Chapter 6: Maternal Adaptation during Pregnancy

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

"I need to get right back to work after delivery."

The nurse instructs a pregnant client on the need to increase foods containing folic acid. Which client statement indicates that teaching has been effective? "Eating an extra orange a day is important." "I need to drink two glasses of milk each day." "I will add spinach to my salad every evening." "Cabbage and cauliflower are important for me to eat."

"I will add spinach to my salad every evening."

The nurse is teaching the pregnant woman about nutrition for herself and her baby. Which statement by the woman indicates that the teaching was effective? "I can eat any seafood that I like because it contains phosphorus, which is a nutrient that pregnant women need." "I will need to take iron supplementation throughout my pregnancy even if I am not anemic." "Milk production requires higher levels of calcium; therefore, if I am going to breastfeed, I must take a calcium supplement during pregnancy." "Because I am pregnant, I can eat anything I want and not worry about weight gain."

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

The nurse is counseling a client with a BMI of 23 about weight gain during pregnancy. The nurse teaches the client that during the second and third trimester of pregnancy, dietary intake should be increase by how many calories per day above what she was eating prior to the pregnancy? 100 300 500 1000

300

A client who is 16 weeks pregnant has a lower blood pressure than that of prepregnancy levels. What should the nurse realize as being the cause for this lower blood pressure? Prepregnancy blood pressure measurements were inaccurate. Blood pressure progressively decreases throughout the entire pregnancy. A decrease in the second trimester may occur because of placental growth. Dehydration because blood pressure increases steadily throughout pregnancy.

A decrease in the second trimester may occur because of placental growth

A nurse is conducting a class for a group of pregnant women in their first trimester about the emotional responses that occur during pregnancy. Which response would the nurse identify as being seen commonly during the second trimester? introversion ambivalence acceptance emotional balance

Acceptance

A woman is at 20 weeks' gestation. The nurse would expect to find the fundus at which area? just above the symphysis pubis midway between the pubis and umbilicus at the level of the umbilicus midway between the umbilicus and xiphoid process

At the level of the umbilicus

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

Blood pressure decreases

A client's menstrual period is two weeks late. She has been feeling tired and has had episodes of nausea in the morning. What classification of pregnancy symptoms is this client experiencing? Positive Presumptive Probable No classification

Presumptive

During an assessment, a client who is 5 months pregnant tells the nurse that she has to change her diet because she is just becoming too fat. Which nursing diagnosis should the nurse use to guide interventions for the client at this time? powerlessness imbalanced nutrition deficient knowledge disturbed body image

disturbed body image

The nurse is caring for a client at 8 weeks' gestation who states, "I did not plan for this right now and I am not happy or excited about this pregnancy. I am not sure what to do." Which response by the nurse is best? "You will become excited and happy when you feel the baby move." "Many women feel this way during the first trimester." "We can refer you to a clinic for potential termination if you desire." "Do not worry. Once you hold this baby, everything will be fine."

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

A pregnant client is concerned because she has noticed that she is developing brown blotches on her forehead and nose. The nurse realizes that the client understood the teaching about this problem when the client makes which statement? "Pregnant women often develop skin problems but this should go away in the third trimester." "These spots are from hyperpigmentation caused by the pregnancy and may be permanent." "I will get them with every pregnancy and they will get worse every time." "This condition is called linea nigra and the spots may fade or go away between pregnancies."

"These spots are from hyperpigmentation caused by the pregnancy and may be permanent."

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

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

The nurse is assessing a pregnant woman who is at 12 weeks' gestation. The woman's BMI was 18 prior to becoming pregnant. Her prepregnancy weight was 98 lb (44.5 kg). Which measurement would the nurse determine as appropriate weight gain for the woman during the first trimester? 99 lb (45 kg) 100 lb (45.5 kg) 102 lb (46 kg) 104 lb (47 kg)

104 lb (47 kg)

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

2+ Protein in urine

A client makes an appointment at the prenatal clinic because she thinks she might be pregnant. Which assessment is a probable sign of pregnancy? amenorrhea enlargement and darkening of areola nausea and vomiting a positive pregnancy test

A positive pregnancy test

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings? The heart rate increase may indicate that the client is experiencing cardiac overload. The blood pressure should be higher since the cardiac volume is increased. Both findings are normal at this point of the pregnancy. Combined, both of these findings are very concerning and warrant further investigation.

Both findings are normal at this point of the pregnancy.

The nurse is caring for a young couple who are expecting their first baby. They are experiencing the phenomenon known as couvade syndrome. What can the nurse explain to this family to help them understand this syndrome? Couvade syndrome is when the pregnant woman becomes self-centered and changes her behavior based on the event taking place inside of her. Couvade syndrome is when the partner begins to experience the same physical symptoms as the pregnant woman experiences. Couvade syndrome is a reflection of an unhealthy relationship between the partner and the pregnancy. The more in tune the partner is with the pregnancy, the less likely this syndrome will take place.

