Ch. 11 Maternal Adaptation During Pregnancy

ANS: A, D, F Probable signs of pregnancy include a positive pregnancy test, ballottement, and softening of the cervix (Goodell 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.

A client comes to the clinic reporting their period is late and they are wondering if they are pregnant. Which assessment findings by the nurse would indicate the client is exhibiting probable signs of pregnancy? (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

c. influence of estrogen and blood vessel proliferation Rationale: 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.

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 effect of pregnancy? a. effects of regurgitation from relaxation of the cardiac sphincter b. increased venous pressure c. influence of estrogen and blood vessel proliferation d. elevated progesterone levels

Estrogen

During the first few months of pregnancy, ________________ hormones stimulates uterine growth.

pica

The compulsive ingestion of nonfood substances is termed ________.

d. 27 mg Rationale: The dietary reference intakes as per the Institute of Medicine are for 27 mg of ferrous iron and 400 to 800 mcg of folic acid per day. Women with a previous history of fetus with a neural tube defect are often prescribed a higher dose.

A 23-year-old female has come to the clinic for her first prenatal visit. After the examination reveals no concerns and potential low-risk pregnancy, the nurse discusses nutritional needs for her and her growing baby. As per the Institute of Medicine, the nurse suggests the client take which amount of ferrous iron daily? a. 20 mg b. 40 mg c. 10 mg d. 27 mg

ANS: ABDE Rationale: Vegan diets do not include any meat, eggs, or dairy products. Pregnant vegetarians must pay special attention to their intake of protein, iron, calcium, and vitamin B12.

A 27-year-old female was just confirmed to be pregnant. She tells the nurse she just switched to a vegan diet. The nurse explains that she must pay special attention to her intake of which elements to ensure she is getting adequate nutrition for her and the baby? Select all that apply. a. calcium b. vitamin B12 c. folate d. iron e. protein

b. Have the client take a pregnancy test. Absence of menstruation, along with consistent nausea, fatigue, breast tenderness, and urinary frequency, are the presumptive signs of pregnancy. To determine if the client may be pregnant, a pregnancy test is indicated.

A 28-year-old client states that they have not had a menstrual period for the past 3 months and suspects they are pregnant. Which should the nurse do next? a. Determine at what age the client began menstruating. b. Have the client take a pregnancy test. c. Assess the client for a fetal heart tone. d. Ask the client the date their last period ended.

b. fetal movement felt by examiner The positive signs of pregnancy are fetal image on a sonogram, hearing a fetal heart rate, and examiner feeling fetal movement. A pregnancy test has 95% accuracy; however, it may come back as a false positive. Hegar sign is a softening of the uterine isthmus. Chadwick sign may have other causes besides pregnancy.

A client arrives to the clinic very excited and reporting a positive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy? a. positive office pregnancy test b. fetal movement felt by examiner c. Hegar sign d. Chadwick sign

a. Inquire about the client's sleeping positions. When a pregnant client lies on their back they can experience vena cava syndrome. This results when the weight of the pregnant uterus presses against the vena cava. Additional symptoms of this include weakens nausea and dizziness. To manage this condition, pregnant clients are encouraged to assume side lying positions instead of lying on their backs. There is no indication that the client is experiencing cardiac, preeclamptic or diabetes-related manifestation

A client at 24 weeks' gestation is seen for a routine monthly check up. The client reports concerns to the nurse about rest periods. The client states that when they awaken they feel weak and lightheaded. What is the most appropriate initial action by the nurse? a. Inquire about the client's sleeping positions. b. Make a referral for a cardiac evaluation. c. Request testing to assess the client's serum glucose levels. d. Assess the client for manifestations of preeclampsia. Complete neurological assessment.

b. "That is a very normal feeling, especially at this point in pregnancy." During the third trimester, the client is preparing for parenthood and is often tired and ready for a break. The client may feel large and unable to do any normal activities, and may feel ready to have the infant in their arms rather than in their uterus. This is not an abnormal statement, and the health care provider should not overreact. Deciding to induce labor is something that should be done in consultation with the health care provider and only when it is necessary for the health/safety of the client or infant.

A client at 40 weeks' gestation informs the nurse that they are tired of being pregnant. What is the best response from the nurse? a. "Do you need to speak with someone about your feelings?" b. "That is a very normal feeling, especially at this point in pregnancy." c. "Most clients would have asked to be induced by this point. Is that what you want?" d. "Are you getting enough rest? If you don't take time for rest, that is why you might be tired."

ANS: A, B, D The 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 carbohydrate, fat, and protein metabolism in the pregnant parent. The increase in RBCs is necessary to transport the additional oxygen required during pregnancy.

