Chapter 11 Maternal Adaptation During Pregnancy

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? Check the discharge for evidence of ruptured membranes. Notify the health care provider of a possible infection. Advise the woman about the need to culture the discharge. Tell the woman that this is entirely normal.

D Vaginal secretions increase during pregnancy and this is considered normal leukorrhea based on the woman's report that she is not experiencing any itching or irritation. There is no evidence indicating the need to notify the health care provider, check for rupture of membranes, or advise her about the need for a culture.

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: remind her that she is still early in the pregnancy and she will feel better about it as the pregnancy progresses. tell her to move home so her family will be nearby to help her. 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.

D A pregnant woman without social support needs to identify someone with whom she can share the experience of pregnancy because social support is a crucial part of adapting to parenthood. Telling her to move home and telling her that she will feel better as the pregnancy progresses do not address the issue of isolation. Also, moving home may not be a possibility for this woman. The nurse should maintain a professional relationship and not commit to a long-term relationship with a client.

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? Preparing for parenthood Telling her partner and family Accepting the baby Accepting the pregnancy

D Acceptance of pregnancy is multi-factorial, and how the woman responds to the pregnancy is certainly influenced by her age and if the pregnancy was planned. As a teenager, she may not have been trying to get pregnant and may not want to accept the role and experience. Baby and parenthood decisions should all occur later.

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

D Couvade syndrome is the occurrence of physical symptoms by the partner, similar to the physical symptoms of the mother. Other emotional symptoms may occur, but they are typically on a person-to-person basis.

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 LH and MSH T4 and GH FSH and LH

D During pregnancy, FSH and LH are both inhibited as there is no need to develop a follicle and release an ovum. There is an increase in the secretion of T4 and MSH. There is a decrease in the production of GH and MSH but not an inhibition.

During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which effect of pregnancy? effects of regurgitation from relaxation of the cardiac sphincter elevated progesterone levels increased venous pressure influence of estrogen and blood vessel proliferation

D During pregnancy, the gums become hyperemic, swollen, and friable and tend to bleed easily. This change is influenced by estrogen and increased proliferation of blood vessels and circulation to the mouth. Elevated progesterone levels cause smooth muscle relaxation, which results in delayed gastric emptying and decreased peristalsis. Increased venous pressure contributes to the formation of hemorrhoids. Relaxation of the cardiac sphincter, in conjunction with slowed gastric emptying, leads to reflux due to regurgitation of the stomach contents into the upper esophagus.

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? cortisol antidiuretic hormone follicle-stimulating hormone oxytocin

D Oxytocin is responsible for milk ejection during breastfeeding. Its secretion is stimulated by stimulation of the breasts via sucking or touching. Secretion of follicle-stimulating hormone is inhibited during pregnancy. The secretion of antidiuretic hormone has no effect on breastfeeding. Cortisol secretion regulates carbohydrate and protein metabolism and is helpful in times of stress.

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

D Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava. Cerebral arteries should not be affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in any orientation. The sympathetic nervous system will not be affected by the supine position.

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? Schedule the client a consult with a psychiatric health care provider. Provide the client with information about pregnancy support groups. Determine if the client's significant other is experiencing similar feelings about the pregnancy. Inform the client this is a normal response to pregnancy that many women experience.

D The maternal emotional response experienced by the client is ambivalence. Ambivalence, or having conflicting feelings at the same time, is universal and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester.

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) 2 lb (0.90 kg) 1.5 lb (0.68 kg) 1 lb (0.45 kg)

D 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.

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? ultrasound picture of her fetus positive hCG blood result uterine growth continued amenorrhea

A A positive sign of pregnancy is visualization of the fetus by ultrasound at 6+ weeks. Amenorrhea is a presumptive sign and can be caused by a variety of factors. Positive hCG in the blood and uterine growth are both probable signs but can be caused by hydatidiform or tumors.

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

A 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).

A client in her second trimester of pregnancy reports discomfort during sexual activity. Which instruction should a nurse provide? Modify sexual positions to increase comfort. Perform stress-relieving and relaxing exercises. Perform frequent douching, and use lubricants. Restrict contact to alternative, noncoital modes of sexual expression.

