Galen College NUR-254 Childbearing / maternity - All Exams (1-4), Review Study guides | A+ Latest Updated 2026/27.

Galen College Nur-254 Childbearing / maternity All Exams 1-4 Review Guides - Updated 2026.

Childbearing Exam #1
Galen College
Nur-254
Childbearing / maternity
Unit 1: Antepartum
What in yellow was on this exam
Nursing Management
o Page 178 Signs/symptoms related to pregnancy
 Categorizing signs/symptoms of pregnancy
 Presumptive: subjective (Patient says they experience), least reliable – not definitive signs of
pregnancy, COULD be caused by something other than pregnancy, QUICKENING
o Breast changes, amenorrhea, nausea and vomiting, urinary frequency, fatigue,
quickening
 Probable: objective, (practitioner can see) “more than likely” pregnant
o Positive pregnancy test, Braxton Hicks (false), Goodell’s sign (cervical softening),
Chadwick’s sign (increased cervical vascularization), Hegar’s sign (softening of lower
uterine segment), enlarging uterus, ballottement (pushing of the uterus – do you feel a
fetus move and come back?)
 Positive: visualization, hearing fetus HR, feel the fetus, VISUAL ULTRA SOUND; practitioner feels
kicking
 What is considered normal or expected?
 Effects on body systems
o Breasts: increase in size, fullness, heaviness, tingling, darkening of the areola, lactation
can occur as early as 18 weeks
o GI: delayed GI motility, constipation, heartburn, nausea and vomiting, hemorrhoids,
increased vascularity of gums, increased saliva
o GU: increased urination; NORMAL
o Cardio: pulse increase, increased blood volume, increased cardiac output
o Respiratory: increased O2 consumption, nasal and sinus congestion, increased
vascularity
o Musculoskeletal: center of gravity shifts, unsteady gait
o Sensory: sciatica, restless legs, muscle cramps, syncope, tension headache
o Integumentary: melasma mask (hyperpigmentation), striae gravidarum (stretch marks),
vascular malformation (spider veins)
 Vital signs
o HR: slight increase
o BP: should not change dramatically from baseline
o RR: SOB is common, difficulty breathing is NOT
o O2: remains stable
o Temp: can slightly increase
▫ Page 187 Calculating GTPAL
 G: gravida
 Number of pregnancies, regardless of the outcome – including current
 T: term
 Delivery at 37-42 weeks
 P: preterm
 Delivery between 20 weeks and 36 weeks 6 days
 A: abortion
 Before 20 weeks, including miscarriage
 L: living
 Number of children that are still living
 REMEMBER! With multiples, they count as one pregnancy!
▫ Page 178 Calculating Naegele’s Rule/EDD (expected date of delivery) – two ways to calculate
 First day of last menstrual period
 Add 7 days + 9 months
 OR
 Add 7 days – 3 months + one year
 EXAMPLE:
 LMP: 1/12/22
 + 7 days = 1/19/22
 + 9 months = 10/19/22
▫ Analyzing labs
 Blood work
 Titers
o Rubella/Varicella: provides passive immunity
 Live vaccines are contraindicated (page 193)
o No booster while pregnant, can offer postpartum
o Toxoplasma- Don’t not clean cat litter, eat raw meat or touch dirt
 CBC

