NUR234 Ch 11: Maternal Adaptation During Pregnancy

A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucus discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse? "If the provider did an exam, it might be just normal vaginal secretions, so don't worry about it." "A one time discharge of bloody mucus in the toilet might have been your mucus plug." "Bloody mucus is a sign you are in labor. Please come to the hospital." "It might be nothing. If it happens again call your provider who is on-call."

"A one time discharge of bloody mucus in the toilet might have been your mucus plug." Bloody mucus can either be a mucus plug or bloody show. The one-time occurrence would be more likely to be the mucus plug. A bloody show would continue if her cervix was changing, but this usually does not occur until after contractions start. It is a sign that something is happening and should be reported to the health care provider. The bloody mucus is not a sign of labor, but it can be an early sign that labor is coming soon.

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." "I can eat any seafood that I like because it contains phosphorus, which is a nutrient that pregnant women need." "Milk production requires higher levels of calcium; therefore, if I am going to breastfeed, I must take a calcium supplement during pregnancy." "Because I am pregnant, I can eat anything I want and not worry about weight gain."

"I will need to take iron supplementation throughout my pregnancy even if I am not anemic." Iron is recommended for all pregnant women because it is almost impossible for the pregnant woman to get what is required from diet alone, especially after 20 weeks' gestation when the requirements of the fetus increase.

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse? "Expect your other children to react positively to their new brother/sister." "Caring for your new infant is instinctual and will come naturally to you." "The hormones of pregnancy may cause anxiety or depression postpartum." "Your old coping methods will adequately get you through this period of adjustment."

"The hormones of pregnancy may cause anxiety or depression postpartum." The "raging hormones" of pregnancy can keep the woman slightly out of touch with her usual methods of coping. Although she may normally interact and communicate in quite mature ways, during a pregnancy she may become depressed, anxious, withdrawn, or angry as she accomplishes her own developmental tasks

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 may have mood swings that could overwhelm your partner." "You will experience quickening, and you will actually feel the baby." "You will be more conscious of the changes taking place in your body now." "You may feel physical discomfort as the baby inside grows."

"You will experience quickening, and you will actually feel the baby." The nurse should inform the client that quickening occurs in the second trimester. The client will be able to physically feel the fetal movements, which will help her bond with her developing fetus. Physical discomfort actually starts to increase in the third trimester as the fetus grows rapidly. The client feels conscious of the changes taking place in her body due to her pregnancy primarily in the first trimester, not the second.

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week? 2 lb (0.90 kg) 1 lb (0.45 kg) 1.5 lb (0.68 kg) 2/3 lb (0.30 kg)

1 lb (0.45 kg) The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be: 1 lb (0.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (0.45 kg) per week. Overweight women should gain about 2/3 lb (0.30 kg) per week.

The nurse is putting together information for a nutritional class for nullipara women. Which information would be most important for the nurse to include? Select all that apply. Consume at least one quart of water daily. Increase caloric intake. Avoid the intake of alcohol. Decrease intake of saturated fats, trans fats, and cholesterol. Increase consumption of fruits, vegetables, and whole grains.

Avoid the intake of alcohol. Decrease intake of saturated fats, trans fats, and cholesterol. Increase consumption of fruits, vegetables, and whole grains.

A client arrives to the clinic very excited and reporting a positive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy? Chadwick sign Hegar sign Fetal movement felt by examiner Positive office pregnancy test

Fetal movement felt by examiner The positive signs of pregnancy are fetal image on a sonogram, hearing a fetal heart rate, and examiner feeling fetal movement. A pregnancy test has 95% accuracy; however, it may come back as a false positive. Hegar sign is a softening of the uterine isthmus. Chadwick sign may have other causes besides pregnancy.

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 is at its highest level at the xiphoid process. The lower uterine segment and cervix have softened. Fundal height has dropped since the last recording. The fundus is at the level of the umbilicus and measures 20 cm.

