NUR 254 EXAM 1 STUDY GUIDE FOR EXAM 1 REVIEW,
LATEST 2024/2025, BEST FOR EXAM PREPARATION - GALEN
COLLEGE OF NURSING
Unit 1-Antepartum Ch.7 p. 150-165 Ch. 8 p.166- 201 Ch.9 p.205-225 Vocabulary
Gravida: pregnant Gravidity: Pregnancy Nulligravida: never Primigravida: pregnant
woman been pregnant & not 1sttime
currently pregnant
Multigravida: 2 or Parity: # of pregnancies Nullipara: pregnancy Primipara:1 pregnancy
more pregnancies reached 20wks gestation not reached 20wks has reached 20wks
gestation gestation or more
Multipara: 2 or more Preterm: reached 20wks but Late preterm: has Early preterm: Has reached
pregnancies reached ends before 37wks 0days reached between 34wks 37wks 0days- 38wks 6days of
20wks or more gestation 0days-36wks 6days of gestation
gestation
Full term: has reached Late term: has reached Post-term: has reached Viability: capacity to live
39wks 0days- 40wks 41wks 0days- 41wks 6days 42wks 0days & beyond outside uterus; no clear
6days gestation age/wt. infants born
22-25wks on threshold of
viability & are especially
vulnerable to brain injury if
they survive
● The acronym GTPAL (gravidity, term, preterm, abortions, living children) can be helpful in remembering this system
of notation.
● Pregnancy test based on hCG or a beta subunit of hCG. Beta hCG begins as early as day of implantation & can be
detected in maternal serum or urine as soon as 7-8 days before menses. hCG levels usually double Q2days for 1 st 4
wks.
● Higher than normal hCG = abnormal gestation (down syndrome, gestational trophoblastic disease) or multiple
gestation. Abnormally slow increase in hCG or lower levels = impending miscarriage or ectopic pregnancy.
● Interpreting pregnancy test= woman’s hx., date of last normal menstrual period, usual cycle length, & results of
previous pregnancy tests. Important to know meds. Pt. is on. Anticonvulsants & tranquilizers can cause false-
positives, whereas diuretics & promethazine can cause false-negatives.
● S/S of pregnancy (3) $$pg.152 table 7.2 : 1. Presumptive-subjective amenorrhea, fatigue, breast changes, 2. Probable-
objective hegar sign, ballottement, pregnancy test along w/ presumptive s/s., 3. Positive- objective that can only be
attributed to presence of fetus; hearing fetal heart tone, visualizing fetus, palpating fetal movements. $$Pt teaching
home pregnancy testing p. 152
● Uterine enlargement results from increased vascularity & dilation of blood vessels, hyperplasia &
hypertrophy of muscle fibers and fibroelastic tissue & dev. of decidua.
● $$Lab values p.159-160, Resp. changes p.160
● Safety Alert p.161: Renal system can be overstressed by excessive dietary sodium intake or
restriction or by use of diuretics. Severe hypovolemia & reduced placental perfusion are two
consequences of using diuretics during pregnancy.
● Maternal physiologic and psychological changes during pregnancy
Reproductive system and breasts: Uterus p.152- Changes in size, shape,and position. Changes in contractility p.153.
Uteroplacental blood flow p.153. Cervical changes p.154. Changes related to the presence of the fetus p.155:
Ballottement (technique of palpating a floating structure by bouncing it gently & feeling it rebound) & Quickening
(first recognition of fetal movement or feelings of life)
Vagina & Vulva p.155: •Hormonal Changes prepare vagina for stretching during labor & birth by causing vaginal
mucosa to thicken •Chadwick Sign (violet-blue vaginal mucosa & cervix) •Leukorrhea (white or
, slightly gray mucoid vaginal discharge w/ a faint musty odor) occurs d/t cervical stimulation by estrogen &
progesterone •Mucus Plug (operculum) normal vaginal discharge that fills the endocervical canal
Breasts p.156: •Fullness, heaviness •Heightened sensitivity from tingling to sharp pain •Areolae become more
pigmented •Montgomery tubercles •Colostrum
General body systems: Cardiovascular systemp.157 table 7.3: •Blood pressure •Supine hypotensive syndrome •Blood
volume and composition •Cardiac output •Circulation and coagulation times •Increases in various clotting factors
$$procedure for bp measurement p.158 box 7.1
Respiratory system p.158 table 7.5 :•Pulmonary function •Basal metabolism rate •Acid-base balance
Renal system p.160: •Anatomic changes •Functional changes •Fluid and electrolyte balance p.161 $$Safety Alert- as
efficient as the renal system is, it can be overstressed by the excessive dietary sodium intake or restriction or by the
use of diuretics. Severe hypovolemia and reduced placental perfusion are two consequences of using diuretics during
pregnancy.
Integumentary system p.161: •Chloasma (mask of pregnancy) •Linea nigra •Striae gravidarum •Angiomas
• Palmar erythema
Musculoskeletal system p.162: •Abdominal Distention & Tone •Ligaments & Muscular Structures •Diastasis Recti
$$Safety Alert p.163- Pregnant women are at increased risk for falling d/t the shifting center of gravity, impaired
balance and joint laxity.
Neurologic system p.163: •Pelvic Nerve Compression •Dorsolumbar Lordosis •Carpal Tunnel •Acrothesia
• Vasomotor Instability •Hypocalcemia
Gastrointestinal system p.163: •Appetite •PICA •Mouth and teeth •Esophagus, stomach, and intestines•Gallbladder and
liver p.164 •Abdominal discomfort $$ Table 7.6 Hormones and effects of changes during pregnancy p.164
● Nutrition P.173- nutritional history important component of prenatal history p.179- foods high in iron, importance of
prenatal vitamins, & recommendations to avoid alcohol and limit caffeine intake.1st trimester crucial for embryonic
and fetal organ development. Healthful diet before conception ensures that adequate nutrients are available for
developing fetus.Folate or folic acid intake is important in the periconceptual period. Neural tube defects are more
common in infants of women w/ poor folic acid intake.
