PrepU: Chapter 11: Maternal Adaptation During Pregnancy

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? "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." "You will become excited and happy when you feel the baby move."

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

Which statement by a pregnant client would validate that she understood the nurse's teaching regarding the risk of venous stasis during pregnancy? "If I lie down on my back, I will be less likely to develop blood clots in my legs." "My clotting times and bleeding times will be unchanged during this pregnancy even though I am at higher risk of clots in my leg vein." "The increase in my blood volume and increased clotting factors can cause me to bleed more at delivery." "My clotting factors will be unchanged during pregnancy but I must be careful to not cross my legs at anytime."

"My clotting times and bleeding times will be unchanged during this pregnancy even though I am at higher risk of clots in my leg vein."

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse? "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." "Expect your other children to react positively to their new brother/sister."

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

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

"This discharge is normal 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 have nothing to be concerned about. I am sure you are not feeling contractions at this point in your pregnancy." "You need to go to the emergency room right away." "You need to come to the office to be examined."

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

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 lb (0.90 kg) 1 lb (0.45 kg) 2/3 lb (0.30 kg) 1.5 lb (0.68 kg)

1 lb (0.45 kg)

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) 178 lb (80.7) 176 lb (79.8 kg) 180 lb (81.6)

177 lb (80.3 kg)

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

2+ Protein in urine

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: 95 beats per minute. 90 beats per minute. 100 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? Blood pressure remains stable until decreasing the day of the birth. Blood pressure progressively decreases throughout the entire pregnancy. Normally, blood pressure increases steadily throughout pregnancy. 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 woman tells the nurse that she is going to use a home pregnancy test to determine whether she is pregnant. Which precautions should the nurse give her? Refrain from eating for 4 hours before testing. Use a diluted urine specimen. Arrange for prenatal care if the test is positive. Wait until after two missed menstrual periods.

Arrange for prenatal care if the test is positive

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

Both findings are normal at this point of the pregnancy

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

Breast tenderness

A client presents 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? Hegar sign Goodell sign Braxton sign Chadwick sign

Chadwick sign

A new mother asks the postpartum nurse if her baby is getting enough nourishment from breastfeeding within the first 24 hours following birth. The nurse would provide her what information? Colostrum, which is the first milk produced, is rich in calories and protein that nourishes the infant well. Breast milk comes in within 12 hours after delivery and nourishment should not be a problem. The mother needs to supplement breastfeedings with formula until her milk comes in. Most infants need minimal nourishment for the first 24 hours, so the mother should not be concerned.

Colostrum, which is the first milk produced, is rich in calories and protein that nourishes the infant well.

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

Darkened breast areolae

Which interventions would a pregnant client be taught regarding dietary restrictions during pregnancy? Select all that apply. Wash raw fruits and vegetables with hot water and a mild soap. Don't drink raw or unpasteurized milk. Eat only soft cheeses such as feta or brie. Discard foods that have been left out at room temperature for more than 2 hours. Limit beef intake to 10-12 ounces per week.

Discard foods that have been left out at room temperature for more than 2 hours. Don't drink raw or unpasteurized milk.

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

Dyspnea

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

Fundal height has dropped since the last recording

A 22-year-old client comes to the walk-in clinic complaining of fatigue, breast heaviness and extreme tenderness, and a clear vaginal discharge. What question would the nurse ask this client? Have you been sexually active in the past 2 months? Do you have a family history of breast cancer? Are you taking oral contraceptives? Do you have vaginal itching?

Have you been sexually active in the past 2 months?

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

Hemorrhoids

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." "I will need to take iron supplementation throughout my pregnancy even if I am not anemic." "I can eat any seafood that I like because it contains phosphorus, which is a nutrient that pregnant women need." "Because I am pregnant, I can eat anything I want and not worry about weight gain."

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

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. 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. Provide the client with information about pregnancy support groups.

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? Refrain from eating for 4 hours before testing. Keep the appointment. Wait until after two missed menstrual periods. Use a diluted urine specimen.

Keep the appointment.

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. 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.

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

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 Nausea and vomiting Positive home pregnancy test Amenorrhea

Positive home pregnancy test

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

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

What effect does progesterone have on normal gallbladder function? It has no effect on the gallbladder. The gallbladder will hypertrophy. Progesterone interferes with gallbladder contraction, leading to stasis of bile. Bile will be produced at a more rapid rate due to the progesterone.

Progesterone interferes with gallbladder contraction, leading to stasis of bile

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

Tell the woman that this is entirely 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 lower uterine segment softens. The cervix looks blue or purple when examined. The cervix softens. The fundus enlarges.

The cervix softens

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? hCG is delaying peristalsis. There is not enough fiber in your diet. This shouldn't be happening. The intestines are displaced by the growing fetus.

The intestines are displaced by the growing fetus.

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?

The vagina has a bluish, purple discoloration.

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 morning sickness breast changes ultrasound pictures amenorrhea fetal heartbeat

breast changes amenorrhea morning sickness

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

calcium deficiency

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? cretinism couvade syndrome pregnancy syndrome pseudo pregnancy

couvade syndrome

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

detect fetal heart sounds with a Doppler

A woman is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and she has no real family support. The nurse's most therapeutic response would be to: tell her to move home so her family will be nearby to help her. remind her that she is still early in the pregnancy and she will feel better about it as the pregnancy progresses. encourage her to identify someone that she can talk to and share the pregnancy experience. offer to meet with the client on a regular basis to provide her someone to talk to about her concerns.

encourage her to identify someone that she can talk to and share the pregnancy experience.

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

fetal movement felt by examiner

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? narcissism stress introversion emotional lability

narcissism

A new mother voices concerns about breastfeeding her infant. The nurse would explain to the mother the two hormones that control lactation and letdown are: prolactin and oxytocin. estrogen and progesterone luteinizing hormone and hCG follicle-stimulating hormone and thyroid hormone.

prolactin and 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 estrogen human placental lactogen progesterone

relaxin

The nurse is assessing a pregnant woman on a routine prenatal visit. Which breast assessment finding will the nurse document as a normal and expected finding? disappearance of superficial veins tingling sensations and tenderness hypopigmentation of the areola and nipples expression of colostrum in the first trimester

tingling sensations and tenderness

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

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

visualization of the fetus by ultrasound