PrepU chapter 11

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

As part of the pigment changes that occur with pregnancy, breast areolae become darker.

The nurse is explaining the latest laboratory results to a pregnant client who is in her third trimester. After letting the client know she is anemic, which heme iron-rich foods should the nurse encourage her to add to her diet? Legumes Dairy Grains Meats

Meats are the best source of heme-rich iron and should be included in her diet if she is not following a vegetarian diet. Grains and legumes are non-heme iron sources. Dairy products will add various vitamins and calcium to the diet.

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

During pregnancy, FSH and LH are both inhibited as there is no need to develop a follicle and release an ovum. There is an increase in the secretion of T4 and MSH. There is a decrease in the production of GH and MSH but not an inhibition.

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.

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.

pregnancy diet for vegitariens

For protein: substitute soy foods, beans, lentils, nuts, grains, and seeds. For iron: eat a variety of meat alternatives, along with vitamin C-rich foods. For calcium: substitute soy, calcium-fortified orange juice, and tofu. For vitamin B12: eat fortified soy foods and a B12 supplement.

The nurse is appraising the laboratory results of a pregnant client who is in her second trimester and notes the following: TSH slightly elevated, glucose in the urine, complete blood count low normal, and normal electrolytes. The nurse prioritizes further testing to rule out which condition? Preeclampsia Anemia Hypothyroidism Gestational diabetes

Glycosuria, glucose in the urine, may occur normally during pregnancy, however if it appears in the urine, the patient should be sent for test to rule out gestational diabetes. Preeclampsia, anemia, and hypothyroidism are not related to glucose nor to renal function. A slightly elevated TSH would indicate possible hyperthyroidism instead of hypothyroidism. Anemia would be indicated by below normal hematocrit. If the client's CBC is low normal than the nurse should monitor future results to ensure the client's counts are not dropping. It would also be appropriate for the nurse to investigate possible dietary issues. Preeclampsia would be best monitored by the blood pressure readings.

Which would be a normal finding by the nurse during a physical exam of a woman in her third trimester? Dyspnea Kyphosis Ptyalism Increased hematocrit

In the third trimester, women experiences dyspnea from the uterus pushing up into the diaphragm. A pregnant woman will experience lordosis, not kyphosis. Ptyalism is excessive saliva production and is often seen in the first trimester of pregnancy. The hematocrit of a pregnant woman will decrease in the third trimester, not increase.

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

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

The nurse is teaching a pregnant woman about breast feeding. The nurse determines that the teaching was successful when the woman identifies which hormone as being released when the newborn sucks at the breast? oxytocin follicle stimulating hormone antidiuretic hormone cortisol

Oxytocin is responsible for milk ejection during breast-feeding. Its secretion is stimulated by stimulation of the breasts via sucking or touching. Secretion of follicle-stimulating hormone is inhibited during pregnancy. The secretion of antidiuretic hormone has no effect on breast-feeding. Cortisol secretion regulates carbohydrate and protein metabolism and is helpful in times of stress

During a physical exam, the physician notates that the pregnant client has a positive Chadwick sign. What client findings would be noted for this symptom? The vagina has a bluish, purple discoloration. The cervix is reddened and swollen. There is a rebound of the fetus felt when the physician pushes on the abdomen. There is hyperpigmentation of the abdomen.

Probable signs of pregnancy include several objective physical changes in the mother. One of them is the Chadwick sign, which is seen during the pelvic exam of the client and involves a bluish, purplish discoloration of the vulva, vagina and cervix

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 Umbilical hernia Hemorrhoids Gastrointestinal reflux

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 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? 2/3 lb (.30 kg) 1 lb (.45 kg) 1.5 lb (.68 kg) 2 lb (.90 kg)

The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (.45 kg) per week. Overweight women should gain about 2/3 lb (.30 kg) per week.

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

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.

