Ch. 11 Maternal adaption during pregnancy

The nurse is completing the teaching for a newly pregnant client with a BMI of 23. Which statement by the client indicates an understanding of weight gain during this pregnancy? "I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy." "I need to gain 0.5 pounds (0.23 kg) per week during this pregnancy." "I need to gain less than 25 pounds (11 kg) during this pregnancy." "I need to gain 1 pound (0.45 kg) per week throughout this pregnancy."

"I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy." Explanation: A prepregnant BMI of 23 is in the normal category, and this client needs to gain 25 to 35 lbs (11 to 16 kg) during this pregnancy. Lower weight gain would be recommended for women with a BMI of over 25. Chapter 12: Nursing Management During Pregnancy - Page 392

A client who is 15 weeks' gestation is attending prenatal classes and asks the nurse, "What changes in development has my baby made?" Which statement(s) would the nurse include in the response? Select all that apply. "Soft hair covers your baby's head." "Your baby makes sucking motions now with its mouth." "You will be able to detect quickening." "The increase in weight of your baby has stopped now." "Your baby's lungs are ready for life outside the uterus."

"Soft hair covers your baby's head." "Your baby makes sucking motions now with its mouth." "You will be able to detect quickening." Explanation: During weeks 13 through 16, a fine hair called lanugo develops on the head. The fetus makes active movement, sucking motions are made with the mouth, weight quadruples, and fetal movement (also known as quickening) is detected by the mother. Alveoli of the lungs have not developed, and thus lungs are not ready for life outside the womb. Chapter 10: Fetal Development and Genetics - Page 328

PP. 18 Resp adaptions?

-Breathing more diaphragmatic than abdominal due to increase in diaphragmatic excursion, chest circumference, and tidal volume -Increase in O2 consumption -Congestion secondary to increased vascularity

PP. 19 GU adaptions?

-Dilation of renal pelvis; elongation, widening, and increase in curve of ureters -Increase in length and weight of kidneys -Increase in glomerular filtration rate; increased urine flow and volume -Increase in kidney activity with woman lying down; greater increase in later pregnancy w/ woman lying on side

PP. 26 Nutritional needs?

-Direct effect of nutrional intake on fetal well-being and birth outcome -Need for vitamin and mineral supplement daily -Dietary recommendations (increase in protein, iron, folate, and calories, USDA Food Guide MyPlate, avoidance of some fish due to mercury

PP. 12 reproductive adaptions ovaries?

-Enlargement until 12th to 14th week of gestation -Cessation of ovulation

PP. 14 GI adaptions?

-Gums:hyperemic, swollen, friable -Ptyalism -Dental problems; gingivitis -Decreased peristalsis and smooth muscle relaxation -Constipation+increased venous pressure+pressure from uterus=hemorrhoids -Slowed gastric emptying; heartburn -Prolonged gallbladder emptying -Nausea and vomiting

PP. 21 Integumentary adaptions?

-Hyperpigmentation; maskof pregnancy (facial melasma) -Linea Nigra -Striae gravidarum -Variscosities -Vascular spiders -Palmar erythema -Decline in hair growth; increase in nail growth

PP. 15 Cardiovascular adaptions?

-Increase in blood vol (50% above prepregnancy levels) -Increase in cardiac output; increased venous return; increased heart rate -Slight decline in blood pressure until midpregnancy, then returning to prepregnancy levels -Increase in number of RBC's; plasma volume > RBC leading to hemodilution (physiologic anemia) -Increase in iron demands, fibrin and plasma fibrinogen levels and some clotting factors leading to hypercoagulable state

PP. 12 reproductive adaptions breasts?

-Increase in size and nodularity to prepare for lactation; increase in nipple size, becoming more erect and pigmented -Production of colostrum; antibody-rich, yellow fluid that can be expressed after the 12th w; conversion to mature milk after delivery

PP. 10 Uterus reproductive adaption?

-Increase in size, weight, length, width, depth, volume, and overall capacity -Pear shape to ovoid shape; positive Hegar sign -Enhanced uterine contractility; Braxton Hicks contractions -Ascent into abdomen after first 3 months -Fundal height by 20 weeks gestation at level of umbilicus; 20 cm; reliable determination of gestational age until 36 w gestation

PP. 11 reproductive adaptions for cervix?

-Softening (Goodell sign) -Mucus plug formation -Increased vascularization (Chadwick sign) -Ripening about 4 weeks before birth

PP. 20 Muscular adaption?

-Softening and stretching of ligaments holding sacroiliac joints and pubis symphysis -Postural changes; increased swayback and upper spine extension -Forward shifting of center of gravity -Increase in lumbosacral curve (lordosis); compensatory curve in cervicodorsal area -Waddle gait

PP. 23 Endocrine adaptions?

