NSG 3500 Maternal Q9 April 2025
Exam 1
In class info:
Molar pregnancy: no pregnancy for a year, get HCG drawn every 1-2 months, birth control 1 year. don't get pregnant
Layering of meds for magnesium sulfate for preterm labor: if you get an order that your patient is already on
mag or they’re one of the other medications and they get an order for mag CALL doctor and let them know they’re
already on mag and don’t think they want to be on another medication Don't give
Patient preeclampsia patient has elevated blood pressure, proteinuria, facial swelling, elevated liver enzymes:
you will go right to starting magnesium on that patient. HIGH PRIORITY! mag can layer
At risk for ectopic pregnancy: IUD, any STI’s, any clot (gunk), previous abdominal surgery.
Phases of the menstrual cycle: need to look at these
Braxon hicks’ contractions characteristics felt in the abdomen and groin region. Irregular and painless
Rubella immunity: if mom is immune, she is immune no need to give rubella.
Mom with negative blood type: Give RhoGAM at 28 weeks, if baby is negative no need for a second shot but if
baby is positive blood type, then you’ll need to give mom a second dose after baby is born within 72 hours.
If mom is positive blood type: No need to give RhoGAM.
Give milk not orange juice: for diabetes. It should be below 140!
Any patient that has potential for bleeding: Do a large bore IV (14,16,18G)
st Placent a agruption
Amniocenteses: Done after 1 trimester, sign a consent, chromosome abnormalities, and check baby’s lungs
maturity. After 1st after 12 weeks
Dyspepsia indigestion: It’s okay to drink water with meals, you do not want them to eat spicy food, or cold food
(ice cream). No cold Ispicy don't lay down
Any time a patient is in the ER, and you don’t know what’s going on with them or suspect you know what’s MD
going on: you still need to pump that information to your doctor in case if you need orders.
neural tribeAlpha-fetoprotein: this test for neural tube defect. Part of the triple marker test for fetal genetic screening, low
downs levels may indicate certain genetic conditions such as Down Syndrome or trisomy 18, and elevated levels can
&
indicate Neural tube defects.
Syndromes: Trisomy 18 (Edwards syndrome infant usually dies in the first 3 months) Trisomy 21 or 22 (down
Facul
-
syndrome)
- -
Trisomy 13 C (Patau syndrome infant usually dies in the first 3 months).
>
BMI: below 18.5 underweight should gain 28-40pounds
18.5-24.9 normal / healthy weight should gain 25-35 pounds
25.0-29.9 overweight should gain 15-25 pounds
30.0 and above obese should gain 11-20 pounds
gainless
Common discomforts with pregnancy:
st
1 tri- N/V, Fatigue, breast tenderness, urinary frequency, nocturia.
nd -
2 tri- dyspepsia, hemorrhoids, gum hyperplasia and bleeding, dependent edema, lag varicosities, hyperventilation
- - - -
and SOB, numbness and tingling of fingers, supine hypotensive syndrome.
rd
3 fatigue, urinary frequency, dyspepsia, hemorrhoids, gum hyperplasia and bleeding, leg cramps, dependent edema,
leg varicosities, dyspareunia, nocturia, rounds ligament pain, Braxton hicks’ contractions, supine hypotensive
syndrome. painless
All trimesters: Ptyalism, nasal congestion, back pain, leukorrhea, constipation, insomnia.
Progesterone causes fatigue, slowing down in the GI track, uterine lining to build up. when the uterine line is
not needed because no fertilize egg falls into the uterine, girls on their period have their uterine start contracting
that is called dysmenorrhea, this is caused by prostaglandin. Prostaglandin is in semen and when you have sex,
and it gets pushed up to the cervix and its absorbed also stimulates contractions as well.
Prostaglandin: causes painful periods and uterine contractions if you’re in preterm labor.
Decrease in progesterone and estrogen when a woman is in menopause makes woman have lack of sleep, hot
flashes, mood swings, irregular periods. This is a sign their reproductive system is goanna shut down. That’s
why we give hormone replacement.
Very common for a little girl to start her period and misses a month or so: this is normal and will regulate itself
When boys go through puberty: their testosterone starts to spike they have growth spurts (linear bone growth),
voice deepens, coarse hair growth, increase in energy and anger.
Postmenopausal woman: look up when taking hormonal replacement therapy when its contraindicated:
breast cancer breastfeeding
Cervical cancer
, cancer patients
If mom is positive for syphilis: give Penicillin before 20 weeks. If we don’t baby can have congenital syphilis or
worst case can die.
