Maternal adaptation during pregnancy PrepU

A pregnant woman is experiencing morning sickness. Which of the following responses indicates a need for further teaching?

"I'll take antacid between meals." Correct Explanation: The patient should avoid use of medications unless prescribed by the provider. Avoiding an empty stomach, snacking on a cracker, or eating small servings of bland food are better options and may manage the morning sickness.

The nurse is teaching a prenatal class about preparing for their expanding families. Which of the following is helpful advice from the nurse?

"The hormones of pregnancy may cause anxiety or depression postpartum." Correct Explanation: The "raging hormones"of pregnancy can keep the woman slightly out of touch with her usual methods of coping. Although she may normally interact and communicate in quite mature ways, during a pregnancy, she may become depressed, anxious, withdrawn, or angry as she accomplishes her own developmental tasks. Siblings often react to a pregnancy by regression in behavior and attitude because they fear that they will be replaced or unloved. In addition to anticipatory guidance concerning the alterations in family structure and functioning, prenatal preparation for first-time parents involves learning the basics of infant care and preparing for infant feeding, particularly for women who plan to breastfeed.

Which of the following changes related to the vital signs is expected in pregnant women?

Blood pressure decreases. Correct Explanation: Pulse and temperature often increase, while lung space is decreased in pregnant women. It is common for blood pressure to decrease during pregnancy.

Amanda is about 16 weeks pregnant and is concerned because she feels her "abdomen" contracting. She calls the doctors office and speaks to the nurse. What is the most appropriate response to Amanda's concern?

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." Correct Explanation: Braxton Hicks contractions are the painless, intermittent, "practice" contractions of pregnancy.

A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which of the following information should the nurse offer?

"You will experience quickening, and you will actually feel the baby." Correct Explanation: The nurse should inform the client that quickening occurs in the second trimester. The client will be able to physically feel the fetal movements, which will help her bond with her developing fetus. Physical discomfort actually starts to increase in the third trimester as the fetus grows rapidly. The client feels conscious of the changes taking place in her body due to her pregnancy primarily in the first trimester, not the second. The client is likely to have mood swings in the first trimester of the pregnancy, which can be very overwhelming for the client as well as her partner.

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week?

1 lb Correct Explanation: The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb per week. Overweight women should gain about 2/3 lb per week

The blood volume in pregnant women increases by what percent

40-50 percent Explanation: Blood volume increase by approximately 40-50 percent above prepregnancy levels by the end of the third trimester.

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks pregnant. The nurse would expect this woman's heart rate to be approximately:

85 beats per minute Correct Explanation: During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.

A friend tells you that she is going to use a home pregnancy test to determine whether she is pregnant. Which of the following precautions would you give her?

Arrange for prenatal care if the test is positive. Correct Explanation: Home pregnancy testing can be accurate as soon as a period is missed; it should not take the place of prenatal care.

During a routine antepartal visit, a pregnant woman reports a white thick vaginal discharge. Which of the following would the nurse do next?

Ask the woman if she is having any itching or irritation. Correct Explanation: Although vaginal secretions increase during pregnancy, the nurse would need to ascertain if this discharge is the normal leukorrhea of pregnancy or if it is a monilial vaginitis, which is common during pregnancy. The nurse needs additional information to conclude that the woman's complaint is normal. A culture may or may not be necessary. There is no evidence to suggest that her membranes have ruptured.

As a pregnant woman lies on the examining table, she grows very short of breath and dizzy. This phenomenon probably happens because

Blood is trapped in the vena cava in a supine position Correct Explanation: Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava. Cerebral arteries should not be affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in any orientation. The sympathetic nervous system will not be affected by the supine position.

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called?

Couvade syndrome Correct Explanation: Some fathers actually experience some of the physical symptoms of pregnancy, such as nausea and vomiting, along with their partner. This phenomenon is called couvade syndrome.

Which of the following would the nurse identify as a normal physiologic change in the renal system due to pregnancy?

Dilation of the renal pelvis Correct Explanation: The renal pelvis becomes dilated during pregnancy, possibly due to the effect of progesterone on smooth muscle. The glomerular filtration rate increases during pregnancy. The kidneys enlarge during pregnancy. The ureters elongate, widen, and become more curved above the pelvic rim.

When teaching a client about hormones, which of the following should the nurse identify as responsible in developing the ductal system of the breasts in preparation for lactation during pregnancy?

