COMPREHENSIVE REVIEW FOR THE
NCLEX-RN EXAMINATION (LATEST
2025/2026 UPDATE)
Anatomy and Physiology of
Reproduction
The Menstrual Cycle
HESI Hint • The menstrual phase varies in length in most
women.
HESI Hint • Ovulation occurs approximately 14 days before
the next menstrual cycle.
HESI Hint • To avoid pregnancy a woman should abstain
from unprotected sexual intercourse during her fertile
days.The most fertile days for pregnancy are the day before
ovulation and the day of ovulation.The fertile period begins
4-5 days prior to ovulation and ends 24-48 hours after
ovulation.A couple must avoid unprotected intercourse for
several days before an anticipated ovulation and for 3 days
after ovulation to prevent pregnancy because sperm can
, Hint •
live in a woman's body approximately 4 to 5 days and ecs
live approximately 24-48 hours after being released.
HESI Hint • Some women do not realize they are preåant
because they experience implantation bleeding or
spotting.
Antepartum Nursing Care
HESI Signs of healthy psychosocial maternalfetal bonding
include massaging the abdomen, nicknaming the fetus,
and talking to the fetus in utero.
HESI Hint • Practice determining gravidity and parity. A
woman who is 6 weeks pregnant has the following
maternal history:
• She has healthy 2-year-old male fraternal twins
• She had a miscarriage at 22 weeks
• She had an elective abortion at 6 weeks. 5 years
earlier. • With this pregnancy she is gravida 4 para 2.
only 2 deliveries after 20 weeks' gestation, and twins
are two living
• GTPAL is 4 1-1-1-21 (G-4 pregnancies (twins.
miscarriage. electrive abortion. current
pregnancy;T-l (twins count as one birth); P-l (22
week miscarriage);A-l (elective abortion at 6
weeks); L-2 (twins).
HESI Hint • For many women. battering (emotional or
physical abuse) begins during pregnancy.Women should be
assessed for abuse in private. away from the partner. bya
nurse who is familiar with local resources and knows how
to determine the safety of the client.
Five digits: GTPAL (Gravidity, Term Births, Preterm
Births, Abortions and Miscarriages, Living
Children) provides information of the client's
obstetrical history.
,(l) Gravidity — number of pregnancies
(2) Term — term births or pregnancies
delivered (full term is a fetus at 38-40
weeks' gestation).
(3) Preterm — pregnancy that has reached 20
weeks of gestation but ends before
completion of 37 weeks of gestation
(4) Abortions and Miscarriages — pregnancy
that does not reach 20 weeks of gestation.
(5) Living children — infants that have survived
birth
Calculate gestational age: estimated date of birth (EDB)
using the Nägele rule:
l. Count back 3 months from the first day of the last
normal menstrual period, and add 7 days.
2. For example: If the LMP was March 23, the EDB would
be December 30.
HESI Hint • Practice calculating EDB. If the first day of
a woman's last normal menstrual period was
December
9. what is her EDB. using the Nägele rule? Answer:
September 16. Count back 3 months and add 7 days
(always give February 28 days).
HESI Hint • At approximately 28 to 32 weeks' gestation, a
plasma volume increase of 25% to 40% occurs, resulting
in normal hemo&llution of pregnancy and Hct values.
above or hemoglobin levels above 13g/dL are
associated with gestational hypertension. High Hct
values may look good. but in reality they represent a
gestational hypertension disorder and a depleted
vascular space.
HESI Hint • Hgb and Hct data can be used to evaluate
nutritional status. Example:A 22-year-old primigravida at
12 weeks' gestation has an Hgb of 9.6 g/dL and an Hct of
31 She has gained 3 pounds during the first trimester.
A weight gain of 907.18 to 1814.4 g. (2 to 4 1b) during the
first trimester is recommended. Since this client is anemic
supplemental iron and a diet higher in iron are needed.
Foods high in iron:
• Fish and red meats
, Hint •
• Cereals and yellow vegetables
• Green leafy vegetables and citrus fruits
• Ec yolks and dried fruits
HESI As pregnancy advances. the uterus presses on
abdominal vessels (vena cava and aorta).Teach the woman
that a left side-lying position relieves supine hypotension
and increases perfusion to uterus. placenta. and fetus.
HESI Hint • The normal FHR is 1 10 to 160 bpm. Changes
in FHR are the first and most important indicators of
compromised blood flow to the fetus; these changes
require action! Fetal well-being is determined by
assessing fundal height. fetal heart tones and rate. fetal
movement. and uterine activity (contractions).
HESI Hint • Early intervention can optimize maternal and
fetal outcome.Teach clients to report immediately any of
the following danger signs. Possible indications of
preeclampsia and eclampsia are:
• Visual disturbances
• Swelling of face. fingers. or sacrum Severe,
continuous headache
• Persistent vomiting Epigastric pain
• Infection:
• Chills
• Temperature over 380 C uria
• Pain in abdomen
• Fluid discharge or bleeding from vagina (anything
other than normal leukorrhea)
• Change in fetal movement or increased FHR
HESI Hint • Most providers prescribe prenatal vitamins to
ensure that the client receives an adequate intake of
vitamins. However. only the health care provider can
prescribe prenatal vitamins. It is the nurse's responsibility
to teach about proper diet and about taking prescribed
vitamins as they have been prescribed by the health care
provider.
