NR602 EXAM QUESTIONS &
DETAILED ANSWERS PASSED
ALREADY GRADED A+
Presumptive signs of pregnancy - correct answer ✔✔Subjective signs. Amenorrhea, nausea,
vomiting, increased urinary frequency, excessive fatigue, breast tenderness, quickening at 18-20
weeks.
Probable signs of pregnancy - correct answer ✔✔Objective Signs. Goodell sign (softening of
cervix), Chadwick sign (cervix is blue/purple), Hegar's sign (softening of lower uterine segment),
uterine enlargement, Braxton Hicks contractions (may be plapated by 28 weeks), uterine souffle
(soft blowing sound due to blood pulsating through the placenta), integumentary pigment
changes, ballottement, fetal outline definable, positive pregnancy test (could be hydatidiform
mole, choriocarcinoma, increased pituitary gonadotropins at menopause).
Positive signs of pregnancy - correct answer ✔✔Diagnostic. Fetal heart rate auscultated by
fetoscope at 17-20 weeks or by Doppler at 10-12 weeks, Palpable fetal movement after 20
weeks, visualization of fetus with cardiac activity by ultrasound (fetal parts visible by 8 weeks).
Pregnancy and fundal height measurement - correct answer ✔✔As pregnancy progresses, the
fundus rises out of the pelvis. At 12 weeks gestation, the fundus is located at the level of the
symphysis pubis and the umbilicus. By 20 weeks gestation, the fundus is at the same height as
the umbilicus. Until term, the fundus enlarges 1 cm per week. As the time for birth approaches,
the fundal height drops slightly. This process is called lighting and occurs mostly for primigravida
and may not occur for woman who are multigravida until she goes into labor.
Naegele's rule - correct answer ✔✔The EDB for women with 28 day cycles - Nagele's rule - Add
7 days to LMP then subtract 3 months.
Example: 4/23 LMP of April 23 + 7 days = 4/30 (April 30th) - 3 months = January 30th (following
year)
,Hematological changes during pregnancy - correct answer ✔✔During pregnancy, the heart is
displaced upward and to the with withing the chest cavity by the gravid uterus's pressure on the
diaphragm. As pregnancy progresses, the risk for inferior vena cava and aortic compression
leading to supine hypotension increases when the woman lies in a supine position. Advice
pregnant women to lie left lateral position. Cardiac output in pregnancy increases by 30-50%.
Peaks in early third trimester and maintained until birth. Stroke volume is also increased during
pregnancy by 20-30% which allows for the 30% increase in oxygen consumption observed
during pregnancy. Heart rate and heart sounds changes. Volume of the first heart sound may be
increased with splitting. 3rd heart sound may be detected. Systolic murmurs may be detected.
Increase of 15-20 beats/min by 32 weeks gestation. BP decreases by 5-15 mm Hg due to
peripheral vascular resistance. 1st and 3rd trimester should be pre-pregnancy values. Blood
volume increases by 30-50% and peaks at 30-34 weeks gestation. 75% of the increase of blood
volume is plasma. Blood volume changes results in anemia due to the hemodilution. Clotting
factors increase as well creating a risk for clotting during pregnancy.
Indications and contraindications for prescribing combined estrogen birth control - correct
answer ✔✔Combined Estrogen - Take everyday, has hormone free intervals of 7 days,
Indications - Safe for healthy women. Studies show a decrease in the possibility of endometrial
or cervical cancer not found with the mini pill or POP.
Contraindications - direct effects of the hormonal ingredient, as in breast cancer, or
thromboembolism.
Indications and contraindications for prescribing progesterone-only birth control - correct
answer ✔✔Progesterone-only - Mini pill - must take every day at the same time and there are
no hormone free intervals. These pills only thicken the cervical mucus to prevent pregnancy.
Make the mucus thick for 22 hours so it needs to be taken constantly to avoid the mucus to
return to regular consistency.
Indications - POPs are a safe method for many women who cannot take estrogen for medical
reasons. POPs are preferable to COCs for lactating women because they do not cause adverse
effects on the volume or quality of breastmilk.
Contraindications - almost none.
, menarche - correct answer ✔✔The initiation of menstruation, called menarche, usually
happens between the ages of 12 and 15
Influenza (flu)a - correct answer ✔✔Women who are pregnant are at increased risk for flu-
related complications.
Any gestation when the injection is available
Tetanus, diphtheria, pertussis (Tdap) - correct answer ✔✔After maternal vaccination, antibodies
cross the placenta and decrease the risk of pertussis infection in the newborn.
Third trimester (ideally 27-36 weeks' gestation)
Hepatitis B - correct answer ✔✔If the woman is at risk for acquiring HBV, she should be
vaccinated. Indications include risk of occupational exposure to blood, treatment for a sexually
transmitted infection, more than 1 sex partner in the past 6 months, recent intravenous drug
use, and HBsAg-positive sex partner. 3 injections beginning at any point in gestation
Sperm can live for up to 5 days in the female reproductive tract, and pregnancy can occur with
intercourse 5 days prior to ovulation. The highest risk of pregnancy is... - correct answer ✔✔in
the 48 hours immediately preceding ovulation
Measles, mumps, rubella - correct answer ✔✔This live virus vaccine has a (theoretical) risk to
the fetus.
Varicella - correct answer ✔✔This live virus vaccine has a (theoretical) risk to the fetus.
Tier 1 methods of contraception and efficacy - correct answer ✔✔Most effective - less than 1
per 100 pregnancies - Vasectomy, implant, tubal occlusion, and IUD. After procedure, little or
nothing to do or remember Vasectomy: Use another method for first 3 months.
