chp6 OB maternal adaptation
What are probable indicators of pregnancy? Select all that apply. 1 Ballottement 2 Urinary frequency 3 Nausea and vomiting 4 Uterine enlargement 5 Braxton Hicks contractions
1,4,5 Probable indicators of pregnancy include ballottement, uterine enlargement, Braxton Hicks contractions, placental souffle, and a positive pregnancy test. Probable indicators combined with presumptive signs strongly suggest pregnancy. Urinary frequency, nausea, and vomiting are presumptive indicators of pregnancy, and these signs alone are not reliable for the diagnosis of pregnancy.
A patient in the first trimester of pregnancy reports feelings of ambivalence. How does the nurse react to this finding? 1 The nurse understands it as a normal response during pregnancy. 2 The nurse refers the patient to a support group. 3 The nurse understands that it may be due to a psychological complication. 4 The nurse reports it to the primary health care provider.
1 Ambivalence is the phenomenon of having conflicting feelings simultaneously. This is a normal response observed in people preparing for a new role, such as parenthood. It is not necessary to refer the patient to a support group, because her response is normal. The patient's ambivalence is not due to any physiological complication. This is not a condition that needs immediate medical supervision.
During a woman's physical examination, the nurse notes that the lower uterine segment is soft on palpation. How does the nurse documents this finding? 1 Hegar sign 2 McDonald sign 3 Chadwick sign 4 Goodell sign
1 Hegar sign
The nurse discusses the developmental tasks of expectant fathers with a prenatal class group. Which issues must the father address to assume the identity as a parent? Select all that apply. 1 Seeking closer ties with his own father 2 Making efforts to be seen as relevant to childbearing 3 Struggling for recognition as a parent from friends and family 4 Incorporating the concepts that the pregnancy and the baby are real into his own life 5 Knowing that his experiences and feelings are shared by other men in the same situation
2,3,4 The responses of the expectant father are dynamic and progress through phases that are subject to individual variation. An expectant father must address making an effort to be seen as relevant to childbearing; struggling for recognition as a parent from his family and social network; and grappling with the reality of pregnancy and the new child. Seeking closer ties with his own father and knowing that his experiences and feelings are shared by other men in the same situation are strategies for resolving the issues that must be addressed by men to become fathers, but they are not among the three actual issues that a man must address to assume the identity of a father.
Some men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms. What is this phenomenon called? 1 Quickening 2 Labor syndrome 3 Couvade syndrome 4 Pregnancy syndrome
3 The phenomenon in which men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms, is called couvade syndrome. Quickening is the mother's first perception of fetal movement. Labor syndrome and pregnancy syndrome are not part of this phenomenon.
With regard to the father's acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know what? 1 The father goes through three phases of acceptance of his own. 2 The father's attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth. 3 In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. 4 Typically men remain ambivalent about fatherhood right up to the birth of their child.
1 A father typically goes through three phases of acceptance: accepting the biologic fact, adjusting to the reality, and focusing on his role. The father-child attachment can be as strong as the mother-child relationship and can begin during pregnancy. In the last 2 months of pregnancy, many expectant fathers work hard to improve the environment of the home for the child. Typically, the expectant father's ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and focusing on his role.
During a patient's physical examination, the nurse notes that the lower uterine segment is soft on palpation. How would the nurse document this finding? 1 Hegar sign 2 McDonald sign 3 Chadwick sign 4 Goodell sign
1 At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy.
A patient who is pregnant used a home pregnancy test that showed a negative result. What will the nurse check for in the medication history of the patient? 1 Diuretics 2 Analgesics 3 Tranquilizers 4 Anticonvulsants
1 Diuretics are the medications that are usually prescribed to a client with hypertension. These drugs may interfere with the levels of human chorionic gonadotropin (hCG) hormone. This may give a false-negative result in a home pregnancy test. Analgesics are the group of drugs used for pain relief. These drugs do not affect the hCG levels and therefore do not show a false report in the home pregnancy test. Tranquilizers are drugs used for reducing anxiety, fear, and tension. The use of a tranquilizer can cause a false-positive test of pregnancy, because it increases the hCG levels. Anticonvulsants are a group of drugs used in treating epileptic seizures; they affect the hCG levels and can cause a false positive test.
The nurse caring for a pregnant woman knows that her health teaching regarding fetal circulation has been effective when the woman reports that she has been sleeping what way? 1 In a side-lying position 2 On her back with a pillow under her knees 3 With the head of the bed elevated 4 On her abdomen
1 Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, thereby enhancing blood flow to the fetus. However, it is now known that either side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, blood return to the right atrium will be diminished. Although lying with the head of the bed elevated is recommended and ideal for later in pregnancy, the woman must still maintain a lateral tilt to the pelvis to avoid compression of the vena cava. Many women will find lying on the abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus.
The nurse is assessing a patient with couvade syndrome. What symptoms is the nurse likely to find? Select all that apply. 1 Nausea 2 Skin rashes 3 Sore throat 4 Weight gain 5 Persistent cough
1,4 Couvade syndrome is a condition in which men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms. During this condition some emotional and physiological changes are observed in men. Couvade syndrome does not have any impact on the skin or throat. Therefore, the patient will not have skin rashes, sore throat, or persistent cough.
