Chapter 11: Maternal Adaptation During Pregnancy - Antepartum
A pregnant client in her first trimester of pregnancy reports spontaneous, irregular, painless contractions. What does this indicate? preterm labor infection of the gastrointestinal (GI) tract Braxton Hicks contractions acid indigestion
Braxton Hicks contractions Explanation: Spontaneous, irregular, painless contractions, called Braxton Hicks contractions, begin during the first trimester. These contractions are not the signs of preterm labor, infection of the GI tract, or acid indigestion. Acid indigestion causes heartburn. Acid indigestion or heartburn (pyrosis) is caused by regurgitation of the stomach contents into the upper esophagus and may be associated with the generalized relaxation of the entire digestive system.
A woman comes to the prenatal clinic and undergoes a pelvic exam. The doctor notes a softening of the uterine isthmus. The nurse recognizes that this finding is known as what sign? Hegar sign Chadwick sign Quickening Goodell sign
Hegar sign Explanation: The Hegar sign is one of three signs that can be noted by a digital pelvic exam and involves the softening of the lower uterine segment. This is one of the probable signs of pregnancy, along with a positive Chadwick sign and Goodell sign.
The nurse is assessing a pregnant client at 20 weeks' gestation and obtains a hemoglobin level. Which result would be a cause for concern? 12.8 g/dl 11.9 g/dl 11.2 g/dl 10.6 g/dl
10.6 g/dl Explanation: 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 counseling a client with a BMI of 23 about weight gain during pregnancy. The nurse teaches the client that during the second and third trimester of pregnancy, dietary intake should be increase by how many calories per day above what she was eating prior to the pregnancy? 100 300 500 1000
300 Explanation: A BMI of 23 is considered a healthy weight. For clients at a healthy weight, 300 additional calories are needed to support fetal growth in the second and third trimester of the pregnancy. If the client had been underweight, more calories would have been recommended; if the client had been obese, less calories would have been recommended.
Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks' pregnant. The nurse would expect this woman's heart rate to be approximately: 85 beats per minute. 90 beats per minute. 95 beats per minute. 100 beats per minute.
85 beats per minute. Explanation: During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.
Which information provided by a client would be considered a presumptive sign of pregnancy? Reports of increased hunger Weight gain Breast tenderness Ballottement
Breast tenderness Explanation: Presumptive signs of pregnancy are things reported by the woman to the health care provider and occur early in pregnancy. Breast tenderness is a common sign reported by women 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.
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? Chadwick sign Hegar sign Goodell sign Braxton sign
Chadwick sign Explanation: 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 pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem? Varicose veins Umbilical hernia Hemorrhoids Gastrointestinal reflux
Hemorrhoids Explanation: The displacement of the intestines and possible slowed motility of the intestines can lead to constipation in the pregnant woman. This, along with elevated venous pressure, can lead to development of hemorrhoids.
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 client's legs slightly elevated. Place the client in an orthopneic position. Keep the head of the client's bed slightly elevated. Place the client in the left lateral position.
Place the client in the left lateral position. Explanation: 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.
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. breast changes ultrasound pictures fetal heartbeat amenorrhea hydatidiform mole morning sickness
breast changes amenorrhea morning sickness Explanation: Presumptive signs are possible signs of pregnancy that appear in the first trimester, often only noted subjectively by the mother (e.g., breast changes, amenorrhea, morning sickness). Probable signs are signs that appear in the first and early second trimesters, seen via objective criteria, but can also be indicators of other conditions (e.g., hydatidiform mole). Positive signs affirm that proof exists that there is a developing fetus in any trimester and are objective criteria seen by a trained observer or diagnostic study, (e.g., ultrasound.)
Which assessment finding in the pregnant woman at 12 weeks' gestation should the nurse find most concerning? The inability to: You Selected: feel fetal movements. Correct response: detect fetal heart sounds with a Doppler. Explanation: 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 woman 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.
detect fetal heart sounds with a Doppler. Explanation: 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 woman 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.
The nurse is conducting an annual examination on a young female who reports her last menses was 2 months ago. The client insists she is not pregnant due to a negative home pregnancy test. Which assessment should the nurse use to assess confirm the pregnancy? Chadwick sign fetal heartbeat positive urine human chorionic gonadotropin (hCG) uterine size and shape changes
fetal heartbeat Explanation: The only positive sign of pregnancy is a sign or symptom that could only be attributable to the fetus; thus, fetal heartbeat can have no other origin. Chadwick sign is a color change in the cervix, vagina, and perineum; these could all be the result of other causes. A positive urine hCG is a probable sign as it can be related to causes other than pregnancy. A change in the size and shape of the uterus can occur due to other causes.
