NUR 504 Exam 3 Practice Questions and
Solutions
Initial Prenatal Subjective Assessment ✅First prenatal visit: like it to be around 10-12
weeks or so ideally, but may not be coming in until much later...If come in later may
need to add in other things.
Current pregnancy: when LMP was, helps determine due date. Also want to know
subjective s/s if any...such as vomiting, breast tenderness, fatigue...want to know if
periods regular, Irregular bc may change how accurate due date may be...might want to
know if she was on any birth control during the time of conception, and if
planned/unplanned (unplanned doesn't necessarily mean unwanted)...
Past pregnancies: her GTPAL status, what happened with pregnancies, if there was any
significant conditions, complications, issues with previous pregnancies/deliveries, what
type of anesthesia she used and if there was any issues with that.
GYN history: when last pap smear was and results of that, if she has had any abnormal
GYN conditions, what they were, and what was done about them...about any GYN
surgeries and outcome of surgeries, STIs history, sexual partner history,
Current medical history: what conditions, disorders does she have currently,
medications (prescription and OTC), allergies, prepregnancy weight. General health
including her nutrition. Current immunization status for various immunizations we have
gone over. If she has had any illnesses or exposures since she has been pregnant (got
the flu or whatever).
Past medical history: normal quesitons as we would. Both her own and her family's.
Close attention to genetic disorders that may be passed along.
Religious/cultural history: Special religious or cultural beliefs or practices that may
impact what we do in pregnancy or delivery.
Occupational history: does she work outside the home. Is anything she does at work
harmful or concerning for pregnancy?
FOB history (father of baby): His medical history as well bc
Factors that Might Make Pregnancy High Risk ✅Social: If she does drugs, if she
doesn't have money for prenatal care, suspect domestic abuse, doesn't have a support
system available to her, age above 35 or very young, does she feel physically and
emotionally ready? If having children very close together,
Medical: Anything medical technically could cause issues, but might be exceptionally
concerned with suicidal tendencies, hypertension, diabetes, cancer, any heart condition,
HIV, thyroid or renal conditions, autoimmune disorders.
OB: Miscarriages, ectopic pregnancies, many elective abortions, Rh factor if she is
negative, any previous complications like placental abruption, placental previa,
preeclampsia,
Initial Prenatal Objective Assessment ✅• VS/Ht/Wt
• Urine specimen collection
,• Head-to-toe general assessment
o Uterine/Pelvic examination last
• EDC/EDD/EDB
o If LMP unknown, may need to use objective assessment to determine due date
• Fetal HR
o Doppler
• Can start to hear it with Dooppler around 10-12 weeks.
o Electronic fetal monitoring equipment
• Uterine Assessment
o Fundal height: first half of pregnancy we feel for fundus and measure distance from
symphysis pubis and umbilicus, At 12 weeks we will be able to feel it right over and
above symphysis pubis. Then at 16 weeks, midway between symmphysis pubis and
umbilicus. At 20 weeks, at level of umbilicus.
• McDonald's method: Between weeks 22-34 we can use McDonald method- we are
taking tape measure and measuring from symphysis pubis to top of uterus (fundus) and
measuring in cm.
• What normal limits is considered it # of cm should equal number of weeks + or - 2. If
28 weeks, normal limits would be 26-30cm. 32 weeks, WNL would be 30-34. Not valid if
past 34 weeks. Only valid between 22-34 weeks.
• Pelvimetry (Pelvic Assessment)
o Inlet
o Pelvic cavity (midpelvis)
o Outlet
o Using fingers and feeling outlet of pelvis trying to gather relative size, shape, whether
it seems favorable for vaginal delivery...such crude data though so not used for much
other than to know that delivery may be not feasible...
• Labs
o CBC: baseline lab levels, H&H, platelets, RBCs
o VDRL/RPR/STS (reactive/nonreactive or positive/negative): tests for syphilis. If
reactive/positive we give penicillin to treat.
o GC/Chlamydia culture (negative or positive): Gonorrhea or Chamydia
o Pap smear (normal or abnormal cytology): tells us whether normal or abnormal
cytology.
o U/A: to confirm pregnancy typically at initial visit
o HbsAg (reactive/nonreactive or positive/negative): hepatitis B surface antigen, we
want it to be nonreac
Subsequent Prenatal Visits ✅• Frequency
o First 28 weeks: every 4 weeks
o 28-36 weeks: every 2 weeks
o After 36 weeks: every week (maybe twice a week if very close to due date)
• Vitals-consistency in taking is key-compare to baseline
• Weight (compare to first visit weight)
o First trimester: 31/2 to 5 lbs
o Second trimester: 12 to 15 lbs
o Third trimester: 12 to 15 lbs
, o Overall weight gain: 25-35 lbs is standard, assuming average weight individual to start
with. If underweight may want them to gain more, or if overweight may want them to
gain a little less.
• General physical assessment
• Uterine size
• FHR
• Specimen collection as needed
o Blood
• CBC
• Regular screening as described in part 2 of unit 5 ppt
o Urine: dipstick to check for things like blood, leukocytes, protein, ketones, that aren't
supposed to be there. If are spilled into urine need to assess further.
o Cervical swabs
• Taken as indicated in part 2 of unit 5, or otherwise if patient symptomatic
• Psychological adjustment
o Mother
• 1st trimester-period of adjustment
• 2nd trimester-period of radiant health
• 3rd trimester-period of watchful waiting
o Father
• 1st trimester
• 2nd trimester
• 3rd trimester
• Educational needs
o Self-care during pregnancy
o Sexual activity
o Preparation for parenting
o Preparation for childbirth
o Signs of labor
o Abnormal s/s that necessitate physician notification
Uterus Changes ✅Changes from a small, almost solid pear-shaped organ measuring
approx. 7.5 x 5 x 2.5 cm and weighing about 2 oz to a size of approx. 28 x 24 x 21 cm
and weighing about 2.5 lbs. (you don't need to memorize these sizes and weights, it is
just to give you a frame of reference).
Its capacity increases from 10ml to 5000 ml or more.
Change in size is mainly d/t increase in size of the existing myometrial cells. Only a
limited increase in cell # occurs. Uterine wall thickens in the first few months of
pregnancy then thins as the musculature distends.
Fundus can be palpated, beginning when uterus is no longer a pelvic organ just above
pubic bone at 12 weeks, midway between the symphysis pubis and umbilicus at 16
weeks, at the umbilicus at mid-pregnancy (20 weeks) and just below diaphragm around
36 weeks.
Cervix Changes ✅Major component of cervical tissue is connective tissue, which is
rearranged as pregnancy progresses. Endocervical glands produce a thick, tenacious
