Chapter 11
A woman is at 20 weeks' gestation. The nurse would expect to find the fundus at which of the following? A) Just above the symphysis pubis B) Mid-way between the pubis and umbilicus C) At the level of the umbilicus D) Mid-way between the umbilicus and xiphoid process
Ans: C The uterus, which starts as a pear-shaped organ, becomes ovoid as length increases over width. By 20 weeks' gestation, the fundus, or top of the uterus, is at the level of the umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in centimeters, which corresponds to the number of gestational weeks, is commonly used to date the pregnancy.
A primiparous client is being seen in the clinic for her first prenatal visit. It is determined that she is 11 weeks pregnant. The nurse develops a teaching plan to educate the client about what she will most likely experience during this period. Which of the following would the nurse include? A) Ankle edema B) Urinary frequency C) Backache D) Hemorrhoids
Ans: B The client is in her first trimester and would most likely experience urinary frequency as the growing uterus presses on the bladder. Ankle edema, backache, and hemorrhoids would be more common during the later stages of pregnancy.
The nurse is discussing the insulin needs of a primiparous client with diabetes who has been using insulin for the past few years. The nurse informs the client that her insulin needs will increase during pregnancy based on the nurse's understanding that the placenta produces: A) hCG, which increases maternal glucose levels B) hPL, which deceases the effectiveness of insulin C) Estriol, which interferes with insulin crossing the placenta D) Relaxin, which decreases the amount of insulin produced
Ans: B hPL acts as an antagonist to insulin, so the mother must produce more insulin to overcome this resistance. If the mother has diabetes, then her insulin need would most likely increase to meet this demand. hCG does not affect insulin and glucose level. Estrogen, not estriol, is believed to oppose insulin. In addition, insulin does not cross the placenta. Relaxin is not associated with insulin resistance.
A nurse is developing a teaching plan about nutrition for a group of pregnant women. Which of the following would the nurse include in the discussion? (Select all that apply. A) Keep weight gain to 15 lb B) Eat three meals with snacking C) Limit the use of salt in cooking D) Avoid using diuretics E) Participate in physical activity
Ans: B, D, E To promote optimal nutrition, the nurse would recommend gradual and steady weight gain based on the client's prepregnant weight, eating three meals with one or two snacks daily, not restricting the use of salt unless instructed to do so by the health care provider, avoiding the use of diuretics, and participating in reasonable physical activity daily.
A gravida 2 para 1 client in the 10th week of her pregnancy says to the nurse, ìI've never urinated as often as I have for the past three weeks.î Which response would be most appropriate for the nurse to make? A) ìHaving to urinate so often is annoying. I suggest that you watch how much fluid you are drinking and limit it.î B) ìYou shouldn't be urinating this frequently now; it usually stops by the time you're eight weeks pregnant. Is there anything else bothering you?î C) ìBy the time you are 12 weeks pregnant, this frequent urination should no longer be a problem, but it is likely to return toward the end of your pregnancy.î D) ìWomen having their second child generally don't have frequent urination. Are you experiencing any burning sensations?î
Ans: C As the uterus grows, it presses on the urinary bladder, causing the increased frequency of urination during the first trimester. This complaint lessens during the second trimester only to reappear in the third trimester as the fetus begins to descend into the pelvis, causing pressure on the bladder.
A woman in her second trimester comes for a follow-up visit and says to the nurse, ìI feel like I'm on an emotional roller-coaster.î Which response by the nurse would be most appropriate? A) How often has this been happening to you? B) Maybe you need some medication to level things out. C) Mood swings are completely normal during pregnancy. D) Have you been experiencing any thoughts of harming yourself?
Ans: C Emotional lability is characteristic throughout most pregnancies. One moment a woman can feel great joy, and within a short time she can feel shock and disbelief. Frequently, pregnant women will start to cry without any apparent cause. Some women feel as though they are riding an emotional roller-coaster. These extremes in emotion can make it difficult for partners and family members to communicate with the pregnant woman without placing blame on themselves for their mood changes. Clear explanations about how common mood swings are during pregnancy are essential.