, o H&H will increase ( normal Hemoglobin for PG 11)
o Monitor for anemia
 Coombs screening: Rh factor and antibodies
o Rh negative mom, Rh positive baby
o ( rh+ fetal blood crosses into maternal blood stimulating maternal antibodies)
 Rhogam UP to 72hr after birth or any instance when blood may become mixed
 Blood type
 STI screening: HIV, syphilis, chlamydia, gonorrhea
▫ Therapeutic communication
 Speaking with patients about common symptoms of pregnancy
 Current exercise can continue, unless uncomfortable
 HYDRATE
 Careful in HOT weather
 Sleep 8 hours every day if possible
 Change bra, shoes and other clothing to ensure comfort
 Sleep on side after 1st trimester
▫ Providing culturally competent care- don’t offend, always ask about preferences of food/ pain ect; check chart for previous
pain management
o Priority Actions
 What to do first?
▫ Page 198 Relieving discomforts of PG signs/symptoms
 Breast changes= wear supportive maternity bra
 Urgency frequency- empty bladder, kegel exercises, limit fluid before bed, avoid coffee
 N/V= avoid empty overload stomach; dry carb and hot tea, Avoid fried, spicy food;
 Bleeding gums= go to dentist; eat fresh fruit & veggies and soft toothbrush
 Constipation= Drink 2L of water; no stool softner, no laxative, only w/ Dr order
 Not preventable=mask of pg, spider nevi, pruritis, palpitations, food craving, carpal tunnel
 Education
o Page 208 Dietary management
 Weight gain of 25-35lbs is normal
 First trimester: no increase in calories
 2nd and 3rd: 300 calorie increase
 Iron-deficiency anemia
 Organ meats, green veggies, nuts, beans; PeanutButter; cereal, whole wheat, spinach, eggs
omelet
 Take supplements on an empty stomach – mild nausea is common
 Vitamin C will increase absorption= orange , broccoli
 Stools can turn dark green to black and cause constipation
 No calcium blocks absorption of Iron; can take 2hrs before and 2 hours after > no milk, yogurt,
butter
 Folic acid
 Low levels linked to fetal neural tube defects
 Leafy greens
▫ Page 200 Signs of possible complications of PG
 1st trimester
 Severe vomiting= hyperemesis gravida
 Chills, fever; burning upon urination; diarrhea= infection
 Abd cramps; vag bleeding= miscarriage, ectopic pg
 2nd & 3rd Trimester
 Persistent severe vomiting= hyperemesis gravida, HTN, Preclampsia
 Sudden discharge fluid from vag before 37w= Preterm Pre labor rupture of membranes
 Vag bleed, severe abd pain=miscarriage, placenta previa, abruptio placental
 Chills, fever, burning on urination, diarrhea= infection
 Severe backache or flank pain= kidney infection or stones, preterm labor
 Change in fetal movements = absence after quickening, any usual pattern or amt=fetal
jeopardy, intrauterine fetal death
 Absence of FHR=intrauterine fetal death
 Uterine contractions, pelvic pressure; cramping before 37w= preterm labor
 Visual; disturbances, blurry, 2x vision, spots=htn , preeclampsia
 Swelling of face or fingers , over sacrum= htn , preeclampsia
 Headache, severe frequent or continuous= htn , preeclampsia
 Muscular irritability or seizures= htn , preeclampsia
 Epigastric / abd pain = htn , preeclampsia, placenta abruption
 Glycosuria, + glucose tolerance reaction= gestational DM
o Knowing if teaching is effective/ineffective
 Red flag /warning pregnancy symptoms
 Fluid from vagina that is not leukorrhea (thin, white, scant vaginal discharge)
 Abdominal or pelvic pain
 Epigastric pain or severe heartburn
 Sudden or severe edema in face and hands

,  Severe or continuous headache
 Dizziness, blurred vision, seeing spots
 Persistent vomiting
 Dysuria, oliguria
 No fetal movement for over 12 hours
 Leg edema with pain or redness
 Chest pain or dyspnea (not just shortness of breath)
▫ Page 183 Preparing siblings for new baby
o Take child on Prenatal visit. Let them listen to FHR
o Involve child in preparations; help decorate
o If child in crib move to bed 2 months before baby due
o Read books, videos, dvd and hospital tour
o Answer questions about birth. Babies are like
o Take to homes of friends who have babies (realistic expectations)
o With baby doll show sibling how to hold
 Fundal height- measuring from pubic symphysis to highest part of uterus)
o 12 weeks
o 16-36 fundal hieght = weeks of pg
o 20 weeks @ umbilicus
o 36 weeks
o 36-38 weeks lightening
o 40 weeks
Unit 2: High-Risk Childbearing
 Nursing management
o Priority actions
 Recognizing signs/symptoms that should be reported
 Page 294 Miscarriage/ spontaneous abortion: spontaneous loss of pregnancy before
20th week
o Risk factors: maternal age, previous miscarriages, uterine or cervical problems,
smoking, alcohol, drugs
o TYPES:
 Threatened abortion: showing signs but cervix hasn’t opened, light bleeding
and cramping- treatment complete bedrest ..only one baby can be safed
 Inevitable: vaginal bleeding, strong lower stomach cramps, dilated cervix,
fetus is expelled with bleeding
 Complete: all pregnancy tissues leaves uterus
 Incomplete: some pregnancy tissue remains (D&C might be indicated)
 Missed: placental and embryonic tissues remain in uterus but the embryo has
died or never formed – brownish vaginal discharge
 Page 299 Ectopic pregnancy: pregnancy develops/implants anywhere outside of the uterus
o s/s: light vaginal bleeding with abdominal or pelvic pain referred to shoulder
o if blood from fallopian: shoulder pain, urge to have a BM; pink tinge
o if ruptured: stabbing pain in lower quadrant, can radiate to leg or chest, – followed by
lightheadedness, fainting or shock
o GOPHER- gush of blood; one sided pain, pain stops, hemorrhage, Emergency for
Rupture
o Treatment – methotrexate if only stretched; if bleeding sur remove part of fallopian tube
 Page 297 Incompetent cervix: painless dilation of the cervix without labor or contractions of
the uterus
o Risk factors: congenital conditions, exposure to DES (synthetic estrogen), cervical
trauma, excessive cervical dilation = repeated D&C
o Starts between weeks 14 and 20: pelvic pressure, backache, mild abdominal cramps,
light bleeding or spotting
o Treatment- abd Cerclage (tie cervix) tocolytics, bedrest for a few days after procedure,
progesterone, anti inflammatory drugs, antibiotics, hydration
o I need Cerclage because my cervix is weak
 Recognizing signs/symptoms that require follow-up
 Pregnancy complications
o Hyperemesis gravidarum: severe nausea, vomiting, weight loss and dehydration
 Tx: IV hydration, control vomiting, stabilize mom
 Monitor for metabolic alkalosis
 Physician orders that contradict patient conditions
o NO vaginal exam if a mom is bleeding
o Don’t give Pitocin to Patient w/ Abruption placenta they need c-section
 Who to see first?
 Patient priorities based on signs/symptoms
 Immediate stabilization
 End goal is to have mom and baby safe, that being said…
o Stabilize mom first! ABCs