-Thyroid gland: slight enlargement; increased activity; increase in BMR -Pituitary gland: enlargement; decrease in TSH, GH; inhibition of FSH and LH; increase in prolactin, MSH; gradual increase in oxytocin w/ fetal maturation -Pancreas: insulin resistance due to hPL and other hormones in second half of pregnancy -Adrenal glands: increase in cortisol and aldosterone secretion -Prostaglandin secretion -Placental secretion: hCG, hPL, relaxin, progesterone, estrogen

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)

1 lb (0.45 kg) Explanation: The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (0.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (0.45 kg) per week. Overweight women should gain about 2/3 lb (0.30 kg) per week. Chapter 11: Maternal Adaptation During Pregnancy - Page 369

PP. 7 Auscultation of fetal heart tones via Doppler?

10-12w

PP. 3 sx of preg fatigue is seen in how many weeks?

12 w

PP. 5 sx of preg abdominal enlargement?

14w

The nurse is teaching a pregnant woman with a prepregnancy body mass index (BMI) of 26 about recommended weight gain. The nurse determines that the teaching was successful when the woman states that she should gain approximately how much during her pregnancy? 35 to 40 pounds (16 to 18 kilograms) 25 to 35 pounds (11 to 16 kilograms) 28 to 40 pounds (13 to 18 kilograms) 15 to 25 pounds (7 to 11 kilograms)

15 to 25 pounds (7 to 11 kilograms) Explanation: The BMI scale indicates individuals with a BMI less than 18.5 are underweight; BMI of 19.5 to 24.9 are within a normal weight; BMI of 25.0 to 29.9 are considered overweight; and BMI equal to or over 30.0 are obese. A woman with a BMI of 26 is considered overweight and should gain no more than 15 to 25 pounds (7 to 11 kilograms) during pregnancy. Women with a BMI of 18.5 to 24.9 should gain 25 to 35 pounds (11 to 16 kilograms). A woman with a BMI less than 18.5 should gain 28 to 40 pounds (13 to 18 kilograms). Women with a BMI equal to or greater than 30 should only gain 11 to 20 pounds (5 to 9 kilograms) Chapter 11: Maternal Adaptation During Pregnancy - Page 369

PP. 27 healthy weight gain for >25?

15-25lb 1st trimester: 2lb 2nd and 3rd trimester: 2/3 lb/wk

PP. 4 sx of preg fetal movements (quickening)?

16-20w (Says 13-16 on prepu so its in the 2nd trimester)

PP. 5 sx of preg Braxton Hicks contractions?

16-28w

PP. 5 sx of preg ballottement?

16-28w

PP. 4 sx of preg hyperpigmentation of skin?

16w

PP. 7 fetal movement felt by experienced clinician?

20w

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 35 lbs (11 to 16 kg) 28 to 40 lbs (13 to 18 kg) 15 to 25 lbs (7 to 11 kg) 11 to 20 lbs (5 to 9 kg)

25 to 35 lbs (11 to 16 kg) Explanation: A woman with a BMI of 18.5 to 24.9 is of normal weight and should gain 25 to 35 pounds (11 to 16 kg) during the pregnancy. For a woman who is underweight (BMI <18.5), the total weight gain range is 28 to 40 pounds (13 to 18 kg). For a woman who is overweight (BMI = 25-29.9), total weight gain range should be 15 to 25 pounds (7 to 11 kg). For a woman who is obese (BMI = 30 or higher), the total weight gain range should be 11 to 20 pounds (5 to 9 kg). Chapter 11: Maternal Adaptation During Pregnancy - Page 369

PP. 27 Healthy weight for healthy BMI?

25-35lbs First trimester: 3.5-5lb Second and third trimester: 1lb/wk

PP. 27 healthy weight gain for <19.8 BMI?

28-40lb First trimester: 5lb 2nd-3rd trimester: +1lb/wk

PP. 3 sx of preg breast and tenderness is seen in how many weeks?

3-4w

PP. 5 sx of preg positive preg test?

4-12w

PP. 3 sx of preg nausea and vomiting is seen in how many weeks?

4-14w

PP. 7 verification of the embryo or fetus?

4-6w

PP. 3 sx of preg amenorrhea is seen in how many weeks?

4w

PP. 5 sx of preg goodell sign?

5w

PP. 3 sx of preg urine freq is when?

6-12w

PP. 5 sx of preg Hegar sign?

6-12w

PP. 5 sx of preg chadwick sign?

6-8w

PP. 4 sx of preg breast enlargement?

6w

PP. 4 sx of preg uterine enlargement?