A The nurse should instruct the client to change sexual positions to increase comfort as the pregnancy progresses. Although the nurse should also encourage her to engage in alternative, noncoital modes of sexual expression, such as cuddling, caressing, and holding, the client need not restrict herself to such alternatives. It is not advisable to perform frequent douching, because this is believed to irritate the vaginal mucosa and predispose the client to infection. Using lubricants or performing stress-relieving and relaxation exercises will not alleviate discomfort during sexual activity.

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client? constipation iron-deficiency anemia inefficient protein metabolism tooth fracture

B Pica is characterized by a craving for substances that have no nutritional value. Consumption of these substances can be dangerous to the client and her developing fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation of the client's compulsion to consume soil. Consumption of ice due to pica is likely to lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the client has been consuming laundry starch as a result of pica. The nurse should monitor for constipation in the client if she has been consuming clay.

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? diastasis recti melasma (chloasma) edema in lower extremities chronic backache

D The nurse should provide preventive measures for chronic backache as a consequence of lordosis when caring for this client. Melasma (chloasma) is characterized by darkened areas on the face, particularly over the nose and cheeks. It is also known as the mark of pregnancy. Chloasma is not caused by lordosis. Diastasis recti occurs as the pregnancy progresses when the rectus muscle stretches to the point that it separates. It is not caused by lordosis. Edema in lower extremities occurs due to an impeded venous return caused by the pressure of the growing fetus on pelvic and femoral areas. It is not caused by lordosis.

A client arrives to the clinic very excited and reporting a positive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy? fetal movement felt by examiner Chadwick sign positive office pregnancy test Hegar sign

A The positive signs of pregnancy are fetal image on a sonogram, hearing a fetal heart rate, and examiner feeling fetal movement. A pregnancy test has 95% accuracy; however, it may come back as a false positive. Hegar sign is a softening of the uterine isthmus. Chadwick sign may have other causes besides pregnancy.

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

A As part of the pigment changes that occur with pregnancy, breast areolae become darker. The breast tissue should not be softer or slacker than before. There should not yet be any lymph enlargement, and the nipples should not have fissures.

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. 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. Her body is changing and she may be angry about it.

A During the first trimester of pregnancy, the woman often has mood swings, bouts of irritability and is hypersensitive. The partner needs to know that these are all normal behaviors for a pregnant woman.

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? The infant will be small and could have problems. 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 smaller but should quickly gain weight.

A Explanation: 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.

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? Diastasis recti Round ligament pain Linea nigra Chadwick sign

A In advanced pregnancy muscle tone diminishes, which may aid in the separation of the rectus abdominis muscles. This benign finding does not usually cause other symptoms. The nurse may palpate the fetus well through this opening. Linea nigra is a hyperpigmentation along the midline. Chadwick sign is the bluish tinge to the cervix and vaginal walls seen early in pregnancy, and round ligament pain occurs as the uterus enlarges. This discomfort is usually found in the right more often than the left.

Which statement by a pregnant client would validate that she understood the nurse's teaching regarding the risk of venous stasis during pregnancy? "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." "If I lie down on my back, I will be less likely to develop blood clots in my legs." "My clotting factors will be unchanged during pregnancy but I must be careful to not cross my legs at anytime."

A Increased levels of fibrinogen make pregnancy a hypercoagulable state. Clotting times and bleeding times are unchanged, however. The pregnant woman does run the risk of development of a venous thrombosis as the uterus enlarges and inhibits venous return from the lower extremities due to the hypercoagulable state and venous stasis.

A patient is at 22 weeks' gestation is preparing to have her fundal height measured. Given the patient's stage of gestation and following McDonald's rule, what result does the nurse expect? 22 cm 44 cm 11 cm 2.2 cm

A McDonald's rule, a symphysis-fundal height measurement, although not documented to be thoroughly reliable, is an easy method of determining midpregnancy growth. Typically, tape measurement from the notch of the symphysis pubis to over the top of the uterine fundus as a woman lies supine is equal to the week of gestation in centimeters between the 20th and 31st weeks of pregnancy. In a pregnancy of 22 weeks, for example, the fundal height should be 22 cm.

