Chapter 11: Maternal Adaptation During Pregnancy
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%. 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.
The nurse is counseling a young woman who has just entered her second trimester, after an uneventful first trimester. She tells the nurse, "It still doesn't seem real. It's just hard to believe that I will really have a baby." Which future events should the nurse point out that will help the young woman come to believe it is real? Select all that apply. Feeling the baby kick Seeing an ultrasound image of the baby Giving up alcohol Receiving a positive result on a pregnancy test Taking prenatal vitamins
Feeling the baby kick Seeing an ultrasound image of the baby Explanation: During the second trimester, the psychological task of a woman is to accept she is having a baby, a step up from accepting the pregnancy. This change usually happens at quickening, or the first moment a woman feels fetal movement. Shopping for baby clothes for the first time, setting up the crib, seeing a blurry outline on a sonogram screen: any of these small actions may suddenly make the coming baby seem real and desired. Clearly, receiving a positive result on a pregnancy test was not enough to help this woman accept that she was having a baby, as this has already happened. Taking prenatal vitamins and giving up alcohol are more likely to be indicators that the woman has accepted the pregnancy rather than aiding her in accepting the baby.
The nurse is counseling a young woman who has just entered her second trimester, after an uneventful first trimester. She tells the nurse, "It still doesn't seem real. It's just hard to believe that I will really have a baby." Which future events should the nurse point out that will help the young woman come to believe it is real? Select all that apply. Feeling the baby kick Seeing an ultrasound image of the baby Giving up alcohol Receiving a positive result on a pregnancy test Taking prenatal vitamins
Feeling the baby kick Seeing an ultrasound image of the baby Explanation: During the second trimester, the psychological task of a woman is to accept she is having a baby, a step up from accepting the pregnancy. This change usually happens at quickening, or the first moment a woman feels fetal movement. Shopping for baby clothes for the first time, setting up the crib, seeing a blurry outline on a sonogram screen: any of these small actions may suddenly make the coming baby seem real and desired. Clearly, receiving a positive result on a pregnancy test was not enough to help this woman accept that she was having a baby, as this has already happened. Taking prenatal vitamins and giving up alcohol are more likely to be indicators that the woman has accepted the pregnancy rather than aiding her in accepting the baby.
A pregnant vegan reports eating lots of dark green leafy vegetables, legumes, citrus fruits, and berries. To ensure that her infant's nervous system will develop properly, what foods should the nurse recommend that she add to her diet?
Fortified cereals Explanation: The best source to recommend are the fortified cereals to meet the amino acid needs necessary for the development of her infant's nervous system during pregnancy. She should be encouraged to include fortified cereals to meet these needs. The carrots, sweet potatoes, mangoes, nuts, and seeds will add other nutrients to her diet. A vegan will not eat milk and cheese, as they are animal products.
A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?
Fundal height has dropped since the last recording. Explanation: Between 38 and 40 weeks of gestation, the fundal height drops as the fetus begins to descend and engage into the pelvis. Because it pushes against the diaphragm, many women experience shortness of breath. By 40 weeks, the fetal head begins to descend and engage into the pelvis. Although breathing becomes easier because of this descent, the pressure on the urinary bladder now increases, and women experience urinary frequency. The fundus reaches its highest level at the xiphoid process at approximately 36, not 39, weeks. By 20 weeks' gestation, the fundus is at the level of the umbilicus and measures 20 cm. At between 6 and 8 weeks of gestation, the cervix begins to soften (Goodell sign) and the lower uterine segment softens (Hegar's sign).
An obstetrical nurse is conducting a program for pregnant women who are in their first trimester. The program focuses on the changes occurring in the woman's body as a result of the pregnancy. When describing the effect of changing hormonal levels, which information would the nurse most likely include? Select all that apply. Maintenance of the endometrium so that the embryo can implant Maternal metabolic changes to make nutrients available for mother and fetus Decrease in maternal blood volume and red blood cell mass to increase oxygen delivery Decrease in blood supply to the gastrointestinal tract and slowing of peristaltic waves Relaxation of the ligaments that connect the pelvic bones, allowing them to spread slightly Preparing the breasts for lactation, keeping the milk from coming in until birth occurs
Maintenance of the endometrium so that the embryo can implant Maternal metabolic changes to make nutrients available for mother and fetus Relaxation of the ligaments that connect the pelvic bones, allowing them to spread slightly Preparing the breasts for lactation, keeping the milk from coming in until birth occurs Explanation: The hormonal effects of pregnancy include the following: • Maintaining the endometrium so that the embryo can implant, causing changes in the mother's metabolism so that nutrients are available for both • Relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly • Preparing the breasts for lactation, keeping the milk from coming in until birth occurs • Increasing the mother's blood volume and red blood cell mass to increase oxygen • Increasing the blood supply to the gastrointestinal tract and slowing peristaltic waves
The nurse is explaining the latest laboratory results to a pregnant client who is in her third trimester. After letting the client know she is anemic, which heme iron-rich foods should the nurse encourage her to add to her diet?
