Chapter 11 PrepU Maternal Adaptation During Pregnancy

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. Perform stress-relieving and relaxing exercises. Perform frequent douching, and use lubricants. Restrict contact to alternative, noncoital modes of sexual expression.

Modify sexual positions to increase comfort.

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? no classification probable positive presumptive

presumptive

A nurse is explaining to a pregnant client about the various events associated with pregnancy and its progression. Which placental hormone would the nurse identify as playing a key role in stimulating myometrial contractility? estrogen relaxin human chorionic gonadotropin progesterone

progesterone

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? "It might be nothing. If it happens again call your provider who is on-call." "Bloody mucus is a sign you are in labor. Please come to the hospital." "If the provider did an exam, it might be just normal vaginal secretions, so don't worry about it." "A one time discharge of bloody mucus in the toilet might have been your mucus plug."

"A one time discharge of bloody mucus in the toilet might have been your mucus plug."

What is the major concern for a lactose intolerant woman who is pregnant? dangerous symptom of abdominal cramping calcium deficiency nausea and vomiting vitamin D deficiency

calcium deficiency

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

"Many women feel this way during the first trimester."

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." "Your old coping methods will adequately get you through this period of adjustment." "Expect your other children to react positively to their new brother/sister." "Caring for your new infant is instinctual and will come naturally to you."

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

On a prenatal visit, a woman in her second trimester has an ultrasound that confirms that the baby is a girl. Which statement by the mother would be troubling to the nurse concerning this finding? "We don't want to name her because we don't want to get too attached." "In our culture, she will not be named until she is 2 weeks old." "We are not naming her yet because ultrasounds have been known to be wrong sometimes." "We want to wait on naming her until she is born and we can see her."

"We don't want to name her because we don't want to get too attached."

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? "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." "You need to go to the emergency room right away."

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

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

10.6 g/dl

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? 177 lb (80.3 kg) 180 lb (81.6) 178 lb (80.7) 176 lb (79.8 kg)

177 lb (80.3 kg)

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

2+ Protein in urine

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. The fundus is at the level of the umbilicus and measures 20 cm. The lower uterine segment and cervix have softened. Fundal height is at its highest level at the xiphoid process.

Fundal height has dropped since the last recording.

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? Offer support and validation about the client's feelings. Inform the primary health care provider about the client's feeling. Encourage the client to focus on herself, not on the fetus. Inform the client that it is too early to conceptualize the fetus.

Offer support and validation about the client's feelings.

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

Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge.

The nurse is teaching a pregnant teenager 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? The infant will be smaller but should quickly gain weight. The infant will be small and could have problems. It will just make the baby smaller, but there are no other problems associated. There may be little impact on the infant, but the mother can suffer complications.

The infant will be small and could have problems.

For which client is preimplantation genetic diagnosis (PGD) a viable option? client who had a miscarriage at 15 weeks' gestation client in the second week of pregnancy client whose partner has cystic fibrosis client who is currently 32 years of age

client whose partner has cystic fibrosis

A client who is in her sixth week of gestation is being seen for a routine prenatal care visit. The client asks the nurse about changes in her eating habits that she should make during her pregnancy. The client informs the nurse that she is a vegetarian. The nurse knows that she has to monitor the client for which risks arising from her vegetarian diet? Select all that apply. decreased mineral absorption epistaxis iron-deficiency anemia constipation low gestational weight gain

decreased mineral absorption iron-deficiency anemia low gestational weight gain

A 28-year-old primigravida client with diabetes mellitus, in her first trimester, comes to the health care clinic for a routine visit. The client reports frequent episodes of sweating, giddiness, and confusion. What should the nurse tell the client about these experiences? insulin resistance becomes minimal in the latter half of the pregnancy use of insulin needs to be reduced as pregnancy advances tissue sensitivity to insulin increases as pregnancy advances increased secretion of insulin occurs in the first trimester

increased secretion of insulin occurs in the first trimester

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? Chadwick sign melasma (chloasma) ballottement linea rubria

melasma (chloasma)

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. nuts green leafy vegetables beans orange juice lentils

nuts beans lentils

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? progesterone oxytocin human chorionic gonadotropin (hCG) estrogen

oxytocin

The placenta is the site where antibodies in the mother's blood pass into the fetal circulation. These antibodies give passive immunity to the fetus for several common childhood diseases. There are some infections for which the mother does not provide antibodies to the fetus. What infection is the fetus not protected from? rubella smallpox rubeola diphtheria

rubella

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? "Milk production requires higher levels of calcium; therefore, if I am going to breastfeed, I must take a calcium supplement during pregnancy." "Because I am pregnant, I can eat anything I want and not worry about weight gain." "I can eat any seafood that I like because it contains phosphorus, which is a nutrient that pregnant women need." "I will need to take iron supplementation throughout my pregnancy even if I am not anemic."

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

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) 1.5 lb (0.68 kg) 1 lb (0.45 kg) 2 lb (0.90 kg)

1 lb (0.45 kg)

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

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: 100 beats per minute. 95 beats per minute. 90 beats per minute. 85 beats per minute.

85 beats per minute.

