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NSG 432 OB Final Exam Study Guide| Comprehensive Nursing Notes
| Latest 2026–2027 Update
OB Exam Final Study Guide
Signs of Pregnancy (presumptive, probable, positive)
Presumptive examiner that can be attributed
Subjective changes reported only to the presence of the fetus
by the woman that can also • Hegar sign (softening and Signs that are attributed
be caused by other compressibility of the by presence of fetus lower uterine
conditions segment Hearing fetal heart tones
• Breast changes usually at 6 wks) (doppler)
• Amenorrhea • Ballottement (palpating a Palpation of fetal floating
• Nausea and vomiting structure by movement
• Urinary frequency bouncing it gently and Visualization of fetus
• Fatigue feeling it rebound; (ultrasound)
• Discoloration of vaginal generally b/w 16-18 wks)
mucosa • Positive pregnancy tests for presence of HCG hormone
• Quickening ("feeling of • Goodell sign (increased vascularity, slight hypertrophy, and
life"; first recognition of hyperplasia)
fetal movement) • Chadwick sign: violet blue mucosa and cervix d/t increased
Probable Positive vascularity
Objective changes assessed by • Braxton Hicks
an Objective signs contractions (irregular and
assessed by an examiner painless contractions)
HCG is the earliest biological marker to detect pregnancy; can be detected w/in 7-8 days of
conception
Progesterone is the main hormone essential for maintaining pregnancy
Nutrition and Diet for Pregnant Women
• Average expected weight gain during pregnancy is 25-35 lbs for women with a normal
prepregnancy weight
• Increase of about 300 calories/day during pregnancy; calorie needs are greater in last two
trimesters
• Increase of about 500 calories/day needed during lactation
• Diet high in folic acid or folic acid supplements (necessary for all women of childbearing age to
prevent neural tube defects and orofacial clefts in the fetus)
• At least 8-10 (8-oz) glasses of fluids are needed (4-6 of those glasses should be water)
• Protein (meat, eggs, cheese, yogurt, legumes, nuts, grains)
• Fiber (whole grains, bran, vegetables, fruits, nuts, and seeds)
,2
• Calcium (leafy greens)
• Iron (liver, meats, whole grains, dark leafy greens, legumes, dried fruits)
• Zinc
• Iodine
• Magnesium
• Practice Question: Some patients are worried about including fish in their diet during
pregnancy. How can the nurse assist the patient in determining which fish is safe to
consume?
• Ans: Advise the patient to avoid swordfish, shark, and mackerel during pregnancy
Fetal Development Timeline:
- Embryo stage: Day 15 – week 8: most critical time for organ development; by end of 8th week,
all organ systems and external structures are present o Cardiovascular system is the first organ
system to function; heart begins to beat at the end of 3 weeks and complete by week 4
- 5 weeks: Baby is most at risk (teratogens)
- 8 – 10 weeks: Baby looks like a baby
- 10 – 14 weeks: Pancreas begins to function
- 18 – 20 weeks: Movement can be felt
- 24 Weeks: Baby is able to hear
- Practice Question: A pregnant woman at 25 weeks’ gestation tells the nurse that she dropped a
pan last week and her baby jumped at the note. Which response would the nurse give?
o Ans: Babies respond to sounds starting at about 24 weeks of gestation
- Practice Question: A woman is 15 weeks pregnant with her first baby. She asks how long
it will be before she feels the baby move. What is the nurse’s best response?
o Ans: Within the next month, you should start to feel fluttering sensations.
- Practice Question: Which are the most important systems in the baby for post uterine
life?
o Ans: Cardiovascular and respiratory systems
Fetal Circulatory Pathway:
Three important shunts
1. Ductus arteriosus o Connects the pulmonary artery to the aorta, bypassing the
lungs
- In fetal period, shunt is right to left (normal)
- Ductus arteriosus supposed to close after birth due to increased oxygenation
and decrease blood flow through the ductus arteriosus and causes it to
constrict and close by 24 hours of age. The ductus will permanently close
within 3-4 weeks and ductus arteriosus will be a ligament. If this doesn’t
occur then we have PDA.
