NR602 Exam 100% Correct!!
Presumptive signs of pregnancy - ANSWERSubjective signs. Amenorrhea, nausea, vomiting, increased
urinary frequency, excessive fatigue, breast tenderness, quickening at 18-20 weeks.
Probable signs of pregnancy - ANSWERObjective Signs. Goodell sign (softening of cervix), Chadwick
sign (cervix is blue/purple), Hegar's sign (softening of lower uterine segment), uterine enlargement,
Braxton Hicks contractions (may be plapated by 28 weeks), uterine souffle (soft blowing sound due to
blood pulsating through the placenta), integumentary pigment changes, ballottement, fetal outline
definable, positive pregnancy test (could be hydatidiform mole, choriocarcinoma, increased pituitary
gonadotropins at menopause).
Positive signs of pregnancy - ANSWERDiagnostic. Fetal heart rate auscultated by fetoscope at 17-20
weeks or by Doppler at 10-12 weeks, Palpable fetal movement after 20 weeks, visualization of fetus
with cardiac activity by ultrasound (fetal parts visible by 8 weeks).
Pregnancy and fundal height measurement - ANSWERAs pregnancy progresses, the fundus rises out
of the pelvis. At 12 weeks gestation, the fundus is located at the level of the symphysis pubis and the
umbilicus. By 20 weeks gestation, the fundus is at the same height as the umbilicus. Until term, the
fundus enlarges 1 cm per week. As the time for birth approaches, the fundal height drops slightly.
This process is called lighting and occurs mostly for primigravida and may not occur for woman who
are multigravida until she goes into labor.
Naegele's rule - ANSWERThe EDB for women with 28 day cycles - Nagele's rule - Add 7 days to LMP
then subtract 3 months.
Example: 4/23 LMP of April 23 + 7 days = 4/30 (April 30th) - 3 months = January 30th (following year)
Hematological changes during pregnancy - ANSWERDuring pregnancy, the heart is displaced upward
and to the with withing the chest cavity by the gravid uterus's pressure on the diaphragm. As
pregnancy progresses, the risk for inferior vena cava and aortic compression leading to supine
hypotension increases when the woman lies in a supine position. Advice pregnant women to lie left
lateral position. Cardiac output in pregnancy increases by 30-50%. Peaks in early third trimester and
maintained until birth. Stroke volume is also increased during pregnancy by 20-30% which allows for
the 30% increase in oxygen consumption observed during pregnancy. Heart rate and heart sounds
changes. Volume of the first heart sound may be increased with splitting. 3rd heart sound may be
detected. Systolic murmurs may be detected. Increase of 15-20 beats/min by 32 weeks gestation. BP
decreases by 5-15 mm Hg due to peripheral vascular resistance. 1st and 3rd trimester should be pre-
pregnancy values. Blood volume increases by 30-50% and peaks at 30-34 weeks gestation. 75% of
the increase of blood volume is plasma. Blood volume changes results in anemia due to the
hemodilution. Clotting factors increase as well creating a risk for clotting during pregnancy.
Indications and contraindications for prescribing combined estrogen birth control -
ANSWERCombined Estrogen - Take everyday, has hormone free intervals of 7 days,
Indications - Safe for healthy women. Studies show a decrease in the possibility of endometrial or
cervical cancer not found with the mini pill or POP.
Contraindications - direct effects of the hormonal ingredient, as in breast cancer, or
thromboembolism.
, Indications and contraindications for prescribing progesterone-only birth control -
ANSWERProgesterone-only - Mini pill - must take every day at the same time and there are no
hormone free intervals. These pills only thicken the cervical mucus to prevent pregnancy. Make the
mucus thick for 22 hours so it needs to be taken constantly to avoid the mucus to return to regular
consistency.
Indications - POPs are a safe method for many women who cannot take estrogen for medical
reasons. POPs are preferable to COCs for lactating women because they do not cause adverse effects
on the volume or quality of breastmilk.
Contraindications - almost none.
menarche - ANSWERThe initiation of menstruation, called menarche, usually happens between the
ages of 12 and 15
Influenza (flu)a - ANSWERWomen who are pregnant are at increased risk for flu-related
complications.
Any gestation when the injection is available
Tetanus, diphtheria, pertussis (Tdap) - ANSWERAfter maternal vaccination, antibodies cross the
placenta and decrease the risk of pertussis infection in the newborn.
Third trimester (ideally 27-36 weeks' gestation)
Hepatitis B - ANSWERIf the woman is at risk for acquiring HBV, she should be vaccinated. Indications
include risk of occupational exposure to blood, treatment for a sexually transmitted infection, more
than 1 sex partner in the past 6 months, recent intravenous drug use, and HBsAg-positive sex
partner. 3 injections beginning at any point in gestation
Measles, mumps, rubella - ANSWERThis live virus vaccine has a (theoretical) risk to the fetus.
Varicella - ANSWERThis live virus vaccine has a (theoretical) risk to the fetus.
Sperm can live for up to 5 days in the female reproductive tract, and pregnancy can occur with
intercourse 5 days prior to ovulation. The highest risk of pregnancy is... - ANSWERin the 48 hours
immediately preceding ovulation
Tier 1 methods of contraception and efficacy - ANSWERMost effective - less than 1 per 100
pregnancies - Vasectomy, implant, tubal occlusion, and IUD. After procedure, little or nothing to do or
remember Vasectomy: Use another method for first 3 months.
Tier 2 methods of contraception and efficacy - ANSWER4-7 pregnancies per 100 woman - Injectable:
Get repeat injections on time Pills: Take a pill each day Patch, ring: Keep in place, change on time.
Tier 3 methods of contraception and efficacy - ANSWERLeast effective - Condoms, sponge,
withdrawal, spermicides, diaphragm: Use correctly every time you have sex Fertility awareness-
based methods: Abstain or use condoms on fertile days. Newer methods (Standard Days, Natural
Cycles, and Symptothermal may be easier to use and consequently more effective).
most common cause of amenorrhea - ANSWEROvarian function abnormalities are the most common
cause of amenorrhea, and estrogen production is the most reliable measure of ovarian function
A random serum estradiol level that is greater than 40 pg/mL indicates... - ANSWERfunctioning
ovaries
