Chapter 11: Maternal Adaptation During Pregnancy (2)

The nurse is teaching the pregnant woman about nutrition for herself and her baby. Which statement by the woman indicates that the teaching was effective? pg. 348

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

Which information provided by a client would be considered a presumptive sign of pregnancy? pg. 333

Breast tenderness

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? pg. 355

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

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? pg. 334

Positive home pregnancy test

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse? pg. 355

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

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? pg. 343

FSH and LH

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. pg. 333

- amenorrhea - morning sickness - breast changes

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. pg. 349

- broccoli - spinach - oranges

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? pg. 335

24

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: pg. 339

85 beats per minute.

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? pg. 334

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? pg. 336

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

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? pg. 33

Fetal movement felt by examiner

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? pg. 333

Have you been sexually active in the past 2 months?

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? pg. 337

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

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? pg. 357

couvade syndrome

Which assessment finding in the pregnant woman at 12 weeks' gestation should the nurse find most concerning? The inability to: pg. 333

detect fetal heart sounds with a Doppler.

A woman is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and she has no real family support. The nurse's most therapeutic response would be to: pg. 354-355

encourage her to identify someone that she can talk to and share the pregnancy experience.

A client who suspects she is pregnant asks the nurse about the accuracy of home pregnancy tests. The nurse would tell the client that: pg. 334

some of the home pregnancy tests can detect the presence of hCG within 1 day of the woman's missed period.

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? pg. 333

visualization of the fetus by ultrasound