A client in the 10th week of gestation arrives at the maternity clinic reporting morning sickness. The nurse needs to inform the client about the body system adaptations during pregnancy. Which factors correspond to the morning sickness period during pregnancy? Select all that apply. a. reduced stomach acidity b. elevated human chorionic gonadotropin (hCG) c. increased red blood cell (RBC) production d. increased estrogen level e. elevated human placental lactogen (hPL)

a. relaxin 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 dilation (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 and thereby allowing more glucose to become available for fetal growth.

A client in the third trimester of their first pregnancy expresses fear about the birth canal being wide enough for them to push the infant through it during labor. The client is a petite person, and the fetus seems so large. The client asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation (dilatation) and enlargement of the birth canal. What is this hormone? a. relaxin b. progesterone c. estrogen d. human placental lactogen

a. encourage them to identify someone that they can talk to and share the pregnancy experience. A pregnant client without social support needs to identify someone with whom they can share the experience of pregnancy because social support is a crucial part of adapting to parenthood. Telling them to move home and that they will feel better as the pregnancy progresses do not address the issue of isolation. Also, moving home may not be a possibility for this client. The nurse should maintain a professional relationship and not commit to a long-term relationship with a client.

A client is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and they have no real family support. The nurse's most therapeutic response would be to: a. encourage them to identify someone that they can talk to and share the pregnancy experience. b. tell them to move home so their family will be nearby to help. c. remind them that they are still early in the pregnancy and they will feel better about it as the pregnancy progresses. d. offer to meet with the client on a regular basis to provide them someone to talk to about their concerns.

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

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

a. increase of 40% Rationale: Tidal volume or the volume of air inhaled increases by 40% (from 500 to 700 mL) as the pregnancy progresses.

A client is reporting shortness of breath. To ensure there are no developing complications, a tidal volume is obtained. Due to her pregnancy, the health care provider would except to see what type of results on the tidal volume? a. increase of 40% b. decrease of 40% c. decrease of 20% d. increase of 20%

b. Chadwick sign Rationale: Common probable signs of pregnancy include a bluish-purple coloration of the vaginal mucosa and cervix (Chadwick sign), softening of the lower uterine segment or isthmus (Hegar sign), and softening of the cervix (Goodell sign). There is no such thing as Braxton sign; however, there are the Braxton Hicks contractions, which occur throughout the pregnancy preparing the uterus for delivery.

A client presents to the clinic because she thinks she may be pregnant. On examination, the nurse notes that the client's cervix and vaginal mucosa appear a bluish-purple color. The nurse interprets this finding as which sign? a. Hegar sign b. Chadwick sign c. Braxton sign d. Goodell sign

a. Chadwick sign Common probable signs of pregnancy include a bluish-purple coloration of the vaginal mucosa and cervix (Chadwick sign), softening of the lower uterine segment or isthmus (Hegar sign), and softening of the cervix (Goodell sign). There is no such thing as Braxton sign; however, there are the Braxton Hicks contractions, which occur throughout the pregnancy preparing the uterus for delivery.

A client presents to the clinic because the client thinks they may be pregnant. On examination, the nurse notes that the client's cervix and vaginal mucosa appear a bluish-purple color. The nurse interprets this finding as which sign? a. Chadwick sign b. Hegar sign c. Goodell sign d. Braxton sign

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

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

a. visualization of the fetus by ultrasound There are only three documented or positive signs of pregnancy: 1) demonstration of a fetal heart separate from the client'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 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? a. visualization of the fetus by ultrasound b. laboratory test of a urine specimen for hCG c. laboratory test of a blood serum specimen for hCG d. absence of a period

b. presumptive 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 client's menstrual period is two weeks late. The client has been feeling tired and has had episodes of nausea in the morning. What classification of pregnancy symptoms is this client experiencing? a. positive b. presumptive c. probable d. no classification

b. 1 lb (0.45 kg) The recommended weight gain pattern for a client whose prepregnant weight is within the normal range would be 1 lb (0.45 kg) per week during the second and third trimesters. Underweight clients should gain slightly more than 1 lb (0.45 kg) per week. Overweight clients should gain about 2/3 lb (0.30 kg) per week.

A client's prepregnant weight is within the normal range. During the second trimester, the nurse would determine that the client is gaining the appropriate amount of weight when their weight increases by which amount per week? a. 2/3 lb (0.30 kg) b. 1 lb (0.45 kg) c. 1.5 lb (0.68 kg) d. 2 lb (0.90 kg)

ANS: ABCD Rationale: The best source of calcium is milk and dairy products, but for women with lactose intolerance, adaptations are necessary. Additional sources of calcium may be necessary. These may include peanuts, almonds, sunflower seeds, broccoli, salmon, kale, and molasses. In additional, encourage the woman to drink lactose-free dairy products or calcium-enriched orange juice or soy milk.

