The exam is 60 questions and will have questions over the following topics
Reproductive
1. Fertility/Conception-where, when occurs In fallopian tube while being carried downward
toward uterus. Implantation of zygote usually occurs about 5 days after fertilization. Eggs
are only good for about 24 hours. Changes in acidity and thickness of mucus/cervical
allow sperm to live. After fertilization, everything becomes non-friendly to sperm. Egg
gets a shell and begins to divide, vagina becomes very acidic and the cervix gets a thick
mucus plug.
Twinning would occur in the fallopian tubes as well. Either 2/more separate eggs or the
split of a single egg into 2 or more viable zygotes.
2. Menstrual cycle (actions of Estrogen Hormone, Follicle Stimulating Hormone,
Progesterone Hormone, Luteinizing Hormone)
BOX 3.1 Summary of Menstrual cycle hormones pg. 79
Estrogen: secreted by ovaries; crucial for the development and maturation of the follicle;
causes
the uterus to increase in size and weight. Estrogen exerts a positive feedback on LH production
rises to critical levels and exerts pressure for LH to rise and release the mature follicle. Estrogen
levels peak 1 day before ovulation.
Follicle stimulating hormone: secreted by anterior pituitary gland; FSH helps control the
menstrual cycle and stimulates the growth of eggs in the ovaries.
Luteinizing Hormone (LH): is synthesized and secreted by the anterior pituitary gland in
response to GnRH. Like FSH, LH is involved in reproductive processes in both males and
females. When follicle maturation is complete, an LH surge triggers ovulation.
• Progesterone: (PROTECTS THE PREGNANCY) is responsible for preparing
the endometrium for uterine implantation of the fertilized egg.
– Increased progesterone levels cause increased basal temperature
– If a fertilized egg implants, the corpus luteum secretes progesterone in early
pregnancy until the placenta develops and takes over progesterone production
for
the remainder of the pregnancy.
– Closes Cervix
– Changes Mucus to make thick/Mucus Plug
– Builds THICK nutritive lining of the Uterus to prepare for zygote to implant
– Progesterone stops myometrium contractions and increases blood flow by
promoting smooth muscle relaxation in the myometrium during secretory phase.
3. Female anatomy- Know the structures Page 1-2, week 1 Prof. outline
4. Role of prostaglandins: NOT A HORMONE; primary mediators of the body’s
inflammatory processes and are essential for the normal physiologic function of the
female reproductive system; play a key role in ovulation; the menstrual cycle and the
induction of labour.
Pregnancy -Maternal
1. Amniotic fluid- derived from two sources- fluid transported from the maternal blood
across the amnion and fetal urine.
a. Purpose of fluid pg. 305- Sufficient amounts of amniotic fluid help maintain a
constant body temp for the fetus, permits symmetric growth and development,
cushions the fetus from trauma, allows umbilical cord to be relatively free from
compression, and promotes fetal movement to enhance musculoskeletal
development.
b. Oligohydramnios / Polyhydramnios Too little fluid (less than 500 mL at term)
associated with uteroplacental insufficiency, fetal renal abnormalities, higher risk
of surgical births and low-birth-weight infants/ too much fluid (more than 2,000
mL) associated with maternal diabetes, neural tube defects, chromosomal
deviations, and malformations of the CNS and/or GI tract that prevent normal
swallowing of amniotic fluid by the fetus.
1. Placental functions-- It is the way the baby gets food and oxygen, It provides an exchange
of nutrients and waste products between the mother and the developing fetus.
a. Know the purpose of the hormones
i. hCG- Human chorionic gonadotropin hormone : preserves the corpus
luteum and its progesterone production so that the endometrial lining of
the uterus is maintained; this is the basis for pregnancy tests
ii. hPL- Human placental lactogen; (human chorionic somatomammotropinhCS)modulates fetal and maternal metabolism, participates in the
development of maternal breasts for lactation, and decreases maternal
glucose utilization- which increases glucose availability to the fetus
iii. Estrogen -estriol: causes enlargement of a woman’s breast, uterus, and
external genitalia; stimulates myometrial contractility
iv. Progesterone-progestin: maintains the endometrium , decreases the
contractility of the uterus, stimulates maternal metabolism and breast
development, provides nourishment for the early conceptus (the products
of conception after fertilization in the early stages of growth and
differentiation)
v. Relaxin: acts synergistically with progesterone to maintain pregnancy,
causes relaxation of the pelvic ligaments ( waddle occurs) , and softens the
cervix in preparation for birth
Fetal development pg. 306
1. Critical times for fetal development of major organs- first trimester 0-13 wks
2. Fetal development of the respiratory system
3. Fetal development of the cardiac system
4. Fetal circulation-the umbilical cord and fetal shunts
Week 3: beginning development of: brain, spinal cord, heart , GI tract; neural tube forms- later
becomes spinal cord; leg and arm buds appear and grow out from body
Week 4: brain differentiates ; limb buds grow & develop more
Week 5: heart beats @ reg rhythm ; beginning structures of eyes and ears
Week 6: beginning formation of lungs; fetal circulation established ; liver produces RBCs,
further development of brain, CNS forms, primitive skeleton forms
Week 8: heart development completes , placenta is working
Week 13-16: fetus makes active movement, fetal movement detected by mother - quickening*
Week 17-20: rapid brain growth, fetal heart tones can be heard with stethoscope, muscles are
well developed
Weeks 21-24: alveoli forming in lungs, lungs being to form surfactant
Weeks 25-28: rapid brain development
Weeks 29-32: increased CNS control over body functions, rhythmic breathing movements occur
Prenatal Care
1. Action of Estrogen and Progesterone during the pregnancy : The increase in estrogen
during pregnancy enables the uterus and placenta to:
● improve vascularization (the formation of blood vessels)
● transfer nutrients
● support the developing baby
● In addition, estrogen is thought to play an important role in helping the fetus develop and
mature.