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? Normally, blood pressure increases steadily throughout pregnancy. Blood pressure progressively decreases throughout the entire pregnancy. Blood pressure remains stable until decreasing the day of the birth. A decrease in blood pressure in the second trimester may occur because of placental growth.

A decrease in blood pressure in the second trimester may occur because of placental growth.

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? Telling her partner and family Preparing for parenthood Accepting the baby Accepting the pregnancy

Accepting the pregnancy

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? Cerebral arteries are growing congested with blood. Blood is trapped in the vena cava in a supine position. Sympathetic nerve responses cause dyspnea when a woman lies supine. The uterus requires more blood in a supine position.

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

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? Combined, both of these findings are very concerning and warrant further investigation. Both findings are normal at this point of the pregnancy. The heart rate increase may indicate that the client is experiencing cardiac overload. The blood pressure should be higher since the cardiac volume is increased.

Both findings are normal at this point of the pregnancy.

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

Breast tenderness

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? Blood pressure decreases in the third trimester. Hemoglobin levels rise significantly during pregnancy. Pregnancy typically causes a decrease in respiratory rate. During pregnancy blood volume can increase by at least 40%.

During pregnancy blood volume can increase by at least 40%.

Which would be a normal finding by the nurse during a physical exam of a woman in her third trimester? Ptyalism Dyspnea Increased hematocrit Kyphosis

Dyspnea

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? LH and MSH T4 and GH FSH and T4 FSH and LH

FSH and LH

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? Provide the client with information about pregnancy support groups. Inform the client this is a normal response to pregnancy that many women experience. Determine if the client's significant other is experiencing similar feelings about the pregnancy. Schedule the client a consult with a psychiatric health care provider.

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

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? Grains Legumes Meats Dairy

Meats

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 head of the client's bed slightly elevated. Keep the client's legs slightly elevated. Place the client in an orthopneic position. Place the client in the left lateral position.

Place the client in the left lateral position.

A young mother in a prenatal class asks the nurse why there is amniotic fluid in the uterus with her baby. Which functions of the amniotic fluid should the nurse point out to the client? Select all that apply. Contributes to mammary gland development in preparation for lactation Stimulates uterine growth to accommodate the developing fetus Protects the fetus from changes in temperature Maintains the endometrial lining of the uterus Shields the fetus against pressure or a blow to the mother's abdomen

Shields the fetus against pressure or a blow to the mother's abdomen Protects the fetus from changes in temperature

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. Advise the woman about the need to culture the discharge. Check the discharge for evidence of ruptured membranes. Notify the health care provider of a possible infection.

Tell the woman that this is entirely normal.

During a physical exam, the physician notates that the pregnant client has a positive Chadwick sign. What client findings would be noted for this symptom? There is hyperpigmentation of the abdomen. The cervix is reddened and swollen. The cervix has a bluish, purple discoloration. There is a rebound of the fetus felt when the physician pushes on the abdomen.

The cervix has a bluish, purple discoloration.

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? It is possible she is losing her mucus plug, which can cause bloody show. She may have a bleeding disorder so she needs to come back to the clinic for blood work. Some bleeding during pregnancy is not uncommon and this finding is expected. The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual.

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

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 lower uterine segment softens. The cervix softens. The fundus enlarges. The cervix looks blue or purple when examined.

The cervix softens.

A nurse is describing what happens at fertilization as the zygote begins life. Which statement is most accurate? The zygote begins life with the diploid number of chromosomes The zygote begins life with its second meiotic division just before ovulation. The zygote begins life with its first meiotic division before ovulation. The zygote begins life with the haploid number of chromosomes

The zygote begins life with the diploid number of chromosomes

The nurse is presenting a nutritional plan to a primigravida client who is questioning the addition of iodized salt to her diet. Which explanation should the nurse prioritize in answering this client? Progesterone formation is dependent on a high iodine intake. Adrenal gland activity during pregnancy decreases iodine's effectiveness. Thyroid activity, which depends on iodine intake, increases during pregnancy. Because of decreased thyroid activity during pregnancy, the thyroid does not produce as much as normal.

Thyroid activity, which depends on iodine intake, increases during 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. Use knee-high support hose. Elevate the feet and legs. Walk daily. Sit in a hot tub at least three times a week. Use thigh-high support hose.

Use thigh-high support hose. Walk daily. Use knee-high support hose.

A woman in her 16th week of pregnancy comes to the health center for a follow up visit. Which physiologic change would the nurse expect to assess? Select all that apply. increased blood pressure a uterus that is palpable colostrum that can be expelled from the nipples linea nigra and melasma (chloasma) varicosities of the vulva, rectum, and/or legs

a uterus that is palpable colostrum that can be expelled from the nipples

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. hydatidiform mole fetal heartbeat breast changes amenorrhea ultrasound pictures morning sickness

breast changes amenorrhea morning sickness

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

detect fetal heart sounds with a Doppler.

A nursing student is explaining to a newly pregnant woman what happens during each stage of fetal development. At which stage does the nurse inform the woman that the lungs are fully shaped? end of 8 weeks end of 16 weeks end of 4 weeks end of 12 weeks

end of 16 weeks

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? positive urine human chorionic gonadotropin (hCG) fetal heartbeat Chadwick sign uterine size and shape changes

fetal heartbeat