NR 602 FINAL EXAM 4-VERSION SET 2026
COMPREHENSIVE QUESTIONS AND
DETAILED SOLUTIONS
⩥ 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.
⩥ 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
⩥ Influenza (flu)a. Answer: Women who are pregnant are at increased
risk for flu-related complications.
COMPREHENSIVE QUESTIONS AND
DETAILED SOLUTIONS
⩥ 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.
⩥ 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
⩥ Influenza (flu)a. Answer: Women who are pregnant are at increased
risk for flu-related complications.
