Nursing 317: Maternal Adaptation During Pregnancy (NCLEX Questions and Review)

Which information provided by a client would be considered a presumptive sign of pregnancy? -Reports of increased hunger -Weight gain -Breast tenderness -Ballottement

-Breast tenderness

A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucous discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse? -"It might be nothing. If it happens again call your provider who is on-call." -"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 mucous plug." -"Bloody mucus is a sign you are in labor. Please come to the hospital."

-"A one time discharge of bloody mucus in the toilet might have been your mucous plug." Bloody mucus can either be a mucous plug or bloody show. The one time occurrence would be more likely to be the mucous 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 fundus reaches its highest level at the xiphoid process at approximately __ weeks

-36

Fetal macrosomic

-A condition in which a baby has a weight of more the 8 pounds, 13 ounces at birth.

What is Amenorrhea?

-An abnormal absence of menstruation

____ supplementation 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.

-Iron

Place the following events in the sequence the pregnant woman would experience them, from first to last. All options must be used. -Braxton Hicks contractions -uterine enlargement -quickening -labor -amennorhea

1. amennorhea 2. uterine enlargement 3. quickening 4. Braxton Hicks contractions 5. labor

A urinalysis is done on a client in her third trimester. Which result would be considered abnormal? -Trace of glucose -2+ Protein in urine -Specific gravity of 1.010 -Straw-like color

2+ Protein in urine During pregnancy, there may be a slight amount of glucose found in the urine due to the fact that the kidney tubules are not able to absorb as much glucose as there were before pregnancy. However, there should be minimal protein in the urine. A specific gravity of 1.010 and a straw- like color are both normal findings.

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings? -The heart rate increase may indicate that the client is experiencing cardiac overload. -The blood pressure should be higher since the cardiac volume is increased. -Both findings are normal at this point of the pregnancy. -Combined, both of these findings are very concerning and warrant further investigation.

Both findings are normal at this point of the pregnancy. A pregnant woman will normally experience a decrease in her blood pressure during the second trimester. An increase in the heart rate of 10 to 15 beats per minute on average is also normal, due to the increased blood volume and increased workload of other organ systems. Hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure.

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 can eat any seafood that I like because it contains phosphorus, which is a nutrient that pregnant women need." -"I will need to take iron supplementation throughout my pregnancy even if I am not anemic." -"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 supplementation 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.

A pregnant client is concerned because she has noticed that she is developing brown blotches on her forehead and nose. The nurse realizes that the client understood the teaching about this problem when the client makes which statement? -"Pregnant women often develop skin problems but this should go away in the third trimester." -"These spots are from hyperpigmentation caused by the pregnancy and may be permanent." -"I will get them with every pregnancy and they will get worse every time." -"This condition is called linea nigra and the spots may fade or go away between pregnancies."

-"These spots are from hyperpigmentation caused by the pregnancy and may be permanent." The brown blotches the client is experiencing on her face is called chloasma or the "mask of pregnancy." Hyperpigmentation is one of the skin changes that pregnant women experience. This condition may be permanent or may regress between pregnancies. Linea nigra is the darkened line in the middle of the abdomen seen on some pregnant women. Chloasma does not go away in the third trimester and there is no evidence that it will get worse with each pregnancy.

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 -22 -20 -18

-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.

A woman comes to the clinic for her first prenatal checkup. The woman has a body mass index (BMI) of 22. The nurse would anticipate that this client should gain approximately how much weight during her pregnancy? -25 to 35 lbs (11 to 16 kg) -28 to 40 lbs (13 to 18 kg) -15 to 25 lbs (7 to 11 kg) -11 to 20 lbs (5 to 9 kg)

-25 to 35 lbs (11 to 16 kg) A woman with a BMI of 18.5 to 24.9 is of normal weight and should gain 25 to 35 pounds (11 to 16 kg) during the pregnancy. For a woman who is underweight (BMI <18.5), the total weight gain range is 28 to 40 pounds (13 to 18 kg). For a woman who is overweight (BMI = 25-29.9), total weight gain range should be 15 to 25 pounds (7 to 11 kg). For a woman who is obese (BMI = 30 or higher), the total weight gain range should be 11 to 20 pounds (5 to 9 kg).

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks pregnant. The nurse would expect this woman's heart rate to be approximately: -85 beats per minute. -90 beats per minute. -95 beats per minute. -100 beats per minute.

-85 beats per minute During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.