Meats Explanation: Meats are the best source of heme-rich iron and should be included in her diet if she 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.
A client in her second trimester of pregnancy reports discomfort during sexual activity. Which instruction should a nurse provide?
Modify sexual positions to increase comfort. Explanation: The nurse should instruct the client to change sexual positions to increase comfort as the pregnancy progresses. Although the nurse should also encourage her to engage in alternative, noncoital modes of sexual expression, such as cuddling, caressing, and holding, the client need not restrict herself to such alternatives. It is not advisable to perform frequent douching, because this is believed to irritate the vaginal mucosa and predispose the client to infection. Using lubricants or performing stress-relieving and relaxation exercises will not alleviate discomfort during sexual activity.
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?
aldosterone Explanation: 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.
Place the following events in the sequence the pregnant woman would experience them, from first to last. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1amenorrhea 2uterine enlargement 3quickening 4Braxton Hicks contractions 5labor
amenorrhea uterine enlargement quickening Braxton Hicks contractions labor Explanation: The correct sequence is amenorrhea, uterine enlargement, quickening, Braxton Hicks contractions, and labor.
The nurse is assessing several pregnant women in a clinic setting. Which assessment finding would alert the nurse to notify the health care provider?
blood pressure measured at 170/88 mm Hg Explanation: During pregnancy, women may expertise increased nasal stuffiness, increased urination, fatigue, and skin pigment increases. Elevated blood pressure is a concern during pregnancy and would be reported.
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:
encourage her to identify someone that she can talk to and share the pregnancy experience. Explanation: A pregnant woman without social support needs to identify someone with whom she can share the experience of pregnancy because social support is a crucial part of adapting to parenthood. Telling her to move home and telling her that she will feel better as the pregnancy progresses do not address the issue of isolation. Also, moving home may not be a possibility for this woman. The nurse should maintain a professional relationship and not commit to a long-term relationship with a client.
What is a positive sign of pregnancy?
fetal movement felt by examiner Explanation: The positive signs of pregnancy are fetal image on sonogram, hearing a fetal heart rate, and the examiner feeling fetal movement.
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?
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.
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. hCG relaxin estrogen testosterone cortisol
hCG relaxin estrogen Explanation: 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.
A nurse conducting a presentation for a group of nurses explains the changes in various body systems related to pregnancy. The nurse determines that additional teaching is needed when the group chooses which component as contributing to the pregnant woman's hypercoagulable state?
increased number of red blood cells Explanation: The increase in red blood cells is necessary to transport the additional oxygen required during pregnancy. It has no effect on the hypercoagulable state. Both fibrin and plasma fibrinogen levels increase, along with various blood clotting factors, leading to a hypercoagulable state.
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?
influence of estrogen and blood vessel proliferation Explanation: 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.
A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client?
iron-deficiency anemia Explanation: Pica is characterized by a craving for substances that have no nutritional value. Consumption of these substances can be dangerous to the client and her developing fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation of the client's compulsion to consume soil. Consumption of ice due to pica is likely to lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the client has been consuming laundry starch as a result of pica. The nurse should monitor for constipation in the client if she has been consuming clay.
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 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.
A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate?
"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 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 best response from the triage nurse?
"A one time discharge of bloody mucus in the toilet might have been your mucus plug." Explanation: 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 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." Explanation: Braxton Hicks contractions are the painless, intermittent, "practice" contractions 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?
"They will be able to hear the fetal heart rate on auscultation." Explanation: 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 sign is a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy.
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 of gestation?
1,500 ml Explanation: 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 maternal tissues.
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?
25 to 35 lbs (11 to 16 kg) Explanation: 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).
At her 16-week checkup, a client's blood pressure is slightly decreased from her prepregnancy level. The nurse evaluates this change based on which statements concerning blood pressure during pregnancy?