A lactose intolerant client is concerned about getting enough calcium in her diet. Which foods could the nurse suggest she include in her diet to increase her calcium intake? Select all that apply. a. peanuts b. molasses c. broccoli d. almonds e. carrots

d. 24 Rationale: By 20 weeks' gestation, the fundus 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 mother comes in with her 17-year-old daughter to find out why she has not had a menstrual cycle for a few months. Examination confirms the daughter is pregnant with a fundal height of approximately 24 cm. The nurse interprets this finding as indicating that the daughter is approximately how many weeks pregnant? a. 20 b. 18 c. 22 d. 24

Presumptive: Urinary frequency, Breast enlargement, Amenorrhea, Nausea and vomiting Probable: Abdominal enlargement, Hegar sign, Chadwick sign, Positive pregnancy test Positive: Fetal heart sounds , Visualization of fetus by ultrasound

A nurse in a prenatal clinic is caring for a 24-year-old client who has come to the clinic to confirm pregnancy. The nurse discusses presumptive, probable, and positive signs of pregnancy with the client. For each finding, click to specify if the finding indicates presumptive, probable, or positive. fetal heart sounds abdominal enlargement urinary frequency Visualization of fetus by ultrasound Hegar sign breast enlargement Chadwick sign amenorrhea nausea and vomiting Positive pregnancy test

a. FSH and LH During pregnancy, FSH and LH are both inhibited as there is no need to develop a follicle and release an ovum. There is an increase in the secretion of T4 and MSH. There is a decrease in the production of GH and MSH but not an inhibition.

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? a. FSH and LH b. FSH and T4 c. T4 and GH d. LH and MSH

c. FSH and LH Rationale: During pregnancy, FSH and LH are both inhibited as there is no need to develop a follicle and release an ovum. There is an increase in the secretion of T4 and MSH. There is a decrease in the production of GH and MSH but not an inhibition.

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? a. LH and MSH b. T4 and GH c. FSH and LH d. FSH and T4

b. Estrogen Rationale: During the first few months of pregnancy, estrogen stimulates uterine growth, and the uterus undergoes a tremendous increase in size, weight, length, width, depth, volume, and overall capacity. Progesterone causes thickening of the uterine lining in anticipation of implantation of the fertilized ovum; from then on, it maintains the endometrium, inhibits uterine contractility, and assists in the development of the breasts for lactation. hCG is responsible for maintaining the maternal corpus luteum, which secretes progesterone and estrogens with synthesis occurring before implantation. It is the basis for early pregnancy tests because it appears in the maternal bloodstream soon after implantation. Oxytocin is responsible for uterine contractions, both before and after birth.

A nurse is conducting a prenatal class for a group of primipara women in their first trimester. When describing the changes that occur in the uterus, the nurse identifies which hormone as responsible for uterine growth? a. Oxytocin b. Estrogen c. Progesterone d. Human chorionic gonadotropin (hCG)

b. oxytocin Rationale: Oxytocin is responsible for stimulating the uterine contractions that bring about delivery. Progesterone and estrogen help maintain the pregnancy, and prolactin helps with stimulating milk production after the delivery.

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? a. prolactin b. oxytocin c. progesterone d. estrogen

a. The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. Slight bleeding after a pelvic exam in a pregnant client is common due to the vascularity of the cervix during pregnancy. Suggesting a bleeding disorder is frightening and not substantiated by the data. Bleeding is not a normal finding during pregnancy and losing the mucus plug occurs at the end of pregnancy, just prior to labor.

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

b. decreased peristalsis of urinary tract Renal and ureteral dilation (dilatation) occurs due to hormonal changes during pregnancy. This dilation causes the kidney size to increase, especially on the right. Additionally, peristalsis decreases in the urinary tract, leading to urinary stasis and increased risk of infection. The renal pelvis does not dilate due to the hormones. Increased glomerular filtration rate leads to urinary frequency, not pyelonephritis. Intake of caffeinated beverages may cause urinary tract infections, but since the client has never had urinary problems previously, this should not be the cause.

A pregnant client comes to the prenatal clinic reporting urinary frequency and lower back pain on the right, stating that this has never happened before. An exam validates the diagnosis of pyelonephritis. Which factor would contribute to this condition? a. drinking too many caffeinated liquids b. decreased peristalsis of urinary tract c. increased glomerular filtration rate d. dilated renal pelvis from pregnancy

c. Hemorrhoids The displacement of the intestines and possible slowed motility of the intestines can lead to constipation in the pregnant client. This, along with elevated venous pressure, can lead to development of hemorrhoids.

A pregnant client may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem? a. Varicose veins b. Umbilical hernia c. Hemorrhoids d. Gastrointestinal reflux

c. "This discharge is normal during pregnancy." During pregnancy, vaginal secretions become more acidic, white, and thick. Most clients 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.

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

ANS: ACD Rationale: Ways to ensure adequate protein intake include using soy foods, beans, lentils, nuts, grains, and seeds. Orange juice and green leafy vegetables can help promote calcium and vitamin C intake.