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? Linea rubria Chadwick's sign Ballottement Chloasma (melasma)

The so-called mask of pregnancy, chloasma (also known as melasma) can appear as brown blotchy areas on the forehead, cheeks, and nose of the pregnant woman. This condition may be permanent, or it may regress between pregnancies.

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)

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).

The community nurse is preparing a presentation for a health fair illustrating successful pregnancies. Which component should the nurse prioritize as the most critical to ensure a postive psychological experience with the pregnancy by the mother? Early prenatal care Age at the time of pregnancy Having a planned pregnancy Social support

All options are correct and play a role pregnancy, but the most critical for a positive psychological experience is for the woman to have a social support system. Early care, maternal age, and planned pregnancy all affect fetal and maternal health, but are not necessarily linked to positive psychological experiences.

A client calls to cancel an appointment for the first prenatal visit after reporting a home pregnancy test is negative. Which instruction should the nurse prioritize? Use a diluted urine specimen. Wait until after two missed menstrual periods. Keep the appointment. Refrain from eating for 4 hours before testing.

Although home pregnancy tests are accurate 95% of the time, they may still have false positives or false negatives, and the client needs to seek prenatal care and confirmation from her health care provider. Diluting the urine, waiting to miss a second period, or eating before the test would have no effect. The tests look for hCG, which is not affected.

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? At the level of the umbilicus At the xiphoid process Halfway between the symphysis pubis and the umbilicus Below the symphysis pubis

As the pregnancy progresses, the uterus enlarges and enters the abdominal cavity. At 16 weeks, the nurse should be able to palpate the uterus halfway between the symphysis pubis and the umbilicus.

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 description illustrates this alteration? The cervix looks blue or purple when examined. The lower uterine segment softens. The fundus enlarges. The cervix softens.

At about the eighth week of gestation, the cervix softens, a probable sign known as Goodell's sign. The cervix also looks blue or purple when examined; this is Chadwick's sign, and may occur as early as the sixth week of pregnancy. At about 6 weeks, the lower uterine segment softens, a probable sign called Hegar's sign. A softening of the uterine fundus, where the embryo has implanted, also occurs by about the seventh week, and the fundus enlarges by the eighth week.

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

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 lactose intolerant client is concerned about getting enough calcium in her diet. Which foods could the nurse suggest she include in her diet to increase her calcium intake? Select all that apply. peanuts almonds broccoli molasses carrots

Correct response: peanuts almonds broccoli molasses Explanation: The best source of calcium is milk and dairy products, but for women with lactose intolerance, adaptations are necessary. Additional sources of calcium may be necessary. These may include peanuts, almonds, sunflower seeds, broccoli, salmon, kale, and molasses. In additional, encourage the woman to drink lactose-free dairy products or calcium-enriched orange juice or soy milk.

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

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 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

Presumptive signs are 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.)

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 normal gallbladder contractions, which leads to stasis of bile. This stasis results in cholestasis, either seen in the gall bladder or the liver.

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.

Vascular changes during pregnancy manifested in the integumentary system include varicosities of the legs, vulva, and perineum. Varicose veins commonly are the result of distention, instability, and poor circulation. Various interventions to reduce the risk of developing varicosities include elevating both legs when sitting or lying down; avoiding prolonged standing or sitting; walking daily for exercise; avoiding tight clothing or knee-high hosiery; and wearing support hose if varicosities are a preexisting condition to pregnancy.

Thyroxine (t4)

Also called thryoid hormone, thyroxine is produced and secreted by the thyroid gland. it targets all cells in the body and increases overall body metabolism.

MSH (melanocyte stimulating hormone)

A hormone produced and secreted by the anterior pituitary that regulates the activity of pigment-containing cells in the skin of some vertebrates.

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.