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? oxytocin antidiuretic hormone follicle-stimulating hormone cortisol

A Oxytocin is responsible for milk ejection during breastfeeding. Its secretion is stimulated by stimulation of the breasts via sucking or touching. Secretion of follicle-stimulating hormone is inhibited during pregnancy. The secretion of antidiuretic hormone has no effect on breastfeeding. Cortisol secretion regulates carbohydrate and protein metabolism and is helpful in times of stress.

A student nurse is preparing for a presentation that will illustrate the various physiologic changes in the woman's body during pregnancy. Which cardiovascular changes up through the 26th week should the student point out? Increased pulse rate and decreased blood pressure Decreased pulse rate and increased blood pressure Increased pulse rate and blood pressure No change in pulse rate or blood pressure

A Pulse rate frequently increases during pregnancy, although the amount varies from a slight increase to 10 to 15 beats per minute. Blood pressure generally decreases slightly during pregnancy, reaching its lowest point during the second trimester.

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? 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. 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.

A Slight bleeding after a pelvic exam in a pregnant woman is common due to the vascularity of her cervix during pregnancy. Suggesting a bleeding disorder is frightening and not substantiated by the data. Bleeding is not a normal finding during pregnancy and losing the mucus plug occurs at the end of pregnancy, just prior to labor.

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? couvade syndrome pseudo pregnancy cretinism pregnancy syndrome

A Some fathers actually experience some of the physical symptoms of pregnancy, such as nausea and vomiting, along with their partner. This phenomenon is called couvade syndrome.

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? presumptive no classification positive probable

A The most common presumptive sign of pregnancy is a missed menstrual period, or amenorrhea. Other presumptive signs include nausea, fatigue, swollen, tender breasts, and frequent urination.

A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which information should the nurse offer? "You will experience quickening, and you will actually feel the baby." "You may feel physical discomfort as the baby inside grows." "You may have mood swings that could overwhelm your partner." "You will be more conscious of the changes taking place in your body now."

A The nurse should inform the client that quickening occurs in the second trimester. The client will be able to physically feel the fetal movements, which will help her bond with her developing fetus. Physical discomfort actually starts to increase in the third trimester as the fetus grows rapidly. The client feels conscious of the changes taking place in her body due to her pregnancy primarily in the first trimester, not the second. The client is likely to have mood swings in the first trimester of the pregnancy, which can be very overwhelming for the client as well as her partner.

A pregnant client arrives at the maternity clinic reporting constipation. Which factors could be the cause of constipation during pregnancy? Select all that apply. decreased activity level intestinal displacement use of iron supplements increase in estrogen levels reduced stomach acidity

A, B, C Constipation during pregnancy is due to changes in the gastrointestinal system. Constipation can result from decreased activity level, use of iron supplements, intestinal displacement secondary to a growing uterus, slow transition time of food throughout the GI tract, a low-fiber diet, and reduced fluid intake. Increase in progesterone, not estrogen levels, causes constipation during pregnancy. Reduced stomach acidity does not cause constipation. Morning sickness has been linked to stomach acidity.

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? Nausea and vomiting Fatigue Positive home pregnancy test Amenorrhea

C A urine pregnancy test is considered a probable sign of pregnancy as the hCG may be from another source other than pregnancy. Fatigue, amenorrhea, and vomiting are presumptive or possible signs of pregnancy and can also have other causes.

A nurse is conducting a nutrition class for a group of pregnant women. What information accurately addresses this issue? Select all that apply. Total iron requirements equal 1,000 mg, with the greatest need being in the second trimester. Since an iodine deficiency can cause intellectual deficits in infants, mothers are recommended to use iodized salt. Calcium supplements may decrease the chance of developing pre-eclampsia in women who had a pre-existing deficiency. Folic acid is needed during the third trimester to reduce the chance of birth defects such as neural tube defects and cleft lip/palate. The baby will require increased protein for development, so the mother needs to ingest 8 to 9 g of additional protein per day above her nonpregnant requirements.

