Evolve: Ch 7

14. A woman pregnant for the first time is concerned because she has not felt the baby move. She tells the nurse that her mother told her this is a bad sign and that something may be wrong with the baby. The woman is 12 weeks pregnant. The best response by the nurse should be based on the knowledge that quickening occurs at: 10 to 12 weeks. 12 to 14 weeks. 14 to 16 weeks. 16 to 20 weeks.

16 to 20 weeks. Quickening occurs from about weeks 16 to 20. The primigravida will notice the fetal movements later than a multigravida.

16. Fetal movement felt by the examiner is considered a positive indication of pregnancy. However, fetal movement felt by the pregnant woman is considered: A presumptive indication of pregnancy. A probable indication of pregnancy. Also a positive indication of pregnancy.

A presumptive indication of pregnancy. The woman may misinterpret peristalsis in the large intestine for fetal movement. It is unlikely for an experienced examiner to be deceived by these intestinal movements.

23. Which of the following are considered presumptive indications of pregnancy? (Select all that apply). Amenorrhea Nausea and vomiting Abdominal enlargement Ballottement Positive pregnancy test Auscultation of fetal heart sounds

Amenorrhea Nausea and vomiting

9. The nurse noted a trace of glucose in the urine of an 8-month-pregnant woman. The nurse understands that this may be caused by: Excessive sugar intake over the past few hours. A sign of diabetes mellitus. The client needs further lab work. An increase in the glomerular filtration rate that is normal during pregnancy. An increase in the bacteria count in the urine.

An increase in the glomerular filtration rate that is normal during pregnancy. An increase in the glomerular filtration rate causes the filtered glucose level to exceed the ability of the renal tubules to reabsorb it. This causes a spilling of glucose into the urine.

29. Several times during the pregnancy, lab work will be done to check the hemoglobin or hematocrit levels. This is done to screen for ____________.

Anemia

31. Maternal hyperthermia during the first trimester may be associated with fetal _____________.

Anomalies

28. At about 20 weeks of pregnancy, a sudden tap on the cervix during vaginal examination may cause the fetus to rise in the amniotic fluid and then rebound to its original position. This movement is termed ___________.

Ballottement

7. During the initial assessment of a 3-month-pregnant client, the nurse discovers that the client has to stand up for 8 hours at work. The nurse is aware that this may increase the client's risk of: Ankle edema. Blood clots. Preterm labor. Vaginal bleeding.

Blood clots. During pregnancy, the plasma fibrinogen level rises about 50% and plasma fibrin level increases about 40%. These increase the risk of blood clots. The fact that the client stands for prolonged periods increases stasis of blood in the veins of the legs, which further increases the risk for blood clots.

25. Select which nutrients need to be increased more during a multifetal pregnancy than with a single-fetal pregnancy. (Select all that apply). Calories Iron Calcium Folic acid Sodium

Calories Correct Iron Correct Calcium Correct Folic acid Correct

3. During a vaginal exam, the practitioner noted a bluish discoloration of the vagina and labia. This is considered an early sign of pregnancy and is termed: Goodell's sign. Hegar's sign. Chadwick's sign.

Chadwick's sign. Chadwick's sign is a bluish purple color of the vagina and labia caused by the congestion of blood in the area. Goodell's sign is cervical softening. Hegar's sign is the softening of the lower uterine segment due to pregnancy.

1. A new antepartal client states that she is about 15 weeks pregnant. The nurse palpates the fundus midway between the symphysis pubis and umbilicus. The nurse best interprets these findings as: Not congruent; the fundal height is too high for the age of the pregnancy. Not congruent; the fundal height is too low for the age of the pregnancy. Congruent; the fundal height is at the level appropriate for the age of the pregnancy.

Congruent; the fundal height is at the level appropriate for the age of the pregnancy. The fundal height should be midway between the symphysis pubis and umbilicus at about 16 weeks.

30. The decrease in intestinal motility caused by progesterone during pregnancy and the use of iron supplementation increase a woman's risk for _____________.