● Rapid increase in first trimester -leads to nausea
● Second trimester: milk duct development, breast enlargement
● Peaks in third trimester
- Progesterone levels also are extraordinarily high during pregnancy. The changes in
progesterone cause a laxity or loosening of ligaments and joints throughout the body . In
addition, high levels of progesterone cause internal structures to increase in size, such as
the ureters. The ureters connect the kidneys with the maternal bladder. Progesterone is
also important for transforming the uterus from the size of a small pear — in its
non-pregnant state — to a uterus that can accommodate a full-term baby.
2. Teratogenic agents: Before 8 weeks can interfere with growth. Any substance,organism,
physical agent, or deficiency state present during gestation that is capable of inducing
abnormal postnatal structure or function by interfering with normal embryonic and fetal
development; produce physical or functional defects in the human embryo or fetus after
the pregnant women has been exposed to that substance
- Physical deformities
- Problems in behavioral/emotional development
- Decreased intellectual quotient (IQ)
- Preterm labor
- Spontaneous abortions
- Classified into four types: physical agents, metabolic conditions, infection,
drugs/chemical agents
a. Common medications that are teratogenic pg. 310i. Thalidomide - limb malformations
ii. Alcohol- fetal alcohol spectrum disorder
iii. ACE inhibitors- prematurity, intrauterine growth restriction
iv. Cocaine- placental abruption, prematurity, microcephaly
v. Tetracycline- yellow-brown teeth discoloration
b. Immunizations- which ones can you have and not have during pregnancy
i. Pg 401/ CDC recommends that pregnant women get two vaccines during
every pregnancy: the inactivated flu vaccine (the injection, not the live
nasal flu vaccine) and the Tdap vaccine. Hep B, Rabies
ii. Don’t get
● Human papillomavirus (HPV) vaccine
● Measles, mumps, and rubella (MMR) vaccine
● Live influenza vaccine (nasal flu vaccine)
● Varicella (chicken pox) vaccine
● BCG (TB)
● Typhoid
1. Signs of pregnancy pg. 333
a. Presumptive signs of Pregnancy Subjective signs- signs that the mother can
perceive; absence of menstruation- not a reliable sign of pregnancy, but if
accompanied with other s/s- N/V, fatigue, breast tenderness…. pregnancy may be
likely
i. Least reliable indicators of pregnancy; because any one of them can be
caused by conditions other than pregnancy.. (i.e.- amenorrhea can be
caused by menopause)
ii. Fatigue; breast tenderness; N/V, Amenorrhea, Urinary frequency,
hyperpigmentation of the skin, fetal movements (quickening), uterine
enlargement, breast enlargement
b. Probable signs of pregnancy- objective signs: those that can be detected by
physical examination; softening of the lower uterine segment or isthmus- HEGAR
SIGN); softening of the cervix- GOODELL SIGN; bluish-purple coloration of the
vaginal mucosa and cervix- CHADWICK SIGN; Braxton Hicks Contractions, +
preg. test, abdominal enlargement, Ballottement- the examiner pushes against the
woman’s cervix and feels rebound from the floating fetus
c. Positive signs of pregnancy- ultrasound verification of embryo or fetus, fetal
movement felt by experienced clinician, auscultation of fetal heart tones via
doppler
1. Uterine growth during pregnancy pg. 338
i. Size increases to 20 times that of nonpregnant size
ii. Capacity increases by 2,000 times to accommodate the developing fetus
iii. Weight increases from 2 oz. to approximately 2 lb at term
iv. Hyperplasia and hypertrophy of myometrial cells- increase in size
v. Increased strength and elasticity allow uterus to contract and expel fetus
during birth
vi. Rise in blood flow
a. Fundal height: can be correlated with gestational weeks most accurately between
wks 18 & 32/ measured in centimeters….
