Chapter 11 PrepU: Maternal Adaptation During Pregnancy
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."
The nurse is caring for a client as 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."
A client at 40 weeks' gestation informs the nurse that she is tried of being pregnant. What is the best response from the nurse?
"That is a very normal feeling, especially at this point in pregnancy."
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."
A client at 36 weeks' gestation comes in for her weekly primary care provider visit. She tells the nurse, "I am having contractions, but they are irregular and go away when I rest. Do you think I am going into labor?" The best response by the nurse would be:
"These are called Braxton-Hicks contractions and are preparing your body for labor but are not 'true' labor contractions
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."
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."
A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which information should the nurse offer?
"You will experience quickening, and you will actually feel the baby."
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
A woman's pregnant 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 he weight increases by which amount per week?
1 lb (0.45 kg)
The nursing instructor is pointing out to a group of nursing students the various findings which are expected during a normal assessment of a pregnant client. The instructor determines the session is successful when the students correctly provide which gestational week that the examiner should be able to feel fetal movement?
22
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 25 lbs (11 to 16 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 increased by how many calories per day above what she was eating prior to the pregnancy?
300
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 mlU/mL (32 IU/L)
At her 16-week checkup, a client's blood pressure is slightly decreased from her pregnancy 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
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
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
Which change related to the vital signs is expected in pregnant women?
Blood pressure decreases
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
A client reports 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
A pregnant client is considered 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
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?
FSH & LH
The nurse is performing as assessment of a woman who has come to a health care facility for a diagnosis of pregnancy. The woman is positive for breast changes, nausea, and amenorrhea. On physical exam, it is noted that the client has softening of the cervix. How should the nurse document this in her notes?
Goodell sign
A pregnant woman tells the nurse she often has allergic responses to drugs. She is concerned that she will be allergic to her fetus or her body will reject the pregnancy. The nurse's reply would be based on which statement?
Immunologic activity is decreased during pregnancy
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
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
The partner of a pregnant client in her first trimester asks the nurse about a 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 if herself. What response would correctly address these concerns?
Pregnant women often experience mood swings and self-centeredness but this is normal.
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
A client takes a home pregnancy test. While she is waiting to read the results, her phone rings. When she gets off the phone 15 minutes have passed. The package instructions are to read the pregnancy result at 3 minutes and warn that waiting longer may result in a false positive. What is a false positive?
The test reads positive but the client is not pregnant
The nurse is assessing a pregnant woman in her second trimester. Which tasks would indicate to the nurse that the client is successfully incorporating the maternal role into her personality?
The woman acknowledges the fetus as a separate entity within her
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?
Thyroid activity, which depends on iodine intake, increases during pregnancy
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
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?
accepting the pregnancy
Which information provided by a client would be considered a presumptive sign of pregnancy?
breast tenderness
During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding?
bruising
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
Which assessment finding in the pregnant woman at 12 weeks' gestation should the nurse find most concerning? The inability to:
detect fetal heart sounds with a Doppler
Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy?
dilation of the renal pelvis
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
The nursing instructor is teaching a class on the nutritional needs of the pregnant client. The instructor determines the session is successful when the students correctly choose which supplement as being known to prevent up to 70% of CNS birth defects?
folic acid
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
A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem?
hemorrhoids
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%
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?
inform the client this is a normal response to pregnancy that many women experience
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?
keep the appointment
In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which information would the nurse most likely include?
over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge
The nurse is teaching a pregnant woman about breastfeeding. The nurse determines that the teaching was successful when the woman identifies which hormone as being released when the newborn sucks at the breast?
oxytocin
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
During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to avoid what condition?
supine hypotension syndrome
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
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
A nurse urges a pregnant at the first prenatal office visit to begin taking iron supplements immediately. What is the rationale for this intervention?
to avoid anemia
A client in her 39th week of gestation reports swelling in the legs after standing for long periods of time. The nurse recognizes that this factor increases the client's risk for which condition?
venous thrombosis