A pregnant woman who is a vegetarian asks the nurse, "What would you suggest to make sure that I get enough protein in my diet while I am pregnant?" Which food(s) would be appropriate for the nurse to suggest? Select all that apply. a. Beans b. Green leafy vegetables c. Lentils d. Nuts e. Orange juice

b. 2+ Protein in urine During pregnancy, there may be a slight amount of glucose found in the urine due to the fact that the kidney tubules are not able to absorb as much glucose as there were before pregnancy. However, there should be minimal protein in the urine. A specific gravity of 1.010 and a straw- like color are both normal findings.

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

a. 25 to 35 lbs (11 to 16 kg) Rationale: A woman with a BMI of 18.5 to 24.9 is of normal weight and should gain 25 to 35 pounds (11 to 16 kg) during the pregnancy. For a woman who is underweight (BMI <18.5), the total weight gain range is 28 to 40 pounds (13 to 18 kg). For a woman who is overweight (BMI = 25-29.9), total weight gain range should be 15 to 25 pounds (7 to 11 kg). For a woman who is obese (BMI = 30 or higher), the total weight gain range should be 11 to 20 pounds (5 to 9 kg).

A woman comes to the clinic for her first prenatal checkup. The woman has a body mass index (BMI) of 22. The nurse would anticipate that this client should gain approximately how much weight during her pregnancy? a. 25 to 35 lbs (11 to 16 kg) b. 11 to 20 lbs (5 to 9 kg) c. 28 to 40 lbs (13 to 18 kg) d. 15 to 25 lbs (7 to 11 kg)

c. 1 lb (.45 kg) Rationale: The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (.45 kg) per week. Overweight women should gain about 2/3 lb (.30 kg) per week.

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? a. 2/3 lb (.30 kg) b. 1.5 lb (.68 kg) c. 1 lb (.45 kg) d. 2 lb (.90 kg)

ANS: CDE Rationale: The placenta begins to produce the following hormones during pregnancy: hCG, hPL, relaxin, progesterone, and estrogen. Testosterone is secreted by ovaries and cortisol by the adrenal cortex.

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. a. testosterone b. cortisol c. estrogen d. relaxin e. hCG

c. "They will be able to hear the fetal heart rate on auscultation." Rationale: 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. Amenorrhea is a presumptive sign of pregnancy. Hegar's sign is a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy.

After teaching a group of women about the signs of pregnancy, the nurse understands that teaching was successful if the group makes which statement about positive signs? a. "The woman will have amenorrhea." b. "The client will experience quickening." c. "They will be able to hear the fetal heart rate on auscultation." d. "There will be a positive Hegar's sign."

b. Oranges c. Spinach d. Broccoli Rationale: Good food sources of folic acid include dark green vegetables, such as broccoli, romaine lettuce, and spinach; baked beans; black-eyed peas; citrus fruits; peanuts; and liver. Apples and almonds are not necessarily high in folic acid.

After teaching a woman about the importance of folic acid in pregnancy, the nurse determines that the teaching was successful when the woman identifies which food(s) as being high in folic acid? Select all that apply. a. Almonds b. Oranges c. Spinach d. Broccoli e. Apples

c. A decrease in blood pressure in the second trimester may occur because of placental growth. Because the placenta "traps" a great deal of blood for fetal circulation as it expands at about 3 months, blood pressure of the pregnant client may temporarily be slightly decreased. Otherwise, blood pressure stays fairly constant throughout pregnancy.

At their 16-week checkup, a client's blood pressure is slightly decreased from their prepregnancy level. The nurse evaluates this change based on which statements concerning blood pressure during pregnancy? a. Normally, blood pressure increases steadily throughout pregnancy. b. Blood pressure remains stable until decreasing the day of the birth. c. A decrease in blood pressure in the second trimester may occur because of placental growth. d. Blood pressure progressively decreases throughout the entire pregnancy.

a. 85 beats per minute. 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.

Before becoming pregnant, a client's heart rate averaged 72 beats per minute. The client is now 15 weeks' pregnant. The nurse would expect this client's heart rate to be approximately: a. 85 beats per minute. b. 90 beats per minute. c. 95 beats per minute. d. 100 beats per minute.

c. 85 beats per minute. Rationale: 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.

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: a. 95 beats per minute. b. 100 beats per minute. c. 85 beats per minute. d. 90 beats per minute.

a. bruising Bruising would not be a normal finding. Evidence of bruising might suggest intimate partner violence. Linea nigra, striae, and darkening of the umbilicus are normal findings.

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding? a. bruising b. linea nigra c. striae d. darkening of the umbilicus

d. Ask the woman if she is having any itching or irritation. Rationale: 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 report is normal. A culture may or may not be necessary. There is no evidence to suggest that her membranes have ruptured.

