OB - Chapter 11: Maternal Adaptation During Pregnancy

A patient who has just given a blood sample for pregnancy testing in the doctor'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. Which of the following should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy? a) Laboratory test of a urine specimen for hCG b) Laboratory test of a blood serum specimen for hCG c) Visualization of the fetus by ultrasound d) Absence of a period

Visualization of the fetus by ultrasound

A client comes to the prenatal clinic for a follow-up examination. When assessing the breasts, which of the following would the nurse expect to find? Select all that apply. a) Hyperpigmentation of the nipple b) Pallor of the areolae c) Increased sensitivity d) Prominent veins e) Warmth

• Prominent veins • Hyperpigmentation of the nipple • Increased sensitivity

A pregnant woman is experiencing morning sickness. Which of the following responses indicates a need for further teaching? a) "I'll avoid an empty stomach." b) "I'll eat frequent small servings of bland foods." c) "I'll take antacid between meals." d) "I'll snack on unsalted cracker."

"I'll take antacid between meals."

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

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

A client at 36 weeks' gestation comes in for her weekly physician visit. She tells the nurse, "I am having contractions, but they are irregular and go away when I rest. Do you think I am going into labor?" The best response by the nurse would be: a) "These are called Braxton-Hicks contractions and are preparing your body for labor but are not 'true' labor contractions." b) "It is too early for you too be in labor. Something may be wrong with the pregnancy." c) "I think we better send you to the hospital for admission. You could be in labor." d) "I think you are going into labor. We may need to give you medications to stop the contractions."

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

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? a) 1.5 lb b) 2/3 lb c) 2 lb d) 1 lb

1 lb

The blood volume in pregnant women increases by what percent? a) 40-50 percent b) 30-40 percent c) 20-30 percent d) 10-20 percent

40-50 percent

At her 16-week checkup, a patient's blood pressure is slightly decreased from her pre-pregnancy level. You evaluate this change based on which of the following statements concerning blood pressure during pregnancy? a) Normally, blood pressure increases steadily throughout pregnancy. b) Blood pressure remains stable until decreasing the day of the delivery. c) Blood pressure progressively decreases throughout the entire pregnancy. d) A decrease in the second trimester may occur because of placental growth.

A decrease in the second trimester may occur because of placental growth.

A feeling expressed by most women upon learning they are pregnant is: a. Acceptance b. Depression c. Jealousy d. Ambivalence

Ambivalence

Question: Place the following events in the sequence the pregnant woman would experience them, from first to last. 1. Amennorhea 2. Quickening 3. Braxton Hicks contractions 4. Uterine enlargement 5. Labor

Amennorhea Uterine enlargement Quickening Braxton Hicks contractions Labor

A friend tells you that she is going to use a home pregnancy test to determine whether she is pregnant. Which of the following precautions would you give her? a) Use a diluted urine specimen. b) Arrange for prenatal care if the test is positive. c) Refrain from eating for 4 hours before testing. d) Wait until after two missed menstrual periods.

Arrange for prenatal care if the test is positive.

During a routine antepartal visit, a pregnant woman reports a white thick vaginal discharge. Which of the following would the nurse do next? a) Check the discharge for evidence of ruptured membranes. b) Tell the woman that this is entirely normal. c) Ask the woman if she is having any itching or irritation. d) Advise the woman about the need to culture the discharge.

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

As a pregnant woman lies on the examining table, she grows very short of breath and dizzy. This phenomenon probably happens because a) Her cerebral arteries are growing congested with blood b) Sympathetic nerve responses cause dyspnea when a woman lies supine c) The uterus requires more blood in a supine position d) Blood is trapped in the vena cava in a supine position

Blood is trapped in the vena cava in a supine position

Which of the following changes related to the vital signs is expected in pregnant women? a) Pulse decreases. b) Blood pressure decreases. c) Lung space increases. d) Temperature decreases.

Blood pressure decreases.