The nurse is assessing a pregnant woman in the second trimester. Which of the following tasks would indicate to the nurse that the client is incorporating the maternal role into her personality? A) The woman demonstrates concern for herself and her fetus as a unit. B) The client identifies what she must give up to assume her new role. C) The woman acknowledges the fetus as a separate entity within her. D) The client demonstrates unconditional acceptance without rejection.
Ans: C Incorporation of the maternal role into her personality indicates acceptance by the pregnant woman. In doing so, the woman becomes able to identify the fetus as a separate individual. Demonstrating concern for herself and her fetus as a unit is associated with introversion and more commonly occurs during the third trimester. Identification of what the mother must give up to assume the new role occurs during the first trimester. Demonstrating unconditional acceptance without rejection occurs during the third trimester.
A woman suspecting she is pregnant asks the nurse about which signs would confirm her pregnancy. The nurse would explain that which of the following would confirm the pregnancy? A) Absence of menstrual period B) Abdominal enlargement C) Palpable fetal movement D) Morning sickness
Ans: C Only positive signs of pregnancy would confirm a pregnancy. The positive signs of pregnancy confirm that a fetus is growing in the uterus. Visualizing the fetus by ultrasound, palpating for fetal movements, and hearing a fetal heartbeat are all signs that make the pregnancy a certainty. Absence of menstrual period and morning sickness are presumptive signs, which can be due to conditions other than pregnancy. Abdominal enlargement is a probable sign.
Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen. The nurse documents this as which of the following? A) Linea nigra B) Striae gravidarum C) Melasma D) Vascular spiders
Ans: A Linea nigra refers to the darkened line of pigmentation down the middle of the abdomen in pregnant women. Striae gravidarum refers to stretch marks, irregular reddish streaks on the abdomen, breasts, and buttocks. Melasma refers to the increased pigmentation on the face, also known as the mask of pregnancy. Vascular spiders are small, spiderlike blood vessels that appear usually above the waist and on the neck, thorax, face, and arms.
A group of students are reviewing the signs of pregnancy. The students demonstrate understanding of the information when they identify which as presumptive signs? (Select all that apply. A) Amenorrhea B) Nausea C) Abdominal enlargement D) Braxton-Hicks contractions E) Fetal heart sounds
Ans: A, B Presumptive signs include amenorrhea, nausea, breast tenderness, urinary frequency and fatigue. Abdominal enlargement and Braxton-Hicks contractions are probable signs of pregnancy. Fetal heart sounds are a positive sign of pregnancy.
A pregnant woman comes to the clinic and tells the nurse that she has been having a whitish vaginal discharge. The nurse suspects vulvovaginal candidiasis, based on which assessment finding? A) Fever B) Vaginal itching C) Urinary frequency D) Incontinence
Ans: B Vaginal secretions become more acidic, white, and thick during pregnancy. Most women experience an increase in a whitish vaginal discharge, called leukorrhea. This is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans, a monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Fever would suggest a more serious infection. Urinary frequency occurs commonly in the first trimester, disappears during the second trimester, and reappears during the third trimester. Incontinence would not be associated with a vulvovaginal candidiasis. Incontinence would require additional evaluation.
Which of the following changes in the musculoskeletal system would the nurse mention when teaching a group of pregnant women about the physiologic changes of pregnancy? A) Ligament tightening B) Decreased swayback C) Increased lordosis D) Joint contraction
Ans: C With pregnancy, the woman's center of gravity shifts forward, requiring a realignment of the spinal curvatures. There is an increase in the normal lumbosacral curve (lordosis). Ligaments of the sacroiliac joints and pubis symphysis soften and stretch. Increased swayback and an upper spine extension to compensate for the enlarging abdomen occur. Joint relaxation and increased mobility occur due to the influence of the hormones relaxin and progesterone.
During a vaginal exam, the nurse notes that the cervix has a bluish color. The nurse documents this finding as: A) Hegar's sign B) Goodell's sign C) Chadwick's sign D) Ortolani's sign
Ans: C Bluish coloration of the cervix is termed Chadwick's sign. Hegar's sign refers to the softening of the lower uterine segment or isthmus. Goodell's sign refers to the softening of the cervix. Ortolani's sign is a maneuver done to identify developmental dysplasia of the hip in infants.