A decrease in blood pressure in the second trimester may occur because of placental growth. Explanation: Because the placenta "traps" a great deal of blood for fetal circulation as it expands at about 3 months, maternal blood pressure may temporarily be slightly decreased. Otherwise, blood pressure stays fairly constant throughout pregnancy.
Hormone levels of a woman 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 spontaneous abortion (miscarriage) would occur. Explanation: 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.
The nurse is spending time with a client who has just learned, unexpectedly, that she is pregnant. Which initial task should the nurse assist the client to focus on?
Accepting the pregnancy Explanation: The first task of pregnancy is to accept the pregnancy. This task is usually met during the first trimester, although some women have difficulty fully accepting the pregnancy until they can feel the baby move. Accepting the baby or coming child usually occurs in the second trimester. It is also during the second trimester when the woman spends more time with her partner as they prepare for the coming infant. The third trimester is spent making plans for the baby, getting the nursery ready, buying necessary supplies and preparing for the child.
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?
Blood is trapped in the vena cava in a supine position. Explanation: Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava. Cerebral arteries should not be affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in any orientation. The sympathetic nervous system will not be affected by the supine position.
Which change related to the vital signs is expected in pregnant women?
Blood pressure decreases. Explanation: Pulse and temperature often increase, while lung space is decreased in pregnant women. It is common for blood pressure to decrease during pregnancy.
The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting?
Darkened breast areolae Explanation: As part of the pigment changes that occur with pregnancy, breast areolae become darker. The breast tissue should not be softer or slacker than before. There should not yet be any lymph enlargement, and the nipples should not have fissures.
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 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 client who believes she is pregnant. The nurse points out a more definitive assessment is necessary due to which sign being considered a probable sign of pregnancy?
Positive home pregnancy test Explanation: A urine pregnancy test is considered a probable sign of pregnancy as the hCG may be from another source other than pregnancy. Fatigue, amenorrhea, and vomiting are presumptive or possible signs of pregnancy and can also have other causes.
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?
Pregnant women often experience mood swings and self-centeredness but this is normal. Explanation: During the first trimester of pregnancy, the woman often has mood swings, bouts of irritability and is hypersensitive. The partner needs to know that these are all normal behaviors for a pregnant woman.
During a routine prenatal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse take next?
Tell the woman that this is entirely normal. Explanation: 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 pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding?
The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. Explanation: Slight bleeding after a pelvic exam in a pregnant woman is common due to the vascularity of her 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.
The nurse is assessing a pregnant client in her 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?
The intestines are displaced by the growing fetus. Explanation: 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.
Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy?
Visualization of the gestational sac or fetus Explanation: The positive sign that can be elicited earliest in the pregnancy is visualization of the gestational sac or fetus. With transvaginal ultrasound, the gestational sac can be seen as early as 10 days after implantation.
Which information provided by a client would be considered a presumptive sign of pregnancy?
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.
During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding?
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.
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?
couvade syndrome Explanation: Some fathers actually experience some of the physical symptoms of pregnancy, such as nausea and vomiting, along with their partner. This phenomenon is called couvade syndrome.
Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called?
melasma (chloasma) Explanation: 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 pregnant woman. This condition may be permanent, or it may regress between pregnancies.
A client's menstrual period is two weeks late. She has been feeling tired and has had episodes of nausea in the morning. What classification of pregnancy symptoms is this client experiencing?
presumptive Explanation: 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.
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?
"Many women feel this way during the first trimester." Explanation: The best response is to let the client know this is a common feeling among all pregnant women. Most women 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 baby 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 teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse?
"The hormones of pregnancy may cause anxiety or depression postpartum." Explanation: The "raging hormones" of pregnancy can keep the woman slightly out of touch with her usual methods of coping. Although she may normally interact and communicate in quite mature ways, during a pregnancy she may become depressed, anxious, withdrawn, or angry as she accomplishes her 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 women who plan to breastfeed.
A pregnant client is concerned because she has noticed that she is developing brown blotches on her forehead and nose. The nurse realizes that the client understood the teaching about this problem when the client makes which statement?
"These spots are from hyperpigmentation caused by the pregnancy and may be permanent." Explanation: The brown blotches the client is experiencing on her face is called melasma (chloasma) or the "mask of pregnancy." Hyperpigmentation is one of the skin changes that pregnant women experience. This condition may be permanent or may regress between pregnancies. Linea nigra is the darkened line in the middle of the abdomen seen on some pregnant women. Melasma does not go away in the third trimester and there is no evidence that it will get worse with each pregnancy.