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which of the following would the nurse identify as an abnormal finding? a) Bruising b) Darkening of the umbilicus c) Linea nigra d) Striae

Bruising

Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called? a) Ballotment b) Chloasma c) Linea rubria d) Chadwick's sign

Chloasma

If a woman is 3 months pregnant, which of the following findings related to breast changes would you expect to assess? a) Slack, soft breast tissue b) Enlarged lymph nodes c) Deeply fissured nipples d) Darkened breast areolae

Darkened breast areolae

A client in her second trimester of pregnancy is anxious about the blotchy, brown pigmentation appearing on her forehead and cheeks. She also complains of increased pigmentation on her breasts and genitalia. When educating the client, which of the following would the nurse identify as the condition experienced by the client? a) Vascular spiders b) Linea nigra c) Facial melasma (cholasma) d) Striae gravidarum

Facial melasma (cholasma)

Which of the following is a positive sign of pregnancy? a) Positive pregnancy test b) Hegar's sign c) Uterine contractions d) Fetal movement felt by examiner

Fetal movement felt by examiner

The urine of a woman in her second trimester of pregnancy is found to contain glucose. For which condition should she be tested? a) Anemia b) Gestational diabetes c) Preeclampsia d) Hypothyroidism

Gestational diabetes

Pregnancy tests (both urine and blood) measure levels of which hormone to validate the existence of pregnancy? a) Human chorionic gonadotropin (hCG) b) Estrogen c) Progesterone d) Aldosterone

Human chorionic gonadotropin (hCG)

During a routine visit to the clinic, a client tells the nurse that she thinks she may be pregnant. The physician orders a pregnancy test. The nurse should know the purpose of this test is to determine which change in the client's hormone level? a) Decrease in LH b) Increase in human chorionic gonadotropin (HCG) c) Increase in luteinizing hormone (LH) d) Decrease in HCG

Increase in human chorionic gonadotropin (HCG)

When describing the pregnant woman's hypercoagulable state, which of the following would the nurse identify as being least likely related? a) Increased clotting factors b) Increased number of red blood cells c) Increased plasma fibrinogen d) Increased levels of fibrin

Increased number of red blood cells

A woman in her third trimester shows the nurse a narrow, brown line that has formed on her abdomen, running from her belly button down to her pubic region. She expresses concern about this and asks the nurse whether it is normal. The nurse explains that this is a normal occurrence of pregnancy and that it results from the release of melanocyte-stimulating hormone from the pituitary, causing the appearance of extra pigmentation on the skin. This phenomenon is known as which of the following? a) Linea nigra b) Diastasis c) Striae gravidarum d) Melasma

Linea nigra

The nurse explains to a pregnant client, who is anemic, that she will need to take vitamins with iron during her pregnancy. What are food would you include on the patient's diet plan? a) Grains b) Meats c) Dairy d) Legumes

Meats

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which of the following data collected by the nurse are presumptive signs of her pregnancy? Select all that apply. a) Ultrasound pictures b) Morning sickness c) Amenorrhea d) Fetal heartbeat e) Hydatidiform mole f) Breast changes

Morning sickness Amenorrhea Breast changes

The nurse teaches a pregnant woman about breastfeeding, stating that stimulation of the breast through sucking or touching stimulates the secretion of which hormone? a) Cortisol b) Oxytocin c) Antidiuretic hormone d) Follicle stimulating hormone

Oxytocin

A woman calls the clinic to schedule an appointment because "I think I might be pregnant." Upon further assessment gathering of information from the woman, which of the following would be a probable sign of pregnancy? a) Fatigue b) Nausea and vomiting c) Amenorrhea d) Positive home pregnancy test

Positive home pregnancy test

Early in pregnancy, frequent urination results mainly from which of the following? a) Decreased glomerular selectivity b) Increased concentration of urine c) Addition of fetal urine to maternal urine d) Pressure on the bladder from the uterus

Pressure on the bladder from the uterus

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? a) Probable b) Presumptive c) No classification d) Positive

Presumptive

The hormone responsible for the initiation of lactation is what? a) Progesterone b) Prolactin c) Oxytocin d) Estrogen

Prolactin

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? a) Quickening b) Placenta previa c) Lightening d) Linea nigra