The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. The mother will most likely experience which of the following at that time? A) Dysuria B) Dyspnea C) Constipation D) Urinary frequency
Ans: D Lightening refers to the descent of the fetal head into the pelvis and engagement. With this descent, pressure on the diaphragm decreases, easing breathing, but pressure on the bladder increases, leading to urinary frequency. Dysuria might indicate a urinary tract infection. Constipation may occur throughout pregnancy due to decreased peristalsis, but it is unrelated to lightening.
A nursing instructor is teaching a class to a group of students about pregnancy, insulin, and glucose. Which of the following would the instructor least likely include as opposing insulin? A) Prolactin B) Estrogen C) Progesterone D) Cortisol
Ans: D Prolactin, estrogen, and progesterone are all thought to oppose insulin. As a result, glucose is less likely to enter the mother's cells and is more likely to cross over the placenta to the fetus. After the first trimester, hPL from the placenta and steroids (cortisol) from the adrenal cortex act against insulin. hPL acts as an antagonist against maternal insulin, and thus more insulin must be secreted to counteract the increasing levels of hPL and cortisol during the last half of pregnancy.
A nurse strongly encourages a pregnant client to avoid eating swordfish and tilefish because these fish contain which of the following? A) Excess folic acid, which could increase the risk for neural tube defects B) Mercury, which could harm the developing fetus if eaten in large amounts C) Lactose, which leads to abdominal discomfort, gas, and diarrhea D) Low-quality protein that does not meet the woman's requirements
Ans: B Nearly all fish and shellfish contain traces of mercury and some contain higher levels of mercury that may harm the developing fetus if ingested by pregnant women in large amounts. Among these fish are shark, swordfish, king mackerel, and tilefish. Folic acid is found in dark green vegetables, baked beans, black-eyed peas, citrus fruits, peanuts, and liver. Folic acid supplements are needed to prevent neural tube defects. Women who are lactose intolerant experience abdominal discomfort, gas, and diarrhea if they ingest foods containing lactose. Fish and shellfish are an important part of a healthy diet because they contain high-quality proteins, are low in saturated fat, and contain omega-3 fatty acids.
When assessing a woman in her first trimester, which emotional response would the nurse most likely expect to find? A) Ambivalence B) Introversion C) Acceptance D) Emotional lability
Ans: A During the first trimester, the pregnant woman commonly experiences ambivalence, with conflicting feelings at the same time. Introversion heightens during the first and third trimesters when the woman's focus is on behaviors that will ensure a safe and healthy pregnancy outcome. Acceptance usually occurs during the second trimester. Emotional lability (mood swings) is characteristic throughout a woman's pregnancy.
In a client's seventh month of pregnancy, she reports feeling ìdizzy, like I'm going to pass out, when I lie down flat on my back.î The nurse integrates which of the following in to the explanation? A) Pressure of the gravid uterus on the vena cava B) A 50% increase in blood volume C) Physiologic anemia due to hemoglobin decrease D) Pressure of the presenting fetal part on the diaphragm
Ans: A The client is describing symptoms of supine hypotension syndrome, which occurs when the heavy gravid uterus falls back against the superior vena cava in the supine position. The vena cava is compressed, reducing venous return, cardiac output, and blood pressure, with increased orthostasis. The increased blood volume and physiologic anemia are unrelated to the client's symptoms. Pressure on the diaphragm would lead to dyspnea.
A nurse is assessing a pregnant woman on a routine checkup. When assessing the woman's gastrointestinal tract, which of the following would the nurse expect to find? (Select all that apply. A) Hyperemic gums B) Increased peristalsis C) Complaints of bloating D) Heartburn E) Nausea
Ans: A, C, D, E Gastrointestinal system changes include hyperemic gums due to estrogen and increased proliferation of blood vessels and circulation to the mouth; slowed peristalsis; acid indigestion and heartburn; bloating and nausea and vomiting.