The blood pressure of a pregnant patient becomes low when the patient lies on her back. What would be the best nursing intervention to maintain normal blood pressure in the patient? 1 Position the patient to lie on the left side and rest. 2 Suggest that the patient perform aerobic exercises daily. 3 Have the patient stand up and take a deep breath. 4 Tell the patient to lie straight facing up and take frequent rest periods.
1 Pregnant women often experience hypotension when they lie on their backs (in the supine position). The blood that is trying to return to the right atrium is diminished because the uterus is compressing the vena cava. Therefore, the nurse should have the patient lie on either side to rest. This will reduce the uterine pressure on the right atrium and help in optimum circulation. Aerobic exercise will not be helpful in reducing the pressure caused by uterine compression. Making the patient stand up and take deep breaths will worsen the symptoms of hypotension. Making the patient lie in the supine position will further increase the uterine compression and hypotension.
The nurse providing care for a woman at 32 weeks of gestation prepares to measure the patient's blood pressure. Which position does the nurse place the patient in to get the most accurate reading? 1 Sitting 2 Standing 3 Supine 4 Side-lying
1 The most accurate and preferred position for blood pressure measurement is sitting. An accurate blood pressure in pregnant women is affected by the maternal position. Systolic pressure remains largely unchanged, or decreases slightly, if it is measured when the woman is sitting or standing. Arterial pressures are approximately 10 mm Hg lower when the pregnant woman is in a supine or side-lying position than when she is sitting or standing.
The nurse prepares to teach a pregnant patient about the importance of having a healthy store and intake of calcium. What does the nurse include in the teaching? 1 Absorption of calcium from the intestine doubles during pregnancy. 2 Most of the calcium that the fetus needs is taken from maternal bone stores. 3 Maternal stores of calcium are depleted in order to meet fetal calcium needs. 4 Calcium is not absorbed because it is stored for use during the third trimester.
1 The nurse includes the fact that absorption of calcium from the intestine doubles during pregnancy, and it is important to have a healthy store and intake of calcium throughout the pregnancy. Maternal bone stores only provide about 28 to 30 g of calcium, which is small in comparison to the entire body's stores of calcium. Maternal stores of calcium are not depleted in order to meet fetal calcium needs. Calcium is still absorbed by the body during pregnancy, and it is used during the third trimester.
A woman presents to the clinic requesting an early ultrasonography to confirm pregnancy based on symptoms she is experiencing. Which signs and symptoms reported by the patient does the nurse identify as presumptive because they can be caused by conditions other than pregnancy? Select all that apply. 1 Fatigue 2 Urinary frequency 3 Nausea and vomiting 4 Positive fetal movement 5 Absence of menstruation 6 Positive fetal heart sounds
1,2,3,5 Fatigue, urinary frequency, nausea and vomiting, and the absence of menstruation are presumptive signs of pregnancy. This means that they are subjective signs experienced and reported by women but are the least reliable because many other conditions can cause the same signs and symptoms. Positive fetal movement and heart sounds are definitive objective signs of pregnancy that can be verified by health care providers and are only attributable to pregnancy.
During the first trimester of pregnancy the woman experiences a variety of psychological responses. The nurse assessing a patient at this stage of pregnancy expects to observe which reactions? Select all that apply. 1 Ambivalence 2 Self as a primary focus 3 Fetus as a primary focus 4 Quickly changing moods 5 Fantasizing about the baby after birth
1,2,4 Whether or not the pregnancy is planned, upon confirmation most women are ambivalent, or have conflicting feelings about being pregnant, because it will have permanent effects on their lives. Throughout the first trimester the woman's primary focus is on herself. Physical changes and hormonal changes in pregnancy result in emotional liability and quickly changing moods throughout the first trimester. Once the second trimester begins the pregnant woman's focus shifts to the fetus and fantasies about life after the baby is born
The nurse is teaching a prenatal class for expectant parents and informs the group that oxygen consumption rises by 20% in pregnancy. Which organs account for this increased oxygen requirement? Select all that apply. 1 Expanding uterus 2 Fetus and placenta 3 Maternal digestive system 4 Maternal heart and kidneys 5 Maternal respiratory and breast tissues
1,2,4,5 Oxygen consumption increases by 20% in pregnancy, with half of the increase used by the expanding uterus, the fetus, and the placenta; 30% used by the maternal heart and kidneys; and the rest used by the maternal respiratory muscles and breast tissues. The maternal digestive system slows down during pregnancy due to the effects of progesterone, so there is no increased need for oxygen consumption by this system.
A pregnant woman and her partner are attending a third trimester prenatal class, and the partner asks the nurse teaching the class why the pregnant woman frequently reports a backache and appears to waddle when she walks. The nurse describes which normal occurrences of pregnancy that account for the changes in the woman's posture and gait? Select all that apply. 1 Relaxin and progesterone cause relaxation of ligaments. 2 Increased mobility of pelvic joints causes a wider stance. 3 The spouse has gained too much weight during pregnancy. 4 Progressive lordosis during pregnancy often leads to backache. 5 The enlarging uterus is heavy and causes the mother to lean backward.
