Pregnancy

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? 1 Fundal height has dropped since the last recording. 2 Fundal height is at its highest level at the xiphoid process. 3 The fundus is at the level of the umbilicus and measures 20 cm. 4 The lower uterine segment and cervix have softened.

1 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. NOT 2 The fundus reaches its highest level at the xiphoid process at approximately 36, not 39, weeks. 3 By 20 weeks' gestation, the fundus is at the level of the umbilicus and measures 20 cm. 4 At between 6 and 8 weeks of gestation, the cervix begins to soften (Goodell sign) and the lower uterine segment softens (Hegar's sign).

A nurse is educating a prenatal client at her second visit. The client is worried about "blotchy brown spots" on her forehead. The nurse reassures the client about this change by giving which appropriate response? 1 "Avoid sun because it will make the discoloring darker." 2 "Apply over-the-counter bleach cream to the area once a day." 3 "This discoloring could be the start of skin cancer. We can refer you to the primary care provider." 4 "This discoloring could be permanent, and you could use makeup to cover it up."

1 Increased estrogen levels during pregnancy can cause pigmentation to increase. This discoloration is not harmful and will eventually fade; however, sunlight can make it darker. NOT 2 Bleaching is not an appropriate suggestion. 3.4. The nurse should not tell the client that the discoloration is permanent or a sign of cancer.

A client has consumed a large quantity of fish during pregnancy and expressed concern about the unborn child. What can mercury exposure during pregnancy cause? 1 brain and neurologic abnormalities in the fetus 2 stunted fetal growth 3 fetal malformations 4 spontaneous abortion (miscarriage)

1 Mercury can be toxic, particularly to developing brains in fetuses and young children. Mercury poisoning in a fetus can result in learning delays in walking or talking to more severe problems such as cerebral palsy, seizures, and intellectual disability.

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? 1 oxytocin 2 follicle-stimulating hormone 3 antidiuretic hormone 4 cortisol

1 Oxytocin is responsible for milk ejection during breastfeeding. Its secretion is stimulated by stimulation of the breasts via sucking or touching. NOT 2 Secretion of follicle-stimulating hormone is inhibited during pregnancy. 3 The secretion of antidiuretic hormone has no effect on breastfeeding. 4 Cortisol secretion regulates carbohydrate and protein metabolism and is helpful in times of stress.

The nurse is providing prenatal care to a young couple who is pregnant with their first child. In what period of development would the nurse explain to the couple that most congenital defects would occur? 1 the period of the zygote 2 the period of the embryo 3 the period of the fetus 4 all periods are equally vulnerable

2 During the period of the embryo, which lasts until the eighth week after conception, the embryo is in what is called the critical phase of human development. During these weeks, all the organs and structures of the human are formed and are most susceptible to damage.

A woman in the 34th week of pregnancy says to the nurse, "I still feel like having intercourse with my husband." The woman's pregnancy has been uneventful. The nurse responds based on the understanding that: 1 it is safe to have intercourse at this time. 2 intercourse at this time is likely to cause rupture of membranes. 3 there are other ways that the couple can satisfy their needs. 4 intercourse at this time is likely to result in premature labor.

1 Sexual activity is permissible during pregnancy unless there is a history of vaginal bleeding, placenta previa, risk of preterm labor, multiple gestation, incompetent cervix, premature rupture of membranes, or presence of infection. NOT 2.4. Rupture of membranes or premature labor is unlikely since the woman's pregnancy has been uneventful so far. 3 Alternative sexual positions may be necessary as the woman's abdomen increases in size.

A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. What does the nurse anticipate in this woman's pregnancy? 1 potential for greater than usual back pain 2 cesarean birth 3 increased risk of miscarriage 4 increased risk of fetal trauma

1 Surgical correction of scoliosis (lateral curvature of the spine) involves implanting stainless-steel rods on both sides of the vertebrae to strengthen and straighten the spine. Such rod implantations do not interfere with pregnancy; a woman may notice more than usual back pain, however, from increased tension on back muscles. If a woman's pelvis is distorted due to scoliosis, a cesarean birth may be scheduled to ensure a safe birth, but this is not required in this scenario. Vaginal birth, if permitted, requires the same management as for any woman. With the improved management of scoliosis, the high maternal and perinatal risks associated with the disorder reported in earlier literature no longer exist.

