NR 602 WEEK 4 MIDTERM EXAM SCRIPT 2026
COMPLETE QUESTIONS AND SOLUTIONS
100% CORRECT
● Probable signs of pregnancy . Answer: high likelihood of pregnancy
but there are still other conditions that may cause the findings.
Goodell's sign: Cervical softening (around 4 weeks)
Chadwick's sign: Blueish coloration of the vagina & cervix (6-8 weeks)
Enlarged uterus• Positive urine or blood pregnancy test (β-hCG)
● Positive signs of pregnancy . Answer: Most reliable and most
objective signs.
• Palpation of the fetus by the health care provider
• Ultrasound and visualization of the fetus
• Fetal Heart Tones (FHT) auscultated by the health care provider
● Hegar's sign . Answer: Probable sign of pregnancy.
Occurs at four months.
Occurs when the uterus bends in an anterior direction on the softened
lower uterine segment or isthmus.
,● Fundal Height at 38-40 weeks . Answer: below the xiphoid process
once lightening occurs
● Naegele's Rule . Answer: add 7 days to first day of LMP, subtract 3
months, and add 1 year
Ex: LMP - 8/10/19 + 7 days = 8/17/19 - 3 months = 05/17/19 + 1 year =
05/17/20
● Fundal Height
- 24 to 36 weeks . Answer: Measured in cm. Measure the distance
between the upper edge of pubic symphysis and the top of the uterine
fundus with a tape measure. Fundal height equals the number of
gestational weeks (+/- 2cm). For example, a 28 week gestation fetus
should have a fundal height that measures between 26 and 30cm.
● Fundal Height at 12 weeks . Answer: Uterine fundus first rises above
the symphysis pubis
● Fundal Height at 16 weeks . Answer: Uterine fundus is between the
symphysis pubis and umbilicus
● Fundal Height at 20 weeks . Answer: Uterine fundus is at the level of
the umbilicus
,● Hematologic changes during pregnancy . Answer: -CO increased
30%-50% and SV increases 20% to 30%
-HR increases by 15-20 beats/min by 32 weeks' gestation.
- increase RBC volume leading to hemodilution, so decrease in RBC,
WBC, H/H. Iron deficiency anemia is common.
-Inc in sed rate, fibrinogen
- dec PT, PTT - at risk for clots
-Second trimester: systolic BP decreases by 2-8 mm Hg and diastolic BP
decreases by 5-15 mm Hg due to peripheral vascular resistance
Third trimester: BP gradually returns to pre-pregnancy values
● Indications for combined vs progesterone-only birth control . Answer:
-Regulation of menstrual bleeding
-Help with skin problems such as acne and hirsutism
-Good for pts with: PCOS, Women with pelvic pain (eg, endometriosis-
related or chronic pelvic pain) or dysmenorrhea, painful ovarian cysts to
suppress ovulation (with higher dose estrogen) and subsequent
formation of new cysts;
, -Endometriosis: Monophasic COC and skip placebo week
Benefits:
-Rapid reversibility
-Decreased menstrual blood loss
-Decreased risk of ovarian and endometrial cancers as well as ectopic
pregnancies.
● Contraindications for combined vs. progesterone-only birth control .
Answer: cardiovascular risk factors, migraine with aura, or a history of
VTE
-Breastfeeding (progestin only!)
● Combined Oral Contraception (COC) . Answer: More predictable
bleeding patterns due to stabilization of the endometrium
Estrogen suppresses the production of FSH, preventing the emergence of
a dominant follicle
e.g. COCs, the patch, and the vaginal ring
● Progestin-only Contraception . Answer: -Less risks but irregular
bleeding during first six months. -Many become amenorrheic after 1
year
COMPLETE QUESTIONS AND SOLUTIONS
100% CORRECT
● Probable signs of pregnancy . Answer: high likelihood of pregnancy
but there are still other conditions that may cause the findings.
Goodell's sign: Cervical softening (around 4 weeks)
Chadwick's sign: Blueish coloration of the vagina & cervix (6-8 weeks)
Enlarged uterus• Positive urine or blood pregnancy test (β-hCG)
● Positive signs of pregnancy . Answer: Most reliable and most
objective signs.
• Palpation of the fetus by the health care provider
• Ultrasound and visualization of the fetus
• Fetal Heart Tones (FHT) auscultated by the health care provider
● Hegar's sign . Answer: Probable sign of pregnancy.
Occurs at four months.
Occurs when the uterus bends in an anterior direction on the softened
lower uterine segment or isthmus.
,● Fundal Height at 38-40 weeks . Answer: below the xiphoid process
once lightening occurs
● Naegele's Rule . Answer: add 7 days to first day of LMP, subtract 3
months, and add 1 year
Ex: LMP - 8/10/19 + 7 days = 8/17/19 - 3 months = 05/17/19 + 1 year =
05/17/20
● Fundal Height
- 24 to 36 weeks . Answer: Measured in cm. Measure the distance
between the upper edge of pubic symphysis and the top of the uterine
fundus with a tape measure. Fundal height equals the number of
gestational weeks (+/- 2cm). For example, a 28 week gestation fetus
should have a fundal height that measures between 26 and 30cm.
● Fundal Height at 12 weeks . Answer: Uterine fundus first rises above
the symphysis pubis
● Fundal Height at 16 weeks . Answer: Uterine fundus is between the
symphysis pubis and umbilicus
● Fundal Height at 20 weeks . Answer: Uterine fundus is at the level of
the umbilicus
,● Hematologic changes during pregnancy . Answer: -CO increased
30%-50% and SV increases 20% to 30%
-HR increases by 15-20 beats/min by 32 weeks' gestation.
- increase RBC volume leading to hemodilution, so decrease in RBC,
WBC, H/H. Iron deficiency anemia is common.
-Inc in sed rate, fibrinogen
- dec PT, PTT - at risk for clots
-Second trimester: systolic BP decreases by 2-8 mm Hg and diastolic BP
decreases by 5-15 mm Hg due to peripheral vascular resistance
Third trimester: BP gradually returns to pre-pregnancy values
● Indications for combined vs progesterone-only birth control . Answer:
-Regulation of menstrual bleeding
-Help with skin problems such as acne and hirsutism
-Good for pts with: PCOS, Women with pelvic pain (eg, endometriosis-
related or chronic pelvic pain) or dysmenorrhea, painful ovarian cysts to
suppress ovulation (with higher dose estrogen) and subsequent
formation of new cysts;
, -Endometriosis: Monophasic COC and skip placebo week
Benefits:
-Rapid reversibility
-Decreased menstrual blood loss
-Decreased risk of ovarian and endometrial cancers as well as ectopic
pregnancies.
● Contraindications for combined vs. progesterone-only birth control .
Answer: cardiovascular risk factors, migraine with aura, or a history of
VTE
-Breastfeeding (progestin only!)
● Combined Oral Contraception (COC) . Answer: More predictable
bleeding patterns due to stabilization of the endometrium
Estrogen suppresses the production of FSH, preventing the emergence of
a dominant follicle
e.g. COCs, the patch, and the vaginal ring
● Progestin-only Contraception . Answer: -Less risks but irregular
bleeding during first six months. -Many become amenorrheic after 1
year
