Exam 2: Pregnancy (Module 8)

GTPAL is an acronym used to summarize a person’s obstetric history and pregnancy outcomes.

• Gravida (total # of pregnancies)

• Term births (≥37 weeks)

• Preterm births (20 wks — 36 wks 6 days)

• Abortions (< 20 weeks; spontaneous or induced)

• Living children

What is GTPAL and what does it stand for?

G4
T1
P1
A1
L3

A client is currently pregnant. She has had:

• One term birth

• One miscarriage at 10 weeks

• One preterm twin delivery

• Three living children

What is her GTPAL?

July 12, 2026 + 7 days = July 19, 2026

July 19, 2026 - 3 months = April 19, 2026

April 19, 2026 +1 year = April 19, 2027

EDD = April 19, 2027

A client's last menstrual period (LMP) began on July 12, 2026. Using Naegele's Rule, what is her estimated date of delivery (EDD)?

“This is an expected physiologic change of pregnancy because the body is working harder to support the growing baby”

A pregnant client asks why she feels mildly short of breath despite having normal lung sounds and oxygen saturation. Which explanation by the nurse is most appropriate?

A. Increased blood volume

B. Increased cardiac output

C. Increased heart rate

D. Hypercoagulable state

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Expected changes:

• ✅ Blood volume increases 30–50%

• ✅ Cardiac output increases 30–50%

• ✅ Heart rate increases by 10–20 bpm

• ✅ Pregnancy is a hypercoagulable state

• ❌ GFR actually increases, not decreases.

A nurse is teaching a prenatal class about cardiovascular changes during pregnancy. Which findings are expected? (Select all that apply.)

A. Increased blood volume

B. Increased cardiac output

C. Increased heart rate

D. Hypercoagulable state

E. Decreased glomerular filtration rate

“Pregnancy creates a hypercoagulable state, increasing the risks of DVT and PE.”

A pregnant client asks why the nurse encourages frequent ambulation during pregnancy and after delivery. Which explanation is most accurate?

Elevated Progesterone

• Slows GI motility → constipation

• Relaxes esophageal sphincter → heartburn

A pregnant client reports heartburn and constipation. Which physiologic change is primarily responsible for these symptoms?

linea nigra (normal skin change during pregnancy)

A nurse observes a dark vertical line extending from a pregnant client's umbilicus to her pubic bone. Which is the nurse suspecting?

• Linear nigra

• Melasma ("mask of pregnancy")

• Striae gravidarum

• Spider angiomas

• Palmar erythema

Whata re the expected skin changes during pregnancy?

“Approximately 340 additional calories per day during the second trimester.”

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Remember:

• 1st trimester (conception — 12 wks): Usually no increase

• 2nd trimester (13 — 27 wks): +340 kcal/day

• 3rd trimester (28 — 40 wks): +450 kcal/day

A client at 24 weeks' gestation asks how many extra calories she should consume each day. Which response is correct?

“Folic acid helps prevent neural tube defects, such as spina bifida.”

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Recommended Folic Acid intake of 400 mcg/day for most low-risk women before conception and during early pregnancy.

A client asks why folic acid is recommended before conception and during early pregnancy. Which response is most accurate?

“Iron supports increased maternal blood volume and fetal growth.”

A pregnant client asks why iron supplementation is prescribed during pregnancy. Which teaching should the nurse provide?

• Take with vitamin C to improve absorption.

• Avoid taking with calcium or dairy products.

• Dark stools and constipation are expected side effects.

What teaching should be provided regarding iron supplementation?

Underweight (BMI <18.5): 28–40 lb

Normal (BMI 18.5–24.9): 25–35 lb

Overweight (BMI 25–29.9): 15–25 lb

Obese (BMI ≥30): 11–20 lb

A pregnant client with a normal pre-pregnancy BMI asks how much weight she should gain during pregnancy. Recall the weight gain recommednations based on the client’s BMI.

Hyperemesis gravidarum

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Hallmark Finding of Hyperemesis Gravidarum:

• weight loss >5%

• dehydration

• ketonuria

• electrolyte imbalance

A pregnant client reports severe nausea and vomiting, has lost 6% of her pre-pregnancy weight, and has ketones in her urine. Which condition should the nurse suspect?

A. Daily weights

B. Strict intake and output

C. IV fluids

D. Monitor electrolytes

A nurse is caring for a client with hyperemesis gravidarum. Which nursing interventions are appropriate? (Select all that apply.)

A. Daily weights

B. Strict intake and output

C. IV fluids

D. Monitor electrolytes

E. Encourage three large meals daily

Chronic Hypertension

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Chronic Hypertension occurs before pregnancy or before 20 wks gestation.

A pregnant client develops hypertension at 18 weeks' gestation. Which hypertensive disorder does the nurse suspect?

Gestational Hypertension

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Gestational Hypertension:

• occurs after 20 weeks gestation

• elevated BP

• no proteinuria

• no severe features

A pregnant client develops hypertension at 32 weeks' gestation without proteinuria or signs of organ damage. Which condition is most likely?