1,2,4,5 Relaxin and progesterone initiate relaxation of the ligaments from 28 to 30 weeks, then the pelvic symphysis separates. The increased mobility of the pelvic joints causes the pregnant woman to assume a wide stance with the "waddling" gait of pregnancy. Progressive lordosis, or curvature of the lower spine, often leads to backache and is caused by the uterus increasing in size and weight, causing the expectant mother to lean backward to maintain her balance. There is no indication in the scenario that the pregnant woman has gained an excessive amount of weight, although pre-pregnancy obesity and back problems increase the intensity of issues during pregnancy.
Which are considered presumptive indications of pregnancy? Select all that apply. 1 Fatigue 2 Amenorrhea 3 Ballottement 4 Uterine souffle 5 Cervical softening 6 Breast and skin changes
1,2,6 Fatigue, amenorrhea, and breast and skin changes are presumptive indications of pregnancy. Ballottement, uterine souffle, and cervical softening are considered probable indications of pregnancy.
What signs should the nurse include in the lesson while explaining the presumptive signs of pregnancy toR a group of women? Select all that apply. 1 Fatigue 2 Hegar sign 3 Quickening 4 Amenorrhea 5 Ballottement
1,3,4 The changes that occur during pregnancy are classified into three categories, namely presumptive, probable, and positive signs of pregnancy. Presumptive signs of pregnancy are the signs or changes felt by the women which may have other causes other than pregnancy. Fatigue, quickening, and amenorrhea are some of the presumptive signs of pregnancy. The Hegar sign is a probable sign of pregnancy but can potentially be caused by something other than pregnancy. The Hegar sign indicates the compressibility of the lower uterine segment, which cannot be felt by the woman. Ballottement is a technique of palpating a fetus by inserting a finger into the vagina, bouncing it gently, and feeling the fetus rebound. It is a probable sign of pregnancy.
Pregnant women spend a great deal of time and energy learning new behaviors to become mothers. As the woman works to establish a relationship with the infant, she must also reorder her relationship with her partner and family through which maternal tasks of pregnancy? Select all that apply. 1 Seeking safe passage 2 Resolving problems 3 Securing acceptance 4 Learning to give more of herself 5 Committing herself to the unknown child
1,3,4,5 As the woman works to establish a relationship with the infant, she must also reorder her relationship with her partner and family. This psychological work of pregnancy has been grouped into four maternal tasks: seeking safe passage for herself and the baby through pregnancy, labor, and childbirth; securing acceptance of the baby and herself from her partner and family; learning to give more of herself; and developing attachment and interconnection with the unknown child. Resolving problems occurs in conjunction with each of the four maternal tasks; it is not a task on its own.
The nurse assesses a primipara at 26 weeks of gestation who has always exercised extensively and actively participated in sports. The woman expresses concerns about brown marks on her face and feeling "fat and ugly." After educating the patient and her partner about normal emotional and physical changes during pregnancy, the nurse expects which outcomes for the next prenatal visit? Select all that apply. 1 Expresses feelings about body changes to her partner and the health care team 2 Continues to exercise and actively participate in sports as she did pre-pregnancy 3 Acknowledges realistic expectations about weight gain and exercise during pregnancy 4 Continues to report mutually satisfying sexual activity with her partner during pregnancy 5 Makes statements that demonstrate positive acceptance of expected pregnancy body changes
1,3,4,5 Expected outcomes to be evaluated at the patient's next prenatal visit include expressing feelings about body changes to her partner and the health care team; setting realistic expectations for weight gain and exercise during pregnancy; continuing mutually satisfactory sexual activity during pregnancy; and making statements that indicate acceptance of expected body changes during her pregnancy. The patient and the health care team should acknowledge that not all pre-pregnancy exercise may be possible, so they should plan only activities that won't cause injury to the woman and the fetus.
A pregnant woman at 32 weeks of gestation presents to the prenatal clinical for her scheduled appointment. She expresses concern as she describes changes in her skin during pregnancy. Which normal integumentary changes does the nurse expect to observe in an assessment? Select all that apply. 1 Chloasma 2 Linea alba 3 Linea nigra 4 Darkened areola 5 Palmar erythema
1,3,4,5 Increased pigmentation from elevated levels of estrogen, progesterone, and melanocyte-stimulating hormone occurs in 91% of pregnant women. Areas of pigmentation include brownish patches called melasma and chloasma, which is referred to as the mask of pregnancy and involves the forehead, cheeks, and bridge of the nose. The linea alba, or the line that marks the longitudinal division of the midline of the abdomen, darkens to become the linea nigra during pregnancy due to hormonal changes. Preexisting moles (nevi), freckles, and the areolae become darker as pregnancy progresses. Redness of the hands or soles of the feet, known as palmar erythema, is normal due to the increased blood volume and increased vascularization during pregnancy. Because the linea alba darkens and becomes the linea nigra, the nurse would not expect to see it in a pregnant woman.