7-12w

Normal maternal emotional responses?

Ambivalence Introversion Acceptance Mood swings Changes in body image

What is seen in 3rd trimester?

Braxton Hicks contractions (16-28w) Ballottement (16-28w)

What is seen in 1st trimester?

Breast tenderness (3-4w) Amenorrhea (4w) Nausea and vomiting (4-14w) Goodell sign (5w) Fatigue (12w) Urinary frequency (6-12w) Chadwick sign (6-8w) Hegar sign (6-8w) Positive preg test (4-12w) Uterine enlargement (7-12w) Breast enlargement (6w)

PP. 2 Sx of preg Chadwick sign?

Chadwick sign: bluish-purple coloration of vaginal mucosa and cervix

At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy? Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy. Watch the diet so no additional weight is gained during this pregnancy. Limit weight gain to less than 5 lb (2 kg) for the remainder of this pregnancy. Increase weight gain to 1.5 lb (0.68 kg) per week during this pregnancy.

Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy. Explanation: Expected weight gain is 1.5 lb (0.68 kg) per month in the first trimester and 1 lb (.45 kg) per week for the second and third trimester. This client needs to continue to gain 1 lb (.45 kg) per week. Restricting weight gain near the end of pregnancy can negatively impact fetal growth. Chapter 12: Nursing Management During Pregnancy - Page 392

PP. 34 partners changes?

Couvade syndrome, ambivalence Acceptance of role (2nd trimester) Preparation for reality of new role (3rd trimester)

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

During pregnancy blood volume can increase by at least 40%. Explanation: The pregnant woman can experience a blood volume increase by approximately 40% to 50% above prepregnancy levels by the end of the third trimester. Pregnancy results in an increased respiratory rate to provide oxygen to both the mother and fetus. Hemoglobin levels are usually low during pregnancy because of hemodilution of red blood cells, which is termed physiologic anemia of pregnancy. Blood pressure usually reaches a low point mid-pregnancy and, thereafter, increases to prepregnancy levels by the third trimester. Chapter 11: Maternal Adaptation During Pregnancy - Page 357

The nurse is conducting an obstetrics assessment on a client at 20 weeks' gestation who is questioning the nurse about the development of the fetus. Which new occurring developments can the nurse point out to this client? Eyelids are open. Lungs are fully shaped. Eyebrows and scalp hair are present. A developed startle reflex is evident.

Eyebrows and scalp hair are present. Explanation: At 20 weeks, the fetus is still developing. All structures are present, but not in full size. The fetus will have limited amounts of eyebrows and scalp hair. At 20 weeks, the eyelids are not present; the lungs are present, but not developed. The startle reflex will not be evident until after birth. Chapter 10: Fetal Development and Genetics - Page 328

At a prenatal checkup with a client at 7 weeks' gestation, the nurse would identify what as a normal finding? Quickening is detected by the mother. Fetal heart sounds are heard. Gender identity is determined with ultrasound. The fetus would have a startle reflex.

Fetal heart sounds are heard. Explanation: Although the heart is not fully developed, it begins to beat at week 5, and a regular rhythm and can be heard at week 7. Quickening is felt around week 13. Gender identity can be determined at weeks 9 to 12. The startle reflex can be seen around weeks 21 to 24. Chapter 10: Fetal Development and Genetics - Page 328

What is seen in 2nd trimester?

Fetal movements (quickening) (16-20w) Abdominal enlargement (14w) Braxton Hicks (16-28w) Ballottement (16-28w) Hyperpigmentation (16w) Nausea and vomiting (4-14w)

A woman at 15 weeks' gestation asks the nurse what the fetus currently looks like at this stage of the pregnancy. Which response by the nurse would be most accurate? The fetus is covered with a white, greasy film called vernix. The fetus is about 15 in (38 cm) in length. Fingernails are present. Rhythmic breathing movements are occurring.

Fingernails are present. Explanation: Vernix caseosa, a white, greasy film, covers the fetus at weeks 17 through 20. The fetus reaches a length of approximately 15 in (38 cm) by weeks 25 to 28. Fingernails and toenails are present by approximately week 13 through 16. Rhythmic breathing movements occur between weeks 29 through 32. Chapter 10: Fetal Development and Genetics - Page 328

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

Heart rate increases 10 to 15 beats per minute. The areolae become more prominent. Nasal congestion increases due to edema. Explanation: The pregnant uterus is globular shaped, not pear-shaped. The heart rate usually increases 10 to 15 beats per minute over the prepregnancy rate of 60 to 100 beats per minute. The respiratory rate is essentially unchanged. The areolae of the breasts become more prominent with a deepened pigmentation. Mothers report that they experience more nasal congestion during pregnancy that occurs secondary to edema found in the nasal passages. Chapter 11: Maternal Adaptation During Pregnancy - Page 365

PP. 11 reproductive adaptions vagina?