At her 16-week checkup, a client's blood pressure is slightly decreased from her prepregnancy level. The nurse evaluates this change based on which statements concerning blood pressure during pregnancy? -Normally, blood pressure increases steadily throughout pregnancy. -Blood pressure remains stable until decreasing the day of the birth. -A decrease in the second trimester may occur because of placental growth. -Blood pressure progressively decreases throughout the entire pregnancy.

-A decrease in the second trimester may occur because of placental growth. Because the placenta "traps" a great deal of blood for fetal circulation as it expands at about 3 months, maternal blood pressure may temporarily be slightly decreased. Otherwise, blood pressure stays fairly constant throughout pregnancy.

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. -Tell the woman that this is entirely normal. -Advise the woman about the need to culture the discharge. -Check the discharge for evidence of ruptured membranes.

-Ask the woman if she is having any itching or irritation. Although vaginal secretions increase during pregnancy, the nurse would need to ascertain if this discharge is the normal leukorrhea of pregnancy or if it is a monilial vaginitis, which is common during pregnancy. The nurse needs additional information to conclude that the woman's report is normal. A culture may or may not be necessary. There is no evidence to suggest that her membranes have ruptured.

Which change related to the vital signs is expected in pregnant women? -Pulse decreases. -Lung space increases. -Blood pressure decreases. -Temperature decreases.

-Blood pressure decreases. -Pulse and temperature often increase, while lung space is decreased in pregnant women. It is common for blood pressure to decrease during pregnancy. (Dilation of vessels)

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 -Ultrasound pictures -Fetal heartbeat -Amenorrhea -Hydatidiform mole morning sickness

-Breast changes -Amenorrhea -Morning sickness

Match the common Probable sign of pregnancy with its correct description -Chadwick's sign -Hegar's sign -Goodell's sign (softening of the lower uterine segment or isthmus) (bluish-purple coloration of the vaginal mucosa and cervix) (softening of the cervix)

-Chadwick's sign: bluish-purple coloration of the vaginal mucosa and cervix -Hegar's sign: softening of the lower uterine segment or isthmus -Goodell's sign: softening of the cervix

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

-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.

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? -Pseudo pregnancy -Pregnancy syndrome -Couvade syndrome -Cretinism

-Couvade syndrome Some fathers actually experience some of the physical symptoms of pregnancy, such as nausea and vomiting, along with their partner. This phenomenon is called couvade syndrome.

The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting? -Slack, soft breast tissue -Deeply fissured nipples -Enlarged lymph nodes -Darkened breast areolae

-Darkened breast areolae

Which assessment finding in the pregnant woman at 12 weeks' gestation should the nurse find most concerning? The inability to: -Detect fetal heart sounds with a Doppler. -Feel fetal movements. -Hear the fetal heartbeat with a stethoscope. -Palpate the fetal outline.

-Detect fetal heart sounds with a Doppler. Fetal heart sounds are audible with a Doppler at 10 to 12 weeks of gestation but cannot be heard through a stethoscope until 18 to 20 weeks of gestation. Fetal movements can be felt by a woman as early as 16 weeks of pregnancy and felt by the examiner around 20 weeks' gestation. The fetal outline is also palpable around 20 weeks of gestation.

Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy? -Decrease in glomerular filtration rate -Dilation of the renal pelvis -Reduction in kidney size -Shortening of the ureters

-Dilation of the renal pelvis The renal pelvis becomes dilated during pregnancy, possibly due to the effect of progesterone on smooth muscle. The glomerular filtration rate increases during pregnancy. The kidneys enlarge during pregnancy. The ureters elongate, widen, and become more curved above the pelvic rim.

The nurse has determined that based on the client's physical examination she is at high risk for developing varicose veins. Which suggestions might the nurse teach the client to help reduce her risk? Select all that apply. -Elevate the feet and legs. -Walk daily. -Use thigh-high support hose. -Sit in a hot tub at least three times a week. -Use knee-high support hose.

-Elevate the feet and legs. -Walk daily. -Use thigh-high support hose.

A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur during pregnancy. Which hormones would the nurse most likely identify as being inhibited during the pregnancy? -FSH and LH -FSH and T4 -T4 and GH -LH and MSH

-FSH and LH

What is Quickening?

-Fetal movements felt by the mother

A pregnant woman tells the nurse she often has allergic responses to drugs. She is concerned that she will be allergic to her fetus or her body will reject the pregnancy. The nurse's reply would be based on which statement? -Immunologic activity is decreased during pregnancy. -The level of aldosterone during pregnancy reduces production of IgG antibodies. -The decreased corticosteroid activity during pregnancy ensures this will not happen. -The kidneys release a hormone during pregnancy to prevent this from happening.