Estrogen Correct Explanation: Estrogen aids in developing the ductal system of the breasts in preparation for lactation during pregnancy. Prolactin stimulates the glandular production of colostrum. During pregnancy, the ability of prolactin to produce milk is opposed by progesterone. Progesterone supports the endometrium of the uterus to provide an environment conducive to fetal survival. Oxytocin is responsible for uterine contractions, both before and after delivery. Oxytocin is also responsible for milk ejection during breastfeeding.

A client in her second trimester of pregnancy is anxious about the blotchy, brown pigmentation appearing on her forehead and cheeks. She also complains of increased pigmentation on her breasts and genitalia. When educating the client, which of the following would the nurse identify as the condition experienced by the client?

Facial melasma (cholasma) Correct Explanation: The skin and complexion of pregnant women undergo hyperpigmentation, primarily as a result of estrogen, progesterone, and melanocyte stimulating hormone levels. The increased pigmentation that occurs on the breasts and genitalia also develops on the face to form the "mask of pregnancy," or facial melasma (cholasma). This is a blotchy, brownish pigment that covers the forehead and cheeks in dark-haired women. The symptoms experienced by the client do not indicate linea nigra, striae gravidarum, or vascular spiders. The skin in the middle of the abdomen may develop a pigmented line called the linea nigra, which extends from the umbilicus to the pubic area. Striae gravidarum, or stretch marks, are irregular reddish streaks that appear on the abdomen, breasts, and buttocks in about 50% of pregnant women after month 5 of gestation. Vascular spiders appear as small, spider-like blood vessels in the skin and are usually found above the waist and on the neck, thorax, face, and arms.

Which of the following is a positive sign of pregnancy?

Fetal movement felt by examiner Correct Explanation: The positive signs of pregnancy are fetal image on sonogram, hearing a fetal heart rate, and examiner feeling fetal movement.

One specific vitamin is known to prevent up to 70 percent of birth defects of the central nervous system, called neural tube defects. Which vitamin should all woman who are at risk for getting pregnant have daily in their diet?

Folic Acid Correct Explanation: All women who are at risk of becoming pregnant, either planned or unplanned, should make certain to have 400mcg a day of folic acid. The folic acid needs to be in the body prior to the pregnancy to be the most effective in the prevention of the defects. Iodine affects thyroid development. Zinc is required for enzyme formation and gene expression. Vitamin A helps develop vision.

A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she's been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which of the following is the nurse most likely to observe?

Fundal height has dropped since the last recording. Correct Explanation: Between 38 and 40 weeks of gestation, the fundal height drops as the fetus begins to descend and engage into the pelvis. Because it pushes against the diaphragm, many women experience shortness of breath. By 40 weeks, the fetal head begins to descend and engage into the pelvis. Although breathing becomes easier because of this descent, the pressure on the urinary bladder now increases, and women experience urinary frequency. The fundus reaches its highest level at the xiphoid process at approximately 36, not 39, weeks. By 20 weeks' gestation, the fundus is at the level of the umbilicus and measures 20 cm. At between 6 and 8 weeks of gestation, the cervix begins to soften (Goodell sign) and the lower uterine segment softens (Hegar sign)

Pregnancy tests (both urine and blood) measure levels of which hormone to validate the existence of pregnancy?

Human chorionic gonadotropin (hCG) Correct Explanation: The outer layer of the developing embryo produces hCG. Pregnancy tests (both urine and blood) measure levels of this hormone, whose presence validates the existence of a pregnancy and initiates a feedback loop that preserves the corpus luteum for longer than the normal 14 days.

During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which of the following?

Influence of estrogen and blood vessel proliferation Correct Explanation: During pregnancy, the gums become hyperemic, swollen, and friable and tend to bleed easily. This change is influenced by estrogen and increased proliferation of blood vessels and circulation to the mouth. Elevated progesterone levels cause smooth muscle relaxation, which results in delayed gastric emptying and decreased peristalsis. Increased venous pressure contributes to the formation of hemorrhoids. Relaxation of the cardiac sphincter, in conjunction with slowed gastric emptying, leads to reflux due to regurgitation of the stomach contents into the upper esophagus.

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. Which of the following conditions should the nurse monitor for in the client as a manifestation of consuming soil?

Iron-deficiency anemia Correct Explanation: Pica is characterized by a craving for substances that have no nutritional value. Consumption of these substances can be dangerous to the client and her developing fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation of the client's compulsion to consume soil. Consumption of ice due to pica is likely to lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the client has been consuming laundry starch as a result of pica. The nurse should monitor for constipation in the client if she has been consuming clay.

