NR602 Exam Questions and Answers
100% Correct
Presumptive signs of pregnancy - ANSWER-Subjective signs. Amenorrhea, nausea,
vomiting, increased urinary frequency, excessive fatigue, breast tenderness, quickening
at 18-20 weeks.
Probable signs of pregnancy - ANSWER-Objective 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 - ANSWER-Diagnostic. 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 - ANSWER-As 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 - ANSWER-The 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 - ANSWER-During 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 -
ANSWER-Combined 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.
, 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... -
ANSWER-in the 48 hours immediately preceding ovulation
Tier 1 methods of contraception and efficacy - ANSWER-Most 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 - ANSWER-4-7 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 - ANSWER-Least 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).
Indications and contraindications for prescribing progesterone-only birth control -
ANSWER-Progesterone-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 - ANSWER-The initiation of menstruation, called menarche, usually happens
between the ages of 12 and 15