As part of the assessment of a client's health history during the first prenatal visit, the nurse is having the client complete a 24-hour recall to establish what and how much the woman is eating. In which section of the health history should the nurse record this information? 1 day history/social profile 2 demographic data 3 history of past illnesses 4 chief concern

1 The day history/social profile contains information about a woman's current nutrition, elimination, sleep, recreation, and interpersonal interactions. This information can be elicited best by asking a woman to describe what her typical day is like. NOT 4 The chief concern is the reason the woman has come to the health care setting—in this instance, the fact she is or thinks she is pregnant. Among other things, this section of the health history should include the date of her last menstrual period, whether it was normal for her and whether she has used a home test pregnancy kit. 2 Demographic data usually obtained includes name, age, address, telephone number, e-mail address, religion, ethnicity, type and place of employment, and health insurance information. 3 Questions about a woman's past medical history are important because a past condition can become active during or immediately following pregnancy.

A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage? 1 From fertilization to the end of the second week after fertilization 2 Approximately 2 weeks after fertilization to the end of the eighth week 3 Approximately 9 weeks after fertilization to birth 4 Approximately 6 weeks after fertilization to the end of 8 weeks

1 The pre-embryonic stage begins at fertilization and lasts through the end of the second week after fertilization. NOT 2 The embryonic stage begins approximately 2 weeks after fertilization and ends at the conclusion of the eighth week after fertilization. 3 The fetal stage begins at 9 weeks after fertilization and ends at birth. 4 There is no distinct stage recognized approximately 6 to 8 weeks after fertilization. This is part of the embryonic stage period.

A nurse is conducting a refresher class for a group of nurses working in the prenatal clinic. After reviewing fetal development with the group, the nurse determines that the teaching was successful when the group identifies which barrier to other sperm after fertilization? 1 zona pellucida 2 zygote 3 cleavage 4 morula

1 The zona pellucida is the clear protein layer that acts as a barrier to other sperm once one sperm enters the ovum for fertilization. NOT 2 The zygote refers to the union of the nuclei of the ovum and sperm resulting in the diploid number of chromosomes. 3 Cleavage is another term for mitosis. 4 The morula is the result of four cleavages leading to 16 cells that appear as a solid ball of cells. The morula reaches the uterine cavity about 72 hours after fertilization.

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? 1 The infant will be small and could have problems. 2 There may be little impact on the infant, but the mother can suffer complications. 3 It will just make the baby smaller, but there are no other problems associated. 4 The infant will be smaller but should quickly gain weight.

1 Women who gain less than 16 pounds (7257 g) are at risk of giving birth to small infants, which is associated with poor neonatal outcomes. The infant may not quickly gain weight but continue to slowly put on weight.

Which hormone(s) is secreted by the placenta during the pregnancy? Select all that apply. 1 progesterone 2 testosterone 3 estrogen 4 human chorionic gonadotropin 5 prolactin

1.3.4. The placenta secretes hormones that help to sustain the pregnancy. These include progesterone, estrogen, human placental lactogen, and human chorionic gonadotropin. NOT 2 Testosterone is secreted by the male testes. 5 Prolactin is secreted by the anterior pituitary gland.

The nurse is aware that cord compression is not continuous when variable decelerations occur and that compression happens when which of the following takes place? 1 The uterus relaxes between contractions. 2 The uterus contracts and squeezes the cord against the fetus. 3 prematurity 4 fetal sleep

2 Cord compression is not continuous when variable decelerations are occurring. The compression occurs when the uterus contracts and squeezes the cord against the fetus. It is relieved when the uterus relaxes between contractions. NOT 3.4. Prematurity and fetal sleep will cause decreased or absent variability.

The nurse has been given a basin containing a newly delivered placenta. Which action will the nurse complete next? 1 Place in a bag and store in the refrigerator. 2 Analyze for fragments. 3 Send to the laboratory for testing. 4 Remove all blood from the placenta.

2 Hospital policies may vary slightly, but after delivery the placenta is analyzed for any fragments. If the placenta appears to have fragments missing, the uterus is assessed for retained fragments. After analysis, the nurse labels and places the placenta in the refrigerator for storage. The placenta is a vascular structure and is not drained of all blood.

A woman who is 4 months pregnant has pyrosis. Which suggestion would the nurse give her? 1 Take 30 ml of milk of magnesia after every meal. 2 Eat small meals and do not lie down after meals. 3 Try to include complex carbohydrates in meals. 4 Increase vitamin intake by adding more citrus fruit.