Quickening

During pregnancy, which of the following should the expectant mother reduce or avoid? a. Raw meat or uncooked shellfish b. Fresh, washed fruits and vegetables c. Whole grains d. Protein and iron from meat sources

Raw meat or uncooked shellfish

A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the patient's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation and enlargement of the birth canal. This hormone is which of the following? a) Estrogen b) Human placental lactogen c) Relaxin d) Progesterone

Relaxin

A pregnant client complains of an increase in a thick, whitish vaginal discharge. Which of the following information should a nurse provide to this client? a) Such discharge is normal during pregnancy. b) Refrain from any sexual activity. c) Consult physician for fungal infection. d) Use local antifungal agents regularly.

Such discharge is normal during pregnancy.

A 28-year-old client complains of skipping her menses and suspects she is pregnant. When assessing this client, which of the following would the nurse identify as a presumptive sign of pregnancy? a) Abdominal enlargement b) Softening of the cervix c) Urinary frequency d) Positive home pregnancy test

Urinary frequency

Which of the following is a presumptive sign or symptom of pregnancy? a. Restlessness b. Elevated mood c. Urinary frequency d. Low backache

Urinary frequency

A nurse should teach a client who is pregnant for the first time that she should be able to feel the baby move at about how many weeks gestation? a) 14 to 16 b) 10 to 12 c) 12 to 14 d) 18 to 20

18 to 20

A woman in her first trimester of pregnancy is concerned about the effect that pregnancy will have on her appearance. She is fit but underweight, and she plans to restrict her weight gain as much as possible during pregnancy. How much weight do you advise her to gain? a) 28 to 40 pounds b) 15 to 25 pounds c) 16 to 30 pounds d) 25 to 30 pounds

28 to 40 pounds

One specific vitamin is known to prevent up to 70 percent of birth defects of the central nervous system, called neural tube defects. Which vitamin should all woman who are at risk for getting pregnant have daily in their diet? a) Folic Acid b) Vitamin A c) Iodine d) Zinc

Folic Acid

Amanda is about 16 weeks pregnant and is concerned because she feels her "abdomen" contracting. She calls the doctors office and speaks to the nurse. What is the most appropriate response to Amanda's concern? a) "You have nothing to be concerned about. I am sure you are not feeling contractions at this point in your pregnancy." b) "You need to go to the emergency room right away." c) "You need to come to the office to be examined." d) "What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

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

A student nurse asks the instructor about maternal pulse and blood pressure changes during the prenatal period. Which of the following responses from the nurse about cardiovascular changes during the first and second trimesters is accurate? a) "Women experience increased pulse rate and blood pressure." b) "Women experience increased pulse rate and decreased blood pressure." c) "Women experience decreased pulse rate and increased blood pressure." d) "Women experience no change in pulse rate or blood pressure."

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

A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which of the following information should the nurse offer? a) "You may have mood swings that could overwhelm your partner." b) "You will experience quickening, and you will actually feel the baby." c) "You will be more conscious of the changes taking place in your body now." d) "You may feel physical discomfort as the baby inside grows."

"You will experience quickening, and you will actually feel the baby."

A woman in the second trimester of pregnancy reports that she is "tired all the time." She appears pale and her hematocrit, though within the normal range, is low. Which recommendation would be most helpful for this woman? a) A calcium supplement b) More seafood and organ meats in her diet c) More meat in her diet d) An iron supplement

An iron supplement

A nurse is caring for a pregnant client who has been diagnosed with lordosis. The nurse offers preventive measures for which of the following consequences of lordosis when caring for this client? a) Edema in lower extremities b) Chloasma c) Chronic backache d) Diastasis

Chronic backache

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called? a) Pseudo pregnancy b) Cretinism c) Pregnancy syndrome d) Couvade syndrome

Couvade syndrome

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's 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 of the following is the nurse most likely to observe? a) Fundal height is at its highest level at the xiphoid process. b) The lower uterine segment and cervix have softene c) Fundal height has dropped since the last recording. d) The fundus is at the level of the umbilicus and measures 20 cm.

