CNCM 217 · Maternal & Child Health Nursing
MCHN Exam Review
Focus: all seven lectures • MCQs • Rationales • Flashcards • Cram Sheet
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Must-know numbers
Fact Value Normal fetal heart rate 110–160 bpm Age of viability 24 weeks Full-term pregnancy 37–40 wk (normal 38–42) Genetic disorder incidence 1 in 20 newborns Generations in genetic hx at least 3 Amniocentesis / CVS timing 15–18 wk / 10–12 wk AR risk (2 carriers) 25% affected, 50% carrier, 25% clear Menarche average 12.4 yr (9–17) Cycle interval / flow 28 d (23–35) / 30–80 mL, 4–6 d Ovulation ~day 14; BBT rises ~1°F after Sperm maturity / oligospermia 65–75 d / <20 M/mL Semen composition prostate 60%, sem.ves. 30%, epidid. 5%, bulbo. 5% DMPA / implant 150 mg IM q3mo / 3 yr Emergency contraception Plan B ≤72 h; ella ≤120 h Subfertility def. no conception after 1 yr (8–12% of couples) Normal semen baseline 33–46 M/mL, 50% motile, 30% normal Prenatal visits q4wk to 28 wk; q2wk 28–36; weekly after
Signs of pregnancy
Type Meaning & examples Presumptive Subjective, felt by woman; can mean other things. Breast changes/amenorrhea/N&V (2 wk), urination (3 wk), uterine enlargement/fatigue (12 wk), quickening (18 wk), linea nigra/melasma/striae (24 wk). Probable Objective, examiner-verified. hCG (1 wk); Chadwick/Goodell/Hegar/gestational sac (6 wk); ballottement (16 wk); Braxton Hicks/fetal outline felt (20 wk). Positive Confirms pregnancy. Fetal outline on UTZ (8 wk), heart audible (10–12 wk), movement felt by examiner (20 wk).
Chadwick: vagina pink → violet · Goodell: cervix softens · Hegar: lower uterine segment softens · Ballottement: fetus rises when LUS tapped.
AOG, Naegele & GTPAL
Naegele: −3 months, +7 days, +1 year (or +9 months, +7 days).LMP Dec 10 2024 → EDD Sept 17 2025.
GTPAL: Gravida / Term (≥37 wk) / Preterm (<37 wk) / Abortions / Living / Multiple.Primigravida = 1st pregnancy; primipara = 1 birth past 24 wk; grand multipara = 5+.
Worked GTPAL: Twins 35 wk, boy 38 wk, 1 miscarriage 16 wk, now pregnant → G4 T1 P2 A1 L3 M1 .
Genetics
Disorder Cause / karyotype & key features Down (T21) extra 21; epicanthal folds, simian crease, hypotonia (best prognosis) Edwards (T18) extra 18; small jaw, clenched fists; poor survival Patau (T13) extra 13; cleft lip, brain/heart defects Turner 45XO (F); short, webbed neck, no menses, infertile Klinefelter 47XXY (M); small testes, gynecomastia Cri-du-chat 5p−; cat cry, small head, wide-set eyes Fragile X most common inherited ID in males
Pattern Clues & examples AD every gen; M=F; 50% risk · Huntington, Marfan AR may skip; both carriers; 25% risk · CF, sickle cell, PKU XR mostly males; mother carrier · hemophilia, Duchenne
Genotype = makeup; phenotype = appearance. Screening (MSAFP/cfDNA)=risk; diagnostic (amnio/CVS)=confirms.
Ethnicity: sickle cell→African; Tay-Sachs→Eastern Jewish; thalassemia→Mediterranean/Asian.
Ethics: confidentiality + informed consent + non-coercion.
Menstrual cycle & anatomy
Axis: hypothalamus (GnRH) → ant. pituitary (FSH & LH) → gonads.
FSH matures follicle + estrogen; LH surge (d14) → ovulation + progesterone.
Corpus luteum makes progesterone; no pregnancy → corpus albicans.
Spinnbarkeit = stretchy egg-white mucus (fertile). Uterine layers: endo → myo → peri. Isthmus = C-section site.
Leydig cells → testosterone; seminiferous tubules → sperm; cryptorchidism = undescended.
Contraception
Method Key point Abstinence 0% fail; best STI prevention LAM infant <6 mo, fully breastfed, no menses Withdrawal sperm in pre-ejaculate; unreliable Douching ineffective (sperm reach mucus in 90 s) Symptothermal mucus + BBT; best NFP Condoms (M/F) ONLY method vs STI/HIV COCs estrogen↓FSH/LH; progestin thickens mucus Patch / ring 3 wk on, 1 wk off DMPA 150 mg IM q3mo; don't massage site Implant / IUD 3 yr / hormonal or copper Sterilization tubal ligation (F), vasectomy (M; sperm viable 6 mo) Emergency Plan B ≤72 h, ella ≤120 h; NOT abortion
Missed COC: 1 → take when remembered · 2 → take 2 + backup · 3–4 → discard, start new pack.
Subfertility & ART
Evaluate: <35 after 1 yr; >35 after 6 mo. Clomid: blocks estrogen → ↑FSH/LH; max 3 courses.
Aid conception: coitus every other day; male-superior; hips up; supine 20 min; no douching.
ART Where / needs IUI uterus; patent tubes + ovulation IVF lab (in vitro); bypasses tubes/sperm GIFT fallopian tube; needs ≥1 patent tube ZIFT lab → tube; rare
OHSS = major IVF risk (swollen ovaries, fluid) → halt stimulation. Alternatives: surrogacy, adoption, child-free.
Sexual health
Cycle: Excitement → Plateau → Orgasm (shortest) → Resolution. Women: no refractory period.
WHO: physical/emotional/mental/social well-being, not just absence of disease. Sex OK in normal pregnancy until labor.
Harassment = unwanted repeated advances; violence = no consent/privacy/force.
Mnemonics
Presumptive — FM QLU BFANS: Freq. urination, Melasma, Quickening, Linea nigra, Uterine enlargement, Breast changes, Fatigue, Amenorrhea, N/V, Striae.
Positive — FHM: Fetal outline on UTZ, Heart audible, Movement felt by examiner. PMRR: Promotion, Maintenance, Restoration, Rehabilitation. ADPIE: Assess, Diagnose, Plan, Implement, Evaluate.