o Complications:
a) Reopen d/t hypoxia, asphyxia or prematurity, murmur can be heard upon
auscultation
, 3
b) Patent ductus arteriosus (PDA)
- left-to-right shunt, acyanotic at presentation; cyanosis may occur later
* Left-to-Right shunts: “LaterR” cyanosis
* PDA occurs when ductus arteriosus doesn’t constrict within
time frame and eventually will result in late cyanosis in the
lower extremities (differential cyanosis)
* This causes a continuous/machine-like murmur
2. Ductus venous
o Connects the umbilical vein and the inferior vena cava, bypassing the liver o
When the cord is clamped and severed, the umbilical arteries, vein and the ductus
venosus are functionally closed; they are converted into ligaments within 2-3
months
3. Foramen ovale
o Opening between the right and left atria of the heart, bypassing the lungs o The
pressure of the pulmonary artery and right atrium will drop. The increased
pulmonary blood flow from left side of the heart increased the pressure in the left
atrium and thereby closing the foramen ovale.
• The fetal circulation bypass is present because of the nonfunctioning lungs. Therefore,
once fetus is born, these bypasses (the ones above) must close to allow blood to flow
through the lungs and the liver.
• Practice Question: What are the signs of respiratory distress in the infant?
o Ans: Nasal flaring, grunting, and retractions
Blood Screening/Typing
• ABO typing is done to determine the woman's blood type in the ABO antigen system
• Rh typing is done to determine the woman's blood type in the rhesus antigen system
• If the mom is Rh negative (absence of antigen) and has a negative antibody screen, she will need
repeat antibody screens and should receive Rh immune globulin at 28 wks of gestation
• No problems when mother is Rh positive and baby is Rh negative. Difficulty arises when the
mother is Rh negative and the baby is Rh positive.
• Coomb’s Testing:
• This is the screening tool for Rh incompatibility
• Can detect other antibodies that may place the fetus at risk for incompatibility with maternal
antigens
Primary vs. Secondary Powers
Primary Powers Secondary Powers
• Involuntary (uterine contractions) Laboring woman experiences urge to push
• Signal beginning of labor when presenting part reaches pelvic floor
• Primary powers are responsible for Uses bearing-down efforts (secondary the effacement
and dilation of the powers) to aid in expulsion of the fetus cervix and descent of the fetus
NSG 432 OB Final Exam Study Guide| Comprehensive Nursing Notes
| Latest 2026–2027 Update
OB Exam Final Study Guide
Signs of Pregnancy (presumptive, probable, positive)
Presumptive examiner that can be attributed
Subjective changes reported only to the presence of the fetus
by the woman that can also • Hegar sign (softening and Signs that are attributed
be caused by other compressibility of the by presence of fetus lower uterine
conditions segment Hearing fetal heart tones
• Breast changes usually at 6 wks) (doppler)
• Amenorrhea • Ballottement (palpating a Palpation of fetal floating
• Nausea and vomiting structure by movement
• Urinary frequency bouncing it gently and Visualization of fetus
• Fatigue feeling it rebound; (ultrasound)
• Discoloration of vaginal generally b/w 16-18 wks)
mucosa • Positive pregnancy tests for presence of HCG hormone
• Quickening ("feeling of • Goodell sign (increased vascularity, slight hypertrophy, and
life"; first recognition of hyperplasia)
fetal movement) • Chadwick sign: violet blue mucosa and cervix d/t increased
Probable Positive vascularity
Objective changes assessed by • Braxton Hicks
an Objective signs contractions (irregular and
assessed by an examiner painless contractions)
HCG is the earliest biological marker to detect pregnancy; can be detected w/in 7-8 days of
conception
Progesterone is the main hormone essential for maintaining pregnancy
Nutrition and Diet for Pregnant Women
• Average expected weight gain during pregnancy is 25-35 lbs for women with a normal
prepregnancy weight
• Increase of about 300 calories/day during pregnancy; calorie needs are greater in last two
trimesters
• Increase of about 500 calories/day needed during lactation
• Diet high in folic acid or folic acid supplements (necessary for all women of childbearing age to
prevent neural tube defects and orofacial clefts in the fetus)
• At least 8-10 (8-oz) glasses of fluids are needed (4-6 of those glasses should be water)
• Protein (meat, eggs, cheese, yogurt, legumes, nuts, grains)
• Fiber (whole grains, bran, vegetables, fruits, nuts, and seeds)
,2
• Calcium (leafy greens)
• Iron (liver, meats, whole grains, dark leafy greens, legumes, dried fruits)
• Zinc
• Iodine
• Magnesium
• Practice Question: Some patients are worried about including fish in their diet during
pregnancy. How can the nurse assist the patient in determining which fish is safe to
consume?