Fundal height has dropped since the last recording.

When obtaining a blood test for pregnancy, which hormone would the nurse expect the test to measure? a. Human chorionic gonadotropin (hCG) b. Human placental lactogen (hPL) c. Follicle-stimulating hormone (FSH) d.Luteinizing hormone (LH)

Human chorionic gonadotropin (hCG)

A pregnant woman you care for tells you 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. You would base your reply to her on which of the following statements? a) The kidneys release a hormone during pregnancy to prevent this from happening. b) The level of aldosterone during pregnancy reduces production of IgG antibodies. c) Immunologic activity is decreased during pregnancy. d) The decreased corticosteroid activity during pregnancy ensures this will not happen.

Immunologic activity is decreased during pregnancy.

A 28-year-old primigravida client with diabetes mellitus, in her first trimester, comes to the health care clinic for a routine visit. The client reports frequent episodes of sweating, giddiness, and confusion. What should the nurse tell the client about these experiences? a) Insulin resistance becomes minimal in the latter half of the pregnancy b) Tissue sensitivity to insulin increases as pregnancy advances c) Increased secretion of insulin occurs in the first trimester d) Use of insulin needs to be reduced as pregnancy advances

Increased secretion of insulin occurs in the first trimester

During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which of the following? a) Increased venous pressure leads to increased gingival friability. b) Elevated progesterone levels cause smooth muscle relaxation. c) Influence of estrogen and blood vessel proliferation d) Effects of regurgitation from relaxation of the cardiac sphincter

Influence of estrogen and blood vessel proliferation

The husband of a pregnant woman tells the nurse that his wife is increasingly preoccupied with herself and her fetus. The woman is in her first trimester of pregnancy. The nurse interprets this as which of the following? a) Ambivalence b) Emotional lability c) Introversion d) Acceptance

Introversion

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. Which of the following conditions should the nurse monitor for in the client as a manifestation of consuming soil? a) Tooth fracture b) Constipation c) Iron-deficiency anemia d) Inefficient protein metabolism

Iron-deficiency anemia

While providing an education to a prenatal class for first time mothers and fathers during the first trimester, you include information that the father may experience which of the following as normal during the pregnancy: a) Desire to be the women and give birth b) No changes, only the mother has changes during pregnancy c) Feeling distanced from the mother d) Physical symptoms similar to the mother

Physical symptoms similar to the mother

A client in her 29th week of gestation complains of 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 of the following interventions should the nurse implement to help alleviate this client's condition? a) Keep the client's legs slightly elevated. b) Place the client in an orthopneic position. c) Place the client in the left lateral position. d) Keep the head of the client's bed slightly elevated.

Place the client in the left lateral position.

The nurse midwife is performing a pelvic examination on a client who came to her following a positive home pregnancy test. The nurse checks the woman's cervix for the probable sign of pregnancy known as Goodell's sign. Which of the following describes this alteration? a) The cervix softens. b) The lower uterine segment softens. c) The cervix looks blue or purple when examined. d) The fundus enlarges.

The cervix softens.

A teenager in the clinic is refusing to eat during her pregnancy because she does not want to "get fat". What information should the nurse provide on the outcomes of the infant related to poor maternal weight gain? a) The fetus could develop congenital anomalies b) The infant will be small and could have problems c) It will just make the baby smaller but there are no other problems associated d) There is little impact on the infant, the mother will suffer complications

The infant will be small and could have problems

Which of the following statements would the nurse include in the teaching plan for a pregnant woman related to changes in the uterus? a) The uterus reaches its maximum height in the abdomen at 39 weeks. b) The uterus changes from a pear-shaped organ to an oval one. c) Uterine growth occurs because of an increase in the number of cells in the uterus. d) The uterus moves into the abdomen by the second month of pregnancy.

The uterus changes from a pear-shaped organ to an oval one.