2 Pyrosis, or heartburn, occurs in pregnancy because the uterine pressure against the stomach causes regurgitation into the esophagus. Eating small meals and remaining upright limits the possibility of regurgitation.

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? 1 "You will become excited and happy when you feel the baby move." 2 "Many women feel this way during the first trimester." 3 "We can refer you to a clinic for potential termination if you desire." 4 "Do not worry. Once you hold this baby, everything will be fine."

2 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. NOT 1 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. 4 Stating not to worry and everything will be fine is nontherapeutic communication and does not focus on the client's concern. 3 The nurse would discuss the client's feelings and concerns before making a referral.

The nurse is assessing a primipara's fundal height at 36 weeks' gestation and notes the fundus is now located at the xiphoid process of the sternum. The client asks if this is normal. Which response to the client would be best? 1 "By this time, the fundus should drop down lower because the baby is moving towards the pelvic inlet." 2 "At 36 weeks' gestation, the fundus is in the normal expected location." 3 "To be honest, the fundus should be lower since you have gained minimal weight." 4 "Just get prepared, the fundus might actually get a little higher until a few days before you go into labor."

2 The fundus grows to reach the umbilicus at 20 to 22 weeks and the xiphoid process of the sternum at 36 weeks. Therefore, this fundus is in the normal, expected location. After 36 weeks' gestation, lightening occurs and the fundus will drop ~4 cm below the xiphoid process. Once the fundus reaches the xiphoid process, it cannot go higher without severely compromising maternal respiratory efforts.

The nurse is educating a group of nursing students about the etiology of labor. Which of the following should the nurse explain as the hormone produced by the posterior pituitary? 1 progesterone 2 oxytocin 3 estrogen 4 relaxin

2 The posterior pituitary produces oxytocin. Oxytocin brings about uterine contractions. NOT 1 Progesterone is a hormone produced by the corpus luteum involved in maintaining the pregnancy till term. 4 Relaxin is a hormone that causes backache through its influence on the pelvic joints. 1.3.4. Progesterone, estrogen, and relaxin are not the hormones produced by the posterior pituitary.

The nurse is concerned that a pregnant client is not adjusting emotionally to being pregnant. Which statement indicates that the client may need additional counseling? 1 "I cannot wait to lose all of this excess weight." 2 "I need to get right back to work after delivery." 3 "My mother has been so helpful during this time." 4 "My dad has already purchased toys for the baby!"

2 The statement that the client needs to get back to work after delivery could indicate that she feels the pregnancy is robbing her of financial stability or ruin chances of a promotion. NOT 1 Desiring to lose weight after pregnancy does not indicate that the client is not adjusting emotionally to being pregnant. 3.4. The statements about parental support do not indicate that the client is not adjusting emotionally to being pregnant.

The nurse is preparing a client for a chorionic villus sampling procedure. Which factor should the nurse point out in the teaching session to the client? 1 "The results should be available in about 2 weeks." 2 "You'll have an ultrasound first and then the test." 3 "Afterward, you can resume your exercise program." 4 "This test is very helpful for identifying spinal defects."

2 With chorionic villus sampling (CVS), an ultrasound is done to confirm gestational age and viability. Then, under continuous ultrasound guidance, CVS is performed using either a transcervical or transabdominal approach. With the transcervical approach, the woman is placed in the lithotomy position and a sterile catheter is introduced through the cervix and inserted in the placenta, where a sample of chorionic villi is aspirated. This approach requires the client to have a full bladder to push the uterus and placenta into a position that is more accessible to the catheter. A full bladder also helps to better visualize the structures. With the transabdominal approach, an 18-gauge spinal needle is inserted through the abdominal wall into the placental tissue and a sample of chorionic villi is aspirated. Regardless of the approach used, the sample is sent to the cytogenetics laboratory for analysis. The results are usually available in less than one week. After the procedure, the woman is assisted into a position of comfort and any excess lubricant or secretions are cleaned from the area. The woman is instructed about signs to watch for and report, such as fever, cramping, and vaginal bleeding. The woman is also urged not to engage in any strenuous activity for the next 48 hours. Rho(D) immune globulin is given to an unsensitized Rh-negative woman after the procedure. CVS can be used to detect numerous genetic disorders but not neural tube defects, as no amniotic fluid is collected with this procedure. The woman would need to have maternal serum alpha fetoprotein levels drawn at 16 to 18 weeks' gestation to test for neural tube defects.

