Prep U - Chapter 11: Maternal Adaptation During Pregnancy

The nursing instructor is presenting the basic physiologic changes in the woman that can occur during a pregnancy. The instructor determines the session is successful when the students correctly choose which change in the respiratory function during pregnancy as normal? increased tidal volume increased expiratory volume decreased respiratory rate decreased oxygen consumption

increased tidal volume

What is the major concern for a lactose intolerant woman who is pregnant? dangerous symptom of abdominal cramping vitamin D deficiency nausea and vomiting calcium deficiency

calcium deficiency

Which interventions would a pregnant client be taught regarding dietary restrictions during pregnancy? Select all that apply. Limit beef intake to 10 to 12 ounces per week. Wash raw fruits and vegetables with hot water and a mild soap. Discard foods that have been left out at room temperature for more than 2 hours. Do not drink raw or unpasteurized milk. Eat only soft cheeses such as feta or brie.

- discard food that have been left out at room temp for more than 2 hours - wash raw fruits and beggies with hot water and a mild soap - do not drink raw or unpasteurized milk

A urinalysis is done on a client in her third trimester. Which result would be considered abnormal? Trace of glucose Specific gravity of 1.010 2+ Protein in urine Straw-like color

2+ protein in urine

The nursing instructor is pointing out to a group of nursing students the various findings which are expected during a normal assessment of a pregnant client. The instructor determines the session is successful when the students correctly provide which gestational week that the examiner should be able to feel fetal movement? 6 28 22 18

22

A patient is at 22 weeks' gestation is preparing to have her fundal height measured. Given the patient's stage of gestation and following McDonald's rule, what result does the nurse expect? 11 cm 44 cm 2.2 cm 22 cm

22 cm

A woman tells the nurse that she is going to use a home pregnancy test to determine whether she is pregnant. Which precautions should the nurse give her? Use a diluted urine specimen. Arrange for prenatal care if the test is positive. Wait until after two missed menstrual periods. Refrain from eating for 4 hours before testing.

Arrange for prenatal care if the test is positive.

A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize? Sympathetic nerve responses cause dyspnea when a woman lies supine. The uterus requires more blood in a supine position. Blood is trapped in the vena cava in a supine position. Cerebral arteries are growing congested with blood.

Blood is trapped in the vena cava in a supine position.

A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur during pregnancy. Which hormones would the nurse most likely identify as being inhibited during the pregnancy? FSH and LH T4 and GH FSH and T4 LH and MSH

FSH and LH

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 has 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 observation is most likely? Fundal height is at its highest level at the xiphoid process. The lower uterine segment and cervix have softened. Fundal height has dropped since the last recording. The fundus is at the level of the umbilicus and measures 20 cm.

Fundal height has dropped since the last recording.

In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which information would the nurse most likely include? Most of the hormonal changes are permanent after the pregnancy is completed. Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge. Using herbs will help ease the discomfort. Taking hormonal replacement therapy can improve the discomfort of the changes.

Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge.

During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to avoid what condition? Frequent urination Supine hypotension syndrome Preeclampsia Heartburn

Supine hypotension syndrome

During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first? Take the client's blood pressure. Turn the client on her left side. Ask the client to breathe deeply. Listen to fetal heart tones.

Turn the client on her left side.

On day 3 after a cesarean birth, the client is complaining of soreness in her left leg. On examination the nurse notes the left leg is swollen, and the calf is red, tender and warm to touch. These findings indicate: venous insufficiency. deep vein thrombosis. varicose veins. peripheral artery disease.

deep vein thrombosis

A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem? Hemorrhoids Varicose veins Gastrointestinal reflux Umbilical hernia

hemorrhoids

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client? constipation tooth fracture inefficient protein metabolism iron-deficiency anemia

iron-deficinecy anemia

A nurse is explaining how hormones affect the pregnancy. Which hormone would the nurse describe as being responsible for stimulating uterine contractions during labor and birth? oxytocin progesterone prolactin estrogen

oxytocin

The nurse is assessing a client who believes she is pregnant. The nurse points out a more definitive assessment is necessary due to which sign being considered a probable sign of pregnancy? Positive home pregnancy test Nausea and vomiting Amenorrhea Fatigue

positive home pregnancy

The nurse is assessing a pregnant woman and noticing behavior changes that indicate she is beginning to accomplish the maternal tasks of becoming a mother. The client is in her third trimester. Which behavior would the nurse most likely assess? questioning of her ability to become a good mother identifying what must be given up to assume her new role accepting the pregnancy but not yet the fetus acknowledging the fetus as a separate entity

questioning of her ability to become a good mother

A client who has just given a blood sample for pregnancy testing in the health care provider'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. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy? laboratory test of a urine specimen for hCG laboratory test of a blood serum specimen for hCG absence of a period visualization of the fetus by ultrasound

visualization of the fetus by ultrasound

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence? placenta previa quickening lightening linea nigra

quickening

Which change related to the vital signs is expected in pregnant women? Temperature decreases. Lung space increases. Pulse decreases. Blood pressure decreases.