Psychosocial questions about infertility: if patient is telling you things like their frustrated, their self-esteem is
suffering, they feel like a failure: GO with lease invasive thing first you want more info, ask if they will be willing to
go through work up like husband go through it or herself.
Chlamydia: most common sign it is asymptomatic, if they have untreated chlamydia can lead to PID and gunk up
fallopian tube they will have problems with fertility.
PID at risk: recent partner in the last 6 months, smoker.
st
HPV: cervical cancer in woman. We give Gardasil to boys and girls it protects HPV. This is given before 1 sexual
activity.
Infertility Medication: Clomiphene citrate (clomid), this is an ovarian hyperstimulation. This drug alters your
mood, laughing, crying, angry. pelvic discomfort. RARE side effect/adverse if they say SOB, chest feels tight this is
pleural effusion. CALL provider.
Proliferative stage: end of menses through ovulation.
Secretory stage: time of ovulation to the period just before menses.
Basal body temp: take in the morning do not get out of bed. Should increase body temp 0.3-0.6c. this means
ovulation
Chad wicks: blue/purple on cervix, vagina and vulva.
Naegele’s rule – add 7 days, subtract 3 months, and 1 year. If got pregnant in January, February or March will have
the baby in the same year.
GTPAL: G (pregnancy), T (37weeks and greater), P (36 weeks and less), A (abortion 20 weeks and less), L(living)
Positive- (baby) sonogram, fetal heart sounds, and fetal movement felt by examiner.
Presumptive: (mom) amenorrhea, N/V, urinary frequency, fatigue, breast tenderness and changes Montgomery
glands, quickening.
Strech marks: use lotion
Rubella: titer if their rubella immune their immune! If not, immune there is nothing you can do about it while
pregnant because it’s a live vaccine. After baby is born offer rubella vaccine before discharge to mom so she is
immune for next pregnancy.
If you see test question about baby passing leave the baby with parents until their ready to depart with baby.
IUGR (intrauterine growth restriction): this is diagnosed by fundal height. You can either be 2 above or 2 below
but if your 28 weeks you should not be measuring at 25 weeks. You can have this with hyperemesis gravidarum.
Phenergan (promethazine): is super Costic like battery acid. Dilute it when giving IV. Can be given rectal. This is
usually used for hyperemesis gravidarum.
Placenta Previa: BRIGHT red, PAINLESS bleeding. Large bore IV (14,16,18G). (PPBP)
rd
Placental Abruption: PAINFUL, 3 trimester DARK red bleeding. Rigid abdomen. (PAPDR)
Therapeutic mag levels: 4.8-8.4. if at 9 that’s mag toxicity. Give calcium gluconate IM.
Ph levels of pee 4.6-8.0: so, anything below that it is alkalotic that means baby’s sac has ruptured … anything in
between that its pee so you’ll call doctor and say she is still intact she just peed herself. (test maker has used 4.7 /
4.8)
Preeclampsia- to be diagnosed with this must have elevated BP 140/90, Proteinuria (3+ / 4+), if she has a seizure
(this is now considered eclampsia), HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). They
will have hyperreflexia. Liver enzymes labs: AST (0-35) / ALT (4-36).
Preeclampsia seizure prevention: PADDED SIDE RAILS
HELLP syndrome goes to DIC: this is going to be “Ooze”
Som/hr
If they say they have elevated liver enzymes they will say: epigastric type pain or LUQ pain.
How to treat DIC: Heparin
Preeclampsia Mag sulfate: IV piggyback Q1hr 2-4g an hour. Kidneys cannot excrete they will get mag toxic fast!
So, you must check Urine output!! You can give magnesium sulfate, and they can also layer meds with
preeclampsia!!
Kick count: lay on left side 10 kicks in one-hour good sign. 6 or less NOT good.
Biophysical profile: FHR 110-160. This is a sonogram combine with other fetal markers.
Contraction stress test: if they have a positive stress test that means it is not GOOD baby did not tolerate.
Blood pressure: Check blood pressure cuff if BP is too low. &U
If baby’s BP read 100: check moms’ apical pulse for 1 full minute to ensure its not moms HR that is reading 100.
tom
Folic acid: any answer that has citrus in it is going to be the answer.
Constipation question: ambulate, fluid intake, fiber don’t sit on toilet and strain.