-Immunologic activity is decreased during pregnancy. It is unproven why women do not reject fetal (foreign) tissue, but a substance secreted by the placenta is thought to decrease the usual immunologic response and prevent this from happening.

Which physical change would the nurse expect to find in a pregnant client? Select all that apply. -Increased blood volume -Decreased clotting factors Supine hypotension -Negative Hagar sign -Increased hemoglobin

-Increased blood volume -Supine hypotension The pregnant client will experience blood volume increases of 40-45% over prepregnancy levels. Supine hypotension occurs when the pregnant client lies down on her back in the latter half of the pregnancy and the uterus pushes down on the aorta and vena cava, decreasing cardiac return. The hemoglobin decreases due to physiologic hemodilution. The blood clotting factors increase during pregnancy, not decrease. A positive Hagar sign is one of the presumptive signs of pregnancy.

A client who is in her sixth week of gestation is being seen for a routine prenatal care visit. The client asks the nurse about changes in her eating habits that she should make during her pregnancy. The client informs the nurse that she is a vegetarian. The nurse knows that she has to monitor the client for which risks arising from her vegetarian diet? Select all that apply. -epistaxis -iron-deficiency anemia -decreased mineral absorption -constipation -low gestational weight gain

-Iron-deficiency anemia -Decreased mineral absorption -Low gestational weight gain

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client? -Iron-deficiency anemia -Constipation -Tooth fracture -Inefficient protein metabolism

-Iron-deficiency anemia Pica is characterized by a craving for substances that have no nutritional value. Consumption of these substances can be dangerous to the client and her developing fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation of the client's compulsion to consume soil. Consumption of ice due to pica is likely to lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the client has been consuming laundry starch as a result of pica. The nurse should monitor for constipation in the client if she has been consuming clay.

The nurse is assessing a pregnant client at her 12 weeks' gestation and the client reports some new bumps on the dark part of her nipples. What is the best response from the nurse when questioned by the client as to what they are? -Normal bumps of pregnancy; they do nothing -Might be sign of cancer; need to speak with provider -Montgomery tubercles; secrete lubricant for the nipples -Striae, stretching of the breast tissue

-Montgomery tubercles; secrete lubricant for the nipples All women have Montgomery tubercles; they become more prominent during pregnancy and help to prepare the nipples for breastfeeding. The bumps are not specific to pregnancy and are not a sign of cancer. They are not the result of stretching.

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 woman's partner may experience as a normal response? -Feeling distanced from the mother -No changes, only the mother has changes during pregnancy -Physical symptoms similar to the mother -Desire to be the woman and give birth

-Physical symptoms similar to the mother Couvade syndrome is the occurrence of physical symptoms by the partner, similar to the physical symptoms of the mother. Other emotional symptoms may occur, but they are typically on a person-to-person basis.

_______ 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

-Positive (e.g., ultrasound.)

Amanda's menstrual period is two weeks late. She has been feeling tired and has had bouts of nausea in the morning. What classification of pregnancy symptoms is Amanda experiencing? -Positive -Presumptive -Probable -No classification

-Presumptive The most common presumptive sign of pregnancy is a missed menstrual period, or amenorrhea. Other presumptive signs include nausea, fatigue, swollen, tender breasts, and frequent urination.

_________ signs are signs that appear in the first and early second trimesters, seen via objective criteria, but can also be indicators of other conditions...

-Probable signs (e.g., hydatidiform mole).

What effect does progesterone have on normal gallbladder function? -It has no effect on the gallbladder. -The gallbladder will hypertrophy. -Progesterone interferes with gallbladder contraction, leading to stasis of bile. -Bile will be produced at a more rapid rate due to the progesterone.

-Progesterone interferes with gallbladder contraction, leading to stasis of bile. Progesterone interferes with normal gallbladder contractions, which leads to stasis of bile. This stasis results in cholestasis, either seen in the gall bladder or the liver.

The mother the two hormones that control lactation and letdown are...

-Prolactin and oxytocin.

A client who is entering her third trimester comes to the prenatal clinic for a follow-up examination. When assessing the breasts, which findings would the nurse expect? Select all that apply. -Pallor of the areolae -Prominent veins -Hyperpigmentation of the nipple -Warmth increased sensitivity

-Prominent veins -Hyperpigmentation of the nipple -Increased sensitivity Normal breast findings include prominent veins, nodular breasts, increased sensitivity to touch, and hyperpigmentation of the nipples and areolae. Warmth would suggest possible infection.

