Review Practice Exercise 1

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Practice Exercise 1

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Total Questions : 5

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Question 1:

Which of the following is considered a presumptive sign of pregnancy?

A. Positive pregnancy test B. Auscultation of fetal heart tones C. Nausea and vomiting D. Visualization of the fetus by ultrasound

Answer and Explanation

Choice A:

A positive pregnancy test is a probable sign. It detects hCG, which rises after implantation. However, elevated hCG can also occur in trophoblastic disease or recent miscarriage, making it insufficient alone for diagnosis.

Choice B:

Auscultation of fetal heart tones is a positive sign. Fetal heart sounds are independent of the mother’s and confirm fetal presence. They can be detected by Doppler from 10–12 weeks of gestation.

Choice C:

Nausea and vomiting are classic presumptive signs of pregnancy, resulting from elevated estrogen and hCG levels. These symptoms are common in early pregnancy but are subjective and not exclusive to pregnancy.

Choice D:

Visualization of the fetus by ultrasound is a positive sign. Seeing the embryo or fetus with cardiac activity confirms intrauterine pregnancy. Cardiac motion can be seen by transvaginal ultrasound at approximately 5–6 weeks.

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Question 2:

A nurse is assessing a patient who reports nausea and vomiting at 8 weeks gestation. What is the most likely physiological cause of this symptom?

A. Increased progesterone levels suppressing uterine contractions B. Elevated hCG levels stimulating the chemoreceptor trigger zone C. Increased blood volume causing gastric irritation D. Uterine pressure on the stomach reducing gastric capacity

Answer and Explanation

Choice A:

Increased progesterone suppresses uterine contractions by relaxing smooth muscle but is not the primary cause of nausea and vomiting. Its main effects are maintaining the endometrial lining and reducing uterine irritability, not stimulating the vomiting center.

Choice B:

Elevated hCG levels are strongly associated with nausea and vomiting in early pregnancy. hCG peaks between 8–11 weeks and directly stimulates the chemoreceptor trigger zone in the brainstem, inducing nausea. This explains the timing and severity of symptoms during the first trimester.

Choice C:

Increased blood volume begins rising early in pregnancy but peaks around 32–34 weeks. It does not directly irritate the gastric lining nor explain first-trimester nausea, which is hormonally mediated.

Choice D:

Uterine pressure on the stomach becomes relevant later in pregnancy, particularly in the third trimester, leading to reflux or reduced gastric capacity—not nausea at 8 weeks.

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Question 3:

Goodell’s sign is characterized by:

A. Bluish discoloration of the vaginal mucosa B. Softening of the cervical tip C. Softening of the lower uterine segment D. Passive movement of the unengaged fetus

Answer and Explanation

Choice A:

Bluish discoloration of the vaginal mucosa is Chadwick’s sign, not Goodell’s. It results from increased blood flow to the cervix and vagina and appears around 6–8 weeks, also classified as a probable sign.

Choice B:

Goodell’s sign refers to softening of the cervical tip, detectable during a pelvic exam around 6–8 weeks. This change occurs due to increased vascularity and hypertrophy from elevated estrogen, classifying it as a probable sign of pregnancy.

Choice C:

Softening of the lower uterine segment is Hegar’s sign, not Goodell’s. It is detected during bimanual examination around 6–12 weeks and reflects uterine softening below the cervix, also a probable sign.

Choice D:

Passive movement of the unengaged fetus during palpation is ballottement, not Goodell’s. It occurs between 16–18 weeks and is another probable sign, observed during a physical exam when the fetus rebounds after being pushed.

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Question 4:

Which of the following are presumptive signs of pregnancy? Select all that apply.

A. Amenorrhea B. Fetal heart sounds C. Nausea and vomiting D. Uterine enlargement E. Quickening

Answer and Explanation

Choice A:

Amenorrhea is a presumptive sign because it is a subjective experience commonly caused by pregnancy. It occurs due to suppression of the hypothalamic–pituitary–ovarian axis by rising hCG and progesterone.

Choice B:

Fetal heart sounds are a positive sign. They provide direct evidence of fetal life and are detected by Doppler around 10–12 weeks. This confirms pregnancy beyond doubt.

Choice C:

Nausea and vomiting are presumptive signs caused by rising hCG levels stimulating the chemoreceptor trigger zone. These symptoms are subjective and occur in other conditions, making them non-definitive.

Choice D:

Uterine enlargement is a probable sign. It is an objective finding noted during bimanual examination or ultrasound but may also result from tumors or fibroids. It suggests pregnancy but is not conclusive without positive signs

Choice E:

Quickening refers to the woman’s first perception of fetal movement, usually between 16–20 weeks. It is a subjective experience and can be confused with gastrointestinal activity, classifying it as presumptive.

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Question 5:

Which of the following are probable signs of pregnancy? Select all that apply.

A. Auscultation of fetal heart tones B. Chadwick’s sign C. Ballottement D. Fatigue E. Uterine enlargement (palpable by examiner)

Answer and Explanation

Choice A:

Auscultation of fetal heart tones is a positive sign. It confirms the presence of a viable fetus and is typically detected by Doppler at 10–12 weeks. It is definitive and diagnostic for pregnancy.

Choice B:

Chadwick’s sign is a probable sign. It is the bluish discoloration of the vaginal mucosa and cervix due to increased vascularity, seen around 6–8 weeks of gestation and detectable during pelvic examination.

Choice C:

Ballottement is a probable sign. It refers to the passive rebound of the fetus when the cervix is tapped, typically evident between 16–18 weeks. It is a physical exam finding that may suggest pregnancy.

Choice D:

Fatigue is a presumptive sign. It is a subjective experience reported by the pregnant woman and can be caused by many non-pregnancy-related conditions such as anemia, stress, or hypothyroidism.

Choice E:

Uterine enlargement, when palpated by a clinician, is a probable sign. The uterus increases in size due to the growing embryo, but similar enlargement can occur in cases of fibroids or adenomyosis.

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Practice Exercise 1

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