Vitamin C: help with absorption of iron. Think tomatoes juice, orange juice.
calcium: juice
citrus
st
Folic acid: helps neuro tube development, but after 1 trimester it helps regulate RBC development. iron=
leafy
Exam 1
In class info:
Molar pregnancy: no pregnancy for a year, get HCG drawn every 1-2 months, birth control 1 year. don't get pregnant
Layering of meds for magnesium sulfate for preterm labor: if you get an order that your patient is already on
mag or they’re one of the other medications and they get an order for mag CALL doctor and let them know they’re
already on mag and don’t think they want to be on another medication Don't give
Patient preeclampsia patient has elevated blood pressure, proteinuria, facial swelling, elevated liver enzymes:
you will go right to starting magnesium on that patient. HIGH PRIORITY! mag can layer
At risk for ectopic pregnancy: IUD, any STI’s, any clot (gunk), previous abdominal surgery.
Phases of the menstrual cycle: need to look at these
Braxon hicks’ contractions characteristics felt in the abdomen and groin region. Irregular and painless
Rubella immunity: if mom is immune, she is immune no need to give rubella.
Mom with negative blood type: Give RhoGAM at 28 weeks, if baby is negative no need for a second shot but if
baby is positive blood type, then you’ll need to give mom a second dose after baby is born within 72 hours.
If mom is positive blood type: No need to give RhoGAM.
Give milk not orange juice: for diabetes. It should be below 140!
Any patient that has potential for bleeding: Do a large bore IV (14,16,18G)
st Placent a agruption
Amniocenteses: Done after 1 trimester, sign a consent, chromosome abnormalities, and check baby’s lungs
maturity. After 1st after 12 weeks
Dyspepsia indigestion: It’s okay to drink water with meals, you do not want them to eat spicy food, or cold food
(ice cream). No cold Ispicy don't lay down
Any time a patient is in the ER, and you don’t know what’s going on with them or suspect you know what’s MD
going on: you still need to pump that information to your doctor in case if you need orders.
neural tribeAlpha-fetoprotein: this test for neural tube defect. Part of the triple marker test for fetal genetic screening, low
downs levels may indicate certain genetic conditions such as Down Syndrome or trisomy 18, and elevated levels can
&
indicate Neural tube defects.
Syndromes: Trisomy 18 (Edwards syndrome infant usually dies in the first 3 months) Trisomy 21 or 22 (down
Facul
-
syndrome)
- -
Trisomy 13 C (Patau syndrome infant usually dies in the first 3 months).
>
BMI: below 18.5 underweight should gain 28-40pounds
18.5-24.9 normal / healthy weight should gain 25-35 pounds
25.0-29.9 overweight should gain 15-25 pounds
30.0 and above obese should gain 11-20 pounds
gainless
Common discomforts with pregnancy:
st
1 tri- N/V, Fatigue, breast tenderness, urinary frequency, nocturia.
nd -
2 tri- dyspepsia, hemorrhoids, gum hyperplasia and bleeding, dependent edema, lag varicosities, hyperventilation
- - - -
and SOB, numbness and tingling of fingers, supine hypotensive syndrome.
rd
3 fatigue, urinary frequency, dyspepsia, hemorrhoids, gum hyperplasia and bleeding, leg cramps, dependent edema,
leg varicosities, dyspareunia, nocturia, rounds ligament pain, Braxton hicks’ contractions, supine hypotensive
syndrome. painless
All trimesters: Ptyalism, nasal congestion, back pain, leukorrhea, constipation, insomnia.
Progesterone causes fatigue, slowing down in the GI track, uterine lining to build up. when the uterine line is
not needed because no fertilize egg falls into the uterine, girls on their period have their uterine start contracting
that is called dysmenorrhea, this is caused by prostaglandin. Prostaglandin is in semen and when you have sex,
and it gets pushed up to the cervix and its absorbed also stimulates contractions as well.
Prostaglandin: causes painful periods and uterine contractions if you’re in preterm labor.
Decrease in progesterone and estrogen when a woman is in menopause makes woman have lack of sleep, hot
flashes, mood swings, irregular periods. This is a sign their reproductive system is goanna shut down. That’s
why we give hormone replacement.
Very common for a little girl to start her period and misses a month or so: this is normal and will regulate itself
When boys go through puberty: their testosterone starts to spike they have growth spurts (linear bone growth),
voice deepens, coarse hair growth, increase in energy and anger.
Postmenopausal woman: look up when taking hormonal replacement therapy when its contraindicated:
breast cancer breastfeeding
Cervical cancer
, cancer patients
If mom is positive for syphilis: give Penicillin before 20 weeks. If we don’t baby can have congenital syphilis or
worst case can die.
