Evolve OB: Ch 6

Rubin described specific steps that provide a framework for understanding maternal role development. These steps include which one(s) of the following? (Select all that apply.) A. mimicry B. fantasy C. ambivalence D. grief work E. behavior modification

A. mimicry B. fantasy D. grief work Rubin (1984) observed specific steps that provide a framework for understanding the process of maternal role taking: mimicry, role play, fantasy, the search for a role fit, and grief work.

During pregnancy, the cardiac output is highest when the woman is in which position? A. side-lying B. sitting C. standing D. supine

A. side-lying Cardiac output is highest when the woman is lying on her side and lower in the sitting, standing, or supine position.

During the initial assessment of a 3-month-pregnant patient, the nurse discovers that the patient has to stand up for 8 hours at work. The nurse is aware that this may increase the patient's risk of A. ankle edema B. blood clots C. preterm labor D. vaginal bleeding

B. blood clots During pregnancy, the plasma fibrinogen level rises about 50% and plasma fibrin level increases about 40%. These increase the risk of blood clots. The fact that the patient stands for prolonged periods increases stasis of blood in the veins of the legs, which further increases the risk for blood clots.

A mother who just gave birth to her second son may have feelings of grief because A. it is typical to desire a girl when there is already a son in the family B. two children means less time to pursue the mother's ambitions C. there is a loss between herself and the first child; she thinks that the older child is growing up and away from her D. she is concerned there will be less time for a relationship with her husband

C. there is a loss between herself and the first child; she thinks that the older child is growing up and away from her The woman giving birth to another child spends a great deal of time working out a new relationship with the first child. This behavior may foster feelings of guilt as she tries to expand her love to include the second child.

If "nesting" is an accepted cultural norm, it will most likely occur at which time during the pregnancy? A. first trimester B. second trimester C. third trimester D. anytime throughout the pregnancy

C. third trimester Nesting is a third-trimester phenomenon. The baby's room and necessities will be finalized at this time.

A 7-month-pregnant patient is concerned about how her 3-year-old will adapt to the new baby. One suggestion the nurse can give is A. not to talk to the toddler about the new baby until it is born because toddlers do not understand the concept of newborns B. to have the toddler help pack up all the toddler's baby toys to give to the new baby C. to move the toddler to a "big girl" bed now so the toddler won't associate the new baby with the loss of her crib D. to teach the toddler that sharing will be important when the new baby arrives

C. to move the toddler to a "big girl" bed now so the toddler won't associate the new baby with the loss of her crib Any changes in sleeping arrangements should be made several weeks before the birth so that the toddler does not feel displaced by the new baby. The toddler needs to be told of the new baby close to the time of birth because toddlers do not have a clear perception of time. Toddlers do not understand the concept of sharing and may have feelings of jealousy and resentment if the baby takes over the toddler's toys.

The patient, 8 months pregnant, comes into the clinic for her regular appointment. She is lying down in the supine position on the exam table and starts to complain about nausea and dizziness. Her skin is cool and clammy. The next action by the nurse should be to A. take the patient's vital signs B. listen to the fetal heart rate C. turn the patient onto her side D. wipe her face off with a cool cloth

C. turn the patient onto her side During the second and third trimesters, the weight of the gravid uterus can partially occlude the vena cava when the woman is lying supine. This causes a drop in maternal blood pressure, decrease in cardiac output, and decrease in blood flow to the fetus. The corrective action is to turn the patient onto her side and advise her to never lie on her back unless a wedge or pillow is placed under the right hip to displace the uterus away from the vena cava.

The one hormone from the anterior pituitary that increases during pregnancy is

prolactin

When comparing the uterine souffle to the funic souffle, the uterine souffle would have the same rate as the A. maternal heart rate B. fetal heart rate C. respiratory rate

A. maternal heart rate The uterine souffle is a soft blowing sound auscultated over the uterus. It corresponds to the maternal pulse. The funic souffle is heard over the umbilical cord and corresponds to the fetal heart rate.

Fetal movement felt by the examiner is considered a positive indication of pregnancy. However, fetal movement felt by the pregnant woman is considered A. a presumptive indication of pregnancy B. a probable indication of pregnancy C. also a positive indication of pregnancy

A. a presumptive indication of pregnancy The woman may misinterpret peristalsis in the large intestine for fetal movement. It is unlikely for an experienced examiner to be deceived by these intestinal movements.

