's hands and feet are blue, The nurse explains that this is a common and temporary condition called
Acrocyanosis
While evaluating reflex of newborn, nurse notes with loud noise the newborn systemically abducts and extends his arms, his fingers fan out and forma a C with the thumb and forefinger, and he has a slight tremor, the nurse would document positive
Moro reflex
While assessing skin of 24 h old newborn, the nurse notes a pink popular rash with vesicles superimposed on the thorax, back and abdomen, the nurse should
Document the finding as erythema toxicum
With regard to the functioning of the renal system in newborns, nurses should be aware that
The pediatrician should be notified if the newborn has not voided in 24 hours
A collection of blood between the skull bone and its periosteum is known as cephalohematoma. To reassure the new parents infants develops such a soft bulge it is important that the nurse be aware
May occur with spontaneous vaginal birth
A woman gave birth to an infant boy 10 hours ago, Where would the nurse expect to locate this woman's fundus
One centimeter above the umbilicus
Which woman is most likely to experience strong after pains
Gravida 4, para 4-0-0-4
2 days ago a woman gave birth to a full term infant, Last night she awakened several times to urinate and notes that her gown and bedding were wet from profuse diaphoresis. One mechanism for the diaphoresis and diuresis that this woman is experiencing during the early postpartum periods is
Loss of increased blood volume associated with pregnancy
All of these statements indicate impacts of breastfeeding on the family or society at large except
Breast feeding costs employers in terms of time lost from work
With regard to the care management of preterm labor, nurses should be aware
The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change
Nurses should be aware that induction of labor
Is rated for viability by a bishop score
• A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness
Thrombopheltbitis
What statement about multifetal pregnancy is not accurate
Twin pregnancies come to term with the same frequency as single pregnancies
With regard to medications, herbs, shots, and other substances normally encountered
Both prescription and OTC drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus
Which statement about pregnancy is accurate
A normal pregnancy lasts about 10 lunar months
When assessing a women in first stage of labor the nurse recognizes that the most conclusive sign that uterine contraction are effective would be
Dilation of cervix
With regard to use of intrauterine devices (IUD) nurse should be aware
IUDs containing cooper can provide an emergency contraception option if inserted within a few days of unprotected intercourse
When assessing a women in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal
Attitude
The most critical nursing action in caring for the newborn immediately after birth is
Keeping the newborn's airway clear
On vaginal examination of 30 year old women nurse documents the following findings: profuse, thin, grayish white vaginal discharge with a "fishy" odor, complaints of pruritus, On the basis of these findings the nurse suspects that this women has
Bacterial vaginitis (BV)
With regard to hemolytic disease of the newborn, nurses should be aware that
The indirect Coombs test is done on the mother on the cord blood after birth
While assessing the newborn he nurse should be aware that the average expected apical pulse range of a full-term quiet/alert newborn is
120-140 bpm
A woman has thick, white lumpy cottage cheese like discharge, with patches on her labia and in her vagina. She complains of intense pruritus the nurse practitioner would order which preparation for treatment
Fluconazole
Which condition not uncommon in pregnancy is likely to require careful medical assessment during puerperium
Headaches
Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes?
Herpes simplex virus
A woman will be taking oral contraceptive using s 28-day pack. The nurse should advice this women to protect against pregnancy by
Taking one pill at the same time every day
The 2 primary areas of risk for sexually transmitted infections (STIs) are
Risky sexual behavior and inadequate preventive health behaviors
A man smokes 2 packs of cigarettes a day, he wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant, the nurse's most appropriate response is
Smoking can reduce the quality of your sperm
When evaluating women for STIs, the nurse should be aware the most common bacterial sexually transmitted infection is
Chlamydia
To adequately care for laboring women the nurse should know which stage of labor varies the most in length
first
26 year old women G2 P1 is 28 weeks pregnancy when she experiences bright red, painless vaginal bleeding. She has not previously had any prenatal care for this pregnancy. Upon arrival at the hospital what would be an expected diagnostic procedure:
Ultrasounds for placental location
Which contraceptive method protects against sexually transmitted infections and HIV
Barrier methods