A client in her 10th week of gestation arrives at the maternity clinic reporting morning sickness. The nurse needs to inform the client about the body system adaptations during pregnancy. Which factors correspond to the morning sickness period during pregnancy? Select all that apply. -Reduced stomach acidity -Elevated human chorionic gonadotropin (hCG) -Increased red blood cell (RBC) production -Increased estrogen level elevated human placental lactogen (hPL)

-Reduced stomach acidity -Elevated human chorionic gonadotropin (hCG) -Increased estrogen level

In addition to increasing levels of hCG, which other two factors contribute to morning sickness?

-Reduced stomach acidity and high levels of circulating estrogens

A 33-week pregnant client is in the office for a routine visit. She lies down on her back and while the nurse is listening for fetal heart tones, the client tells the nurse that she is lightheaded and her blood pressure is 82/58. What is the most likely explanation for this problem? -She is experiencing supine hypotension syndrome -She did not drink enough fluids prior to coming to the office. -Her hematocrit is low and she needs additional iron supplements. -The baby is kicking her spinal column, causing a pinched nerve.

-She is experiencing supine hypotension syndrome As the uterus gets larger toward the end of the pregnancy, it presses the aorta and vena cava against the spine, causing decreased blood return to the heart. This reduces cardiac output and the woman may feel lightheaded and dizzy and her blood pressure will drop.

A client who suspects she is pregnant asks the nurse about the accuracy of home pregnancy tests. The nurse would tell the client that: -Home pregnancy tests often give a false positive result. -Their reliability is only about 90%. -Some of the home pregnancy tests can detect the presence of hCG within one day of the woman's missed period. -The test works best on a midday urine sample.

-Some of the home pregnancy tests can detect the presence of hCG within one day of the woman's missed period. Home pregnancy tests are 95% reliable if used according to the instructions on the kit. In fact, some can detect hCG within one day after a missed period. These tests often give a false negative, not false positive reading and results can be tested with the first voided specimen of the day.

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

-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 healthcare provider, check for rupture of membranes, or advise her about the need for a culture.

A 24-week pregnant client 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? -The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. -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 mucous 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 nurse is assessing a pregnant client in her third trimester who is reporting a first-time occurrence of constipation. When asked why this is happening, what is the best response from the nurse? -There is not enough fiber in your diet. -The intestines are displaced by the growing fetus. -This shouldn't be happening. -hCG is delaying peristalsis.

-The intestines are displaced by the growing fetus. The growing fetus is displacing the intestines and interfering with peristalsis, delaying the passage of fecal matter and resulting in constipation. This is common and expected; however, the client should take measures to prevent hemorrhoids that can occur as the result of the pressure and straining. Progesterone, not hCG, can delay gastric emptying and decrease peristalsis.

The nurse is holding an education class for clients in their third trimester and their partners. What information would she 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. -If backaches occur, the mother needs to be examined due to the possibility of an often-seen disc problem induced by pregnancy. -The mother will sleep more at night during the third trimester in preparation of the birth. -Nesting instincts begin during this period, allowing the mother to prepare for the baby.

-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 mother to prepare for the baby. During the third trimester, the mother begins to shop for clothing and nursery furniture, which is nesting. Additionally, she will experience urinary frequency due to the gravid uterus pushing down on the bladder. Lastly, the couple needs to attend childbirth classes to better understand what to expect, as well as providing social contact with other parents going through the same thing.

A woman in a prenatal clinic tells the nurse that her pregnancy was unplanned and unwanted. At what point in pregnancy does the average woman change her mind about an unwanted pregnancy? -Around the third month -When quickening occurs -After lightening happens -After the seventh month

-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.

Milk production actually requires higher levels of _________, which can be obtained from a healthy diet.

-Zinc

Presumptive signs are possible signs of pregnancy that appear in the first trimester, often only noted subjectively by the mother and include...

-breast changes, amenorrhea, morning sickness

An elevation of which hormone corresponds to the morning sickness period of approximately 6 to 12 weeks during early pregnancy?

-hCG

The ____ levels in a normal pregnancy usually double every 48 to 72 hours, until they reach a peak at approximately 60 to 70 days after fertilization.

-hCG

_______ increases during the second half of pregnancy, and it helps in the preparation of mammary glands for lactation and is involved in the process of making glucose available for fetal growth by altering maternal carbohydrate, fat, and protein metabolism.

-hPL