blood pressure decreases

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 (0.45 kg) 2 lb (0.90 kg) 1.5 lb (0.68 kg) 2/3 lb (0.30 kg)

1 lb (0.45 kg)

The nurse obtains a human chorionic gonadotropin (hCG) level from a woman who thinks that she is pregnant. Which result would the nurse identify as a positive pregnancy result? 32 mIU/mL (32 IU/L) 8 mIU/mL (8 IU/L) 24 mIU/mL (24 (IU/L) 16 mIU/mL (16 IU/L)

32 mIU/mL (32 IU/L)

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings? Combined, both of these findings are very concerning and warrant further investigation. Both findings are normal at this point of the pregnancy. The heart rate increase may indicate that the client is experiencing cardiac overload. The blood pressure should be higher since the cardiac volume is increased.

Both findings are normal at this point of the pregnancy.

A 22-year-old client comes to the walk-in clinic complaining of fatigue, breast heaviness and extreme tenderness, and a clear vaginal discharge. What question would the nurse ask this client? Have you been sexually active in the past 2 months? Do you have vaginal itching? Do you have a family history of breast cancer? Are you taking oral contraceptives?

Have you been sexually active in the past 2 months?

A client in her second trimester of pregnancy reports discomfort during sexual activity. Which instruction should a nurse provide? Modify sexual positions to increase comfort. Perform stress-relieving and relaxing exercises. Perform frequent douching, and use lubricants. Restrict contact to alternative, noncoital modes of sexual expression.

Modify sexual positions to increase comfort.

In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which information would the nurse most likely include? Taking hormonal replacement therapy can improve the discomfort of the changes. Most of the hormonal changes are permanent after the pregnancy is completed. Using herbs will help ease the discomfort. Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge.

Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge.

What effect does progesterone have on normal gallbladder function? The gallbladder will hypertrophy. It has no effect on the gallbladder. Progesterone interferes with gallbladder contraction, leading to stasis of bile. Bile will be produced at a more rapid rate due to the progesterone.

Progesterone interferes with gallbladder contraction, leading to stasis of bile.

During a routine prenatal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse take next? Tell the woman that this is entirely normal. Notify the health care provider of a possible infection. Check the discharge for evidence of ruptured membranes. Advise the woman about the need to culture the discharge.

Tell the woman that this is entirely normal.

A pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding? The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. Some bleeding during pregnancy is not uncommon and this finding is expected. It is possible she is losing her mucus plug, which can cause bloody show. She may have a bleeding disorder so she needs to come back to the clinic for blood work.

The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual.

A nurse is leading a discussion in a prenatal class for a group of primigravida clients. Which factor would the nurse include when explaining the changes that are expected to occur in the uterus during the pregnancy? Uterine growth occurs because of an increase in the number of cells in the uterus. The uterus moves into the abdomen by the second month of pregnancy. The uterus changes from a pear-shaped organ to an oval one. The uterus reaches its maximum height in the abdomen at 39 weeks.

The uterus changes from a pear-shaped organ to an oval one.

A woman in her 16th week of pregnancy comes to the health center for a follow up visit. Which physiologic change would the nurse expect to assess? Select all that apply. varicosities of the vulva, rectum, and/or legs a uterus that is palpable linea nigra and melasma (chloasma) increased blood pressure colostrum that can be expelled from the nipples

a uterus that is palpable colostrum that can be expelled from the nipples

A pregnant client in her second trimester reports feeling tired all the time. The nurse notes pale skin and low normal hemoglobin on assessment. Which recommendation should the nurse prioritize for this client? A calcium supplement More meat in her diet An iron supplement More seafood and organ meats in her diet

an iron supplement

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply. - morning sickness - hydatidiform mole - fetal heartbeat - ultrasound pictures - breast changes - amenorrhea

breast changes, amenorrhea, mornign sickness

The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting? Darkened breast areolae Deeply fissured nipples Slack, soft breast tissue Enlarged lymph nodes

darkened breast areolae

A pregnant client arrives at the maternity clinic reporting constipation. Which factors could be the cause of constipation during pregnancy? Select all that apply. - reduced stomach acidity - use of iron supplements - decreased activity level - intestinal displacement - increase in estrogen levels

decreased activity level ue of iron supplements intestinal diplacemnt

A woman in her third trimester shows the nurse a narrow, brown line that has formed on her abdomen, running from her belly button down to her pubic region. She expresses concern about this and asks the nurse whether it is normal. The nurse explains that this is a normal occurrence of pregnancy and that it results from the release of melanocyte-stimulating hormone from the pituitary, causing the appearance of extra pigmentation on the skin. What is the name of this phenomenon? linea nigra diastasis recti striae gravidarum (stretch marks) melasma (chloasma)

linea nigra

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 information should the nurse offer? "You will be more conscious of the changes taking place in your body now." "You may have mood swings that could overwhelm your partner." "You may feel physical discomfort as the baby inside grows." "You will experience quickening, and you will actually feel the baby."