The nurse assesses a pregnant woman at 26 weeks of gestation for changes in sensory organs. Which normal findings does the nurse expect to see during this stage of pregnancy? Select all that apply. 1 Nasal stuffiness 2 Olfactory deficits 3 Mild, temporary hearing loss 4 Intraocular pressure decreases 5 Discomfort wearing contact lenses
1,3,4,5 Nearly 30% of women experience nasal congestion at some point in their pregnancy. This is also known as rhinitis of pregnancy because pregnancy hormones usually cause inflammation in the nasal passages leading to a blocked nose. ] Ear changes in the mucous membranes of the Eustachian tube, such as increased levels of estrogen, may cause women to have blocked ears and mild, temporary hearing loss. The nurse can also expect to find intraocular pressure decreasing. Corneal edema may cause women who wear contact lenses to have some discomfort. The problem resolves after childbirth so women should not get new prescriptions for lenses until several weeks after delivery. Olfactory deficits are not a common problem during pregnancy; pregnant women are usually very sensitive to odors and find many of them too intense.
The nurse is teaching a prenatal class and discusses the four maternal tasks of pregnancy. The nurse assists the expectant mothers in understanding how their feelings and behaviors correlate with these tasks. Which behaviors best demonstrate the "committing herself to the unborn child" task? Select all that apply. 1 The pregnant woman integrates the role of mother into the image of herself. 2 The pregnant woman expresses concern about her ability to mother the infant. 3 Expectant mothers report feedback from their unborn infants during the third trimester. 4 The mother's love for the infant becomes possessive and leads to feelings of vulnerability. 5 The pregnant woman becomes comfortable with the idea of herself as a mother and finds pleasure in contemplating the new role. 6 The pregnant woman describes unique characteristics of the fetus regarding sleep-wake cycles, temperament, and communication.
1,3,4,5,6 The behaviors that best demonstrate the "committing herself to the unborn child" task include integrating the role of mother into the image of herself; reporting feedback from the unborn infant during the third trimester; loving the infant, becoming possessive and leading to feelings of vulnerability; becoming comfortable with the idea of being a mother and finding pleasure in contemplating the new role; and describing unique characteristics of the fetus about sleep-wake cycles, temperament, and communication. Expressing concern about the ability to mother the infant is not one of the normal behaviors of a pregnant woman demonstrating the commitment of herself to the unborn child. Instead, these feelings are a part of ambivalence from the first trimester.
The nursing instructor is educating a student nurse about the hormone human chorionic somatomammotropin. What points should the instructor teach the student nurse? Select all that apply. 1 It facilitates glucose transport across the placental membrane. 2 It promotes growth of the uterus and uteroplacental blood flow. 3 It maintains the endometrium and decreases uterine contractility. 4 It stimulates breast development in order to prepare for lactation. 5 It stimulates maternal metabolism to supply nutrients to the fetus.
1,4,5 Human chorionic somatomammotropin is a protein hormone produced by the placenta. It facilitates glucose transport across the placental membrane, stimulates breast development to prepare for lactation, and accelerates maternal metabolism to supply needed nutrients to the fetus. Estrogen produced by the placenta stimulates uterine growth and uteroplacental blood flow. Progesterone, which maintains the endometrium and decreases the contractility of the uterus, is another proteinaceous hormone produced by the placenta.
The nursing instructor reminds students who are providing care for pregnant patients that the total blood volume increase reaches an average of 30-45% during pregnancy. This average is related to which maternal and fetal requirements? Select all that apply. 1 Meeting the demands of the expanded maternal tissue in the uterus and breasts 2 Providing the pregnant woman with an increased energy reserve to reduce fatigue during pregnancy 3 Increasing systemic vascular resistance during pregnancy in order to maintain stable diastolic blood pressure 4 Assuring transportation of nutrients and oxygen to the placenta, where they become available for the growing fetus 5 Providing a reserve to protect the pregnant woman from the adverse effects of blood loss that can occur during childbirth
1,4,5 Total blood volume increase begins by 6 weeks of gestation and reaches an average of 30-45% during pregnancy. The increased blood volume during pregnancy is needed to meet the demands of the expanded maternal tissue in the uterus and breasts; transport nutrients and oxygen to the placenta, where they become available for the growing fetus; and provide a reserve to protect the pregnant woman from the adverse effects of blood loss that occur during childbirth. The increased blood volume does not increase the energy reserve for the pregnant woman; this is accomplished through adequate nutrition, exercise, and rest. Systemic vascular resistance, not increased vascular resistance, is normal during pregnancy because of vasodilation, the utero-placental unit, increased heat production, decreased sensitivity of angiotensin II, and relaxant factors.
A woman who is 26 weeks pregnant asks the nurse why she has to urinate so frequently. After verifying that the patient's urine sample indicates no urinary tract infection, the nurse explains which factors increase urinary frequency during pregnancy? Select all that apply. 1 Hormonal influences 2 Increased blood volume 3 Consuming too much liquid 4 Changes in renal blood flow 5 Uterine expansion within the pelvis
1.2.4.5 Progesterone influences the relaxation of the smooth muscle tissue of the urinary tract, which results in a urinary urgency and frequency during pregnancy. The total blood volume increase reaches an average of 30% to 45% during pregnancy. Renal plasma flow increases by 50% to 80% during pregnancy. This change results from an increase in plasma volume and cardiac output. The flow is highest when the woman is in the left side-lying position. The glomerular filtration rate rises by as much as 50% because of the higher renal blood flow. Pressure from the expanded uterus pushes the base of the bladder forward and upward near the end of the pregnancy. Consuming too much liquid is not a typical problem during pregnancy since pregnant women are encouraged to drink at least six to eight glasses of water each day. Consuming liquids is not responsible for the pregnant woman's increased urinary frequency during pregnancy.