DETAILED ANSWERS PASSED
ALREADY GRADED A+
Presumptive signs of pregnancy - correct answer ✔✔Subjective signs. Amenorrhea, nausea,
vomiting, increased urinary frequency, excessive fatigue, breast tenderness, quickening at 18-20
weeks.
Probable signs of pregnancy - correct answer ✔✔Objective Signs. Goodell sign (softening of
cervix), Chadwick sign (cervix is blue/purple), Hegar's sign (softening of lower uterine segment),
uterine enlargement, Braxton Hicks contractions (may be plapated by 28 weeks), uterine souffle
(soft blowing sound due to blood pulsating through the placenta), integumentary pigment
changes, ballottement, fetal outline definable, positive pregnancy test (could be hydatidiform
mole, choriocarcinoma, increased pituitary gonadotropins at menopause).
Positive signs of pregnancy - correct answer ✔✔Diagnostic. Fetal heart rate auscultated by
fetoscope at 17-20 weeks or by Doppler at 10-12 weeks, Palpable fetal movement after 20
weeks, visualization of fetus with cardiac activity by ultrasound (fetal parts visible by 8 weeks).
Pregnancy and fundal height measurement - correct answer ✔✔As pregnancy progresses, the
fundus rises out of the pelvis. At 12 weeks gestation, the fundus is located at the level of the
symphysis pubis and the umbilicus. By 20 weeks gestation, the fundus is at the same height as
the umbilicus. Until term, the fundus enlarges 1 cm per week. As the time for birth approaches,
the fundal height drops slightly. This process is called lighting and occurs mostly for primigravida
and may not occur for woman who are multigravida until she goes into labor.
Naegele's rule - correct answer ✔✔The EDB for women with 28 day cycles - Nagele's rule - Add
7 days to LMP then subtract 3 months.
Example: 4/23 LMP of April 23 + 7 days = 4/30 (April 30th) - 3 months = January 30th (following
year)
,Hematological changes during pregnancy - correct answer ✔✔During pregnancy, the heart is
displaced upward and to the with withing the chest cavity by the gravid uterus's pressure on the
diaphragm. As pregnancy progresses, the risk for inferior vena cava and aortic compression
leading to supine hypotension increases when the woman lies in a supine position. Advice
pregnant women to lie left lateral position. Cardiac output in pregnancy increases by 30-50%.
Peaks in early third trimester and maintained until birth. Stroke volume is also increased during
pregnancy by 20-30% which allows for the 30% increase in oxygen consumption observed
during pregnancy. Heart rate and heart sounds changes. Volume of the first heart sound may be
increased with splitting. 3rd heart sound may be detected. Systolic murmurs may be detected.
Increase of 15-20 beats/min by 32 weeks gestation. BP decreases by 5-15 mm Hg due to
peripheral vascular resistance. 1st and 3rd trimester should be pre-pregnancy values. Blood
volume increases by 30-50% and peaks at 30-34 weeks gestation. 75% of the increase of blood
volume is plasma. Blood volume changes results in anemia due to the hemodilution. Clotting
factors increase as well creating a risk for clotting during pregnancy.
Indications and contraindications for prescribing combined estrogen birth control - correct
answer ✔✔Combined Estrogen - Take everyday, has hormone free intervals of 7 days,
Indications - Safe for healthy women. Studies show a decrease in the possibility of endometrial
or cervical cancer not found with the mini pill or POP.
Contraindications - direct effects of the hormonal ingredient, as in breast cancer, or
thromboembolism.
Indications and contraindications for prescribing progesterone-only birth control - correct
answer ✔✔Progesterone-only - Mini pill - must take every day at the same time and there are
no hormone free intervals. These pills only thicken the cervical mucus to prevent pregnancy.
Make the mucus thick for 22 hours so it needs to be taken constantly to avoid the mucus to
return to regular consistency.
Indications - POPs are a safe method for many women who cannot take estrogen for medical
reasons. POPs are preferable to COCs for lactating women because they do not cause adverse
effects on the volume or quality of breastmilk.
Contraindications - almost none.
, menarche - correct answer ✔✔The initiation of menstruation, called menarche, usually
happens between the ages of 12 and 15
Influenza (flu)a - correct answer ✔✔Women who are pregnant are at increased risk for flu-
related complications.
Any gestation when the injection is available
Tetanus, diphtheria, pertussis (Tdap) - correct answer ✔✔After maternal vaccination, antibodies
cross the placenta and decrease the risk of pertussis infection in the newborn.
Third trimester (ideally 27-36 weeks' gestation)
Hepatitis B - correct answer ✔✔If the woman is at risk for acquiring HBV, she should be
vaccinated. Indications include risk of occupational exposure to blood, treatment for a sexually
transmitted infection, more than 1 sex partner in the past 6 months, recent intravenous drug
use, and HBsAg-positive sex partner. 3 injections beginning at any point in gestation
Sperm can live for up to 5 days in the female reproductive tract, and pregnancy can occur with
intercourse 5 days prior to ovulation. The highest risk of pregnancy is... - correct answer ✔✔in
the 48 hours immediately preceding ovulation
Measles, mumps, rubella - correct answer ✔✔This live virus vaccine has a (theoretical) risk to
the fetus.
Varicella - correct answer ✔✔This live virus vaccine has a (theoretical) risk to the fetus.
Tier 1 methods of contraception and efficacy - correct answer ✔✔Most effective - less than 1
per 100 pregnancies - Vasectomy, implant, tubal occlusion, and IUD. After procedure, little or
nothing to do or remember Vasectomy: Use another method for first 3 months.
