Chapter 11: Maternal Adaptation During Pregnancy

What interventions would a pregnant client be taught regarding dietary restrictions during pregnancy? Select all that apply: A. Wash raw fruits and veggies with hot water and mild soap B. Eat soft cheeses like brie C. Discard foods that have been left out at room temperature for more than 2 hours D. Do not drink raw or unpasteurized milk E. Limit beef intake

Correct: A, C, D Soft cheeses should be avoided. There is no need for a limit on beef intake.

The partner of a pregnant client in her first trimester asks the nurse about the client's behavior recently, stating that she is very moody, seems happy one moment and is crying the next and all she wants to talk about is herself. What response would correctly address these concerns? A. Her body is changing and she may be angry about it. B. Pregnant women 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 her more in depth.

Correct: B

A 17-year-old client arrives for an annual examination and reports no changes since the last exam; however, the nurse assesses a positive Chadwick sign, slightly enlarged uterus, and subsequent positive urine pregnancy test. Which task should the nurse prioritize to assist this client who is denying any possibility that she is pregnant? A. Accepting the baby B. Accepting the pregnancy C. Telling family and partner D. Determine plans for baby

Correct: B Acceptance of pregnancy is multi-factorial, and how the woman responds to the pregnancy is certainly influenced by her age and if the pregnancy was planned. As a teenager, she may not have been trying to get pregnant and may not want to accept the role and experience. Baby and parenthood decisions should all occur later

A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucus discharge noted in the toilet after an OB office visit several hours earlier. What is the bestresponse from the triage nurse? A. Bloody mucus is a sign you are in labor. Please come to the hospital. B. A one time discharge of bloody mucus in the toilet might have been your mucus plug C. It is normal to have bloody discharge at this stage in the pregnancy D. It might be nothing. If it happens again call your provider who is on-call

Correct: B Bloody mucus can either be a mucus plug or bloody show. The one-time occurrence would be more likely to be the mucus plug. A bloody show would continue if her cervix was changing, but this usually does not occur until after contractions start. It is a sign that something is happening and should be reported to the health care provider. The bloody mucus is not a sign of labor, but it can be an early sign that labor is coming soon.

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. Progesterone C. Oxytocin D. Estrogen

Correct: C 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.

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. 90 bpm B. 95 bpm C. 85 bpm D. 100 bpm

Correct: C 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.

The nursing instructor is teaching a class on the nutritional needs of the pregnant client. The instructor determines the session is successful when the students correctly choose which supplement as being known to prevent up to 70% of CNS birth defects? A. Vitamin A B. Iodine C. Folic Acid D. Zinc

Correct: C Folic acid is noted to help prevent up to 70% of CNS birth defects; however, the folic acid needs to be in the body prior to the pregnancy to be most effective. Iodine affects thyroid development. Zinc is required for enzyme formation and gene expression. Vitamin A helps develop vision.

The nurse cares for a pregnant client at the first prenatal visit and reviews expected changes that will occur during pregnancy. Which information will the nurse include in the education? A. Decrease in respirations B. Elevation in hemoglobin levels C. Blood volume increases by at least 40% D. Blood pressure is elevated

Correct: C The pregnant woman can experience a blood volume increase by approximately 40% to 50% above prepregnancy levels by the end of the third trimester. Pregnancy results in an increased respiratory rate to provide oxygen to both the mother and fetus. Hemoglobin levels are usually low during pregnancy because of hemodilution of red blood cells, which is termed physiologic anemia of pregnancy. Blood pressure usually reaches a low point mid-pregnancy and, thereafter, increases to prepregnancy levels by the third trimester.

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? A. Notify the provider B. Check for ruptured membranes C. Tell the woman that this is entirely normal D. Advise her that cultures are needed to determine the cause

Correct: C 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 health care provider, check for rupture of membranes, or advise her about the need for a culture.

A client calls to cancel an appointment for the first prenatal visit after reporting a home pregnancy test is negative. Which instruction should the nurse prioritize? A. Use a diluted urine specimen B. Wait until the second missed period C. Do not eat 4 hours before the test D. Keep the appointment

Correct: D Although home pregnancy tests are accurate 95% of the time, they may still have false positives or false negatives, and the client needs to seek prenatal care and confirmation from her health care provider. Diluting the urine, waiting to miss a second period, or eating before the test would have no effect. The tests look for hCG, which is not affected.

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 pregnancy? A. LH and MSH B. T4 and MSH C. GH and FSH D. LH and FSH

Correct: D 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.

The nursing instructor is teaching a class on the various hormones necessary for a successful pregnancy and birthing process. The instructor determines the session is successful when the students correctly choose which hormone as being necessary after birth to ensure growth of the newborn? A. Estrogen B. Progesterone C. Oxytocin D. Prolactin

Correct: D Prolactin is the hormone responsible for the initiation of lactation, the production of breast milk. Oxytocin is responsible for the letdown of milk and uterine contractions enabling the infant to be born, and estrogen and progesterone are responsible for uterine and pregnancy maintenance.

The nurse is teaching a pregnant woman about nutrition for herself and her baby. Which statement by the woman indicates that the teaching was effective? A. Milk production requires high levels of calcium; therefore, if I am going to breastfeed, I must take a calcium supplement during pregnancy B. Seafood offers good amounts of phosphorous C. Calcium is needed when breastfeeding. D. I can eat whatever she may like and does not need to worry about weight gain E. I will need to take iron supplements throughout my pregnancy even if I am not anemic

Correct: E Iron is recommended for all pregnant women because it is almost impossible for the pregnant woman to get what is required from diet alone, especially after 20 weeks' gestation when the requirements of the fetus increase. Pregnant women can get many nutrients from seafood including phosphorus, but there are specific recommendations about types of fish to avoid because of the risk of mercury poisoning. Milk production actually requires higher levels of zinc, which can be obtained from a healthy diet. Calcium requirements do not increase above prepregnancy levels during pregnancy because calcium absorption is enhanced during pregnancy. It can be unsafe for the pregnant woman to eat anything she wants and gain too much weight. A woman who gains too much weight during pregnancy is at risk for delivering a macrosomic baby.

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

Correct: Place the client in the left lateral position The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

Quickening

Fluttering sensation Occurs in second trimester

The nurse is teaching a pregnant woman about breastfeeding. 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. FSH B. Cortisol C. Oxytocin D. Antidiuretic hormone

correct: C Oxytocin is responsible for milk ejection during breastfeeding. 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 breastfeeding. Cortisol secretion regulates carbohydrate and protein metabolism and is helpful in times of stress.