"You will experience quickening, and you will actually feel the baby."

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy? Finding hCG in the urine Positive home pregnancy test Visualization of the gestational sac or fetus Finding of hCG in the blood

Visualization of the gestational sac or fetus

Which information provided by a client would be considered a presumptive sign of pregnancy? Reports of increased hunger Breast tenderness Ballottement Weight gain

breast tenderness

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? cretinism pseudo pregnancy couvade syndrome pregnancy syndrome

couvade syndrome

A pregnant client in her first trimester is being seen at the women's clinic. What statement by the nurse would be most beneficial to this client to support her acceptance of the pregnancy? "I know you are so excited about this baby. Have you begun to think of names?" "I understand that this pregnancy was not planned but I am sure you are very excited anyhow!" "Having feelings of uncertainty are very common when a woman becomes pregnant. I will be glad to talk to you about any concerns you may have." "Often women feel angry when they find out that they are pregnant. Did you feel that way?"

"Having feelings of uncertainty are very common when a woman becomes pregnant. I will be glad to talk to you about any concerns you may have."

The nurse is caring for a client at 8 weeks' gestation who states, "I did not plan for this right now and I am not happy or excited about this pregnancy. I am not sure what to do." Which response by the nurse is best? "We can refer you to a clinic for potential termination if you desire." "Many women feel this way during the first trimester." "Do not worry. Once you hold this baby, everything will be fine." "You will become excited and happy when you feel the baby move."

"Many women feel this way during the first trimester."

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse? "Caring for your new infant is instinctual and will come naturally to you." "The hormones of pregnancy may cause anxiety or depression postpartum." "Your old coping methods will adequately get you through this period of adjustment." "Expect your other children to react positively to their new brother/sister."

"The hormones of pregnancy may cause anxiety or depression postpartum."

A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate? "You need to be assessed for a fungal infection." "You should refrain from any sexual activity." "This discharge is normal during pregnancy." "Use a local antifungal agent regularly."

"This discharge is normal during pregnancy."

A client is about 16 weeks' pregnant and is concerned because she feels her "abdomen" contracting. She calls the primary care provider's office and speaks to the nurse. What is the nurse's most appropriate response to this client's concern? "You have nothing to be concerned about. I am sure you are not feeling contractions at this point in your pregnancy." "You need to go to the emergency room right away." "What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." "You need to come to the office to be examined."

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

A 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She expresses feeling proud and excited about her pregnancy while at the same time feeling fearful and anxious of its implications. Which action should the nurse do next? Schedule the client a consult with a psychiatric health care provider. Provide the client with information about pregnancy support groups. Inform the client this is a normal response to pregnancy that many women experience. Determine if the client's significant other is experiencing similar feelings about the pregnancy.

Inform the client this is a normal response to pregnancy that many women experience.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition? Keep the head of the client's bed slightly elevated. Place the client in an orthopneic position. Place the client in the left lateral position. Keep the client's legs slightly elevated.

Place the client in the left lateral position.

During a physical exam, the physician notates that the pregnant client has a positive Chadwick sign. What client findings would be noted for this symptom? The cervix has a bluish, purple discoloration. There is hyperpigmentation of the abdomen. The cervix is reddened and swollen. There is a rebound of the fetus felt when the physician pushes on the abdomen.

The cervix has a bluish, purple discoloration.

Which assessment finding in the pregnant woman at 12 weeks' gestation should the nurse find most concerning? The inability to: palpate the fetal outline. feel fetal movements. hear the fetal heartbeat with a stethoscope. detect fetal heart sounds with a Doppler.

detect fetal heart sounds with a doppler

The nurse is counseling a young woman who has just entered her second trimester, after an uneventful first trimester. She tells the nurse, "It still doesn't seem real. It's just hard to believe that I will really have a baby." Which future events should the nurse point out that will help the young woman come to believe it is real? Select all that apply. Seeing an ultrasound image of the baby Feeling the baby kick Giving up alcohol Taking prenatal vitamins Receiving a positive result on a pregnancy test

feeling the baby kick, seeing an ultrasound image of the baby

What is a positive sign of pregnancy? fetal movement felt by examiner positive pregnancy test uterine contractions Hegar sign

fetal movement felt by examiner

After teaching a class of newly pregnant women about the many changes the female body undergoes during pregnancy, the nurse determines that the teaching was successful when the class identifies which hormones as being secreted by the placenta? Select all that apply. testosterone hCG cortisol estrogen relaxin

hCG, relaxin, estrogen

The nurse is assessing a primigravida woman at a routine prenatal visit. Which assessment finding is reinforcing to the client that she is definitely pregnant? positive hCG blood result uterine growth continued amenorrhea ultrasound picture of her fetus

ultrasound picture of her fetus

client in her 39th week of gestation reports swelling in the legs after standing for long periods of time. The nurse recognizes that this factor increases the client's risk for which condition? supine hypotension syndrome hemorrhoids venous thrombosis embolism

venours thrombosis