A, B, C Pregnant women need an increase of 5 to 6 g (not 8 to 9 g) of protein above their prepregnancy amounts to support fetal growth. The iron requirements increase dramatically after 20 weeks' gestation to build the fetus's RBC supply. Women who take calcium supplements during pregnancy may have a reduced chance of pre-eclampsia, if they had a prepregnancy deficit. Iodine deficiencies can lead to cretinism, which causes mental deficits and stunted growth, so an easy fix is to use iodized salt while pregnant until there are other health issues that contradict its use. Folic acid is needed in the first trimester, not the third one, to reduce the incidence of neural tube defects because her fetus's spinal column forms early in the pregnancy.

The nurse has determined that based on the client's physical examination she is at high risk for developing varicose veins. Which suggestions might the nurse teach the client to help reduce her risk? Select all that apply. Elevate the feet and legs. Walk daily. Use thigh-high support hose. Sit in a hot tub at least three times a week. Use knee-high support hose.

A, B, C Vascular changes during pregnancy manifested in the integumentary system include varicosities of the legs, vulva, and perineum. Varicose veins commonly are the result of distention, instability, and poor circulation. Various interventions to reduce the risk of developing varicosities include elevating both legs when sitting or lying down; avoiding prolonged standing or sitting; walking daily for exercise; avoiding tight clothing or knee-high hosiery; and wearing support hose if varicosities are a preexisting condition to pregnancy.

In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which information would the nurse most likely include? Taking hormonal replacement therapy can improve the discomfort of the changes. Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge. Using herbs will help ease the discomfort. Most of the hormonal changes are permanent after the pregnancy is completed.

B 'Elevated progesterone levels cause smooth muscle relaxation, which can result in relaxation of the cardiac sphincter and reflux of the stomach contents into the lower esophagus. OTC antacids will usually relieve the symptoms but should be discussed with the health care provider first. The hormonal changes are necessary for the pregnancy to continue, and the woman will return to her usual nonpregnant hormonal levels after the baby is born. Taking hormonal replacement therapy is not recommended. Using herbs should be done only with the knowledge of the health care practitioner due to the side effects and contraindications of some herbs during pregnancy. Some herbs will cause a spontaneous abortion (miscarriage).

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

B As the enlarging uterus increases pressure on the inferior vena cava, it compromises venous return, which can cause dizziness, light-headedness, and pallor when the client is supine. The nurse can relieve these symptoms by turning the client on her left side, which relieves pressure on the vena cava and restores venous return. Although they are valuable assessments, fetal heart tone and maternal blood pressure measurements do not correct the problem. Because deep breathing has no effect on venous return, it cannot relieve the client's symptoms.

The nurse obtains a human chorionic gonadotropin (hCG) level from a woman who thinks that she is pregnant. Which result would the nurse identify as a positive pregnancy result? 24 mIU/mL (24 (IU/L) 8 mIU/mL (8 IU/L) 32 mIU/mL (32 IU/L) 16 mIU/mL (16 IU/L)

C An hCG level lower than 5 mIU/mL (5 IU/l) is considered negative for pregnancy, and anything higher than 25 mIU/mL (25 IU/l) is considered positive for pregnancy.

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." "If the provider did an exam, it might be just normal vaginal secretions, so don't worry about it." "It might be nothing. If it happens again call your provider who is on-call."

B Bloody mucus can either be a mucus plug or bloody show. The one-time occurrence would be more likely to be the mucus plug. A bloody show would continue if her cervix was changing, but this usually does not occur until after contractions start. It is a sign that something is happening and should be reported to the health care provider. The bloody mucus is not a sign of labor, but it can be an early sign that labor is coming soon.

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? "You have nothing to be concerned about. I am sure you are not feeling contractions at this point in your pregnancy." "What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." "You need to come to the office to be examined." "You need to go to the emergency room right away."

B Braxton Hicks contractions are the painless, intermittent, "practice" contractions of pregnancy.