The nurse provides care to a patient who is at 14 weeks of gestation. Which finding does the nurse anticipate? 1 The patient exhibits Chadwick sign. 2 The uterus has risen into the abdomen. 3 Braxton Hicks contractions are palpable. 4 The fundus is at the level of the umbilicus.
2 At 14 weeks of gestation, the nurse anticipates that the uterus would have risen into the abdomen. This is a normal finding by 13 to 16 weeks of gestation. The patient exhibits Chadwick signs at 5 to 8 weeks of gestation, not 14. Braxton Hicks contractions are palpable at 17 to 20 weeks of gestation, not 14. The fundus is at the level of the umbilicus at 20 weeks of gestation. At 14 weeks of gestation, the fundus is midway between the symphysis pubis and the umbilicus.
Due to the increased blood volume and influence of progesterone, what is the average decrease in diastolic blood pressure during pregnancy? 1 5 to 10 mm Hg 2 10 to 15 mm Hg 3 15 to 20 mm Hg 4 20 to 25 mm Hg
2 Due to the increased blood volume and influence of progesterone, blood pressure changes during pregnancy are minimal, with the diastolic pressure decreasing slightly, by about 10 to 15 mm Hg. The average change in diastolic blood pressure during pregnancy is greater than 5 to 10 mm Hg, but less than 15 to 20 and 20 to 5 mm Hg.
The nurse is teaching a pregnant patient who complains of vomiting about the use of dry carbohydrate in the morning. The patient asks the nurse, "My husband has similar problems. Will it be useful for my husband as well?" What can the nurse interpret that the husband has? 1 Vena cava syndrome 2 Couvade syndrome 3 Carpal tunnel syndrome 4 Brachial plexus traction syndrome
2 Intake of dry carbohydrate is recommended in a pregnant patient's diet in order to suppress the vomiting observed during early pregnancy. Sometimes pregnancy symptoms are also experienced by the male partner. This is called couvade syndrome. Vena cava syndrome (supine hypotension) and carpal tunnel syndrome are not affected by intake of dry carbohydrate. Brachial plexus traction syndrome is manifested as drooping of the shoulder, which eventually disappears after childbirth. A dry carbohydrate diet has no effect on brachial plexus traction syndrome
A student nurse is teaching a group of pregnant women about sibling adaptation. Which statement by one of the patients indicates a need for additional teaching? 1 "Show the child how to touch the baby." 2 "Exclude the child during infant feeding times." 3 "Don't force interactions between the child and the baby." 4 "Help the child to have realistic expectations about the baby."
2 It is very important to help siblings adapt to their mother's pregnancy and accept the arrival of a new baby into the family. The child shouldn't be excluded during infant feeding times, because this may cause a feeling of separation. Mothers should be encouraged to teach their children how and where to touch the baby. This encourages the child to get attached to the baby. The child should be left free while interacting with the neonate, but interactions should not be forced. The child should be encouraged to have realistic expectations about what babies are like.
A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates an understanding of the nurse's instructions if she states that which one of these is a positive sign of pregnancy? 1 A positive pregnancy test 2 Fetal movement palpated by the nurse-midwife 3 Braxton Hicks contractions 4 Quickening
2 Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. A positive pregnancy test is a probable sign of pregnancy. Braxton Hicks contractions are a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy.
The nurse is providing care for a patient with twins during labor. The nurse instructs the patient to avoid lying flat on her back. Which condition does the nurse aim to prevent in the patient during labor? 1 Valsalva maneuver 2 Supine hypotension 3 Respiratory alkalosis 4 Painful uterine contractions
2 Supine hypotension may be seen in the pregnant patient when the ascending vena cava and descending aorta are compressed. The patient is more at risk for hypotension in the case of multifetal pregnancy due to a drop in hydrostatic pressure when lying supine. Valsalva maneuver refers to the client holding her breath and tightening the abdominal muscles to help with pushing. Respiratory alkalosis may occur in a pregnant patient due to hyperventilation and not by lying flat on the back. Epidural analgesia is often prescribed to decrease pain experienced during uterine contractions.
When does human chorionic gonadotropin (hCG) reach its maximum levels in a pregnant woman? 1 Between 30 and 50 days into the pregnancy 2 Between 50 and 70 days into the pregnancy 3 Between 70 and 90 days into the pregnancy 4 Between 90 and 100 days into the pregnancy
2 The protein hormone hCG can be detected in the maternal serum by 8 to 10 days after conception, shortly after implantation. The hCG helps preserve the function of the ovarian corpus luteum and ensures the continued supply of estrogen and progesterone required to maintain pregnancy. The hCG reaches its maximum level at 50 to 70 days and then begins to decrease. The hCG levels are still increasing between 30 and 50 days of pregnancy; hCG levels will decrease at 70 to 90 days of pregnancy or at 90 to 100 days of pregnancy.