The nurse explains to a pregnant client, who is anemic, that she will need to take vitamins with iron during her pregnancy. What are food would you include on the patient's diet plan?

Meats Correct Explanation: Grains are a source of iron but not as good a source as the heme iron of meats. The other choices should be avoided when taking the iron and vitamin supplement as milk and legumes decrease the absorption of iron

Amanda's menstrual period is two weeks late. She has been feeling tired and has had bouts of nausea in the morning. What classification of pregnancy symptoms is Amanda experiencing?

Presumptive Correct Explanation: The most common presumptive sign of pregnancy is a missed menstrual period, or amenorrhea. Other presumptive signs include nausea, fatigue, swollen, tender breasts, and frequent urination

A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the patient's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation and enlargement of the birth canal. This hormone is which of the following?

Relaxin Correct Explanation: Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for dilatation at birth; softening of collagen allows for laxness in the lower spine and so helps enlarge the birth canal. The effect of estrogen is to cause breast and uterine enlargement. Progesterone has a major role in maintaining the endometrium, inhibiting uterine contractility, and aiding in the development of the breasts for lactation. Human placental lactogen (hPL), also known as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective, thereby allowing more glucose to become available for fetal growth.

During pregnancy, there are many psychological changes. What is a critical component for a positive psychological experience with pregnancy by the woman?

Social support Correct Explanation: All of the above are correct and play a role pregnancy, but the most critical for a positive psychological experience is for the woman to have a social support system. Early care, maternal age, and planned pregnancy all affect fetal and maternal health, but are not necessarily linked to positive psychological experiences.

A pregnant client complains of an increase in a thick, whitish vaginal discharge. Which of the following information should a nurse provide to this client?

Such discharge is normal during pregnancy. Correct Explanation: During pregnancy, the vaginal secretions become more acidic, white, and thick. Most women experience an increase in a whitish vaginal discharge, called leukorrhea, during pregnancy. The nurse should inform the client that the vaginal discharge is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans infection, a monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Monilial vaginitis is a benign fungal condition and is treated with local antifungal agents. The client need not refrain from sexual activity when there is an increase in a thick, whitish vaginal discharge.

Which change in the breasts should a nurse recognize as a normal change associated with pregnancy?

Tingling sensations and tenderness Correct Explanation: Normal changes in the breasts associated with pregnancy include tingling sensations and tenderness, enlargement of the breast and nipples, hyperpigmentation of the areola and nipples, enlargement of Montgomery tubercles, prominence of superficial veins, development of striae, and expression of colostrum in the second and third trimesters.

A nurse urges a pregnant patient at the first prenatal office visit to begin taking iron supplements immediately. What is the rationale for this intervention?

To avoid anemia Correct Explanation: The increase in the mother's circulatory red blood cell mass requires an additional 400 mg of iron per day or creates a total needed increase of about 800 mg. Iron deficiency can lead to anemia, which is a condition of lower-than-normal levels of red blood cells. Folic acid is taken to prevent megalohemoglobinemia (large, nonfunctioning red blood cells). Iron supplementation does not maintain proper blood glucose levels or reduce the risk for hypertension.

Morning sickness is associated with rising levels of human chorionic gonadotropin (hCG) and progesterone.

True Correct Explanation: Known as morning sickness, nausea and vomiting begins to be noticed at the same time levels of hCG and progesterone begin to rise so these may contribute to its cause. Another reason may be a systemic reaction to increased estrogen levels or decreased glucose levels, because glucose is being used in such great quantities by the growing fetus.

During an examination, a client who's 32 weeks pregnant becomes dizzy, lightheaded, and pale while supine. What should the nurse do first?

Turn the client on her left side. Correct Explanation: As the enlarging uterus increases pressure on the inferior vena cava, it compromises venous return, which can cause dizziness, light-headedness, and pallor when the client is supine. The nurse can relieve these symptoms by turning the client on her left side, which relieves pressure on the vena cava and restores venous return. Although they're valuable assessments, fetal heart tone and maternal blood pressure measurements don't correct the problem. Because deep breathing has no effect on venous return, it can't relieve the client's symptoms.

A patient who has just given a blood sample for pregnancy testing in the doctor's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. Which of the following should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy?

Visualization of the fetus by ultrasound Correct Explanation: There are only three documented or positive signs of pregnancy: 1) demonstration of a fetal heart separate from the mother's, 2) fetal movements felt by an examiner, and 3) visualization of the fetus by ultrasound. The absence of a period is an example of a presumptive symptom, which is a symptom that, when taken as a single entity, could easily indicate other conditions. Laboratory tests of either urine or blood serum for human chorionic gonadotropin (hCG) are examples of probable signs of pregnancy, which are objective and so can be verified by an examiner.