Couvade syndrome is when the partner begins to experience the same physical symptoms as the pregnant woman experiences.

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

Detect fetal heart sounds with a Doppler.

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

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

Hemorrhoids

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

Dyspnea

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

The nurse is counseling a young woman who has just entered her second trimester, after an uneventful first trimester. She tells the nurse, "It still doesn't seem real. It's just hard to believe that I will really have a baby." Which future events should the nurse point out that will help the young woman come to believe it is real? Select all that apply. Feeling the baby kick Seeing an ultrasound image of the baby Giving up alcohol Receiving a positive result on a pregnancy test Taking prenatal vitamins

Feeling the baby kick Seeing an ultrasound image of the baby

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

Fetal movement felt by examiner

During a vaginal exam, the nurse notes that the lower uterine segment is softened. The nurse documents this finding as: Hegar sign. Goodell sign. Chadwick sign. Ortolani sign.

Hegar sign

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? Decreased pulse rate and increased blood pressure Increased pulse rate and decreased blood pressure Increased pulse rate and blood pressure No change in pulse rate or blood pressure

Increased pulse rate and decreased blood pressure

A client at 24 weeks' gestation is seen for a routine monthly check up. She reports concerns to the nurse about rest periods. She states that when she awakens she feels weak and lightheaded. What is the most appropriate initial action by the nurse? Inquire about the client's sleeping positions. Make a referral for a cardiac evaluation. Request testing to assess the client's serum glucose levels. Assess the client for manifestations of preeclampsia. Complete neurological assessment.

Inquire about the client's sleeping positions

A pregnant client at 33 weeks' gestation is in the office for a routine visit. She lies down on her back and while the nurse is listening for fetal heart tones, the client tells the nurse that she feels lightheaded; her blood pressure is 82/58 mm Hg. What is the most likely explanation for this problem? She is experiencing supine hypotension syndrome She did not drink enough fluids prior to coming to the office. Her hematocrit is low and she needs additional iron supplements. The baby is kicking her spinal column, causing a pinched nerve.

She is experiencing supine hypotension syndrome

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

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

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 cervix looks blue or purple when examined. The lower uterine segment softens. The fundus enlarges. The cervix softens.

The cervix softens

The nurse is presenting a nutritional plan to a primigravida client who is questioning the addition of iodized salt to her diet. Which explanation should the nurse prioritize in answering this client? Thyroid activity, which depends on iodine intake, increases during pregnancy. Because of decreased thyroid activity during pregnancy, the thyroid does not produce as much as normal. Progesterone formation is dependent on a high iodine intake. Adrenal gland activity during pregnancy decreases iodine's effectiveness.

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

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? hypopigmentation of the areola and nipples disappearance of superficial veins expression of colostrum in the first trimester tingling sensations and tenderness

Tingling sensations and tenderness

A pregnant client tells the nurse that she is not happy to learn about the pregnancy. At which point in the pregnancy does the nurse realize that the client will change her mind about the pregnancy? around the third month after the seventh month when quickening occurs after lightening happens

When quickening occurs

Place the following events in the sequence the pregnant woman would experience them, from first to last. All options must be used. amenorrhea uterine enlargement Braxton Hicks contractions quickening labor

amenorrhea uterine enlargement quickening Braxton Hicks contractions labor

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding? bruising linea nigra striae darkening of the umbilicus

bruising

A nurse assessing the laboratory results of a pregnant client in her second trimester notes that she has a hemoglobin level of 11 gm/dl. What will the nurse interpret this finding to most likely indicate? iron-deficiency anemia a multiple gestation pregnancy greater-than-expected weight gain hemodilution of pregnancy

hemodilution of pregnancy

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

visualization of the fetus by utlrasound

Increased pigmentation on the face of some pregnant women is called: nigra melanotropin striae gravidarum (stretch marks) melasma (chloasma)

Melasma (chloasma)

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)

Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called? linea rubria Chadwick sign ballottement melasma (chloasma)

Melasma (chloasma)

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

Breast tenderness

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? 8 mIU/mL (8 IU/L) 16 mIU/mL (16 IU/L) 24 mIU/mL (24 (IU/L) 32 mIU/mL (32 IU/L)

32 mIU/mL (32 IU/L)

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

85 beats per minute

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? Use a diluted urine specimen. Wait until after two missed menstrual periods. Arrange for prenatal care if the test is positive. Refrain from eating for 4 hours before testing.

Arrancge for prenatal care if the test is positive.