Fundal height has dropped since the last recording. Between 38 and 40 weeks of gestation, the fundal height drops as the fetus begins to descend and engage into the pelvis. Because it pushes against the diaphragm, many women experience shortness of breath. By 40 weeks, the fetal head begins to descend and engage into the pelvis. Although breathing becomes easier because of this descent, the pressure on the urinary bladder now increases, and women experience urinary frequency. The fundus reaches its highest level at the xiphoid process at approximately 36, not 39, weeks. By 20 weeks' gestation, the fundus is at the level of the umbilicus and measures 20 cm. At between 6 and 8 weeks of gestation, the cervix begins to soften (Goodell sign) and the lower uterine segment softens (Hegar's sign).

A pregnant woman's husband does not voice concerns at prenatal visits. Which observation would lead the nurse to suspect that the husband is emotionally involved in the pregnancy? He states he is concerned about the loss of his free time. He states he definitely wants a girl. He walks around furniture as if his abdomen is enlarged. He has refused to paint the baby's room blue.

He walks around furniture as if his abdomen is enlarged (couvade syndrome). Many partners experience physical symptoms such as nausea, vomiting, and backache to the same degree or even more intensely than their partners during a pregnancy; some begin to gain weight along with their partner. This is known as couvade syndrome. As a woman's abdomen begins to grow, partners may perceive themselves as growing larger too, as if they were the ones who were experiencing changing boundaries the same as the pregnant woman. These symptoms apparently result from stress, anxiety, and empathy for the pregnant woman. Men who identify with their wife's pregnancy may act as if their abdomen is enlarging, the same as they may take on nausea of pregnancy.

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

Hemorrhoids The displacement of the intestines and possible slowed motility of the intestines can lead to constipation in the pregnant woman. This, along with elevated venous pressure, can lead to development of hemorrhoids.

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. Keep the client's legs slightly elevated. Place the client in an orthopneic position. Keep the head of the client's bed slightly elevated.

Place the client in the left lateral position. The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

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

Pregnant women often experience mood swings and self-centeredness but this is normal. During the first trimester of pregnancy, the woman often has mood swings, bouts of irritability and is hypersensitive. The partner needs to know that these are all normal behaviors for a pregnant woman.

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

Seeing an ultrasound image of the baby Feeling the baby kick

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

Supine hypotension syndrome The left side-lying position prevents the heavy uterus from resting on and compressing her vena cava, a condition known as supine hypotensive syndrome. Compression of the vena cava can cause maternal hypotension and poor gas exchange between the placenta and fetus. Preeclampsia is a condition characterized by elevated blood pressure and proteinuria. Once diagnosed, the treatment includes resting in a left-lateral position, but a side-lying position does not prevent preeclampsia.

The primigravid client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." What change in the client typically follows this experience? The client will begin to notice changes in body appearance. The client will begin to experiences stretching pains and discomforts from fetal movement. The client will bond with one's partner and build a family unit. The client acknowledges the fetus's existence as a separate identity.

The client acknowledges the fetus's existence as a separate identity.

During a routine prenatal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse take next? Check the discharge for evidence of ruptured membranes. Notify the health care provider of a possible infection. Advise the woman about the need to culture the discharge. Tell the woman that this is entirely normal.

Tell the woman that this is entirely normal. Vaginal secretions increase during pregnancy and this is considered normal leukorrhea based on the woman's report that she is not experiencing any itching or irritation. There is no evidence indicating the need to notify the health care provider, check for rupture of membranes, or advise her about the need for a culture.

A pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding? She may have a bleeding disorder so she needs to come back to the clinic for blood work. It is possible she is losing her mucus plug, which can cause bloody show. Some bleeding during pregnancy is not uncommon and this finding is expected. The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual.

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

During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first? Turn the client on her left side. Listen to fetal heart tones. Take the client's blood pressure. Ask the client to breathe deeply.