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 assessing a client who believes she is pregnant. The nurse points out a more definitive assessment is necessary due to which sign being considered a probable sign of pregnancy? Fatigue Amenorrhea Positive home pregnancy test Nausea and vomiting

A urine pregnancy test is considered a probable sign of pregnancy as the hCG may be from another source other than pregnancy. Fatigue, amenorrhea, and vomiting are presumptive or possible signs of pregnancy and can also have other causes.

calcium for lactose intolerant

Additional or substitute sources of calcium may be necessary. These may include peanuts, almonds, sunflower seeds, broccoli, salmon, kale, and molasses (McIndoo, 2015). In addition, encourage the woman to drink lactose-free dairy products or calcium-enriched orange juice or soy milk

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

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

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).

When discussing the many changes the woman's body undergoes during pregnancy, the nurse may include that the woman's total blood volume will increase by approximately how much by the 32nd week gestation? 1,500 mL 1,000 mL 500 mL 2,000 mL

Blood volume increases by approximately 1,500 mL or 50% above nonpregnant levels by the 32nd week gestation. This increase in blood volume is needed to provide adequate hydration of fetal and maternal tissues.

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 bestresponse 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."

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.

A pregnant client who is beginning her third trimester asks the nurse why she feels like she is sometimes having labor contractions. The nurse would explain that: she is having "practice" contractions called Braxton Hicks contractions and they are normal. she may be beginning labor, so monitor for her water to break. if these contractions occur late in the day, she should be concerned. she needs to call her doctor immediately to report the contractions.

Braxton Hicks contractions begin in the second trimester as painless, intermittent "practice" contractions and continue into the third trimester, when the mother may experience some discomfort. Braxton Hicks contractions are irregular and usually go away with rest. Braxton Hick contractions normally occur later in the day, not early. It is thought that as the day slows down, the mother is more attuned to these mild, irregular contractions. There is no need to call the doctor unless the contractions become regular, which would be suggestive of labor.

A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate? "You should refrain from any sexual activity." "You need to be assessed for a fungal infection." "This discharge is normal during pregnancy." "Use a local antifungal agents regularly."

During pregnancy, the vaginal secretions become more acidic, white, and thick. Most women experience an increase in a whitish vaginal discharge, called leukorrhea, during pregnancy. The nurse should inform the client that the vaginal discharge is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans infection, a monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Monilial vaginitis is a benign fungal condition and is treated with local antifungal agents. The client need not refrain from sexual activity when there is an increase in a thick, whitish vaginal discharge.

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

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

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.

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.

In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which information would the nurse most likely include? Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge. Most of the hormonal changes are permanent after the pregnancy is completed. Taking hormonal replacement therapy can improve the discomfort of the changes. Using herbs will help ease the discomfort.

Elevated progesterone levels cause smooth muscle relaxation, which can result in relaxation of the cardiac sphincter and reflux of the stomach contents into the lower esophagus. OTC antacids will usually relieve the symptoms but should be discussed with the health care provider first. The hormonal changes are necessary for the pregnancy to continue, and the woman will return to her usual nonpregnant hormonal levels after the baby is born. Taking hormonal replacement therapy is not recommended. Using herbs should be done only with the knowledge of the health care practitioner due to the side effects and contraindications of some herbs during pregnancy. Some herbs will cause a spontaneous abortion.

When a woman is pregnant she often craves specific things, like pickles or ice cream. There is one craving that is associated with iron deficiency anemia and should be reported to the registered nurse if it occurs. What is this craving called? Chocolate mania Carnivorous craving Pica craving Lactose mania

Pica is the persistent ingestion of nonfood substances, such as clay, laundry starch, freezer frost, or dirt. Pica is associated with iron-deficiency anemia, but it is unknown whether iron-deficiency is the cause or the result. Some women find that the cravings cease when they begin taking iron supplements (Mills, 2007). If a nurse suspects or discovers that a pregnant woman is practicing pica, he or she should tell the registered nurse (RN) or the practitioner immediately.

A woman you care for in a prenatal clinic tells you 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

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.