HESI Hint • It is recommended that pregnant women
consume the equivalent of 3 cups of milk or yogurt per
NCLEX-RN EXAMINATION (LATEST
2025/2026 UPDATE)
Anatomy and Physiology of
Reproduction
The Menstrual Cycle
HESI Hint • The menstrual phase varies in length in most
women.
HESI Hint • Ovulation occurs approximately 14 days before
the next menstrual cycle.
HESI Hint • To avoid pregnancy a woman should abstain
from unprotected sexual intercourse during her fertile
days.The most fertile days for pregnancy are the day before
ovulation and the day of ovulation.The fertile period begins
4-5 days prior to ovulation and ends 24-48 hours after
ovulation.A couple must avoid unprotected intercourse for
several days before an anticipated ovulation and for 3 days
after ovulation to prevent pregnancy because sperm can
, Hint •
live in a woman's body approximately 4 to 5 days and ecs
live approximately 24-48 hours after being released.
HESI Hint • Some women do not realize they are preåant
because they experience implantation bleeding or
spotting.
Antepartum Nursing Care
HESI Signs of healthy psychosocial maternalfetal bonding
include massaging the abdomen, nicknaming the fetus,
and talking to the fetus in utero.
HESI Hint • Practice determining gravidity and parity. A
woman who is 6 weeks pregnant has the following
maternal history:
• She has healthy 2-year-old male fraternal twins
• She had a miscarriage at 22 weeks
• She had an elective abortion at 6 weeks. 5 years
earlier. • With this pregnancy she is gravida 4 para 2.
only 2 deliveries after 20 weeks' gestation, and twins
are two living
• GTPAL is 4 1-1-1-21 (G-4 pregnancies (twins.
miscarriage. electrive abortion. current
pregnancy;T-l (twins count as one birth); P-l (22
week miscarriage);A-l (elective abortion at 6
weeks); L-2 (twins).
HESI Hint • For many women. battering (emotional or
physical abuse) begins during pregnancy.Women should be
assessed for abuse in private. away from the partner. bya
nurse who is familiar with local resources and knows how
to determine the safety of the client.
Five digits: GTPAL (Gravidity, Term Births, Preterm
Births, Abortions and Miscarriages, Living
Children) provides information of the client's
obstetrical history.
,(l) Gravidity — number of pregnancies
(2) Term — term births or pregnancies
delivered (full term is a fetus at 38-40
weeks' gestation).
(3) Preterm — pregnancy that has reached 20
weeks of gestation but ends before
completion of 37 weeks of gestation
(4) Abortions and Miscarriages — pregnancy
that does not reach 20 weeks of gestation.
(5) Living children — infants that have survived
birth
Calculate gestational age: estimated date of birth (EDB)
using the Nägele rule:
l. Count back 3 months from the first day of the last
normal menstrual period, and add 7 days.
2. For example: If the LMP was March 23, the EDB would
be December 30.
HESI Hint • Practice calculating EDB. If the first day of
a woman's last normal menstrual period was
December
9. what is her EDB. using the Nägele rule? Answer:
September 16. Count back 3 months and add 7 days
(always give February 28 days).
HESI Hint • At approximately 28 to 32 weeks' gestation, a
plasma volume increase of 25% to 40% occurs, resulting
in normal hemo&llution of pregnancy and Hct values.
above or hemoglobin levels above 13g/dL are
associated with gestational hypertension. High Hct
values may look good. but in reality they represent a
gestational hypertension disorder and a depleted
vascular space.
HESI Hint • Hgb and Hct data can be used to evaluate
nutritional status. Example:A 22-year-old primigravida at
12 weeks' gestation has an Hgb of 9.6 g/dL and an Hct of
31 She has gained 3 pounds during the first trimester.
A weight gain of 907.18 to 1814.4 g. (2 to 4 1b) during the
first trimester is recommended. Since this client is anemic
supplemental iron and a diet higher in iron are needed.
Foods high in iron:
• Fish and red meats
, Hint •
• Cereals and yellow vegetables
• Green leafy vegetables and citrus fruits
• Ec yolks and dried fruits
HESI As pregnancy advances. the uterus presses on
abdominal vessels (vena cava and aorta).Teach the woman
that a left side-lying position relieves supine hypotension
and increases perfusion to uterus. placenta. and fetus.
HESI Hint • The normal FHR is 1 10 to 160 bpm. Changes
in FHR are the first and most important indicators of
compromised blood flow to the fetus; these changes
require action! Fetal well-being is determined by
assessing fundal height. fetal heart tones and rate. fetal
movement. and uterine activity (contractions).
HESI Hint • Early intervention can optimize maternal and
fetal outcome.Teach clients to report immediately any of
the following danger signs. Possible indications of
preeclampsia and eclampsia are:
• Visual disturbances
• Swelling of face. fingers. or sacrum Severe,
continuous headache
• Persistent vomiting Epigastric pain
• Infection:
• Chills
• Temperature over 380 C uria
• Pain in abdomen
• Fluid discharge or bleeding from vagina (anything
other than normal leukorrhea)
• Change in fetal movement or increased FHR
HESI Hint • Most providers prescribe prenatal vitamins to
ensure that the client receives an adequate intake of
vitamins. However. only the health care provider can
prescribe prenatal vitamins. It is the nurse's responsibility
to teach about proper diet and about taking prescribed
vitamins as they have been prescribed by the health care
provider.
HESI Hint • It is recommended that pregnant women
consume the equivalent of 3 cups of milk or yogurt per