Turn the client on her left side. As the enlarging uterus increases pressure on the inferior vena cava, it compromises venous return, which can cause dizziness, light-headedness, and pallor when the client is supine. The nurse can relieve these symptoms by turning the client on her left side, which relieves pressure on the vena cava and restores venous return. Although they are valuable assessments, fetal heart tone and maternal blood pressure measurements do not correct the problem. Because deep breathing has no effect on venous return, it cannot relieve the client's symptoms.

A woman is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and she has no real family support. The nurse's most therapeutic response would be to: a. encourage her to identify someone that she can talk to and share the pregnancy experience. b. tell her to move home so her family will be nearby to help her. c. offer to meet with the client on a regular basis to provide her someone to talk to about her concerns. c. remind her that she is still early in the pregnancy and she will feel better about it as the pregnancy progresses.

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

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

acceptance During the second trimester, the physical changes of pregnancy, including an enlarging abdomen and fetal movement, bring a sense of reality and validity to the pregnancy leading to acceptance.

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. hydatidiform mole breast changes fetal heartbeat morning sickness amenorrhea ultrasound pictures

breast changes amenorrhea morning sickness Presumptive signs: possible signs of pregnancy that appear in the first trimester, often only noted subjectively by the mother (e.g., breast changes, amenorrhea, morning sickness). Probable signs are signs that appear in the first and early second trimesters, seen via objective criteria, but can also be indicators of other conditions (e.g., hydatidiform mole). Positive signs affirm that proof exists that there is a developing fetus in any trimester and are objective criteria seen by a trained observer or diagnostic study, (e.g., ultrasound.)

A new mother asks the postpartum nurse if her baby is getting enough nourishment from breastfeeding within the first 24 hours following birth. The nurse would provide her what information? a. Most infants need minimal nourishment for the first 24 hours, so the mother should not be concerned. b. The mother needs to supplement breastfeedings with formula until her milk comes in. c. Breast milk comes in within 12 hours after delivery and nourishment should not be a problem. d. Colostrum, which is the first milk produced, is rich in calories and protein that nourishes the infant well.

d. Colostrum, which is the first milk produced, is rich in calories and protein that nourishes the infant well. Colostrum is present prior to delivery and provides the infant with adequate nutrition for the first 3 days of life, at which time the mother's actual milk should come in. Formula is not recommended. Infants need nutrition shortly after birth to keep their blood glucose normal.

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

fetal movement felt by examiner The positive signs of pregnancy are fetal image on sonogram, hearing a fetal heart rate, and the examiner feeling fetal movement.

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 follicle-stimulating hormone estrogen progesterone

human chorionic gonadotropin The commonly used laboratory tests for pregnancy are based on the use of a venipuncture or a urine specimen to detect the presence of human chorionic gonadotropin (hCG), a hormone created by the chorionic villi of the placenta, in the urine or blood serum of the pregnant client. Because these tests are only accurate 95% to 98% of the time, positive results from these tests are considered probable rather than positive signs.

Early in pregnancy, frequent urination results mainly from which of the following? addition of fetal urine to maternal urine increased concentration of urine pressure on the bladder from the uterus decreased glomerular selectivity

pressure on the bladder from the uterus Early in pregnancy, the expanding uterus presses on the bladder. Later, it rises above the bladder so the pressure is relieved.

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence? lightening linea nigra placenta previa quickening

quickening The fluttering sensation that can be confused with gas is called "quickening." In the 2 weeks leading up to the 20-week mark, she may feel "flutters" that she may confuse with gas. Lightening is the descent of the presenting part of the fetus into the pelvis. Placenta previa is the implantation of the placenta so that it covers part or all of the cervical os. Linea nigra is a hyperpigmented line that appears on the maternal abdomen between the symphysis pubis and top of the fundus.

At what point in pregnancy does the average woman switch from accepting she is pregnant to accepting she is having a child? after the seventh month around the third month after lightening happens when quickening occurs

when quickening occurs Quickening, or feeling the baby move inside the body, is such a dramatic event that it can cause a woman's perceptions about the pregnancy to change.