OB: Chapter 11: Maternal Adaptation During Pregnancy

If a woman is 3 months pregnant, which finding related to breast changes would the nurse expect to assess?

darkened breast areolae

Which assessment finding in the pregnant woman at 12 weeks of gestation should the nurse find most concerning? The inability to:

detect fetal heart sounds with a Doppler.

During a routine visit to the clinic, a client tells the nurse that she thinks she may be pregnant. The physician prescribes a pregnancy test. The nurse should know the purpose of this test is to determine which change in the client's hormone level?

increase in human chorionic gonadotropin (hCG)

The hormone responsible for the initiation of lactation is what?

prolactin

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse?

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

A client at 36 weeks' gestation comes in for her weekly primary care provider visit. She tells the nurse, "I am having contractions, but they are irregular and go away when I rest. Do you think I am going into labor?" The best response by the nurse would be:

"These are called Braxton-Hicks contractions and are preparing your body for labor but are not 'true' labor contractions."

A client in her second trimester of pregnancy is anxious about the blotchy, brown pigmentation appearing on her forehead and cheeks. She also reports increased pigmentation on her breasts and genitalia. Which statement by the nurse is most appropriate?

"This is called facial melasma and should fade after the birth."

Amanda 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 Amanda's concern?

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

The blood volume in pregnant women increases by what percent?

40 to 50 percent

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?

Goodell's sign

In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which information would the nurse most likely include?

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

During pregnancy, one of progesterone's actions is to allow sodium to be "wasted" or lost in the urine. The nurse would expect to see which hormone increased to help counteract this loss?

aldosterone

Place the following events in the sequence the pregnant woman would experience them, from first to last. All options must be used.

amennorhea uterine enlargement quickening Braxton Hicks contractions labor

As a pregnant woman lies on the examining table, she grows very short of breath and dizzy. This phenomenon probably happens because:

blood is trapped in the vena cava in a supine position.

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 amenorrhea morning sickness

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?

chronic backache

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

Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy?

dilation of the renal pelvis

The nurse explains to a pregnant client, who is anemic, that she will need to take vitamins with iron during her pregnancy. What foods would the nurse include on the client's diet plan?

meats

A nurse is explaining how hormones affect the pregnancy. Which hormone would the nurse describe as being responsible for stimulating uterine contractions during labor and birth?

oxytocin

During pregnancy, there are many psychological changes. What is the most critical component for a positive psychological experience with pregnancy by the woman?

social support

Which change in the breasts should a nurse recognize as a normal change associated with pregnancy?

tingling sensations and tenderness

A client who has just given a blood sample for pregnancy testing in the health care provider's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy?

visualization of the fetus by ultrasound

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

A pregnant woman is experiencing morning sickness. Which response indicates a need for further teaching?

"I'll take antacid between meals."

At 40 weeks' gestation, a woman in for her prenatal visits states to the nurse "I am tired of being pregnant." What is the appropriate response by the nurse?

"That is a very normal feeling, especially at this point in pregnancy."

During pregnancy a woman's breasts change from their prepregnant state. What is one of these changes?

Montgomery's tubercles become more prominent.

During her 12 week prenatal check up, the client informs the nurse on interview that she has developed bumps on the dark part of her nipples. She wants to know what these bumps are. What is the nurse's appropriate answer?

Montgomery's tubercles, secrete lubricant for the nipples

A 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She expresses feeling proud and excited about her pregnancy while at the same time feeling fearful and anxious of its implications. Which action should the nurse do next?

Inform the client this is a normal response to pregnancy that many women experience.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition?

Place the client in the left lateral position.

A nurse conducting a presentation for a group of nurses working at the family health clinic describes the changes in various body systems related to pregnancy. The nurse determines that additional teaching is needed when the group identifies which component as contributing to the pregnant woman's hypercoagulable state?

increased number of red blood cells

A client in her 20th week of gestation expresses concern about her 5-year-old son, who is behaving strangely by not approaching her anymore. He does not seem to be taking the news of a new family member very well. Which strategy can a nurse discuss with the mother to deal with the situation?

Provide constant reinforcement of love and care to the child.

A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate?

"This discharge is normal during pregnancy."

A student nurse asks the instructor about maternal pulse and blood pressure changes during the prenatal period. Which response from the nurse about cardiovascular changes during the first and second trimesters is accurate?

"Women experience increased pulse rate and decreased blood pressure."

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."

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?

1 lb (.45 kg)

Before becoming pregnant, a woman was considered overweight. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by how much per week?

2/3 lb (.66 kg)

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?

24 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. pg 335

A 23-year-old female has come to the clinic for her first prenatal visit. After the examination reveals no concerns and potential low-risk pregnancy, the nurse discusses nutritional needs for her and her growing baby. As per the Institute of Medicine, the nurse suggests the client take which amount of ferrous iron daily?

27 mg

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?

Arrange for prenatal care if the test is positive.

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding?

bruising

A pregnant client states she was unable to breastfeed her last child because her breasts did not produce milk. She desires to breastfeed this child. Which hormones would the nurse monitor to during this pregnancy?

estrogen and human placental lactogen (hPL) Estrogen aids in developing the ductal system of the breasts in preparation for lactation during pregnancy. hPL prepares the mammary glands for lactation. Progesterone supports the endometrium of the uterus to provide an environment conducive to fetal survival. Oxytocin is responsible for uterine contractions, both before and after birth. Oxytocin is also responsible for milk ejection during breastfeeding. pg 346

A pregnant vegan reports that she eats lots of dark green leafy vegetables, legumes, citrus fruits, and berries. To ensure that her infant's nervous system will develop properly, what foods should the nurse recommend that she add to her diet?

fortified cereals

After teaching a class of newly pregnant women about the many changes the female body undergoes during pregnancy, the nurse determines that the teaching was successful when the class identifies which hormones as being secreted by the placenta? Select all that apply.

hCG relaxin estrogen

On a routine hematocrit screen during a prenatal visit, the nurse notices that the client is mildly anemic. When discussing this with the couple, the husband hints that she might be eating unusual things. The nurse recognizes the need for the woman to be evaluated for which condition?

pica

A woman calls the clinic to schedule an appointment because "I think I might be pregnant." Upon further assessment gathering of information from the woman, which finding would be a probable sign of pregnancy?

positive home pregnancy test

Early in pregnancy, frequent urination results mainly from which cause?

pressure on the bladder from the uterus

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 and enlargement of the birth canal. What is this hormone?

relaxin

Which assessment finding in a woman is a positive sign of pregnancy?

visualization of the fetus by ultrasound at 6+ weeks

Which change related to the vital signs is expected in pregnant women?

Blood pressure decreases.

A woman in the second trimester of pregnancy reports that she is "tired all the time." She appears pale and her hematocrit, though within the normal range, is low. Which recommendation would be most helpful for this woman?

an iron supplement

What is a positive sign of pregnancy?

fetal movement felt by examiner

During a routine antepartal visit, a pregnant woman reports a white, thick vaginal discharge. What would the nurse do next?

Ask the woman if she is having any itching or irritation.

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?

Chadwick's sign

A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?

Fundal height has dropped since the last recording.

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's sign. Which description illustrates this alteration?

The cervix softens.