The nurse is teaching a pregnant client in her last trimester about interventions to help reduce risks of complications during pregnancy. Which of the following are recommended guidelines? 1 Take a daily shower, but avoid a tub bath because this could harm the fetus. 2 If planning to breastfeed, bathe as normal using soap and water on the nipples. 3 During the last month, rest on the left side for at least an hour, morning and afternoon. 4 Sleep on your back to avoid supine hypotension syndrome.

3 During the pregnancy's last months, the woman should rest on her left side for at least 1 hour in the morning and afternoon. This position relieves fetal pressure on the renal veins, helps the kidneys excrete fluid, and increases flow of oxygenated blood to the fetus. NOT 1 There is no proof that a tub bath is harmful to the fetus. 2 If breastfeeding, the woman should bathe as normal, but avoid using soap on the nipples. 4 The woman should also avoid sleeping on her back to avoid supine hypotension syndrome.

How can the nurse best counsel a client with pyrosis? 1 "It is important to continue to eat three meals a day." 2 "Chest pain is common and is not a concern in pregnancy." 3 "Avoid lying down 2 hours after eating." 4 "Avoid sleeping in an upright position."

3 For clients with heartburn, it's best to eat smaller, more frequent meals. Sleeping on the left side propped on pillows can aid gastric emptying. Chest pain can be a sign of a serious complication in pregnancy and should always be assessed.

A pregnant client in her first trimester states, "I think I must be having a miscarriage. I have sharp pains in my lower abdomen sometimes!" What does the nurse understand is happening to this client? 1 The client is having a spontaneous abortion (miscarriage). 2 The client is having hyperemesis gravidarum. 3 The client is experiencing stretching of the round and broad ligaments. 4 The client is experiencing an ectopic pregnancy.

3 In the first trimester of pregnancy, sharp pains in the lower abdomen are common. Stretching of the round and broad ligaments that support the growing uterus causes them, which are usually very short and have a stabbing quality. They are not repetitive, but are often associated with position changes, or later fetal movements.

A primigravid client states that she has heard that her nipples will leak milk during the pregnancy and is concerned of embarrassment if this should happen while she is at work. Which nursing suggestion is best? 1 Have a change of clothing available in case the milk leakage happens. 2 Limit fluid intake to prevent the production of milk prior to childbirth. 3 Purchase a padded supportive bra to wear under your clothing. 4 Place tape on your nipples to prevent nipple leakage while at work.

3 The breasts prepare for breastfeeding even before birth of the infant. At about the 16th week of pregnancy, colostrum secretion begins in the breasts. The best suggestion is to wear a padded, supportive bra that can absorb the leakage without it coming through the clothing. NOT 1 Having a change of clothes does not prevent the problem, and it may be noticeable that clothing has been changed. 2 Limiting fluid intake is not suggested. The pregnant woman needs to remain hydrated. 4 Placing tape on the nipples may harm the nipples and, although accepted in a few cultures, is discouraged.

A woman who is 6 weeks pregnant is concerned because she is nauseated every morning. Which measure should the nurse suggest the client use to help relieve nausea? 1 Take two aspirin on arising. 2 Delay toothbrushing until noon. 3 Eat several dry crackers before getting up. 4 Take a teaspoon of baking soda before breakfast.

3 The traditional solution for preventing nausea is for the pregnant client to keep dry crackers, such as saltines, by the bedside and eat a few before rising because increasing carbohydrate intake seems to relieve nausea better than any other nutrition remedy. The client can then eat a light breakfast or delay breakfast until 10 or 11 AM, which is past the time nausea seems to persist. NOT 1 Aspirin is irritating to the stomach and should not be taken. 2 Delaying toothbrushing does not affect nausea. 4 A teaspoon of baking soda should not be suggested because this could adversely affect the client's electrolyte status.

The nurse is emphasizing the importance of adequate rest and sleep with a pregnant client. Which position should the nurse suggest the client use? 1 on the back with a pillow under the head 2 on the stomach with a pillow under her breasts 3 on the back with a pillow under the knees and hips 4 on the side with the weight of the uterus on the bed

4 A good resting or sleeping position for a pregnant client is a left-sided Sims position, with the top leg forward. This position puts the weight of the fetus on the bed, not on the woman, and allows good circulation in lower extremities. NOT 1.3. Lying on the back could cause the weight of the uterus to occlude the inferior vena cava, impeding blood flow to the client and fetus. 2 Stomach lying is not a reasonable option with the size of the uterus.