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 client'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. What is this hormone? relaxin progesterone estrogen human placental lactogen

Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for dilatation at birth; softening of collagen allows for laxness in the lower spine and so helps enlarge the birth canal. The effect of estrogen is to cause breast and uterine enlargement. Progesterone has a major role in maintaining the endometrium, inhibiting uterine contractility, and aiding in the development of the breasts for lactation. Human placental lactogen (hPL), also known as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective, thereby allowing more glucose to become available for fetal growth.

A 39-year-old woman is pregnant with her first child and appears to be thrilled about it. Now in her second trimester, she talks enthusiastically with the nurse about the latest maternity clothes she has bought and models them for the nurse. She also discusses the latest trends in health foods, which she has adopted since learning of her pregnancy. The nurse interprets this information as reflecting which primary emotional response to pregnancy? narcissism stress introversion emotional lability

Self-centeredness (narcissism) may be an early reaction to pregnancy. A woman who previously was barely conscious of her body, who dressed in the morning with little thought about what to wear, suddenly begins to concentrate on these aspects of her life. She dresses so her pregnancy will or will not show. There is no evidence in this scenario of stress, introversion, or emotional lability.

A pregnant client in her third trimester, lying supine on the examination table, suddently grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize? Cerebral arteries are growing congested with blood. The uterus requires more blood in a supine position. Blood is trapped in the vena cava in a supine position. Sympathetic nerve responses cause dyspnea when a woman lies supine.

Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava. Cerebral arteries should not be affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in any orientation. The sympathetic nervous system will not be affected by the supine position.

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." "Your old coping methods will adequately get you through this period of adjustment." "The hormones of pregnancy may cause anxiety or depression postpartum." "Caring for your new infant is instinctual and will come naturally to you."

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. Siblings often react to a pregnancy by regression in behavior and attitude because they fear that they will be replaced or unloved. In addition to anticipatory guidance concerning the alterations in family structure and functioning, prenatal preparation for first-time parents involves learning the basics of infant care and preparing for infant feeding, particularly for women who plan to breastfeed.

A pregnant vegan reports eating lots of dark green leafy vegetables, legumes, citrus fruits, and berries. To ensure that her infant's nervous system will develop properly, what foods should the nurse recommend that she add to her diet? Milk and cheese Carrots, sweet potatoes, and mangoes Nuts, seeds, and chocolate Fortified cereals

The best source to recommend are the fortified cereals to meet the amino acid needs necessary for the development of her infant's nervous system during pregnancy. She should be encouraged to include fortified cereals to meet these needs. The carrots, sweet potatoes, mangoes, nuts, and seeds will add other nutrients to her diet. A vegan will not eat milk and cheese, as they are animal products.

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 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.

A client in her second trimester of pregnancy is anxious about the blotchy, brown pigmentation appearing on her forehead and cheeks. She also reports increased pigmentation on her breasts and genitalia. Which statement by the nurse is most appropriate? "I will let the health care provider know about the pigmentation." "I understand your concern; I would be concerned too." "This is called facial melasma and should fade after the birth." "I can tell you are anxious. Are there any other things worrying you?"

The skin and complexion of pregnant women undergo hyperpigmentation, primarily as a result of estrogen, progesterone, and melanocyte stimulating hormone levels. The increased pigmentation that occurs on the breasts and genitalia also develops on the face to form the "mask of pregnancy," or facial melasma (cholasma). This is a blotchy, brownish pigment that covers the forehead and cheeks in dark-haired women. The nurse would inform the client that this is a normal occurrence in pregnancy and should fade after birth.

The nurse is teaching a pregnant teenager the importance of proper nutrition and adequate weight gain throughout the pregnancy. What is the best response when the client refuses to eat due to fear of possible weight gain? The infant will be small and could have problems. There may be little impact on the infant, but the mother can suffer complications. It will just make the baby smaller, but there are no other problems associated. The infant will be smaller but should quickly gain weight.

Women who gain less than 16 pounds (7,257 g) are at risk for giving birth to small infants, which is associated with poor neonatal outcomes. The infant may not quickly gain weight but continue to slowly put on weight.