The nurse recognizes an expectant mother in the first trimester of pregnancy will most likely experience which step in maternal role-taking when she wears maternity clothes before they are needed and assumes a waddling gait before the normally associated physical changes occur for her? 1 Fantasy 2 Mimicry 3 Role play 4 Search for role fit
2 Mimicry often begins in the first trimester when the woman may wear maternity clothes before they are needed to understand the feelings of women in more advanced stages of pregnancy and see how others react to her. She may also mimic the waddling gait or posture of a woman who is close to delivery long before these changes become necessary for her. Fantasy usually occurs during the second and third trimesters and includes both positive feelings, such as how the baby will look and what characteristics the baby will have, and fear in which the baby's father may not love the baby if it is not perfect. Role play consists of acting out some aspects of what mothers do in order to practice the expected role and receive validation from an experienced observer that she is functioning well. The woman may search for role fit during this period as well. Topics
The nurse providing care for a patient at 35 weeks of gestation auscultates the heart and lungs. Which changes in movement does the nurse make per the location normally used to auscultate for heart sounds in the pregnant woman? 1 Shift upward and inward 2 Shift upward and laterally 3 Shift downward and inward 4 Shift downward and laterally
2 The locations for auscultation of heart sounds may be shifted upward and laterally in late pregnancy. The heart is pushed upward and to the left as the uterus elevates the diaphragm during the third trimester. If the nurse shifts upward and inward, downward and inward, or downward and laterally, the nurse will not best be able to auscultate the pregnant patient's heart sounds.
The nurse is developing a plan of care for a pregnant patient. Which nursing intervention helps to ensure adequate blood supply to the fetus? 1 Encourage the patient to lie down in the supine position. 2 Encourage the patient to recline in the side-lying position. 3 Encourage the patient to do vigorous exercises regularly. 4 Encourage the patient to decrease the intake of folic acid.
2 When the pregnant patient reclines in a side-lying position, it facilitates optimal blood circulation to the uterus. When the pregnant patient lies in the supine position, the pressure on the uterus compresses the inferior vena cava. This reduces the blood return to the right atrium and, in turn, causes decreased uterine circulation. This may lead to intrauterine growth restriction of the fetus. Excessive or vigorous maternal exercise diverts the blood away from the uterus to the skeletal muscles and this compromises placental circulation. A nurse would not advise a pregnant woman to decrease her folic acid intake, because this is an important vitamin for fetal development.
An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" What is the nurse's best response? 1 "This is normal behavior and should begin to subside by the second trimester." 2 "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor I know." 3 "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." 4 "You seem impatient with her. Perhaps this is precipitating her behavior."
3 "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant" is the most appropriate response because it gives an explanation and a time frame for when the mood swings may stop. "This is normal behavior and should begin to subside by the second trimester" is an appropriate response but it does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. "You seem impatient with her. Perhaps this is precipitating her behavior" is judgmental and not appropriate.
After reviewing a patient's urine analysis report, the nurse finds that the patient is pregnant. Based on the presence of which hormone did the nurse made such conclusion? 1 Estrogen 2 Progesterone 3 Human chorionic gonadotropin 4 Human chorionic somatomammotropin
3 Human chorionic gonadotropin is the hormone detected in the maternal serum around 8 to 10 days after conception. Therefore, the presence of human chorionic gonadotropin in the urine sample indicates that the patient is pregnant. This hormone helps to maintain the levels of estrogen and progesterone during pregnancy. Estrogen and progesterone are steroid hormones. They are present in females. The levels of progesterone decrease during labor. Human chorionic somatomammotropin is a protein hormone secreted by the placenta. It is secreted only during pregnancy but it is not used to detect pregnancy, because it is not detected in the maternal serum.
The nurse conducts an assessment on a patient and observes that the patient has congestion and blood of the cervix. Which term will the nurse use to document this finding? 1 Ptyalism 2 Colostrum 3 Hyperemia 4 Chadwick sign
3 Hyperemia is the term that describes congestion and blood of the cervix, which may be caused by increasing levels of estrogen. Ptyalism is excessive salivation, which some women experience when they are pregnant. Colostrum is a thick, yellowish fluid secreted from the sebaceous glands as early as 16 weeks of gestation. Chadwick sign is a bluish-purple discoloration that extends into the vagina and labia and is one of the earliest signs of pregnancy.
The obstetric nurse recognizes which hormone referred to as the "hormone of pregnancy" must be present in adequate amounts from the earliest stages to maintain pregnancy? 1 Estrogen 2 Prolactin 3 Progesterone 4 Luteinizing hormone
3 Progesterone is called the "hormone of pregnancy" because there must be adequate amounts from the earliest stages to maintain pregnancy. Progesterone helps suppress contractions of the uterus and may help prevent tissue rejection of the fetus. Estrogen is produced by the ovaries and later by the placenta and helps the uterus grow, maintains the uterine lining, increases blood circulation, and activates and regulates the production of other key hormones. Prolactin, or the luteotropic hormone, is a protein best known for its role in enabling females to produce milk. Luteinizing hormone (LH) is produced by gonadotropic cells in the anterior pituitary gland. In females, an acute rise of LH triggers ovulation and development of the corpus luteum.