The nurse is teaching a pregnant woman with a prepregnancy body mass index (BMI) of 26 about recommended weight gain. The nurse determines that the teaching was successful when the woman states that she should gain approximately how much during her pregnancy?
15 to 25 pounds (7 to 11 kilograms) Explanation: The BMI scale indicates individuals with a BMI less than 18.5 are underweight; BMI of 19.5 to 24.9 are within a normal weight; BMI of 25.0 to 29.9 are considered overweight; and BMI equal to or over 30.0 are obese. A woman with a BMI of 26 is considered overweight and should gain no more than 15 to 25 pounds (7 to 11 kilograms) during pregnancy. Women with a BMI of 18.5 to 24.9 should gain 25 to 35 pounds (11 to 16 kilograms). A woman with a BMI less than 18.5 should gain 28 to 40 pounds (13 to 18 kilograms). Women with a BMI equal to or greater than 30 should only gain 11 to 20 pounds (5 to 9 kilograms)
The nurse obtains a human chorionic gonadotropin (hCG) level from a woman who thinks that she is pregnant. Which result would the nurse identify as a positive pregnancy result?
32 mIU/mL (32 IU/L) Explanation: 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.
During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings?
Both findings are normal at this point of the pregnancy. Explanation: A pregnant woman will normally experience a decrease in her 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.
A pregnant client is concerned she may develop preeclampsia, so she has stopped adding any salt to her food and is now questioning the nurse about avoiding prepared foods. The nurse should point out some salt is very beneficial and can help prevent which negative outcome for her baby?
Congenital hypothyroidism Explanation: Iodized sodium is needed by the body for normal thyroid function. Women with severe iodine deficiencies deliver infants with congenital hypothyroidism. Low birth weight is related to smoking and alcohol. Neural tube defects are caused by low folic acid levels. When vitamin A levels are too low, night blindness may occur.
A pregnant woman is concerned about the recent onset of a midline swelling that is soft and nontender. The nurse should point out this is most likely related to which condition?
Diastasis recti Explanation: In advanced pregnancy muscle tone diminishes, which may aid in the separation of the rectus abdominis muscles. This benign finding does not usually cause other symptoms. The nurse may palpate the fetus well through this opening. Linea nigra is a hyperpigmentation along the midline. Chadwick sign is the bluish tinge to the cervix and vaginal walls seen early in pregnancy, and round ligament pain occurs as the uterus enlarges. This discomfort is usually found in the right more often than the left.
A nurse is leading a discussion in a prenatal class for a group of primigravida clients. Which factor would the nurse include when explaining the changes that are expected to occur in the uterus during the pregnancy?
The uterus changes from a pear-shaped organ to an oval one. Explanation: The uterus starts as a pear-shaped organ and becomes oval as length increases over width. Uterine growth is primarily related to an increase in size of the myometrial cells. The uterus remains in the pelvic cavity for the first 3 months, after which it progressively ascends into the abdomen. The uterus reaches its highest level at the xiphoid process at approximately 36 weeks. Between 38 to 40 weeks, fundal height drops as the fetus begins to descend and engage into the pelvis.
A 22-year-old client comes to the walk-in clinic complaining of fatigue, breast heaviness and extreme tenderness, and a clear vaginal discharge. What question would the nurse ask this client?
Have you been sexually active in the past 2 months? Explanation: The client is presenting with presumptive or subjective symptoms of pregnancy. Given her symptoms and age, asking about sexual activity is the most appropriate question. Whether she is taking an oral contraceptive will not assist in identifying the cause of her symptoms. If she has vaginal itching, the underlying cause of her symptoms needs to be identified before treatment can be prescribed. Asking about family history is part of a comprehensive health history, but is not the priority based on the client's presentation.
A community health nurse is leading a discussion at a health fair for college students on the topic of the signs of pregnancy. The nurse determines more teaching is necessary when the students choose which sign as a probable sign of pregnancy?
Fetal movement felt by examiner Explanation: Probable signs of pregnancy include a positive pregnancy test, Hegar sign, and uterine contractions. Fetal movement felt by an experienced examiner is considered a positive sign of pregnancy.
A student nurse is preparing for a presentation that will illustrate the various physiologic changes in the woman's body during pregnancy. Which cardiovascular changes up through the 26th week should the student point out?
Increased pulse rate and decreased blood pressure Explanation: Pulse rate frequently increases during pregnancy, although the amount varies from a slight increase to 10 to 15 beats per minute. Blood pressure generally decreases slightly during pregnancy, reaching its lowest point during the second trimester.