Which one(s) of the following are considered presumptive indications of pregnancy? (Select all that apply.) A. amenorrhea B. nausea and vomiting C. abdominal enlargement D. ballottement E. positive pregnancy test F. auscultation of fetal heart sounds

A. amenorrhea B. nausea and vomiting Presumptive (Subjective) indications are subjective changes that are experienced and reported by the woman. These changes are the least reliable indicators of pregnancy because they can be caused by conditions other than pregnancy. C. abdominal enlargement - Probable (Objective) D. ballottement - Probable E. positive pregnancy test - Probable F. auscultation of fetal heart sounds - Positive (Diagnostic)

A patient has come into the clinic stating she was raped 1 week ago. She did not report the rape but is now concerned that she may be pregnant. The pregnancy test that is most likely to be used at this time is the A. immunoassay test B. enzyme-linked immunosorbent assay (ELISA) C. home pregnancy test D. there is no test available that can be accurate this early in a pregnancy

A. immunoassay test The radioimmunoassay test can be accurate as early as 1 week after conception. ELISA is a plate-based assay technique designed for detecting and quantifying substances such as peptides, proteins, antibodies and hormones.

Which one of the following statements by a woman shows she is trying to confirm the pregnancy? A. "I feel good, full of energy." B. "My jeans are getting too tight." C. "My periods have always been irregular." D. "I have had some nausea, but the flu is going around at work."

B. "My jeans are getting too tight." When a woman is trying to confirm the pregnancy, she observes her body carefully for changes, such as an enlarging abdomen. The other answers show she is trying to deny the pregnancy.

Changes in the respiratory system that may be caused by progesterone include which one(s) of the following? (Select all that apply.) A. hypoventilatioin B. decrease in airway resistance by relaxing the smooth muscles C. increase in the sensitivity of the respiratory center to carbon dioxide

B. decrease in airway resistance by relaxing the smooth muscles C. increase in the sensitivity of the respiratory center to carbon dioxide Oxygen consumption rises by 20% in pregnancy. To compensate for the increased need, progesterone causes the woman to hyperventilate slightly by breathing more deeply, although her respiratory rate remains unchanged. Progesterone, along with prostaglandins, helps decrease airway resistance by up to 50% by relaxing the smooth muscle in the respiratory tract. Progesterone is also believed to increase the sensitivity of the respiratory center in the medulla oblongata to carbon dioxide, thus stimulating the increase in minute ventilation.

Select the functions of progesterone during pregnancy. (Select all that apply.) A. increases blood supply to uterine vessels B. maintains the endometrial layer for implantation C. relaxes smooth muscles D. stimulates uterine growth F. facilitates the deposit of maternal fat stores

B. maintains the endometrial layer for implantation C. relaxes smooth muscles F. facilitates the deposit of maternal fat stores Progesterone is the most important hormone of pregnancy. Its major effects include: (1) suppression of FSH and LH, (2) maintenance of the endometrial layer for implantation of the fertilized ovum and prevention of menstruation, (3) decreased uterine contractility to prevent spontaneous abortion, (4) increased fat deposits, (5) stimulation of development of the lobes, lobules, and ducts in the breast for lactation, (6) relaxation of smooth muscles of the uterus, gastric sphincter, bowel, ureters, bladder, (7) increased respiratory sensitivity to carbon dioxide, stimulating ventilation, (8) suppression of the immunologic response, preventing rejection of the fetus, (9) antagonist to insulin, and (10) retention of sodium.

A newly pregnant woman calls her neighbor and volunteers to take care of her infant son while the mother cooks supper. This action is called A. mimicry B. role play C. fantasy D. search for a role fit

B. role play Role play consists of acting out some aspect of what mothers actually do. The pregnant woman searches for opportunities to hold or care for infants to practice mothering.

A patient who is 6 months pregnant complains to the nurse that her husband has been working overtime lately and has applied for a second, part-time job. The nurse can best answer this concern by explaining that A. the husband is having trouble dealing with the wife's physical and emotional changes and is working more B. the husband is aware of the extra expenses associated with pregnancy and childbirth and is trying to accept his financial responsibility as a father C. the husband is denying the pregnancy D. the husband is making a statement that he does not approve of the pregnancy

B. the husband is aware of the extra expenses associated with pregnancy and childbirth and is trying to accept his financial responsibility as a father Financial concerns of a pregnancy increase anxiety in some fathers. They deal with that anxiety by increasing their workload to meet the increased financial needs.