The nurse is examining a patient who states that she may be pregnant. The nurse assesses the patient's cervix for a bluish-purple color that extends to the vagina and labia. Which refers to this early sign of pregnancy? 1 Goodell sign 2 Lightening sign 3 Chadwick sign 4 Braxton Hicks sign
3 The bluish-purple discoloration is referred to as the Chadwick sign and is one of the earliest signs of pregnancy. Goodell sign refers to the cervical softening after conception that causes the cervix to feel more like the lips or earlobe. The lightening sign occurs around 40 weeks gestation when the fetal head descends into the pelvic cavity and the uterus sinks to a lower level. This descent of the fetal head is called lightening because it reduces pressure on the diaphragm and makes breathing easier. Throughout pregnancy, the uterus undergoes irregular contractions called Braxton Hicks.
The nurse is teaching prenatal classes and is asked by several of the expectant partners why the pregnant women seem to be excessively dependent on them during the third trimester of pregnancy. Which is the best explanation by the nurse for this psychological response during the third trimester? 1 The woman may worry about the added responsibility and feel unsure of her ability to be a good parent. 2 The expectant mother is examining her relationships with others and how these ties will change after the birth. 3 The pregnant woman has a need to be reassured of her partner's concern and willingness to provide assistance, so that she feels more secure and able to cope. 4 During this time, many women become increasingly concerned about their ability to protect and provide for the fetus, which is manifested as narcissism and introversion. 00:00:28 Question Answer Confidence ButtonsJust a guessPretty sureNailed it
3 The expectant mother's need for love and attention from her partner is even more pronounced in late pregnancy. When she is reassured of her partner's concern and willingness to provide assistance, she feels more secure and able to cope. Although the woman may worry about the added responsibility and feel unsure of her ability to be a good parent, this concern is commonly addressed and resolved during the first trimester, not the third trimester. Expectant mothers examine their relationships with others and how these ties will change after the birth primarily during the second trimester. Pregnant women become increasingly concerned about their ability to protect and provide for the fetus, which is manifested as narcissism and introversion, during the second trimester.
A pregnant woman who is unsure of her number of weeks of gestation presents to the prenatal clinic for her first visit. She states that she has not had a menstrual period for the past 4 months, but her periods have always been irregular. Upon examining the patient's abdomen, the nurse recognizes that at 16 weeks of gestation, the fundus measures at which height? 1 At the umbilicus 2 At the xiphoid process 3 Just above the symphysis pubis 4 Midway between the symphysis pubis and the umbilicus
3 At 16 weeks of gestation the fundus measures midway between the symphysis pubis and the umbilicus. At 20 weeks, the fundus measures at the umbilicus; at 36 weeks, the fundus measures at the xiphoid process; and at 12 weeks, the fundus measures just above the symphysis pubis.
The nurse is assessing a pregnant woman and observes that the character of the patient's respirations is most likely changed due to pregnancy. In order to compensate for the increased oxygen needs by the pregnant woman, progesterone causes the patient to make which changes in respiration? Select all that apply. 1 Increase respiratory rate 2 Decrease respiratory rate 3 Maintain usual respiratory rate 4 Hyperventilate slightly by breathing more deeply 5 Breathe more shallowly to perform hypoven
3,4 Although the respiratory rate remains unchanged, to compensate for the increased oxygen need, progesterone causes the pregnant woman to hyperventilate slightly by breathing more deeply. There is no need for the mother to increase or decrease respiratory rate or to attempt hypoventilation by breathing more shallowly; these actions may cause dizziness, decreased oxygenation, and potential fall injuries for the patient.
The nurse is teaching a prenatal class and tells the group that because immune function is altered during pregnancy in order to allow the fetus to grow without being rejected by the woman's body, which autoimmune conditions may improve during pregnancy? Select all that apply. 1 Herpes simplex 2 Cytomegalovirus 3 Multiple sclerosis 4 Rheumatoid arthritis 5 Varicella-zoster virus
3,4 Immune function is altered during pregnancy to allow the fetus, which is foreign tissue for the mother, to grow undisturbed without being rejected by the woman's body. This may cause some autoimmune conditions such as multiple sclerosis and rheumatoid arthritis to improve during pregnancy. Resistance to some infections is decreased, and some viral and fungal infections occur more often during pregnancy. The herpes simplex virus, cytomegalovirus, and varicella-zoster virus are among those of particular concern during pregnancy because they can cause congenital viral infections.
Which testing should the nurse perform to determine if a patient is pregnant? 1 Linkage testing 2 Molecular testing 3 Cytogenetic testing 4 Biochemical testing
4 Biochemical testing involves examining proteins and protein products of the genes. A pregnancy confirmation test involves the detection of human chronic gonadotropin (hCG), which is a protein hormone. Biochemical testing for hCG confirms pregnancy within 8 to 10 days of conception. Linkage testing, molecular testing, and cytogenic testing are not helpful in pregnancy testing. Linkage testing is helpful for identifying marker sequences corresponding with the affected gene. Molecular testing is the analysis of nucleic acids. Cytogenetic testing helps in detecting abnormalities in the chromosomes.