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? 18 24 20 22

B By 20 weeks' gestation, the fundus of the uterus is at the level of the umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in centimeters, which corresponds to the number of gestational weeks, is commonly used to date the pregnancy. Therefore for this client, the additional 4 cm would be the equivalent of 4 additional weeks making the gestational age of 24 weeks.

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? Goodell sign Chadwick sign Braxton sign Hegar sign

B Common probable signs of pregnancy include a bluish-purple coloration of the vaginal mucosa and cervix (Chadwick sign), softening of the lower uterine segment or isthmus (Hegar sign), and softening of the cervix (Goodell sign). There is no such thing as Braxton sign; however, there are the Braxton Hicks contractions, which occur throughout the pregnancy preparing the uterus for delivery.

On day 3 after a cesarean birth, the client is complaining of soreness in her left leg. On examination the nurse notes the left leg is swollen, and the calf is red, tender and warm to touch. These findings indicate: peripheral artery disease. deep vein thrombosis. varicose veins. venous insufficiency.

B Deep vein thrombosis is characterized by unilateral leg pain or swelling, redness, or tenderness. These assessment findings are not consistent with the presence of varicose veins, peripheral artery disease, or venous insufficiency. Varicose veins are enlarged, swollen, twisted veins often caused by damaged or faulty valves that allow blood to travel in the wrong direction. Peripheral artery disease is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs, resulting in cold pale extremities. Venous insufficiency occurs when blood doesn't flow back properly to the heart, causing blood to pool in leg veins. Venous insufficiency can be a result of a DVT or varicose veins.

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: 100 beats per minute. 85 beats per minute. 90 beats per minute. 95 beats per minute.

B During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.

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. detect fetal heart sounds with a Doppler. feel fetal movements. palpate the fetal outline.

B Fetal heart sounds are audible with a Doppler at 10 to 12 weeks' gestation but cannot be heard through a stethoscope until 18 to 20 weeks' gestation. Fetal movements can be felt by a woman as early as 16 weeks of pregnancy and felt by the examiner around 20 weeks' gestation. The fetal outline is also palpable around 20 weeks' gestation.

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? There is hyperpigmentation of the abdomen. The cervix has a bluish, purple discoloration. There is a rebound of the fetus felt when the physician pushes on the abdomen. The cervix is reddened and swollen.

B Probable signs of pregnancy include several objective physical changes in the mother. One of them is the Chadwick sign, which is seen during the pelvic exam of the client and involves a bluish, purplish discoloration of the vulva, vagina and cervix.

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

B The displacement of the intestines and possible slowed motility of the intestines can lead to constipation in the pregnant woman. This, along with elevated venous pressure, can lead to development of hemorrhoids.

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? Combined, both of these findings are very concerning and warrant further investigation. 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.

C A pregnant woman will normally experience a decrease in her blood pressure during the second trimester. An increase in the heart rate of 10 to 15 beats per minute on average is also normal, due to the increased blood volume and increased workload of other organ systems. Hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure

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

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

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

C Blood volume increases by approximately 1,500 ml or 50% above nonpregnant levels by the 32nd week of gestation. This increase in blood volume is needed to provide adequate hydration of fetal and maternal tissues.

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

C Calcium deficiency is a major concern for the pregnant woman who is lactose intolerant. There are several ways to address this concern. Some lactose-intolerant individuals are able to tolerate cooked forms of milk, such as pudding or custard. Cultured or fermented dairy products, such as buttermilk, yogurt, and some cheeses may also be tolerated. A chewable lactase tablet may be taken with milk. Lactase-treated milk is available in most supermarkets and may be helpful. Other options are to drink calcium-enriched orange juice or soy milk or to take a calcium supplement. If the woman is infrequently exposed to sunlight, she will need a vitamin D supplement.

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? The mother needs to supplement breastfeedings with formula until her milk comes in. Breast milk comes in within 12 hours after delivery and nourishment should not be a problem. Colostrum, which is the first milk produced, is rich in calories and protein that nourishes the infant well. Most infants need minimal nourishment for the first 24 hours, so the mother should not be concerned.

C Colostrum is present prior to delivery and provides the infant with adequate nutrition for the first 3 days of life, at which time the mother's actual milk should come in. Formula is not recommended. Infants need nutrition shortly after birth to keep their blood glucose normal.