Constipation

21. Changes in the respiratory system that may be caused by progesterone include which of the following? (Select all that apply). Hypoventilation Decrease in airway resistance by relaxing the smooth muscles Increase in the sensitivity of the respiratory center to carbon dioxide

Decrease in airway resistance by relaxing the smooth muscles Increase in the sensitivity of the respiratory center to carbon dioxide

4. The lab work for a new antepartal client shows a hemoglobin level of 12 g/dL. The client is concerned that she is anemic. The nurse should base the answer on which of the following? A hemoglobin level of 12 g/dL is below normal and may be a sign of iron deficiency anemia. A hemoglobin level of 12 g/dL is above the normal level and is reassuring. Even though a hemoglobin level of 12 g/dL is low for an adult, it is within normal limits for the first trimester of a pregnancy. Even though a hemoglobin level of 12 g/dL is high for an adult, it is within normal limits for the first trimester of a pregnancy.

Even though a hemoglobin level of 12 g/dL is low for an adult, it is within normal limits for the first trimester of a pregnancy. During the first trimester of pregnancy, a hemoglobin level below 11 g/dL is necessary for a diagnosis of iron deficiency anemia. The normal hemoglobin level is lower during pregnancy because of the greatly expanded plasma volume.

13. The antepartal client complains of burning and numbness in her left hand. She is diagnosed with carpal tunnel syndrome. The nurse can explain this is because of: Excessive cortisol production during pregnancy. Decrease in central nervous system stimulation during pregnancy. Excessive edema during pregnancy, compressing the median nerve. Production of relaxin during pregnancy.

Excessive edema during pregnancy, compressing the median nerve. Fluid retention during pregnancy is associated with carpal tunnel syndrome. The edema compresses the median nerve.

18. A new client tells the nurse that she has a 7-year-old boy born full term, a 6-year-old girl was born 5 weeks premature, and 5-year-old twin boys who were 6 weeks premature, and that had a therapeutic abortion last year. In using the GTPAL method of pregnancy outcomes, this client would be: G:5, T:1, P:3, A:1, L:3. G:5, T:1, P:2, A:1, L:4. G:4, T:1, P:2, A:1, L:3. G:4, T:1, P:2, A:1, L:4.

G:5, T:1, P:2, A:1, L:4. GTPAL is used to determine pregnancy outcomes, not number of babies. Gravida (G) is the number of times pregnant; term (T) is the number of pregnancies that have gone to term; preterm (P) is the number of pregnancies that were delivered prior to term; abortion (A) is the number of pregnancies that ended prior to 20 weeks' gestation; and living children (L) is the number of pregnancies that delivered living babies.

27. Inadequate insulin production by the pancreas during pregnancy results in ______________.

Gestational Diabetes

19. Ultrasound examinations may be performed at about 12 to 20 weeks of gestation. The main purpose of this study is to determine: Gestational age and may show some fetal anomalies. The gender of the fetus. Cardiac anomalies. Fetal movement and amniotic fluid amounts.

Gestational age and may show some fetal anomalies. Early in the pregnancy the ultrasound will identify gestational age more accurately than dates and may show some fetal anomalies. The sex of the fetus may be determined at that time, but ultrasounds are not done for that reason. Ultrasounds performed in the third trimester may be done to count fetal movement and determine amniotic fluid amounts

8. A client, 9 months pregnant, calls the clinic with complaints of urinary frequency, urgency, and pain. The nurse's next action should be to: Reassure the client that this is normal after lightening occurs during the last month of pregnancy. Refer the client to a specialist because this is a sign of kidney failure. Have the client come in to be assessed for a urinary tract infection. Assure the client that the problem can wait until her next regular appointment.

Have the client come in to be assessed for a urinary tract infection. Frequency and urgency are normal after lightening because of pressure against the bladder. However, the complaint of pain may indicate a urinary tract infection.

15. A client has come into the clinic stating she was raped 1 week ago. She did not report the rape but is now concerned that she may be pregnant. The pregnancy test that is most likely to be used at this time is the: Immunoassay test. Enzyme-linked immunosorbent assay (ELISA). Home pregnancy test. There is no test available that can be accurate this early in a pregnancy.

Immunoassay test. The radioimmunoassay test can be accurate as early as 1 week after conception.

32. The only vaccines for immunization that should be given to pregnant women are those that are _________________.

Inactivated

10. A client, 6 months pregnant, is concerned because a mole on her abdomen is becoming darker. She has heard that this is a sign of cancer. The nurse should base the answer on which of the following? This is a sign of cancer and the mole should be evaluated by a specialist. It is common for moles to become darker during pregnancy because of the increase in hormones; thus, no action is necessary. It is common for moles to become darker during pregnancy; however, it should be evaluated by the physician. It is a sign of integumentary changes that need to be assessed within the next 2 weeks.