, o Now, is baby still alive?
o Medication management for high-risk conditions
 Page 280 Preeclampsia: hypertension AND proteinuria after 20 weeks> seizure related
 Risk factors: family history, multiple pregnancy, African-American, obesity, younger than 19yo,
older than 40yo, pre-existing medical or genetic conditions
 Decreased placental perfusion, generalized vasospasm, vasoconstriction, capillary leaking,
reduced organ perfusion, can affect liver and brain function
o Page 282 HELLP syndrome: lab diagnosis for a variant of preeclampsia that involves
hepatic dysfunction – starts because of hypertension
 H: hemolysis: breakdown of RBCs
 EL: elevated liver enzymes – AST, LST, LFTs
 LP: low platelets (normal 400,00-150,000)
 Increased risk for: pulmonary edema, renal failure, liver hemorrhage or failure,
DIC, placental abruption, acute respiratory distress syndrome, sepsis, stroke,
fetal and maternal death
 Mild Preeclampsia : BP 140/90 or greater, urine dipstick > 1+
 Moderate Preclampsia: BP 160/110, urine dipstick > 3+, persistent or severe headache,
blurred vision, photophobia, epigastric pain, intrauterine growth restriction of fetus
 S/S: independent edema (edema in lower extremities is normal, NOT in upper extremities or
face), deep tendon reflexes = hyperreflexia, clonus = jerky spasms, rhythmic and
involuntary (over 3)
 Severe preeclampsia: BP126/110 prevent seizures, control blood pressure
o Assess respirations, level of consciousness, intake/output
o Pregnancy-safe medications: methyldopa or hydralazine
o Magnesium sulfate: manage and prevent seizures (can also stop them)
 Keep calcium gluconate bedside
 Monitor Mg levels
 If patient has protein in urine and High BP; nurse should give Magnesium Sulfate
initially
 Mg toxicity: decreased RR, decreased LOC, absent deep tendon
reflexes
 Page 289 Eclampsia: onset of seizure activity or coma in a woman with preeclampsia and no prior
history
 Page 242 Diabetes: can be pregestational or gestational (management is pretty much the same)
 Monitor comorbidities, preterm labor, macrosomia (big baby), C-section, polyhydramnios,
hyper/hypoglycemia, increased risk for postpartum hemorrhage, sudden or unexplained stillborn,
congenital malformations
 Insulin needs: change throughout pregnancy
o 1st trimester: reduced
o 2nd trimester: starts to increase
o 3rd trimester: may increase to 2-4x more than “normal”
o Birth: decrease
o Breastfeeding: decrease
 At 24-28 weeks: glucose tolerance test
o Negative = less than 130-140
o Positive = more than 140 (requires further testing)

o Recognizing signs/symptoms
 Placenta abnormalities
 Page 303 Placenta previa: low lying placenta classified by where egg implants and how much
of the cervix is covered (total, partial, marginal)
o placenta covers some or all of the cervix
o Dx – with/ ultrasound
o NO VAG EXAMS (if bleeding)
o S/S can cause painless, bright red, severe vaginal bleeding, fundal height greater
than gestational age, non-tender uterus
 usually occurs towards ends of 2nd trimester or later
o Tx: bed rest, monitoring, possible C-section depending on degree of cervical coverage
 Page 306 Abruptio placenta: partial or complete separation of the placenta from the uterine
lining
o MEDICAL EMERGENCY : C-section is necessary
o s/s: abdominal pain, vaginal bleeding, rigid-board like abdomen/fundus, uterine
contractions, port wine-stained amniotic fluid, dark red vag bleeding, sudden
pain,amopnitic fluid port wine color
o causes/risk factors: hypertension, abdominal trauma, cigarette smoking, alcohol or
cocaine use, blood clotting disorders, diabetes, previous history
 DIC (disseminated intravascular coagulation): “excessive clotting and bleeding at the same time”
 can be triggered by abruptio placentae, serious infection or trauma, escape of amniotic fluid into
bloodstream
 Tx: replace blood and clotting factors, treat the cause, support vital functions