What factors would change during a pregnancy if the hormone progesterone were reduced or withdrawn? a. The woman's gums would become red and swollen and would bleed easily. b. The uterus would contract more and peristalsis would increase. c. Morning sickness would increase and would be prolonged. d. The secretion of prolactin by the pituitary gland would be inhibited.

The uterus would contract more and peristalsis would increase.

Which change in the breasts should a nurse recognize as a normal change associated with pregnancy? a) Disappearance of superficial veins b) Hypopigmentation of the areola and nipples c) Tingling sensations and tenderness d) Expression of colostrum in the first trimester

Tingling sensations and tenderness

A nurse urges a pregnant patient at the first prenatal office visit to begin taking iron supplements immediately. What is the rationale for this intervention? a) To maintain proper blood glucose levels b) To prevent megalohemoglobinemia c) To reduce the risk for hypertension d) To avoid anemia

To avoid anemia

Morning sickness is associated with rising levels of human chorionic gonadotropin (hCG) and progesterone. a) True b) False

True

A client in her 39th week of gestation complains of swelling in the legs after standing for long periods of time. The nurse recognizes that these factors increase the client's risk for which of the following conditions? a) Hemorrhoids b) Venous thrombosis c) Supine hypotension syndrome d) Embolism

Venous thrombosis

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy? a) Finding of hCG in the blood b) Positive home pregnancy test c) Finding hCG in the urine d) Visualization of the gestational sac or fetus

Visualization of the gestational sac or fetus

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy? a) Positive home pregnancy test b) Visualization of the gestational sac or fetus c) Finding of hCG in the blood d) Finding hCG in the urine

Visualization of the gestational sac or fetus

A woman in the last trimester of pregnancy complains of sleeping poorly. She becomes light-headed and dizzy whenever she sleeps on her back, but she can't sleep at all if she lies on her side. How would you suggest she try sleeping? a) Without a pillow b) With a pillow under both hips c) With a pillow under her right hip d) With a pillow under her shoulders

With a pillow under her right hip

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which of the following data collected by the nurse are presumptive signs of her pregnancy? Select all that apply. a) Amenorrhea b) Morning sickness c) Hydatidiform mole d) Ultrasound pictures e) Breast changes f) Fetal heartbeat

• Amenorrhea • Morning sickness • Breast changes

A pregnant client arrives at the maternity clinic complaining of constipation. Which of the following factors could be the cause of constipation during pregnancy? Select all that apply. a) Reduced stomach acidity b) Increase in estrogen levels c) Intestinal displacement d) Use of iron supplements e) Decreased activity level

• Decreased activity level • Use of iron supplements • Intestinal displacement

The nurse is counseling a young woman who has just entered her second trimester. The patient had an uneventful first trimester, with no symptoms of morning sickness. She tells the nurse, "It still doesn't seem real. It's just hard to believe that I will really have a baby." From experience, the nurse knows that which of the following are likely to help the woman accept the fact that she is having a baby? (Select all that apply.) a) Seeing an ultrasound image of the baby b) Giving up alcohol c) Receiving a positive result on a pregnancy test d) Feeling the baby kick e) Taking prenatal vitamins f) Setting up a crib for the baby

• Feeling the baby kick • Seeing an ultrasound image of the baby • Setting up a crib for the baby

A client who is in her 6th 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 of the following risks arising from her vegetarian diet? Select all that apply. a) Increased risk of constipation b) Iron-deficiency anemia c) Low gestational weight gain d) Decreased mineral absorption e) Risk of epistaxis

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

The obstetrical nurse knows that a woman's hormone levels change dramatically during pregnancy. Which of the following hormonal actions accurately represent these changes? Select all that apply. a) Maintaining the endometrium so that the embryo can implant b) Causing changes in the mother's metabolism so that nutrients are available for both c) Preparing the breasts for lactation, keeping the milk from coming in until birth occurs d) Relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly e) Decreasing the blood supply to the gastrointestinal tract and slowing peristaltic waves f) Decreasing the mother's blood volume and red blood cell mass to increase oxygen

• Maintaining the endometrium so that the embryo can implant • Causing changes in the mother's metabolism so that nutrients are available for both • Relaxing 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