It is common for moles to become darker during pregnancy; however, it should be evaluated by the physician. The increased levels of estrogen, progesterone, and melanocyte-stimulating hormone increase pigmentation in 90% of the pregnant woman. Preexisting moles become darker during pregnancy. However, there is a small risk that a cancer is forming and the client needs to have the mole assessed.

17. The client is in for her first prenatal visit. She tells the nurse that she had a normal period starting on April 3 and spotted on May 1. Using Nagele's rule, the nurse establishes the estimated date of birth as: January 10. February 8. October 6. November 4.

January 10. Nagele's rule is to take the first day of the last normal menstrual period, subtract 3 months, and then add 7 days. Spotting may occur during the time of the first missed period when the embryo implants.

22. Select the functions of progesterone during pregnancy. (Select all that apply). Increases blood supply to uterine vessels Maintains the endometrial layer for implantation Relaxes smooth muscles Stimulates uterine growth Facilitates the deposit of maternal fat stores

Maintains the endometrial layer for implantation Relaxes smooth muscles Facilitates the deposit of maternal fat stores

2. When comparing the uterine souffle to the funic souffle, the uterine souffle would have the same rate as the: Maternal heart rate. Fetal heart rate. Respiratory rate.

Maternal heart rate. The uterine souffle is a soft blowing sound auscultated over the uterus. It corresponds to the maternal pulse. The funic souffle is heard over the umbilical cord and corresponds to the fetal heart rate.

12. The primary function of human chorionic gonadotropin during pregnancy is to: Prevent deterioration of the corpus luteum. Produce the extra amount of estrogen and progesterone that is needed. Prevent release of the luteinizing hormone. Stimulate uterine growth.

Prevent deterioration of the corpus luteum. Human chorionic gonadotropin is produced by the trophoblastic cells and prevents deterioration of the corpus luteum. The corpus luteum produces the progesterone needed for the pregnancy until the placenta is developed.

26. The one hormone from the anterior pituitary that increases during pregnancy is ________________.

Prolactin

5. During pregnancy, the cardiac output is highest when the woman is in which position? Side-lying Sitting Standing Supine

Side-lying Cardiac output is highest when the woman is lying on her side and lower in the sitting, standing, or supine position.

20. A healthy pregnant woman desires to increase her activity level. Which of the following is the best exercise during pregnancy? Step aerobics Skiing Basketball Swimming

Swimming Swimming is an excellent form of exercise during pregnancy because the buoyancy of the water helps prevent injuries. Sports such as step aerobics, skiing, and basketball should be postponed until after birth.

11. A pregnant woman may assume a wide stance when standing and have a waddling gait when walking. This is caused by: Loss of calcium in the bones when it is transferred to the fetus. Strengthening of the connective tissue around the pelvis. The effort to compensate for a changing center of gravity. The strain on the muscles and ligaments of the back.

The effort to compensate for a changing center of gravity. The change of the center of gravity and muscle fatigue cause a wide stance and waddling gait during pregnancy.

24. Select the reasons that a preconception visit is important for a woman. (Select all that apply). To identify preexisting problems that may affect the fetus To identify medications the woman is taking that may be harmful to the fetus To inform her to start increasing her folic acid intake To develop a plan of care for the pregnancy To determine the best time of the year to conceive

To identify preexisting problems that may affect the fetus Correct To identify medications the woman is taking that may be harmful to the fetus Correct To inform her to start increasing her folic acid intake Correct

6. The client, 8 months pregnant, comes into the clinic for her regular appointment. She is lying down in the supine position on the exam table and starts to complain about nausea and dizziness. Her skin is cool and clammy. The next action by the nurse should be to: Take the client's vital signs. Listen to the fetal heart rate. Turn the client onto her side. Wipe her face off with a cool cloth.

Turn the client onto her side. During the second and third trimesters, the weight of the gravid uterus can partially occlude the vena cava when the woman is lying supine. This causes a drop in maternal blood pressure, decrease in cardiac output, and decrease in blood flow to the fetus. The corrective action is to advise the pregnant woman never to lie on her back unless a wedge or pillow is placed under the right hip to displace the uterus away from the vena cava.