During a routine antepartal visit, a pregnant woman reports a white, thick vaginal discharge. What would the nurse do next? a. Tell the woman that this is entirely normal. b. Check the discharge for evidence of ruptured membranes. c. Advise the woman about the need to culture the discharge. d. Ask the woman if she is having any itching or irritation.

b. Tell the woman that this is entirely normal. Rationale: Vaginal secretions increase during pregnancy and this is considered normal leukorrhea based on the woman's report that she is not experiencing any itching or irritation. There is no evidence indicating the need to notify the healthcare provider, check for rupture of membranes, or advise her about the need for a culture.

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

c. Both findings are normal at this point of the pregnancy. A pregnant client will normally experience a decrease in their blood pressure during the second trimester. An increase in the heart rate of 10 to 15 beats per minute on average is also normal, due to the increased blood volume and increased workload of other organ systems. Hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure.

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

d. Turn the client on their left side. 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 their left side, which relieves pressure on the vena cava and restores venous return. Although they are valuable assessments, fetal heart tone and client blood pressure measurements do not correct the problem. Because deep breathing has no effect on venous return, it cannot relieve the client's symptoms.

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

a. Supine hypotension syndrome The left side-lying position prevents the heavy uterus from resting on and compressing their vena cava, a condition known as supine hypotensive syndrome. Compression of the vena cava can cause hypotension in the birthing parent and poor gas exchange between the placenta and fetus. Preeclampsia is a condition characterized by elevated blood pressure and proteinuria. Once diagnosed, the treatment includes resting in a left-lateral position, but a side-lying position does not prevent preeclampsia. Urinary frequency in the third trimester is due to the enlarged uterus pressing on the bladder and is not influenced by position. Remaining in an upright position for 1 to 2 hours after meals helps to decrease heartburn.

During late pregnancy, the nurse teaches a pregnant client to lay on their left side to avoid what condition? a. Supine hypotension syndrome b. Preeclampsia c. Frequent urination d. Heartburn

c. couvade syndrome Some partners actually experience some of the physical symptoms of pregnancy, such as nausea and vomiting, along with the pregnant parent. This phenomenon is called couvade syndrome.

During pregnancy a pregnant parent has many psychological adaptations that must be made. The nurse must remember that the nonpregnant partner is also experiencing the pregnancy and has adaptations that must be made. Some partners actually have symptoms of the pregnancy along with the pregnant parent. What is this called? a. pseudo pregnancy b. pregnancy syndrome c. couvade syndrome d. cretinism

a. aldosterone Rationale: Aldosterone is secreted by the adrenal glands, and it normally regulates the absorption of sodium in the kidney. During pregnancy, aldosterone is a key regulator of electrolyte and water homeostasis and plays a central role in blood pressure regulation. ADH (antidiuretic hormone) is secreted by the kidneys and aids in resorption of fluids in the kidneys. Glycogen assists in the balancing of blood glucose, breaking down to glucose when needed by the body. Cortisol is important in helping the body handle stress.

During pregnancy, one of progesterone's actions is to allow sodium to be "wasted" or lost in the urine. The nurse would expect to see which hormone increased to help counteract this loss? a. aldosterone b. cortisol c. glycogen d. ADH

Presumptive

Elevated hCG levels are a _____________ sign of pregnancy.

36 weeks' gestation.

Fundal height is not a reliable indicator of gestational weeks after?

b. A spontaneous abortion (miscarriage) would occur. If the corpus luteum fails to produce progesterone for approximately 6 to 7 weeks, a spontaneous abortion (miscarriage) will occur. After 7 weeks, the placenta will produce enough progesterone to sustain the pregnancy. There is no connection between multifetal pregnancies and the corpus luteum not functioning long enough in progesterone production.

Hormone levels of a client indicate that the corpus luteum stopped functioning and releasing progesterone after 5 weeks. The nurse would recognize that which scenario is the expected outcome? a. The pregnancy would continue unaffected. b. A spontaneous abortion (miscarriage) would occur. c. There is a higher than normal chance of a multifetal pregnancy. d. They will need progesterone supplement throughout the pregnancy.

a. Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge. Rationale: Elevated progesterone levels cause smooth muscle relaxation, which can result in relaxation of the cardiac sphincter and reflux of the stomach contents into the lower esophagus. OTC antacids will usually relieve the symptoms but should be discussed with the health care provider first. The hormonal changes are necessary for the pregnancy to continue, and the woman will return to her usual nonpregnant hormonal levels after the baby is born. Taking hormonal replacement therapy is not recommended. Using herbs should be done only with the knowledge of the health care practitioner due to the side effects and contraindications of some herbs during pregnancy. Some herbs will cause a spontaneous abortion.

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

d. melasma (chloasma) The so-called mask of pregnancy, melasma (also known as chloasma) can appear as brown blotchy areas on the forehead, cheeks, and nose of the client. This condition may be permanent, or it may regress between pregnancies.

