Mater Chapter 6

During a visit to the clinic, a client in the first trimester tells the nurse, "My nose is so stuffy, lately. Could I have a cold?" Which response by the nurse is appropriate?

"A stuffy nose is common in pregnancy because of high estrogen levels."

The nurse is concerned that a pregnant client is not adjusting emotionally to being pregnant. Which statement indicates that the client may need additional counseling?

"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?

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

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?

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

A client is about 16 weeks' pregnant and is concerned because they feels their "abdomen" contracting. The client calls the health 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."

A client's prepregnant weight is within the normal range. During the second trimester, the nurse would determine that the client is gaining the appropriate amount of weight when their weight increases by which amount per week?

1 lb (0.45 kg)

A urinalysis is done on a client in the third trimester. Which result would be considered abnormal?

2+ Protein in urine

The nurse obtains a human chorionic gonadotropin (hCG) level from a client who thinks that they are pregnant. Which result would the nurse identify as a positive pregnancy result?

32 mIU/mL (32 IU/L) anything below 5 is negative anything above 25 is positive

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

85 beats per minute.

A client tells the nurse that they are going to use a home pregnancy test to determine whether they are pregnant. Which precautions should the nurse give the client?

Arrange for prenatal care if the test is positive.

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

Blood pressure decreases.

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and their heart rate is 12 beats per minute higher than at their last visit. How should the nurse interpret these findings?

Both findings are normal at this point of the pregnancy.

Which would be a normal finding by the nurse during a physical exam of a client in the third trimester?

Dyspnea

What physiological changes would be noted in a pregnant client? Select all that apply.

Enlarged pituitary gland Lordosis Delayed gastric emptying and decreased peristalsis

The nurse is performing an assessment of a client who has come to a health care facility for a diagnosis of pregnancy. The client 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 the notes?

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?

Halfway between the symphysis pubis and the umbilicus

A 22-year-old client comes to the walk-in clinic reporting 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?

A client comes to the prenatal clinic and undergoes a pelvic exam. The health care provider notes a softening of the uterine isthmus. The nurse recognizes that this finding is known as what sign?

Hegar sign

During a vaginal exam, the nurse notes that the lower uterine segment is softened. How should the nurse document this finding?

Hegar sign

A pregnant client may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem?

Hemorrhoids

A client at 24 weeks' gestation is seen for a routine monthly check up. The client reports concerns to the nurse about rest periods. The client states that when they awaken they feel weak and lightheaded. What is the most appropriate initial action by the nurse?

Inquire about the client's sleeping positions.

What would the nurse recommend to a pregnant client at 35 weeks' gestation who reports irregular contractions and lower backache?

Lie down and rest and see if the contractions stop and pain subsides.

An obstetrical nurse is conducting a program for pregnant clients who are in their first trimester. The program focuses on the changes occurring in the client's body as a result of the pregnancy. When describing the effect of changing hormonal levels, which information would the nurse most likely include? Select all that apply.

Maintenance of the endometrium so that the embryo can implant Metabolic changes in the client to make nutrients available for client and fetus Relaxation of the ligaments that connect the pelvic bones, allowing them to spread slightly Preparing the breasts for lactation, keeping the milk from coming in until birth occurs

The partner of a pregnant client in their first trimester asks the nurse about the client's behavior recently, stating that they are very moody, seems happy one moment and is crying the next and all they want to talk about is themself. What response would correctly address these concerns?

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

The nurse is counseling a young pregnant client who has just entered the second trimester, after an uneventful first trimester. They tell 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 client come to believe it is real? Select all that apply.

Seeing an ultrasound image of the infant Feeling the infant kick

A pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where they had a pelvic exam. The client states that they noticed blood on the tissue when they 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.

The nurse-midwife is performing a pelvic examination on a client who came to them following a positive home pregnancy test. The nurse checks the client's cervix for the probable sign of pregnancy known as Goodell sign. Which description illustrates this alteration?