The nurse notices a paring knife lying under a laboring patient's bed. The nurse attempts to remove the knife when the patient's mother asks if it could remain under the bed so it will "cut the labor pains." To be sensitive to the cultural needs of the patient, the nurse's best response would be: A. "It is dangerous, so I will take it into the diet kitchen." B. "I will put it on this shelf so it will be out of the way." C. "Let me slide it farther under the bed, out of the way." D. "There is no need for the knife to be there; it won't work to cut the labor pains."

C. "Let me slide it farther under the bed, out of the way." Cultural differences need to be respected and observed if possible. The knife may offer comfort to the laboring woman. The nurse should be observant when young children are in the room to maintain safety.

The nurse noted a trace of glucose in the urine of an 8-month-pregnant woman. The nurse understands that this may be caused by A. excessive sugar intake over the past few hours B. a sign of diabetes mellitus. the patient needs further lab work C. an increase in the glomerular filtration rate that is normal during pregnancy D. an increase in the bacteria count in the urine

C. an increase in the glomerular filtration rate that is normal during pregnancy An increase in the glomerular filtration rate causes the filtered glucose level to exceed the ability of the renal tubules to reabsorb it. This causes a spilling of glucose into the urine.

During the third trimester, it is normal for a woman to feel A. depressed because of a change in the body image B. introverted and concerned about herself C. dependent on her partner and family D. ambivalent about the pregnancy

C. dependent on her partner and family During the third trimester, the expectant mother often becomes increasingly dependent on her partner.

A patient, 9 months pregnant, calls the clinic with complaints of urinary frequency, urgency, and pain. The nurse's next action should be to A. reassure the patient that this is normal after lightening occurs during the last month of pregnancy B. refer the patient to a specialist because this is a sign of kidney failure C. have the patient come in to be assessed for a urinary tract infection D. assure the patient that the problem can wait until her next regular appointment

C. have the patient come in to be assessed for a urinary tract infection Frequency and urgency are normal after lightening because of pressure against the bladder. However, the complaint of pain may indicate a urinary tract infection.

A patient, 6 months pregnant, is concerned because a mole on her abdomen is becoming darker. She has heard that this is a sign of cancer. The nurse should base the answer on which one of the following facts? A. this is a sign of cancer and the mole should be evaluated by a specialist B. it is common for moles to become darker during pregnancy because of the increase in hormones; thus no action is necessary C. it is common for moles to become darker during pregnancy; however, it should be evaluated by the physician D. it is a sign of integumentary changes that need to be assessed within the next 2 weeks

C. it is common for moles to become darker during pregnancy; however, it should be evaluated by the physician The increased levels of estrogen, progesterone, and melanocyte-stimulating hormone increase pigmentation in 90% of pregnant women. Preexisting moles become darker during pregnancy. However, there is a small risk that a cancer is forming and the patient needs to have the mole assessed.

A pregnant woman may assume a wide stance when standing and have a waddling gait when walking. This is caused by A. loss of calcium in the bones when it is transferred to the fetus B. strengthening of the connective tissue around the pelvis C. the effort to compensate for a changing center of gravity D. the strain on the muscles and ligaments of the back

C. the effort to compensate for a changing center of gravity The change of the center of gravity and muscle fatigue cause a wide stance and waddling gait during pregnancy.

Which one of the following statements indicates the primary focus of the pregnant woman during the first trimester? A. "How is the baby's heart today?" B. "Is the baby growing at the right rate?" C. "Since I am not eating much because of the morning sickness, is the baby malnourished?" D. "Why are my breasts so tender?"

D. "Why are my breasts so tender?" During the first trimester, the primary focus of the woman is on herself, not the fetus.

The process of developing strong emotional ties to the developing fetus is known as

attachment

At about 20 weeks of pregnancy, a sudden tap on the cervix during vaginal examination may cause the fetus to rise in the amniotic fluid and then rebound to its original position. This movement is termed

ballottement

When a father experiences the same nausea, vomiting, and fatigue that the pregnant mother experiences, it is termed

couvade

Inadequate insulin production by the pancreas during pregnancy results in

gestational diabetes