A client at 24 weeks' gestation is seen for a routine monthly check up. She reports concerns to the nurse about rest periods. She states that when she awakens she feels weak and lightheaded. What is the most appropriate initial action by the nurse?
Inquire about the client's sleeping positions. Explanation: When a pregnant woman lies on her back she 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 women 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 manifestations.
What would the nurse recommend to a pregnant client at 35 weeks' gestation who reports irregular contractions and lower backache?
Lie down and rest and see if the contractions stop and pain subsides. Explanation: If a client is less than 37 weeks and having contractions that will not go away, she may be in preterm labor and this needs to be reported. The first thing for her to do is lie down and rest to see if the contractions go away. Lower backache and cramping or pain need to be taken seriously and reported to the health care provider if they persist.
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?
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-midwife is performing a pelvic examination on a client who came to her following a positive home pregnancy test. The nurse checks the woman's cervix for the probable sign of pregnancy known as Goodell sign. Which description illustrates this alteration?
The cervix softens. Explanation: 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.
During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first?
Turn the client on her left side. Explanation: 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 her left side, which relieves pressure on the vena cava and restores venous return. Although they are valuable assessments, fetal heart tone and maternal blood pressure measurements do not correct the problem. Because deep breathing has no effect on venous return, it cannot relieve the client's symptoms.
A pregnant client states she was unable to breastfeed her last child because her breasts did not produce milk. She desires to breastfeed this child. Which hormones would the nurse monitor to during this pregnancy?
estrogen and human placental lactogen (hPL) Explanation: Estrogen aids in developing the ductal system of the breasts in preparation for lactation during pregnancy. hPL prepares the mammary glands for lactation. Progesterone supports the endometrium of the uterus to provide an environment conducive to fetal survival. Oxytocin is responsible for uterine contractions, both before and after birth. Oxytocin is also responsible for milk ejection during breastfeeding.
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?
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.
During a prenatal visit, a client in her second trimester of pregnancy verbalizes positive feelings about the pregnancy and conceptualizes the fetus. Which is the most appropriate nursing intervention when the client expresses such feelings?
ffer support and validation about the client's feelings. Explanation: During the second trimester, many women will verbalize positive feelings about the pregnancy and will conceptualize the fetus. The woman may accept her new body image and talk about the new life within her. Generating a discussion about the woman's feelings and offering support and validation at prenatal visits are important nursing interventions. The nurse should encourage the client in her first trimester to focus on herself, not on the fetus; this is not required when the client is in her second trimester. The client's feelings are normal for the second trimester of pregnancy; hence, it is not necessary either to inform the primary health care provider about the client's feelings or to tell the client that it is too early to conceptualize the fetus.
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% 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.
During a routine visit to the clinic, a client tells the nurse that she thinks she may be pregnant. The physician prescribes a pregnancy test. The nurse should know the purpose of this test is to determine which change in the client's hormone level?
increase in human chorionic gonadotropin (hCG) Explanation: Human chorionic gonadotropin (hCG) increases in a woman's blood and urine to fairly large concentrations until the 15th week of pregnancy. The other hormone values are not indicative of pregnancy.
The husband of a pregnant woman in her first trimester tells the nurse that his wife is increasingly preoccupied with herself and her fetus as more signs of the pregnancy present themselves. What should the nurse point out to the husband is probably occurring in this situation?
introversion Explanation: Introversion, or focusing on oneself, is common during early pregnancy, especially as more signs of the pregnancy become apparent. The woman may withdraw and become increasingly preoccupied with herself and her fetus. This is a normal psychological adaptation to upcoming motherhood. Ambivalence is an initial response that involves having conflicting feelings at the same time and is a universal feeling in pregnant women. It is considered normal when preparing for a lifestyle change and new role. In the stage of acceptance, the woman feels tangible signs that someone separate from herself 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 nurse is preparing to teach a community class to a group of first-time parents. Which information should the nurse include concerning what the pregnant woman's partner may experience as a normal response?
physical symptoms similar to the mother Explanation: Couvade syndrome is the occurrence of physical symptoms by the partner, similar to the physical symptoms of the mother. Other emotional symptoms may occur, but they are typically on a person-to-person basis.
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. protein iron vitamin B12 calcium folate
protein iron vitamin B12 calcium Explanation: 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 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?
visualization of the fetus by ultrasound Explanation: There are only three documented or positive signs of pregnancy: 1) demonstration of a fetal heart separate from the mother'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.