i. By 20 wks’ gestation, the fundus is at the level of the umbilicus and
measures 20 cm
ii. 36 wks- fundus reaches highest level, at the xiphoid process
iii. 38 & 40 wks- fundal height drops as fetus begins to descend and engage
into the pelvis
1. Changes of pregnancy
a. Breast changes during pregnancy Nipples enlarge, become darker, small bumps
(Montogomery glands - sebaceous) appear around nipples that lubricate to keep
germs away. Become large, very vascular and sore. Colostrum @ 3-5 days post
delivery - LIQUID GOLD - full of immunoglobulins!
b. Cardiac changes during pregnancy- Heart size and position, blood volume (50%),
cardiac output/HR (50% - 10-15 bpm), Blood pressure (decrease 10-15 bpm),
Blood components (RBC’s 25-33%), coagulation (fibrinogen and fibrin increase).
c. Gastrointestinal changes during pregnancy Drug excretion rates increased
(increased glomerular filtration) Slowed gastric emptying/nausea and vomiting
may increase medication absorption.
d. Renal system changes during pregnancy
1. Vaginal/cervical changes during pregnancy- What are they and when do they occur?
a. Heger’s sign -- Softening of the lower segment of the uterus 6-12 weeks
(Probable sign of pregnancy)
b. Goodell’s sign-- Softening of the cervix (probable sign of pregnancy)
c. Chadwicks-- Bluish discoloration of the cervix (probable sign of pregnancy)
1. Integumentary changes during pregnancy
a. Linea Nigra, - Dark line on the stomach
b. Stria gravidurum, - Stretch marks
c. Melasma- discoloration on the face
1. Dietary needs during pregnancy
a. Folic Acid- foods rich in Folate
b. Concerns with pica/foods that may cause illness
1. Prenatal Care- normal appoint schedule
2. Prenatal Care-Normal weight gain
3. Prenatal Care-Education at specific times
4. Prenatal Care-TORCH syndrome Toxoplasmosis, other (syphilis/varicella/HIV), Rubella,
cytomegalovirus, Varicella. DETAILS: p. 8 of Profs. Outline. Generally, abnormal brain
development, mental impairments, fetal death, blind, deaf, malformations.
5. Physiologic anemia-causes, how to determine
6. Naegles rule-- Expected delivery date (last day of your period 10/7 add 9 months and 7
days 7/14 the baby would be due)
7. GTPAL -Gravita (Total times pregnant) Term (38-40 wks) Premature (20-37 wks)
Abortion (under 20 weeks) Living (total children living) EXAMPLE: Susan is pregnant
with her 4th child. She had her twins at 35 wks gestation, Her son was born 38 wks
gestation, Her daughter was born 39 wks gestation but died shortly after delivery.
G4,T2,P1,A0,L3
8. Danger signs of pregnancy
9. Psychosocial adjustment to pregnancy
10. Reproductive life planning-preconception care
11. Prenatal Testing- teaching needed
a. Ultrasound
b. Amniocentesis/CVS
c. Glucose Screening
d. Non stress test
Labor and Delivery
1. Determining Stage of labor
2. Priority nursing care during labor
3. Categorizing Fetal monitoring strips
4. Nursing response and management of EFM
5. Titrating and administering oxytocin
6. Safety concerns when administering oxytocin
7. Interpreting contraction activity
8. Pain medication during labor-actions and priority safety concerns
9. Induction of labor-nursing concerns
10. Actions of cervical ripening agents.
11. Prolapsed Cord-Priorities of care and risk factors
12. SROM /AROM- Nursing actions
Pregnancy complications
1. Signs, symptoms and risk factors of abruption placenta Separation of the placenta after 20
weeks. Maternal HTN and preeclampsia. Sudden onset of dark red blood. PAIN! Firm,
rigid uterus. Over 35 yo., poor nutrition, multiple gestation, hydramnios, trauma, HTN,
FGR, smoking, violence, history, drug and alcohol use, prolonged pre-labor,
preeclampsia.
2. Care management of the bleeding pregnant woman Blood transfusion, Emergency
hysterectomy. Prevent DIC. 2 large bore IV. Run LR or normal saline. Type and
crossmatch.
3. Nursing care of the patient with placenta previa Monitor fetal status. Assess vaginal
bleeding, weigh pads. DO NOT PERFORM A VAGINAL EXAM. Monitor VS
(increased HR is 1st sign of hypovolemia). Side lying position, 2 large bore IV access
sites. Type and cross. Know coag status, administer Rhogam if necessary and tocolytics
may be give to stop contractions. Bed rest.
4. Preterm labor signs and symptoms
5. Magnesium sulfate uses in labor and delivery, signs and symptoms, assessment, antidote
Labor and Delivery Complications
1. Explain management of labor dystocia
2. Nursing Care for woman with Anaphalactoid
3. Prevention of DIC
4. Assisted birth, preventing injury