A client comes to the clinic and tells the nurse, "I think I might be pregnant." After completing the history and physical examination, the nurse obtains a blood specimen for pregnancy testing. When explaining this test to the client, which hormone will the nurse identify as being measured by this test? estrogen progesterone follicle-stimulating hormone human chorionic gonadotropin
human chorionic gonadotropin Explanation: The commonly used laboratory tests for pregnancy are based on the use of a venipuncture or a urine specimen to detect the presence of human chorionic gonadotropin (hCG), a hormone created by the chorionic villi of the placenta, in the urine or blood serum of the pregnant client. Because these tests are only accurate 95% to 98% of the time, positive results from these tests are considered probable rather than positive signs. The test does not evaluate the level of estrogen, progesterone, or follicle-stimulating hormone.
A pregnant client is reporting shortness of breath. To ensure there are no developing complications, a tidal volume is obtained. What type of results will the nurse expect? increase between 30% and 40% increase up to 25% decrease up to 25% decrease between 30% and 40%
increase between 30% and 40% Explanation: Enlargement of the uterus shifts the diaphragm up to 4 cm above its usual position. As muscles and cartilage in the thoracic region relax, the chest broadens with conversion from abdominal breathing to thoracic breathing. This leads to a 50% increase in air volume per minute. Tidal volume, or the volume of air inhaled, increases gradually by 30% to 40% (from 500 to 700 ml) as the pregnancy progresses.
Early in pregnancy, frequent urination results mainly from which of the following? pressure on the bladder from the uterus increased concentration of urine addition of fetal urine to maternal urine decreased glomerular selectivity
pressure on the bladder from the uterus Explanation: Early in pregnancy, the expanding uterus presses on the bladder. Later, it rises above the bladder so the pressure is relieved.
A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate? "You should refrain from any sexual activity." "You need to be assessed for a fungal infection." "This discharge is normal during pregnancy." "Use a local antifungal agent regularly."
"This discharge is normal during pregnancy." Explanation: During pregnancy, vaginal secretions become more acidic, white, and thick. Most women experience an increase in a whitish vaginal discharge, called leukorrhea, during pregnancy. The nurse should inform the client that the vaginal discharge is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans infection (a monilial vaginitis), which is a very common occurrence in this glycogen-rich environment. Monilial vaginitis is a benign fungal condition and is treated with local antifungal agents. The client need not refrain from sexual activity when there is an increase in a thick, whitish vaginal discharge.
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? "What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." "You need to go to the emergency room right away." "You need to come to the office to be examined." "You have nothing to be concerned about. I am sure you are not feeling contractions at this point in your pregnancy."
"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." Explanation: Braxton Hicks contractions are the painless, intermittent, "practice" contractions of pregnancy.
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? 2/3 lb (0.30 kg) 1 lb (0.45 kg) 1.5 lb (0.68 kg) 2 lb (0.90 kg)
1 lb (0.45 kg) Explanation: The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (0.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (0.45 kg) per week. Overweight women should gain about 2/3 lb (0.30 kg) per week.
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? Use a diluted urine specimen. Wait until after two missed menstrual periods. Keep the appointment. Refrain from eating for 4 hours before testing.
Keep the appointment. Explanation: 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.
During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding? bruising linea nigra striae darkening of the umbilicus
bruising Explanation: Bruising would not be a normal finding. Evidence of bruising might suggest domestic violence. Linea nigra, striae, and darkening of the umbilicus are normal findings.
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? positive office pregnancy test fetal movement felt by examiner Hegar sign Chadwick sign
fetal movement felt by examiner Explanation: 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 28-year-old primigravida client with type 2 diabetes comes to the health care clinic for a routine first trimester visit reporting frequent episodes of fasting blood glucose levels being lower than normal, but glucose levels after meals being higher than normal. What should the nurse point out that these episodes are most likely related to? tissue sensitivity to insulin increases using too much insulin at this stage of the pregnancy normal response to the pregnancy insulin resistance is starting to decrease
normal response to the pregnancy Explanation: This is a normal response to the pregnancy. During pregnancy, tissues become resistant to insulin to provide sufficient levels of glucose for the growing fetus. This can result in three normally occurring responses: blood glucose levels are lower than normal when fasting; blood glucose levels are higher than normal after meals; and insulin levels are increased after meals. The various hormones will prevent the mother from using most of the insulin produced to allow the extra glucose to get to the growing fetus.
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 estrogen prolactin
oxytocin Explanation: 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 woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the 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? relaxin progesterone estrogen human placental lactogen
relaxin Explanation: Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for 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.
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? During pregnancy blood volume can increase by at least 40%. Pregnancy typically causes a decrease in respiratory rate. Hemoglobin levels rise significantly during pregnancy. Blood pressure decreases in the third trimester.
uring pregnancy blood volume can increase by at least 40%. Explanation: 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.