Many changes occur in the body of a pregnant client. Some of these are changes in the integumentary system. What is one change in the integumentary system called? a. linea rubria b. Chadwick sign c. ballottement d. melasma (chloasma)

b. pica Rationale: Pica is the compulsive ingestion of nonfood substances. Pregnant women who develop a pica habit typically have one or two specific cravings. The three main substances consumed by women with pica are soil or clay, ice, and laundry starch. These substances replace nutritive sources and can lead to complications such as iron-deficiency anemia, infection, and constipation.

On a routine hematocrit screen during a prenatal visit, the nurse notices that the client is mildly anemic. When discussing this with the couple, the husband hints that she might be eating unusual things. The nurse recognizes the need for the woman to be evaluated for which condition? a. food cravings b. pica c. vegan diet d. food allergy

Posterior pituitary

Oxytocin, responsible for uterine contractions, is released from the _________________ gland.

ambivalence

Pregnant women commonly experience the emotional response (involves having conflicting feelings at the same time and is a universal feeling in pregnant clients) of ________________ during the first trimester of pregnancy. It is considered normal when preparing for a lifestyle change and new role.

Placenta

The ___________ is a unique endocrine gland with the ability to form protein and steroid hormones.

b. quickening The fluttering sensation that can be confused with gas is called "quickening." In the 2 weeks leading up to the 20-week mark, the client may feel "flutters" that they may confuse with gas. Lightening is the descent of the presenting part of the fetus into the pelvis. Placenta previa is the implantation of the placenta so that it covers part or all of the cervical os. Linea nigra is a hyperpigmented line that appears on the pregnant client's abdomen between the symphysis pubis and top of the fundus.

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? a. lightening b. quickening c. placenta previa d. linea nigra

progesterone

The influence of ___________ hormones leads to decreased peristalsis in the pregnant woman.

ANS: ACD Rationale: Vascular changes during pregnancy manifested in the integumentary system include varicosities of the legs, vulva, and perineum. Varicose veins commonly are the result of distention, instability, and poor circulation. Various interventions to reduce the risk of developing varicosities include elevating both legs when sitting or lying down; avoiding prolonged standing or sitting; walking daily for exercise; avoiding tight clothing or knee-high hosiery; and wearing support hose if varicosities are a preexisting condition to pregnancy.

The nurse has determined that based on the client's physical examination she is at high risk for developing varicose veins. Which suggestions might the nurse teach the client to help reduce her risk? Select all that apply. a. Walk daily. b. Use knee-high support hose. c. Use thigh-high support hose. d. Elevate the feet and legs. e. Sit in a hot tub at least three times a week.

d. 10.6 g/dl The average hemoglobin level at term is 12.5 g/dl. The hemoglobin level is considered normal until it falls below 11 g/dl.

The nurse is assessing a pregnant client at 20 weeks' gestation and obtains a hemoglobin level. Which result would be a cause for concern? a. 12.8 g/dl b. 11.9 g/dl c. 11.2 g/dl d. 10.6 g/dl

b. The intestines are displaced by the growing fetus The growing fetus is displacing the intestines and interfering with peristalsis, delaying the passage of fecal matter and resulting in constipation. This is common and expected; however, the client should take measures to prevent hemorrhoids that can occur as the result of the pressure and straining. Progesterone, not hCG, can delay gastric emptying and decrease peristalsis.

The nurse is assessing a pregnant client in their third trimester who is reporting a first-time occurrence of constipation. When asked why this is happening, what is the best response from the nurse? a. There is not enough fiber in your diet. b. The intestines are displaced by the growing fetus. c. This shouldn't be happening. d. hCG is delaying peristalsis.

c. questioning of ability to become a good mother Rationale: During the third trimester, the woman often questions her ability to become a mother. Accepting the pregnancy but not the fetus as yet and identifying what must be given up to assume new role are characteristic of the first trimester. Learning how to delay own desires and acknowledging the fetus as a separate entity are characteristic of the second trimester.

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

d. 177 lb (80.3 kg) Rationale: A woman with a BMI of 27 is considered overweight. Therefore, during the first trimester, weight gain should be about 2 lb (0.9 kg). For this woman, a weight of 177 lb (80.3 kg) would be appropriate. For a woman whose prepregnancy weight is within the normal weight range, weight gain should be about 3.5 to 5 lb (1.6 to 2.25 kg). For an underweight woman, weight gain should be at least 5 lb (2.25 kg).