• Ans: Advise the patient to avoid swordfish, shark, and mackerel during pregnancy
Fetal Development Timeline:
- Embryo stage: Day 15 – week 8: most critical time for organ development; by end of 8th week,
all organ systems and external structures are present o Cardiovascular system is the first organ
system to function; heart begins to beat at the end of 3 weeks and complete by week 4
- 5 weeks: Baby is most at risk (teratogens)
- 8 – 10 weeks: Baby looks like a baby
- 10 – 14 weeks: Pancreas begins to function
- 18 – 20 weeks: Movement can be felt
- 24 Weeks: Baby is able to hear
- Practice Question: A pregnant woman at 25 weeks’ gestation tells the nurse that she dropped a
pan last week and her baby jumped at the note. Which response would the nurse give?
o Ans: Babies respond to sounds starting at about 24 weeks of gestation
- Practice Question: A woman is 15 weeks pregnant with her first baby. She asks how long
it will be before she feels the baby move. What is the nurse’s best response?
o Ans: Within the next month, you should start to feel fluttering sensations.
- Practice Question: Which are the most important systems in the baby for post uterine
life?
o Ans: Cardiovascular and respiratory systems
Fetal Circulatory Pathway:
Three important shunts
1. Ductus arteriosus o Connects the pulmonary artery to the aorta, bypassing the
lungs
- In fetal period, shunt is right to left (normal)
- Ductus arteriosus supposed to close after birth due to increased oxygenation
and decrease blood flow through the ductus arteriosus and causes it to
constrict and close by 24 hours of age. The ductus will permanently close
within 3-4 weeks and ductus arteriosus will be a ligament. If this doesn’t
occur then we have PDA.
o Complications:
a) Reopen d/t hypoxia, asphyxia or prematurity, murmur can be heard upon
auscultation
, 3
b) Patent ductus arteriosus (PDA)
- left-to-right shunt, acyanotic at presentation; cyanosis may occur later
* Left-to-Right shunts: “LaterR” cyanosis
* PDA occurs when ductus arteriosus doesn’t constrict within
time frame and eventually will result in late cyanosis in the
lower extremities (differential cyanosis)
* This causes a continuous/machine-like murmur
2. Ductus venous
o Connects the umbilical vein and the inferior vena cava, bypassing the liver o
When the cord is clamped and severed, the umbilical arteries, vein and the ductus
venosus are functionally closed; they are converted into ligaments within 2-3
months
3. Foramen ovale
o Opening between the right and left atria of the heart, bypassing the lungs o The
pressure of the pulmonary artery and right atrium will drop. The increased
pulmonary blood flow from left side of the heart increased the pressure in the left
atrium and thereby closing the foramen ovale.
• The fetal circulation bypass is present because of the nonfunctioning lungs. Therefore,
once fetus is born, these bypasses (the ones above) must close to allow blood to flow
through the lungs and the liver.
• Practice Question: What are the signs of respiratory distress in the infant?
o Ans: Nasal flaring, grunting, and retractions
Blood Screening/Typing
• ABO typing is done to determine the woman's blood type in the ABO antigen system
• Rh typing is done to determine the woman's blood type in the rhesus antigen system
• If the mom is Rh negative (absence of antigen) and has a negative antibody screen, she will need
repeat antibody screens and should receive Rh immune globulin at 28 wks of gestation
• No problems when mother is Rh positive and baby is Rh negative. Difficulty arises when the
mother is Rh negative and the baby is Rh positive.
• Coomb’s Testing:
• This is the screening tool for Rh incompatibility
• Can detect other antibodies that may place the fetus at risk for incompatibility with maternal
antigens
Primary vs. Secondary Powers
Primary Powers Secondary Powers
• Involuntary (uterine contractions) Laboring woman experiences urge to push
• Signal beginning of labor when presenting part reaches pelvic floor
• Primary powers are responsible for Uses bearing-down efforts (secondary the effacement
and dilation of the powers) to aid in expulsion of the fetus cervix and descent of the fetus