● Factors that contribute to increase in nutrient needs: development of uterine- placental-fetal unit, Increased maternal
blood volume and constituents, maternal mammary development and increased metabolic rate
● $$Table 9.4Physical assessment of nutritional status Box 9.4 Food intake Questionnaire Box 9.5 Dietary
guidelines
● Sleep p.- may have trouble getting comfortable d/t baby, urinary frequency or muscle cramps. Plan regular rest
periods, back massage, warm showers, lots of pillows or body pillow, & avoid sleeping on back to avoid supine
hypotension (vena cava syndrome). activity and exercise during pregnancy p.182- 150 mins. of moderate
activity/wk.has minimal risk & promotes feeling of well being, enhances psychological well being, circulation,
promotes relaxation & rest and counteracts boredom, shortening course of labor. $$P.183- Pt. Teaching: exercise tips
for pregnant women, pt. Teaching posture and body mechanics.
● How culture can influence the childbearing period Cultural influences: •Emotional response •Clothing
• Physical activity and rest •Sexual activity •Diet
-Supine hypotension(vena cava syndrome) p.175- low BP, d/t woman lying on back, causing feelings of
faintness.encourage to lay on left side to improve blood flow & BP. $vena cava transport oxygenated blood to fetus
(Ch.3 has more detail) $$Box on bottom of p.175 S/S: $pallor,$ dizziness, faintness,breathlessness
$tachycardia $nausea $clammy (damp, cool) skin; sweating Interventions: position woman on her side until s/s
subside & vital signs stabilize w/in normal limits.
● Laboratory and diagnostic tests related to pregnancy- lab value p.159-160 table 7.4 P. 175-176 table 8.1 p.175-
urine, cervical and blood samples are obtained during the initial visit, screening for infectious
, diseases, metabolic conditions. All pregnant women should receive screening for HIV (if refused this should be
documented). PPD may be administered for high risk along w/ Neisseria gonorrhoeae. Also screen for STI’s initial:
syphilis, chlamydia & hep B; & 3rd trimester: HIV, syphilis, chlamydia & gonorrhea. Urine tested for glucose, protein
& leukocytes. Genetic testing may be done also depending on family history. P. 179- f/u visit urine screens for protein,
glucose, nitrates, & leukocytes. Glucose tolerance test recommended for risk factors: obesity, history of gestational DM
(GDM) or unknown impairment of glucose metabolism. Group B streptococcus (GBS) recommended between 35-37
wks; culture result only valid for 5wks.
● Developmental tasks for the childbearing family p.167- maternal and paternal adaptation, accepting the pregnancy,
identifying w/ the mother/father role, reordering personal relationships,establishing a relationship w/ the fetus,
preparing for birth. This includes sibling and grandparent adaptation.
● Management and nursing care for antepartum patients p.171- goal of prenatal care is to promote health & well being
for women, fetus, the newborn and family. Emphasis is on preventative care & optimum self care, prenatal care sought
routinely by women of middle or high socioeconomic status.
● Commonly used antepartum maternity medications p.211-214: Self medication administration is
discouraged. Not all OTC medications or herbal supplements are safe in pregnancy and can cause
complications to mother or fetus.
$$Nursing Alert p.186: although complementary & alternative medicine (CAM) may benefit the woman, some
practices should be avoided because they can increase the risk for complications. It’s important to ask the woman about
OTC products (including herbal & vitamins)
8 p.166-201
● Naegele’s rule p.166-167 $$box8.1 - Remember that this gives you the Estimated Date of Birth/ Estimated Date of
Conception. Both terms are used interchangeably. Most women give birth from 7days before to 7 days after EDB.
First day of LMP subtract 3 months then add 7 days
● Trimesters:
• First: Weeks 1 through 13
• Second: Weeks 14 through 26
• Third: Weeks 27 through 40
$$Unit 2 High- risk Childbearing Ch. 10 Ch. 11 p.244-260,262-264, 269, 276-280 Ch.12
● Factors that can be associated with high-risk childbearing p. 283 box 12.1- Nulliparity, age > 40, pregnancy w/
assisted reproductive techniques, family hx. of pre-eclampsia, obesity/gestational diabetes, chronic HTN, renal disease,
Type 1 DM, pre-eclampsia in previous pregnancy, multifetal gestation, woman born small for gestational age
● Assessment and nursing care for the woman with:
TORCH infection- T—Toxoplasmosis • O—Other (e.g., HBV, parvovirus, HIV, West Nile virus) • R—
Rubella • C—CMV infection • H—Herpes simplex. Bacterial infections are not included in the TORCH
workup because they are usually identified by clinical manifestations and readily available laboratory tests
concurrent hypertension- Obese women are likely to begin pregnancy w/ preexisting conditions like chronic
HTN & type 2 diabetes. women w/ diabetes are more likely to also have preexisting HTN or develop
preeclampsia, which may necessitate hospitalization. Reasons to proceed with birth before full- term gestation
include poor metabolic control, coexisting hypertension, and nonreassuring responses to fetal testing
gestational diabetes- 1-hour glucose tolerance: Screens for GD, done at initial visit for women w/ risk factors,
done at 24–28 weeks for pregnant women at risk whose initial screen was neg, and for others who were not
previously tested. 3-hour glucose tolerance: Tests for GD in women with elevated glucose level after 1-hour test;
must have 2 elevated readings for diagnosis.
-90% of women w/ diabetes in pregnancy have GD.