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

C During pregnancy, there may be a slight amount of glucose found in the urine due to the fact that the kidney tubules are not able to absorb as much glucose as there were before pregnancy. However, there should be minimal protein in the urine. A specific gravity of 1.010 and a straw- like color are both normal findings.

The nurse is assessing several pregnant women in a clinic setting. Which assessment finding would alert the nurse to notify the health care provider? increased nasal congestion increased urination and fatigue blood pressure measured at 170/88 mm Hg increased skin pigment

C During pregnancy, women may expertise increased nasal stuffiness, increased urination, fatigue, and skin pigment increases. Elevated blood pressure is a concern during pregnancy and would be reported.

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

C Fetal heart sounds are audible with a Doppler at 10 to 12 weeks' gestation but cannot be heard through a stethoscope until 18 to 20 weeks' gestation. Fetal movements can be felt by a woman as early as 16 weeks of pregnancy and felt by the examiner around 20 weeks' gestation. The fetal outline is also palpable around 20 weeks' gestation.

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.

C Home pregnancy testing can be accurate as soon as a period is missed; it should not take the place of prenatal care.

A client who suspects she is pregnant asks the nurse about the accuracy of home pregnancy tests. The nurse would tell the client that: The test works best on a midday urine sample. their reliability is only about 90%. home pregnancy tests often give a false positive result. some of the home pregnancy tests can detect the presence of hCG within 1 day of the woman's missed period.

C Home pregnancy tests are 95% reliable if used according to the instructions on the kit. In fact, some can detect hCG within 1 day after a missed period. These tests often give a false negative, not false positive, reading. Results can be tested with the first voided specimen of the day.

When caring for a newborn, the nurse observes that the neonate has developed white patches on the mucus membranes of the mouth. Which condition is the newborn most likely experiencing? cytomegalovirus infection rubella oral candidiasis (thrush) toxoplasmosis

C Monilial vaginitis is a benign fungal condition that is uncomfortable for women; it can be transmitted from an infected mother to her newborn at birth. Neonates develop an oral infection known as thrush, which presents as white patches on the mucous membranes of the mouth. Although rubella, toxoplasmosis, and cytomegalovirus are infections transmitted to the newborn by the mother, this newborn is not experiencing any of these infections. Rubella causes fetal defects, known as congenital rubella syndrome; common defects of rubella are cataracts, deafness, congenital heart defects, cardiac disease, and intellectual disability. Possible fetal effects due to toxoplasmosis include stillbirth, premature delivery, microcephaly, hydrocephaly, seizures, and intellectual disability, whereas possible effects of cytomegalovirus infection include small for gestational age (SGA), microcephaly, hydrocephaly, and intellectual disability.

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

C Presumptive signs of pregnancy are things reported by the woman to the health care provider and occur early in pregnancy. Breast tenderness is a common sign reported by women in early pregnancy but is not a definitive sign. Reports of increased hunger and weight gain could be caused by any disorder or could be normal responses to eating cycles. Ballottement occurs late in the pregnancy and is a probable sign.

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? estrogen progesterone relaxin human placental lactogen

C Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for dilation (dilatation) at birth; softening of collagen allows for laxness in the lower spine and so helps enlarge the birth canal. The effect of estrogen is to cause breast and uterine enlargement. Progesterone has a major role in maintaining the endometrium, inhibiting uterine contractility, and aiding in the development of the breasts for lactation. Human placental lactogen (hPL), also known as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective and thereby allowing more glucose to become available for fetal growth.

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

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

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

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

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

C There are only three documented or positive signs of pregnancy: 1) demonstration of a fetal heart separate from the mother's, 2) fetal movements felt by an examiner, and 3) visualization of the fetus by ultrasound. The absence of a period is an example of a presumptive symptom, which is a symptom that, when taken as a single entity, could easily indicate other conditions. Laboratory tests of either urine or blood serum for human chorionic gonadotropin (hCG) are examples of probable signs of pregnancy, which are objective and so can be verified by an examiner.