Psychosocial questions about infertility: if patient is telling you things like their frustrated, their self-esteem is
suffering, they feel like a failure: GO with lease invasive thing first you want more info, ask if they will be willing to
go through work up like husband go through it or herself.
Chlamydia: most common sign it is asymptomatic, if they have untreated chlamydia can lead to PID and gunk up
fallopian tube they will have problems with fertility.
PID at risk: recent partner in the last 6 months, smoker.
st
HPV: cervical cancer in woman. We give Gardasil to boys and girls it protects HPV. This is given before 1 sexual
activity.
Infertility Medication: Clomiphene citrate (clomid), this is an ovarian hyperstimulation. This drug alters your
mood, laughing, crying, angry. pelvic discomfort. RARE side effect/adverse if they say SOB, chest feels tight this is
pleural effusion. CALL provider.
Proliferative stage: end of menses through ovulation.
Secretory stage: time of ovulation to the period just before menses.
Basal body temp: take in the morning do not get out of bed. Should increase body temp 0.3-0.6c. this means
ovulation
Chad wicks: blue/purple on cervix, vagina and vulva.
Naegele’s rule – add 7 days, subtract 3 months, and 1 year. If got pregnant in January, February or March will have
the baby in the same year.
GTPAL: G (pregnancy), T (37weeks and greater), P (36 weeks and less), A (abortion 20 weeks and less), L(living)
Positive- (baby) sonogram, fetal heart sounds, and fetal movement felt by examiner.
Presumptive: (mom) amenorrhea, N/V, urinary frequency, fatigue, breast tenderness and changes Montgomery
glands, quickening.
Strech marks: use lotion
Rubella: titer if their rubella immune their immune! If not, immune there is nothing you can do about it while
pregnant because it’s a live vaccine. After baby is born offer rubella vaccine before discharge to mom so she is
immune for next pregnancy.
If you see test question about baby passing leave the baby with parents until their ready to depart with baby.
IUGR (intrauterine growth restriction): this is diagnosed by fundal height. You can either be 2 above or 2 below
but if your 28 weeks you should not be measuring at 25 weeks. You can have this with hyperemesis gravidarum.
Phenergan (promethazine): is super Costic like battery acid. Dilute it when giving IV. Can be given rectal. This is
usually used for hyperemesis gravidarum.
Placenta Previa: BRIGHT red, PAINLESS bleeding. Large bore IV (14,16,18G). (PPBP)
rd
Placental Abruption: PAINFUL, 3 trimester DARK red bleeding. Rigid abdomen. (PAPDR)
Therapeutic mag levels: 4.8-8.4. if at 9 that’s mag toxicity. Give calcium gluconate IM.
Ph levels of pee 4.6-8.0: so, anything below that it is alkalotic that means baby’s sac has ruptured … anything in
between that its pee so you’ll call doctor and say she is still intact she just peed herself. (test maker has used 4.7 /
4.8)
Preeclampsia- to be diagnosed with this must have elevated BP 140/90, Proteinuria (3+ / 4+), if she has a seizure
(this is now considered eclampsia), HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). They
will have hyperreflexia. Liver enzymes labs: AST (0-35) / ALT (4-36).
Preeclampsia seizure prevention: PADDED SIDE RAILS
HELLP syndrome goes to DIC: this is going to be “Ooze”
Som/hr
If they say they have elevated liver enzymes they will say: epigastric type pain or LUQ pain.
How to treat DIC: Heparin
Preeclampsia Mag sulfate: IV piggyback Q1hr 2-4g an hour. Kidneys cannot excrete they will get mag toxic fast!
So, you must check Urine output!! You can give magnesium sulfate, and they can also layer meds with
preeclampsia!!
Kick count: lay on left side 10 kicks in one-hour good sign. 6 or less NOT good.
Biophysical profile: FHR 110-160. This is a sonogram combine with other fetal markers.
Contraction stress test: if they have a positive stress test that means it is not GOOD baby did not tolerate.
Blood pressure: Check blood pressure cuff if BP is too low. &U
If baby’s BP read 100: check moms’ apical pulse for 1 full minute to ensure its not moms HR that is reading 100.
tom
Folic acid: any answer that has citrus in it is going to be the answer.
Constipation question: ambulate, fluid intake, fiber don’t sit on toilet and strain.
Vitamin C: help with absorption of iron. Think tomatoes juice, orange juice.
calcium: juice
citrus
st
Folic acid: helps neuro tube development, but after 1 trimester it helps regulate RBC development. iron=
leafy