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

Chronic backache

A pregnant client is concerned she may develop preeclampsia, so she has stopped adding any salt to her food and is now questioning the nurse about avoiding prepared foods. The nurse should point out some salt is very beneficial and can help prevent which negative outcome for her baby? Congenital hypothyroidism Low birth weight Neural tube defects Night blindness

Congenital hypothroidism

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

Calcium deficiency

The nurse is performing an assessment of a woman who has come to a health care facility for a diagnosis of pregnancy. The women is positive for breast changes, nausea, and amenorrhea. On physical exam, it is noted that the client has softening of the cervix. How should the nurse document this in her notes? ballottement Chadwick sign Goodell sign Hegar sign

Goodell sign

A client at 16 weeks' gestation comes to the office for a routine exam. At what location within the abdomen would the nurse anticipate the uterus to be found? At the level of the umbilicus At the xiphoid process Halfway between the symphysis pubis and the umbilicus Below the symphysis pubis

Halfway between the symphysis pubis and the umbilicus

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? Do you have vaginal itching? Are you taking oral contraceptives?

Have you been sexually active in the past 2 months

The nursing student is preparing a pamphlet that will illustrate the various hormones involved with a pregnancy. Which hormone should the nurse indicate is responsible for the let-down of breast milk in this pamphlet? Progesterone Oxytocin Prolactin Estrogen

Oxytocin

The nurse is preparing to teach a community class to a group of first-time parents. Which information should the nurse include concerning what the pregnant woman's partner may experience as a normal response? feeling distanced from the mother no changes, only the mother has changes during pregnancy physical symptoms similar to the mother desire to be the woman and give birth

Physical symptoms similar to the mother

The partner of a pregnant client in her first trimester asks the nurse about the client's behavior recently, stating that she is very moody, seems happy one moment and is crying the next and all she wants to talk about is herself. What response would correctly address these concerns? Her body is changing and she may be angry about it. Pregnant women often experience mood swings and self-centeredness but this is normal. Moodiness and irritability are not usual responses to pregnancy. What you are describing may be normal but we need to talk to her more in depth.

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

In a client's seventh month of pregnancy, she reports feeling "dizzy, like I'm going to pass out, when I lie down flat on my back." The nurse explains that this is due to: pressure of the gravid uterus on the vena cava. a 50% increase in blood volume. physiologic anemia due to hemoglobin decrease. pressure of the presenting fetal part on the diaphragm.

Pressure of the gravid uterus on the vena cava

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: follicle-stimulating hormone and thyroid hormone. prolactin and oxytocin. estrogen and progesterone luteinizing hormone and hCG

Prolactin and oxytocin

The nursing instructor is teaching students about normal changes of pregnancy. The instructor talks about diastasis recti. What is the instructor presenting? separation of the muscles of the abdominal wall raising of the uterus into the abdomen relaxation of the kidneys movement of the bladder to the rear of the pelvis behind the uterus

Separation of the muscles of the abdominal wall

In assessing the dietary intake over the last 24 hours of a pregnant client, which food would be most concerning to the nurse? Medium-well steak and a fresh salad. Smoked salmon and bagels 6 oz. of white tuna with crackers Cooked hot dog on a bun with mustard

Smoked salmon and bagels

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

Supine hypotension syndrome

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. 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. Some bleeding during pregnancy is not uncommon and this finding is expected.

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

A pregnant client is observed talking with another client holding an infant in the clinic waiting room. What does this observation indicate to the nurse? The client is role-playing. The client is being narcissistic. The client is reworking developmental tasks. The client is ambivalent about being pregnant.

The client is role-playing

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

Total iron requirements equal 1,000 mg, with the greatest need being in the second trimester. Calcium supplements may decrease the chance of developing pre-eclampsia in women who had a pre-existing deficiency. Since an iodine deficiency can cause intellectual deficits in infants, mothers are recommended to use iodized salt.

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

Ultrasound picture of her fetus

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy? Finding of hCG in the blood Visualization of the gestational sac or fetus Finding hCG in the urine Positive home pregnancy test

Visualization of the gestational sac or fetus

The spouse of a pregnant client is quiet during prenatal visits but is demonstrating emotional involvement in the pregnancy. What action did the spouse perform? states he definitely wants a girl refuses to paint the baby's room blue states he is concerned about the loss of his free time walks around furniture as if his abdomen is enlarged

Walks around furniture as if his abdomen is enlarged

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

A pregnant woman who is a vegetarian asks the nurse, "What would you suggest to make sure that I get enough protein in my diet while I am pregnant?" Which food(s) would be appropriate for the nurse to suggest? Select all that apply. beans lentils nuts green leafy vegetables orange juice

lentils beans nuts

A nurse is teaching a pregnant woman about ways to prevent the development of the food-borne illness listeriosis. The nurse determines that the teaching was successful when the woman identifies the need to avoid which food(s)? Select all that apply. soft cheeses refrigerated meat spreads canned tuna fish store-made chicken salad pasteurized milk

soft cheeses store-made chicken salad refrigerated meat spreads

A pregnant client questions the nurse about the earliest time she will be able to hear the fetal heartbeat. The nurse informs the client that fetal heart rate can typically be heard the earliest by which method? handheld doppler fetoscope transvaginal ultrasound fetal scalp electrode

transvaginal ultrasound

The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. The mother will most likely experience which of the following at that time? dysuria dyspnea constipation urinary frequency

urinary frequency