The nurse suspects that a patient is pregnant and asks the patient to take a pregnancy test. What finding would indicate that the test result is positive? 1 Presence of cortisol in the serum 2 Presence of estrogen in the serum 3 Presence of progesterone in the serum 4 Presence of human chorionic gonadotropin in the serum
4 One of the early functions of a placenta is to act as an endocrine gland and produce a proteinaceous hormone called human chorionic gonadotropin, which can be detected by blood tests as early as 8 to 10 days after conception. Pregnancy tests specifically test for the presence of this hormone. Cortisol is produced by the adrenal glands in both men and women and has no impact on pregnancy. Progesterone and estrogen are found in female patients regardless of pregnancy. These levels fluctuate depending on the ovulation cycle. During pregnancy, levels of estrogen and progesterone may fluctuate depending on the gestation period.
Why might a pregnant woman at 28 weeks of gestation frequently feel hungry? 1 The mother's tissue sensitivity to insulin increases. 2 The mother's fasting blood glucose levels increase. 3 Blood glucose levels increase 10% to 20% during pregnancy. 4 Blood glucose levels are 10% to 20% lower than before pregnancy.
4 Significant changes in the pancreas during pregnancy are the result of alterations in maternal blood glucose levels and fluctuations in insulin production. Blood glucose levels are 10% to 20% lower than before pregnancy. Hypoglycemia may develop between meals and at night as the fetus continuously draws glucose from the mother. During the second half of pregnancy, maternal tissue sensitivity to insulin begins to decline because of the effects of human chorionic somatomammotropin, prolactin, estrogen, progesterone, and cortisol. The fasting blood glucose level is decreased as glucose passes to the fetus. Maternal blood glucose levels decrease during pregnancy, not increase.
The nurse provides care to a patient who just found out that she is 8 weeks pregnant. She expresses to the nurse that she is excited. However, she is not sure what she is going to do about her upcoming work trip, or what this means for her career in general. She suddenly begins to show conflicting feelings. What is the patient experiencing? 1 Narcissism 2 Uncertainty 3 Introversion 4 Ambivalence
4 This patient is exhibiting ambivalence, which means having conflicting feelings; this is a normal reaction in the first trimester. Narcissism is a finding that is more common in the second trimester, and refers to undue preoccupation with oneself. Uncertainty occurs in the first trimester, and is marked by the patient seeking confirmation from a physician, nurse-midwife, or nurse practitioner. Introversion is a finding that is more common in the second trimester, and refers to the concentration on oneself and the body.
An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. What should the nurse tell the couple? 1 Intercourse should be avoided if any spotting from the vagina occurs afterward. 2 Intercourse is safe until the third trimester. 3 Safer-sex practices should be used once the membranes rupture. 4 Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.
4 Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor. Some spotting can normally occur because of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse.
What nursing interventions will help a woman reorder her relationships as she adapts to pregnancy? Select all that apply. 1 Suggesting that she and her partner attend parenting classes 2 Discussing the parental qualities she would like to possess 3 Suggesting that she get adequate physical rest 4 Promoting sexual expression between the pregnant woman and her partner 5 Promoting communication between the pregnant woman and her mother
4,5 Pregnancy is a maturational milestone during which the woman prepares for a new level of caring and responsibility. Effective communication and sexual expression between the woman and her partner are important during pregnancy. Effective communication between the pregnant woman and her own mother is also important in reordering another key relationship during pregnancy. Attending parenting classes helps the woman prepare for delivery. Discussing parental qualities would help the couple to accept the pregnancy and identify their parental roles. Physical rest is required in the first trimester when the woman feels very fatigued. However, these interventions are not helpful in reordering the relationships during the process of adaptation to pregnancy.
In which order should the developmental tasks required to achieve maternal adaptation be achieved? 1. Preparing for the birth experience 2. Accepting the pregnancy 3. Identifying with the role of mother 4. Establishing a relationship with the unborn child 5. Reordering the relationships between herself and her mother 6. Reordering the relationships between herself and her partner
The developmental tasks required to achieve maternal adaptation include: 1. accepting the pregnancy, 2. identifying with the role of mother, 3. reordering the relationships between herself and her mother 4. and between herself and her partner, 5. establishing a relationship with the unborn child, 6. preparing for the birth experience. The partner's emotional support is an important factor in successfully accomplishing these developmental tasks. Single women with limited support can have difficulty making this adaptation.
The nurse provides care to a pregnant patient at 15 weeks of gestation. The patient is experiencing vascular changes in the skin, including hyperpigmentation. What does the nurse understand about this physiological change? 1 The patient is experiencing a major effect of prolactin. 2 The patient is experiencing an overproduction of aldosterone. 3 The patient is experiencing an insufficient release of oxytocin. 4 The patient is experiencing a reaction to the increase of estrogen in the body.
This patient is experiencing a reaction to the increase of estrogen in the body, which can result in hyperpigmentation. Estrogen is the hormone that is responsible for causing vascular changes in the skin, uterus, respiratory tract, and even the bladder. Prolactin is the hormone responsible for milk production and also acts as an insulin antagonist. Aldosterone is the hormone responsible for conserving sodium and maintaining fluid balance. Oxytocin is the hormone responsible for stimulating uterine contractions and milk ejection after birth.