A woman in the last trimester of pregnancy complains of sleeping poorly. She becomes light-headed and dizzy whenever she sleeps on her back, but she can't sleep at all if she lies on her side. How would you suggest she try sleeping?

With a pillow under her right hip Correct Explanation: Pregnancy places strain on the cardiovascular system with increased fluid in the lungs and heart. When the woman lies flat on her back the uterus and contents can compress the vena cava and aorta and reduce blood flow resulting in the light-headed and dizzy spells. Removal of the pillow would not affect the effects on the vena cava. A pillow under the shoulders would hurt the neck, and a pillow under both hips would exacerbate the light-headedness.

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which of the following data collected by the nurse are presumptive signs of her pregnancy? Select all that apply.

• Amenorrhea • Morning sickness • Breast changes Correct Explanation: Presumptive signs are possible signs of pregnancy that appear in the first trimester, often only noted subjectively by the mother (e.g., breast changes, amenorrhea, morning sickness). Probable signs are signs that appear in the first and early second trimesters, seen via objective criteria, but can also be indicators of other conditions (e.g., hydatidiform mole). Positive signs affirm that proof exists that there is a developing fetus in any trimester and are objective criteria seen by a trained observer or diagnostic study, (e.g., ultrasound.)

A client comes to the prenatal clinic for a follow-up examination. When assessing the breasts, which of the following would the nurse expect to find? Select all that apply.

• Increased sensitivity • Hyperpigmentation of the nipple • Prominent veins Correct Explanation: Normal breast findings include prominent veins, nodular breasts, increased sensitivity to touch, and hyperpigmentation of the nipples and areolae. Warmth would suggest possible infection.

A nurse is assigned to educate a pregnant client regarding the changes in the structures of the respiratory system taking place during pregnancy. Which of the following conditions are associated with such changes? Select all that apply.

• Nasal and sinus stuffiness • Nosebleed • Thoracic rather than abdominal breathing Correct Explanation: Changes in the structures of the respiratory system take place to prepare the body for the enlarging uterus and increased lung volume. Increased vascularity of the respiratory tract is influenced by increased estrogen levels, leading to congestion. This congestion gives rise to nasal and sinus broadens with a conversion from abdominal breathing to thoracic breathing. Persistent cough, Kussmaul respirations, and dyspnea are not associated with the changes in the respiratory tract during pregnancy.

A client in her 10th week of gestation arrives at the maternity clinic complaining of morning sickness. The nurse needs to inform the client about the body system adaptations during pregnancy. Which of the following factors corresponds to the morning sickness period during pregnancy?

• Reduced stomach acidity • Elevation of human chorionic gonadotropin (hCG) • Increase in estrogen level Explanation: hCG levels in a normal pregnancy usually double every 48 to 72 hours, until they reach a peak at approximately 60 to 70 days after fertilization. This elevation of hCG corresponds to the morning sickness period of approximately 6 to 12 weeks during early pregnancy. Reduced stomach acidity and high levels of circulating estrogens are also believed to cause morning sickness. Elevation of hPL and RBC production do not cause morning sickness. hPL increases during the second half of pregnancy, and it helps in the preparation of mammary glands for lactation and is involved in the process of making glucose available for fetal growth by altering maternal carbohydrate, fat, and protein metabolism. The increase in RBCs is necessary to transport the additional oxygen required during pregnancy.

The nurse is counseling a young woman who has just entered her second trimester. The patient had an uneventful first trimester, with no symptoms of morning sickness. She tells the nurse, "It still doesn't seem real. It's just hard to believe that I will really have a baby." From experience, the nurse knows that which of the following are likely to help the woman accept the fact that she is having a baby? (Select all that apply.)

• Seeing an ultrasound image of the baby • Setting up a crib for the baby • Feeling the baby kick Correct Explanation: During the second trimester, the psychological task of a woman is to accept she is having a baby, a step up from accepting the pregnancy. This change usually happens at quickening, or the first moment a woman feels fetal movement. Shopping for baby clothes for the first time, setting up the crib, seeing a blurry outline on a sonogram screen: any of these small actions may suddenly make the coming baby seem real and desired. Clearly, receiving a positive result on a pregnancy test was not enough to help this woman accept that she was having a baby, as this has already happened. Taking prenatal vitamins and giving up alcohol are more likely to be indicators that the woman has accepted the pregnancy rather than aids to her accepting the baby.