Increased vascularity with thickening Lengthening of vaginal vault Secretions more acidic, white, and thick; leukorrhea

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. Explanation: Progesterone interferes with normal gallbladder contractions, which leads to stasis of bile. This stasis results in cholestasis, either seen in the gallbladder or the liver. Chapter 11: Maternal Adaptation During Pregnancy - Page 356

PP. 2 Sx of preg Goodell sign?

Softening of cervix

PP. 2 Sx of preg Hegar sign?

Softening of lower uterine segment of isthmus

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 Explanation: Presumptive signs are possible signs of pregnancy that appear in the first trimester, often only noted subjectively by the mother (e.g., breast changes, amenorrhea, morning sickness). Probable signs are signs that appear in the first and early second trimesters, seen via objective criteria, but can also be indicators of other conditions (e.g., hydatidiform mole). Positive signs affirm that proof exists that there is a developing fetus in any trimester and are objective criteria seen by a trained observer or diagnostic study, (e.g., ultrasound.) Chapter 11: Maternal Adaptation During Pregnancy - Page 351

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

dilation of the renal pelvis Explanation: The renal pelvis becomes dilated during pregnancy, possibly due to the effect of progesterone on smooth muscle. The glomerular filtration rate increases during pregnancy. The kidneys enlarge during pregnancy. The ureters elongate, widen, and become more curved above the pelvic rim. Chapter 11: Maternal Adaptation During Pregnancy - Page 365

A nursing student is explaining to a newly pregnant woman what happens during each stage of fetal development. At which stage does the nurse inform the woman that the lungs are fully shaped? end of 4 weeks end of 8 weeks end of 12 weeks end of 16 weeks

end of 16 weeks Explanation: At the end of 16 weeks, the lungs are fully shaped, fetus swallows amniotic fluid, skeletal structure is identifiable, downy lanugo hair is present on the body, and sex can be determined using ultrasound. Chapter 10: Fetal Development and Genetics - Page 328

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% increase up to 25% decrease up to 25% decrease between 30% and 40%

increase between 30% and 40% Explanation: Enlargement of the uterus shifts the diaphragm up to 4 cm above its usual position. As muscles and cartilage in the thoracic region relax, the chest broadens with conversion from abdominal breathing to thoracic breathing. This leads to a 50% increase in air volume per minute. Tidal volume, or the volume of air inhaled, increases gradually by 30% to 40% (from 500 to 700 ml) as the pregnancy progresses. Chapter 11: Maternal Adaptation During Pregnancy - Page 365

A woman who is pregnant for the first time has arrived to the labor department thinking she was in labor only to be diagnosed with Braxton Hicks contractions and sent home. Prior to leaving the unit, the woman asks, "How will I know when it is 'true' labor?" Which signs/symptoms should the woman associate with true labor? Select all that apply. pain in back that wraps across the abdomen and increases in frequency and intensity leakage of white to yellow discharge from the nipples pink-tinged blood and mucus mixture on underwear sudden gush of clear fluid coming from the vagina urine leakage after coughing or sneezing

pain in back that wraps across the abdomen and increases in frequency and intensity pink-tinged blood and mucus mixture on underwear sudden gush of clear fluid coming from the vagina Explanation: True labor contractions usually begin in the back and sweep forward across the abdomen similar to the tightening of a rubber band. They gradually increase in frequency and intensity over a period of hours. As the cervix softens and ripens, the mucus plug that filled the cervical canal during pregnancy is expelled. The exposed cervical capillaries seep blood as a result of pressure exerted by the fetus. This blood, mixed with mucus, takes on a pink tinge and is referred to as "show" or "bloody show." Labor may begin with rupture of the membranes, experienced either as a sudden gush or as a scanty, slow seeping of clear fluid from the vagina. Leaking colostrum from the nipples can occur throughout the pregnancy. Occasionally, a woman notices urinary incontinence (involuntary loss of urine on coughing or sneezing) during pregnancy. Chapter 12: Nursing Management During Pregnancy - Page 397

A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider? vaginal bleeding painful urination severe, persistent vomiting lower abdominal and shoulder pain

vaginal bleeding Explanation: In a client's second trimester of pregnancy, the nurse should educate the client to look for vaginal bleeding as a danger sign of pregnancy needing immediate attention from the primary care provider. Generally, painful urination, severe/persistent vomiting, and lower abdominal and shoulder pain are the danger signs that the client has to monitor for during the first trimester of pregnancy. Chapter 12: Nursing Management During Pregnancy - Page 401-402