Maternity Chapter 11: Maternal Adaptation in Pregnancy 1-4

85 beats per minute.

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks' pregnant. The nurse would expect this woman's heart rate to be approximately: 85 beats per minute. 90 beats per minute. 95 beats per minute. 100 beats per minute.

chronic backache

A nurse is caring for a pregnant client who has been diagnosed with lordosis. The nurse offers preventive measures for which consequence of lordosis when caring for this client? melasma (chloasma) edema in lower extremities chronic backache diastasis recti

1 lb (0.45 kg)

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week? 2/3 lb (0.30 kg) 1 lb (0.45 kg) 1.5 lb (0.68 kg) 2 lb (0.90 kg)

oxytocin

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? follicle-stimulating hormone cortisol antidiuretic hormone oxytocin

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

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse? "Expect your other children to react positively to their new brother/sister." "Your old coping methods will adequately get you through this period of adjustment." "The hormones of pregnancy may cause anxiety or depression postpartum." "Caring for your new infant is instinctual and will come naturally to you."

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

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? "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." "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."

22

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? 28 6 18 22

Tell the woman that this is entirely normal.

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? Notify the health care provider of a possible infection. 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.

Both findings are normal at this point of the 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? 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. Combined, both of these findings are very concerning and warrant further investigation.

Turn the client on her left side.

During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first? Listen to fetal heart tones. Take the client's blood pressure. Ask the client to breathe deeply. Turn the client on her left side.

Supine hypotension syndrome

During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to avoid what condition? Heartburn Frequent urination Preeclampsia Supine hypotension syndrome

couvade syndrome

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? pseudo pregnancy pregnancy syndrome couvade syndrome cretinism

24

A mother comes in with her 17-year-old daughter to find out why she has not had a menstrual cycle for a few months. Examination confirms the daughter is pregnant with a fundal height of approximately 24 cm. The nurse interprets this finding as indicating that the daughter is approximately how many weeks pregnant? 24 22 20 18

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

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. Most of the hormonal changes are permanent after the pregnancy is completed. Taking hormonal replacement therapy can improve the discomfort of the changes. Using herbs will help ease the discomfort.

melasma (chloasma)

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? linea rubria melasma (chloasma) Chadwick sign ballottement

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

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 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." "In our culture, she will not be named until she is 2 weeks old." "We don't want to name her because we don't want to get too attached."

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

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

Positive home pregnancy test

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? Fatigue Positive home pregnancy test Nausea and vomiting Amenorrhea

10.6 g/dl

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

Darkened breast areolae

The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting? Slack, soft breast tissue Deeply fissured nipples Enlarged lymph nodes Darkened breast areolae

ultrasound picture of her fetus

The nurse is assessing a primigravida woman at a routine prenatal visit. Which assessment finding is reinforcing to the client that she is definitely pregnant? continued amenorrhea positive hCG blood result uterine growth ultrasound picture of her fetus

breast changes amenorrhea morning sickness

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

The areolae become more prominent. Heart rate increases 10 to 15 beats per minute. Nasal congestion increases due to edema.

What physical changes take place when a woman becomes pregnant? Select all that apply. The areolae become more prominent. Respiratory rate increases 20%. The uterus becomes pear-shaped. Heart rate increases 10 to 15 beats per minute. Nasal congestion increases due to edema.

1,500 ml

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? 500 ml 1,000 ml 1,500 ml 2,000 ml

Accepting the pregnancy

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 Accepting the baby Preparing for parenthood Telling her partner and family

FSH and LH

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 and T4 FSH and LH T4 and GH LH and MSH

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

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. 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.

narcissism

A 39-year-old woman is pregnant with her first child and appears to be thrilled about it. Now in her second trimester, she talks enthusiastically with the nurse about the latest maternity clothes she has bought and models them for the nurse. She also discusses the latest trends in health foods, which she has adopted since learning of her pregnancy. The nurse interprets this information as reflecting which primary emotional response to pregnancy? introversion emotional lability narcissism stress

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

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

Keep the appointment.

A client calls to cancel an appointment for the first prenatal visit after reporting a home pregnancy test is negative. Which instruction should the nurse prioritize? Use a diluted urine specimen. Wait until after two missed menstrual periods. Keep the appointment. Refrain from eating for 4 hours before testing.

Place the client in the left lateral position.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition? Keep the client's legs slightly elevated. Place the client in an orthopneic position. Keep the head of the client's bed slightly elevated. Place the client in the left lateral position.