A 31-year-old client at 28 weeks' gestation reports frequent low back pain and ankle edema by the end of the day. Which suggestion should the nurse prioritize for this client? 1 Soak feet every night and perform pelvic rocks. 2 Lie on right side with feet elevated and a heating pad on the back. 3 Take breaks at work and sit in a semi-Fowler position with feet below. 4 Rest when possible with feet elevated at or above the heart.

4 Resting in the recumbent position helps alleviate stress on the back, and elevating the legs will help relieve the edema. NOT 1.2. Soaking the feet or lying on the right side will not alleviate the edema. 3 Sitting semi-Fowler is not enough to alleviate the edema.

A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client? 1 Activate the air bag in the car. 2 Use a lap belt that crosses over the uterus. 3 Apply a padded shoulder strap properly. 4 Always wear a three-point seat belt.

4 To promote easy and safe travel for the client, the nurse should instruct the client to always wear a three-point seat belt to prevent ejection or serious injury from collision. NOT 1 The nurse should instruct the client to deactivate the air bag if possible. 3 The nurse should instruct the client to apply a nonpadded shoulder strap properly, ensuring that it crosses between the breasts and over the upper abdomen, above the uterus. 2 The nurse should instruct the client to use a lap belt that crosses over the pelvis below—not over—the uterus.

Morula

A solid ball of cells that makes up an embryo; in humans, this stage occurs within four days of fertilization.

Between her regularly scheduled visits, a woman in her first trimester of pregnancy who is taking iron supplements for anemia calls the nurse at her obstetrician's office reporting constipation. She reports that she has never had this problem before and asks for some advice about how to get relief. What is the best advice the nurse can give her?

Continue taking iron supplements but increase fluids and high-fiber foods; exercise more Constipation is a common side effect of iron supplementation. The diagnosis of anemia indicates a true need for the iron supplementation; she needs to increase fluid and fiber to relieve the constipation associated with the iron preparations. The nurse should not advise this client to stop taking her iron supplements, even for a few days. The nurse should not advise the client to increase her iron supplementation, nor take the supplements on an every other day basis. These supplements are ordered by the primary care provider based on the client's hematologic status.

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

D. The average hemoglobin level at term is 12.5 g/dL. The hemoglobin level is considered normal until it falls below 11 g/dL.

A normal umbilical cord contains two veins and one artery.

F A normal umbilical cord contains two arteries and one vein

Blood pressure during pregnancy typically increases related to increased blood volume. T/F

False

Levels of hCG continue to rise during pregnancy, returning to normal after delivery T/F

False human chorionic gonadotropin, a hormone secreted during pregnancy by the placenta which stimulates continued production of progesterone by the ovaries hCG levels usually consistently rise until around week 10-12 of your pregnancy, when the levels plateau or even decrease. This is the reason why pregnancy symptoms can be greater in the first trimester and ease off after this time for many women.

Embryo

Multicellular organism during the period from approximately the second to the eighth week after fertilization (after which it is usually termed a fetus).

human chorionic gonadotropin

This hormone signals the corpus luteum of the follicle abandoned by the ovum to continue excreting progesterone and estrogen, which are required to cue the endometrium and uterine musculature to maintain an environment conducive to pregnancy

Striae gravidarum is a normal occurrence during pregnancy that affects skin pigmentation and vasculature T/F

True

The embryo stage of development occurs from day 10 to week 8. T/F

True

The first system to develop in the embryo is the ________________ system.

cardiovascular

Pigmentation changes often seen on the face during pregnancy are called ________________.

chloasma

human Chorionic Somatomammotropin (hCS)

hCS (aka human placental lactogen) acts directly on the mother's metabolism, increasing the insulin resistance of her cells, and thereby increasing her circulating glucose. The passage of this surplus glucose across the placenta to the pregnancy is also facilitated by hCS. This hormone also cues the breasts to prepare for lactation

White blood cell productions typically ________________ during pregnancy.

increase

The exaggerated curve to the lumbar spine that is commonly seen in pregnant women is known as ________________.

lordosis

The ________________ is responsible for three important functions: circulation, protection, and hormone production.

placenta

Zygote

the fertilized egg; it enters a 2-week period of rapid cell division and develops into an embryo

Ambivalence

the state of having contradictory or conflicting emotional attitudes