The nurse is assessing a pregnant woman who has just completed her first trimester. The woman's BMI was 27 prior to becoming pregnant. Her prepregnancy weight was 175 lb (79.4 kg). On reviewing the woman's medical record, which measurement would the nurse determine as appropriate weight gain for the woman during her first trimester? a. 178 lb (80.7) b. 176 lb (79.8 kg) c. 180 lb (81.6) d. 177 lb (80.3 kg)

b. "Many clients feel this way during the first trimester." The best response is to let the client know this is a common feeling among all pregnant clients. Most clients experience ambivalence during the first trimester whether the pregnancy was planned or not. Acceptance of the pregnancy commonly occurs during the second trimester when quickening, or feeling the fetus move, occurs. However, it is not appropriate for the nurse to assume the client will become excited as each pregnancy is unique and a time of dramatic alterations. Stating not to worry and everything will be fine is nontherapeutic communication and does not focus on the client's concern. The nurse would discuss the client's feelings and concerns before making a referral.

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? a. "You will become excited and happy when you feel the infant move." b. "Many clients feel this way during the first trimester." c. "We can refer you to a clinic for potential termination if you desire." d. "Do not worry. Once you hold this infant, everything will be fine."

d. Meats Meats are the best source of heme-rich iron and should be included in the diet if the client is not following a vegetarian diet. Grains and legumes are non-heme iron sources. Dairy products will add various vitamins and calcium to the diet.

The nurse is explaining the latest laboratory results to a pregnant client who is in the third trimester. After letting the client know they are anemic, which heme iron-rich foods should the nurse encourage the client to add to their diet? a. Legumes b. Dairy c. Grains d. Meats

c. Goodell sign The description of a Goodell sign is softening of the cervix. Ballottement is when tapping the lower uterine segment on a bimanual exam elicits the fetus to rise against the abdominal wall. Chadwick sign is when the vagina changes color from pink to violet. Hegar sign is softening of the lower uterine segment.

The nurse is performing an assessment of a client who has come to a health care facility for a diagnosis of pregnancy. The client is positive for breast changes, nausea, and amenorrhea. On physical exam, it is noted that the client has softening of the cervix. How should the nurse document this in the notes? a. ballottement b. Chadwick sign c. Goodell sign d. Hegar sign

ANS: BCD Rationale: For a pregnant woman to meet recommended DRIs, she should eat according to the U.S. Department of Agriculture (USDA) food guide, MyPlate . Some of these guidelines include eating a variety of food from all food groups, using portion control; increase intake of vitamins, minerals, and dietary fiber; lower intake of saturated fats, trans fats, and cholesterol; increase intake of fruits, vegetables, and whole grains; and balance calorie intake with exercise to maintain ideal healthy weight.

The nurse is putting together information for a nutritional class for nullipara women. Which information would be most important for the nurse to include? Select all that apply. a. Consume at least one quart of water daily. b. Increase consumption of fruits, vegetables, and whole grains. c. Avoid the intake of alcohol. d. Decrease intake of saturated fats, trans fats, and cholesterol. e. Increase caloric intake.

a. The infant will be small and could have problems. Clients who gain less than 16 pounds (7257 g) are at risk of giving birth to small infants, which is associated with poor neonatal outcomes. The infant may not quickly gain weight but continue to slowly put on weight.

The nurse is teaching a pregnant adolescent the importance of proper nutrition and adequate weight gain throughout the pregnancy. What is the best response when the client refuses to eat due to fear of possible weight gain? a. The infant will be small and could have problems. b. There may be little impact on the infant, but the client can suffer complications. c. It will just make the infant smaller, but there are no other problems associated. d. The infant will be smaller but should quickly gain weight.

a. oxytocin Rationale: Oxytocin is responsible for milk ejection during breast-feeding. Its secretion is stimulated by stimulation of the breasts via sucking or touching. Secretion of follicle-stimulating hormone is inhibited during pregnancy. The secretion of antidiuretic hormone has no effect on breast-feeding. Cortisol secretion regulates carbohydrate and protein metabolism and is helpful in times of stress.

The nurse is teaching a pregnant woman about breast feeding. The nurse determines that the teaching was successful when the woman identifies which hormone as being released when the newborn sucks at the breast? a. oxytocin b. antidiuretic hormone c. cortisol d. follicle stimulating hormone

c. "The hormones of pregnancy may cause anxiety or depression postpartum." The "raging hormones" of pregnancy can keep the pregnant client slightly out of touch with their usual methods of coping. Although the client may normally interact and communicate in quite mature ways, during a pregnancy they may become depressed, anxious, withdrawn, or angry as they accomplishe their own developmental tasks. Siblings often react to a pregnancy by regression in behavior and attitude because they fear 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 clients who plan to breastfeed.

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

b. "I will need to take iron supplementation throughout my pregnancy even if I am not anemic."

The nurse is teaching the pregnant client about nutrition for themself and the fetus. Which statement by the client indicates that the teaching was effective? a. "I can eat any seafood that I like because it contains phosphorus, which is a nutrient that pregnant clients need." b. "I will need to take iron supplementation throughout my pregnancy even if I am not anemic." c. "Milk production requires higher levels of calcium; therefore, if I am going to breastfeed, I must take a calcium supplement during pregnancy." d. "Because I am pregnant, I can eat anything I want and not worry about weight gain."

b. 32 mIU/ml (32 IU/l) Rationale: An hCG level lower than 5 mIU/mL (5 IU/l) is considered negative for pregnancy, and anything higher than 25 mIU/mL (25 IU/l) is considered positive for pregnancy.