The cervix softens.

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?

They are probably pregnant, but this must be confirmed by other means

The nurse is presenting a nutritional plan to a primigravida client who is questioning the addition of iodized salt to their diet. Which explanation should the nurse prioritize in answering this client?

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

The nurse is holding an education class for clients in their third trimester and their partners. What information would the nurse share with them in preparation for the birth of their child? Select all that apply.

Urinary frequency will return toward the end of the pregnancy. It is recommended that the couple attend childbirth classes soon. Nesting instincts begin during this period, allowing the client to prepare for the infant.

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy?

Visualization of the gestational sac or fetus

A pregnant client in their second trimester comes to the clinic for a routine follow-up visit. The client's prepregnancy blood pressure was 112/70 mm Hg. On this visit, the client's blood pressure is 104/64 mm Hg. The nurse would interpret this finding as suggestive of which event?

a normal pregnancy finding secondary to the effects of progesterone

A client makes an appointment at the prenatal clinic because the client thinks the client might be pregnant. Which assessment would the nurse identify as a presumptive sign of pregnancy?

amenorrhea

A pregnant client 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 nuts lentils

The nurse is educating a newly pregnant client on nutritional needs during pregnancy. Which meal would the nurse recommend the client avoid?

bigeye tuna salad with fresh fruit

The nurse is examining a client who came to the clinic because they thinks they are pregnant. Which data collected by the nurse are presumptive signs of pregnancy? Select all that apply.

breast changes amenorrhea morning sickness

The nurse is assessing a client in their first trimester of pregnancy. When assessing the client's breasts, which finding would the nurse likely observe?

darkened breast areolae

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

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?

dilation of the renal pelvis

A client is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and they have no real family support. The nurse's most therapeutic response would be to:

encourage them to identify someone that they can talk to and share the pregnancy experience.

What is a positive sign of pregnancy?

fetal movement felt by examiner

A client comes to the clinic and tells the nurse, "I think I might be pregnant." After completing the history and physical examination, the nurse obtains a blood specimen for pregnancy testing. When explaining this test to the client, which hormone will the nurse identify as being measured by this test?

human chorionic gonadotropin

Which change in the musculoskeletal system would the nurse mention when teaching a group of pregnant parents about the physiologic changes of pregnancy?

increased lordosis

A nurse conducting a presentation for a group of nurses explains the changes in various body systems related to pregnancy. The nurse determines that additional teaching is needed when the group chooses which component as contributing to the pregnant client's hypercoagulable state?

increased number of red blood cells

The nursing instructor is presenting the basic physiologic changes in the client that can occur during a pregnancy. The instructor determines the session is successful when the students correctly choose which change in the respiratory function during pregnancy as normal?

increased tidal volume

A nurse is assessing a pregnant client and suspects that the client may be experiencing pica. Which additional finding may support this suspicion?

low iron level

Increased pigmentation on the face of some pregnant clients is called:

melasma (chloasma)

Many changes occur in the body of a pregnant client. Some of these are changes in the integumentary system. What is one change in the integumentary system called?

melasma (chloasma)

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 client's partner may experience as a normal response?

physical symptoms similar to the client's

A client's menstrual period is two weeks late. The client has been feeling tired and has had episodes of nausea in the morning. What classification of pregnancy symptoms is this client experiencing?

presumptive

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

A client who suspects they are pregnant asks the nurse about the accuracy of home pregnancy tests. The nurse would tell the client that:

some of the home pregnancy tests can detect the presence of hCG within 1 day of the client's missed period.

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

urinary frequency

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 spouse of a pregnant client is quiet during prenatal visits but is demonstrating emotional involvement in the pregnancy. What action did the spouse perform?

walks around furniture as if their abdomen is enlarged

A pregnant client tells the nurse that they are not happy to learn about the pregnancy. At which point in the pregnancy does the nurse realize that the client will change their mind about the pregnancy?

when quickening occurs