Severe preeclampsia

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Severe Preeclampsia:

• Hypertension after 20 weeks

• Proteinuria and/or organ dysfunction

• Severe headache

• Visual disturbances

• RUQ/epigastric pain

• Hyperreflexia

• Oliguria

• Pulmonary edema

A client at 34 weeks' gestation has a blood pressure of 164/108 mmHg, proteinuria, severe headache, blurred vision, and right upper quadrant pain. Which condition should the nurse suspect?

Eclampsia

A client with preeclampsia begins having tonic-clonic seizures. Which complication has occurred?

B. Deep tendon reflexes absent

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Absent reflexes are an early sign of magnesium toxicity.

Other signs:

• Respiratory depression

• Decreased urine output

• Decreased level of consciousness

Antidote: Calcium gluconate

A nurse is caring for a client receiving magnesium sulfate for severe preeclampsia. Which assessment finding requires immediate action?

A. Blood pressure 150/94

B. Deep tendon reflexes absent

C. Mild flushing

D. Drowsiness

“Routine screening is performed between 24 and 28 weeks' gestation.”

A pregnant client asks when she will be screened for gestational diabetes. Which response by the nurse is correct?

Neonatal Hypoglycemia

A client is diagnosed with gestational diabetes. Which newborn complication is the nurse most concerned about immediately after birth?

A. Blood glucose monitoring

B. Diet modification

C. Regular exercise

D. Insulin if prescribed

A nurse is teaching a client with gestational diabetes. Which interventions should be included? (Select all that apply.)

A. Blood glucose monitoring

B. Diet modification

C. Regular exercise

D. Insulin if prescribed

E. Restrict all carbohydrates

• Around 28 weeks' gestation

• Within 72 hours postpartum if the infant is Rh-positive

• After events that may cause fetomaternal bleeding (e.g., miscarriage, amniocentesis, abdominal trauma)

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Remember: RhoGAM prevents maternal sensitization—it does not treat an already sensitized mother.

A pregnant client is Rh-negative. At which times should Rho(D) immune globulin (RhoGAM) be administered?

ABO incompatibility

A newborn develops jaundice within the first 24 hours of life. The mother has type O blood, and the infant has type A blood. Which condition does the nurse suspect?

Placenta Previa

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Placenta Previa:

Hallmark findings:

• Painless bright red bleeding

• Soft, non-tender uterus

• Placenta partially or completely covers the cervical os

Priority nursing actions:

• Monitor maternal VS

• Monitor fetal heart rate

• Prepare for possible cesarean birth

• DO NOT perform a vaginal examination until placenta previa is ruled out.

NCLEX Pearl: Previa = Painless.

A 33-week pregnant client arrives in the emergency department with painless, bright red vaginal bleeding. Her uterus is soft and non-tender, and the fetal heart rate is reassuring. Which condition should the nurse suspect?

C. Perform a digital vaginal examination

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Remember: A vaginal examination may cause life-threatening hemorrhage in a client with placenta previa.

A nurse is caring for a client with suspected placenta previa. Which provider prescription should the nurse question?

A. Monitor fetal heart rate

B. Establish IV access

C. Perform a vaginal examination

D. Monitor maternal vital signs

Placental Abruption

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Placental Abruption:

Hallmark findings:

• Painful vaginal bleeding

• Rigid, tender uterus

• Frequent contractions

• Fetal distress

• Possible hypovolemic shock

Priority nursing actions:

• Notify the provider immediately

• Continuous fetal monitoring

• Prepare for emergency delivery if indicated

• Monitor for maternal shock

NCLEX Pearl: Abruption = Abdominal pain.

A pregnant client at 35 weeks presents with sudden severe abdominal pain, a rigid, tender uterus, and dark vaginal bleeding. Which condition should the nurse suspect?

To reduce nausea:

• Eat crackers before getting out of bed

• Eat small, frequent meals

• Avoid an empty stomach

A pregnant client reports nausea every morning during the first trimester. Which nursing teaching is most appropriate?

“Heartburn is caused by relaxation of the lower esophageal sphincter due to progesterone.”

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Teach the client to:

• Avoid spicy or fatty foods

• Eat smaller meals

• Remain upright after eating

A pregnant client reports frequent heartburn. Which teaching should the nurse provide?

• Increased fluid intake

• High-fiber diet

• Regular exercise/ambulation

A pregnant client complains of constipation. Which nursing interventions are most appropriate?

“Dorsiflex the foot and stretch the calf muscles.”

Avoid pointing the toes, which can worsen the cramp.

A pregnant client develops painful leg cramps at night. Which instruction should the nurse provide?

C. Client with painless bright-red vaginal bleeding

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Painless bright-red bleeding suggests placenta previa, which places both the mother and fetus at risk for hemorrhage.

A nurse is caring for four pregnant clients. Which client should the nurse assess first?

A. Client with mild morning nausea

B. Client with heartburn after meals

C. Client with painless bright-red vaginal bleeding

D. Client with constipation for two days