A woman comes to the prenatal clinic suspecting that she is pregnant, and assessment reveals probable signs of pregnancy. Which of the following would be included as part of this assessment? (Select all that apply A) Positive pregnancy test B) Ultrasound visualization of the fetus C) Auscultation of a fetal heart beat D) Ballottement E) Absence of menstruation F) Softening of the cervix
Ans: A, D, F Probable signs of pregnancy include a positive pregnancy test, ballottement, and softening of the cervix (Goodell's sign). Ultrasound visualization of the fetus, auscultation of a fetal heart beat, and palpation of fetal movements are considered positive signs of pregnancy. Absence of menstruation is a presumptive sign of pregnancy.
The nurse is teaching a pregnant woman about recommended weight gain. The woman has a prepregnancy body mass index of 26. The nurse determines that the teaching was successful when the woman states that she should gain no more than which amount during pregnancy? A) 35 to 40 pounds B) 25 to 35 pounds C) 28 to 40 pounds D) 15 to 25 pounds
Ans: D A woman with a body mass index of 26 is considered overweight and should gain no more than 15 to 25 pounds during pregnancy. Women with a body mass index of 18.5 to 24.9 (considered healthy weight) should gain 25 to 35 pounds. A woman with a body mass index less than 18.5 should gain 28 to 40 pounds.
While talking with a woman in her third trimester, which behavior indicates to the nurse that the woman is learning to give of oneself? A) Showing concern for self and fetus as a unit B) Unconditionally accepting the pregnancy without rejection C) Longing to hold infant D) Questioning ability to become a good mother
Ans: D Learning to give of oneself would be demonstrated when the woman questions her ability to become a good mother to the infant. Showing concern for herself and fetus as a unit reflects the task of ensuring safe passage throughout pregnancy and birth. Unconditionally accepting the pregnancy reflects the task of seeking acceptance of the infant by others. Longing to hold the infant reflects the task of seeking acceptance of self in the maternal role to the infant.
A pregnant client in her second trimester has a hemoglobin level of 11 g/dL. The nurse interprets this as indicating which of the following? A) Iron-deficiency anemia B) A multiple gestation pregnancy C) Greater-than-expected weight gain D) Hemodilution of pregnancy
Ans: D Feedback: During pregnancy, the red blood cell count increases along with an increase in plasma volume. However, there is a greater increase in the plasma volume as a result of hormonal factors and sodium and water retention. Thus, the plasma increase exceeds the increase in RBCs, resulting in hemodilution of pregnancy, which is also called physiologic anemia of pregnancy. Changes in maternal iron levels would be more indicative of an iron-deficiency anemia. Although anemia may be present with a multiple gestation, an ultrasound would be a more reliable method of identifying it. Weight gain does not correlate with hemoglobin levels.
When teaching a pregnant client about the physiologic changes of pregnancy, the nurse reviews the effect of pregnancy on glucose metabolism. Which of the following would the nurse include as the underlying reason for the effect? A) Pancreatic function is affected by pregnancy. B) Glucose is utilized more rapidly during a pregnancy. C) The pregnant woman increases her dietary intake. D) Glucose moves through the placenta to assist the fetus.
Ans: D Feedback: The growing fetus has large needs for glucose, amino acids, and lipids, placing demands on maternal glucose stores. During the first half of pregnancy, much of the maternal glucose is diverted to the growing fetus. The pancreas continues to function during pregnancy. However, the placental hormones can affect maternal insulin levels. The demand for glucose by the fetus during pregnancy is high, but it is not necessarily used more rapidly. Placental hormones, not the woman's dietary intake, play a major role in glucose metabolism during pregnancy.
Assessment of a pregnant woman reveals that she compulsively craves ice. The nurse documents this finding as which of the following? A) Quickening B) Pica C) Ballottement D) Linea nigra
Ans: B Pica refers to the compulsive ingestion of nonfood substances such as ice. Quickening refers to the mother's sensation of fetal movement. Ballottement refers to the feeling of rebound from a floating fetus when an examiner pushes against the woman's cervix during a pelvic examination. Linea nigra refers to the pigmented line that develops in the middle of the woman's abdomen.