Fundal height has dropped since the last recording.

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

venous thrombosis

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? embolism hemorrhoids supine hypotension syndrome venous thrombosis

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

A client is about 16 weeks' pregnant and is concerned because she feels her "abdomen" contracting. She calls the primary care provider's office and speaks to the nurse. What is the nurse's most appropriate response to this client's concern? "What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." "You need to go to the emergency room right away." "You need to come to the office to be examined." "You have nothing to be concerned about. I am sure you are not feeling contractions at this point in your pregnancy."

She is probably pregnant, but this must be confirmed by other means

A client makes an appointment with an obstetrician and assessment reveals positive Hegar and Chadwick signs. What should the nurse teach the client about these results? The client more likely has a gynecologic disorder rather than pregnancy The client is definitively pregnant Pregnancy cannot be confirmed She is probably pregnant, but this must be confirmed by other means

The test reads positive but the client is not pregnant.

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 test 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 test reads negative but the client is pregnant. The test reads negative and the client is not pregnant. The test reads positive and the client is pregnant.

visualization of the fetus by ultrasound

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? laboratory test of a urine specimen for hCG visualization of the fetus by ultrasound laboratory test of a blood serum specimen for hCG absence of a period

prominent veins hyperpigmentation of the nipple increased sensitivity

A client who is entering her third trimester comes to the prenatal clinic for a follow-up examination. When assessing the breasts, which findings would the nurse expect? Select all that apply. pallor of the areolae prominent veins hyperpigmentation of the nipple warmth increased sensitivity

presumptive

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? positive no classification probable presumptive

confusion when dealing with the partner's mood swings

A nurse is educating a client about the various psychological feelings experienced by a woman and her partner during pregnancy. Which feeling is experienced by the expectant partner during the second trimester of pregnancy? ambivalence along with extremes of emotions confusion when dealing with the partner's mood swings preparation for the new role as a parent and negotiating his or her role during labor sympathetic response to the partner's pregnancy

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

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

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

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

"This discharge is normal during pregnancy."

A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate? "You should refrain from any sexual activity." "You need to be assessed for a fungal infection." "This discharge is normal during pregnancy." "Use a local antifungal agent regularly."

Hemorrhoids

A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem? Varicose veins Umbilical hernia Hemorrhoids Gastrointestinal reflux

Diastasis recti

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? Linea nigra Chadwick sign Diastasis recti Round ligament pain

Secretions from sebaceous glands on the areola Appearance of striae Darkening of the areola Nodular tissue upon palpation

A pregnant woman questions the nurse about changes she is noticing in her breasts and is concerned if they are normal. Which reported changes would the nurse recognize as normal breast changes during pregnancy? Select all that apply. Secretions from sebaceous glands on the areola Appearance of striae Darkening of the areola Nodular tissue upon palpation Red rash over the anterior breast tissue

2+ Protein in urine

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

relaxin

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? progesterone estrogen relaxin human placental lactogen

The infant will be small and could have problems.

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

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

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? "You will become excited and happy when you feel the baby move." "Many women feel this way during the first trimester." "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."

Seeing an ultrasound image of the baby Feeling the baby kick

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 Giving up alcohol Receiving a positive result on a pregnancy test Taking prenatal vitamins Seeing an ultrasound image of the baby

physical symptoms similar to the mother

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? feeling distanced from the mother no changes, only the mother has changes during pregnancy physical symptoms similar to the mother desire to be the woman and give birth

Thyroid activity, which depends on iodine intake, increases during pregnancy.

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. 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. Adrenal gland activity during pregnancy decreases iodine's effectiveness.

Pregnant women often experience mood swings and self-centeredness but this is normal.

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? Her body is changing and she may be angry about it. Pregnant women often experience mood swings and self-centeredness but this is normal. Moodiness and irritability are not usual responses to pregnancy. What you are describing may be normal but we need to talk to her more in depth.

fetal movement felt by examiner

What is a positive sign of pregnancy? positive pregnancy test fetal movement felt by examiner Hegar sign uterine contractions

detect fetal heart sounds with a Doppler.

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. feel fetal movements. hear the fetal heartbeat with a stethoscope. palpate the fetal outline.

Blood pressure decreases.

Which change related to the vital signs is expected in pregnant women? Pulse decreases. Lung space increases. Blood pressure decreases. Temperature decreases.

dilation of the renal pelvis

Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy? reduction in kidney size decrease in glomerular filtration rate dilation of the renal pelvis shortening of the ureters

Breast tenderness

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