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? a. 8 mIU/ml (8 IU/l) b. 32 mIU/ml (32 IU/l) c. 24 mIU/ml (24 IU/l) d. 16 mIU/ml (16 IU/l)

d. The cervix softens. At about the 8th week of gestation, the cervix softens, a probable sign known as Goodell sign. The cervix also looks blue or purple when examined; this is Chadwick sign, and may occur as early as the 6th week of pregnancy. At about 6 weeks, the lower uterine segment softens, a probable sign called Hegar sign. A softening of the uterine fundus, where the embryo has implanted, also occurs by about the 7th week, and the fundus enlarges by the 8th week.

The nurse-midwife is performing a pelvic examination on a client who came to them following a positive home pregnancy test. The nurse checks the client's cervix for the probable sign of pregnancy known as Goodell sign. Which description illustrates this alteration? a. The cervix looks blue or purple when examined. b. The lower uterine segment softens. c. The fundus enlarges. d. The cervix softens.

b. Pregnant clients often experience mood swings and self-centeredness but this is normal. During the first trimester of pregnancy, the client often has mood swings, bouts of irritability and is hypersensitive. The partner needs to know that these are all normal behaviors for a pregnant client.

The partner of a pregnant client in their first trimester asks the nurse about the client's behavior recently, stating that they are very moody, seems happy one moment and is crying the next and all they want to talk about is themself. What response would correctly address these concerns? a. Your partner's body is changing and they may be angry about it. b. Pregnant clients often experience mood swings and self-centeredness but this is normal. c. Moodiness and irritability are not usual responses to pregnancy. d. What you are describing may be normal but we need to talk to them more in depth.

25 - 35

The recommended amount of weight gain during pregnancy is ______ to ____ pounds.

a. introversion Introversion, or focusing on oneself, is common during early pregnancy, especially as more signs of the pregnancy become apparent. The pregnant client may withdraw and become increasingly preoccupied with themself and the fetus. This is a normal psychological adaptation to upcoming parenthood. Ambivalence is an initial response that involves having conflicting feelings at the same time and is a universal feeling in pregnant clients. It is considered normal when preparing for a lifestyle change and new role. In the stage of acceptance, the client feels tangible signs that someone separate from themself is present. This response is common during the second trimester. Emotional lability involves experiencing mood swings (e.g., feeling great joy at one moment and then within a short time feeling shock and disbelief).

The spouse of a pregnant client in the first trimester tells the nurse that the client is increasingly preoccupied with themself and the fetus as more signs of the pregnancy present themselves. What should the nurse point out to the spouse is probably occurring in this situation? a. introversion b. ambivalence c. acceptance d. emotional lability

a. 1,500 ml Blood volume increases by approximately 1,500 ml or 50% above nonpregnant levels by the 32nd week of gestation. This increase in blood volume is needed to provide adequate hydration of fetal and client tissues.

When discussing the many changes the client's body undergoes during pregnancy, the nurse may include that the client's total blood volume will increase by approximately how much by the 32nd week of gestation? a. 1,500 ml b. 1,000 ml c. 500 ml d. 2,000 ml

d. 1,500 mL Rationale: Blood volume increases by approximately 1,500 mL or 50% above nonpregnant levels by the 32nd week gestation. This increase in blood volume is needed to provide adequate hydration of fetal and maternal tissues.

When discussing the many changes the woman's body undergoes during pregnancy, the nurse may include that the woman's total blood volume will increase by approximately how much by the 32nd week gestation? a. 500 mL b. 1,000 mL c. 2,000 mL d. 1,500 mL

a. detect fetal heart sounds with a Doppler. Fetal heart sounds are audible with a Doppler at 10 to 12 weeks' gestation but cannot be heard through a stethoscope until 18 to 20 weeks' gestation. Fetal movements can be felt by a client as early as 16 weeks of pregnancy and felt by the examiner around 20 weeks' gestation. The fetal outline is also palpable around 20 weeks' gestation.

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

a. dilation of the renal pelvis Rationale: 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.

Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy? a. dilation of the renal pelvis b. decrease in glomerular filtration rate c. shortening of the ureters d. reduction in kidney size

c. Breast tenderness Presumptive signs of pregnancy are things reported by the client to the health care provider and occur early in pregnancy. Breast tenderness is a common sign reported by clients in early pregnancy but is not a definitive sign. Reports of increased hunger and weight gain could be caused by any disorder or could be normal responses to eating cycles. Ballottement occurs late in the pregnancy and is a probable sign.

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

Ultrasound

_______________ verification of embryo or fetus is a sign of a positive indicator of pregnancy.