Chapter 11: Maternal Adaptation During Pregnancy

A pregnant client in her first trimester is being seen at the women's clinic. What statement by the nurse would be most beneficial to this client to support her acceptance of the pregnancy?

"Having feelings of uncertainty are very common when a woman becomes pregnant. I will be glad to talk to you about any concerns you may have." Explanation: When a woman discovers she is pregnant, she may be shocked or overjoyed but there still may be feelings of ambivalence regarding the pregnancy. She may question her mothering skills; if the pregnancy was unplanned, she may have concerns about finances. It is the nurse's job to reassure the woman that her feelings are normal at this stage. The other responses do not provide the correct support needed by this woman.

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." Explanation: 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. Pregnant women can get many nutrients from seafood including phosphorus, but there are specific recommendations about types of fish to avoid because of the risk of mercury poisoning. Milk production actually requires higher levels of zinc, which can be obtained from a healthy diet. Calcium requirements do not increase above prepregnancy levels during pregnancy because calcium absorption is enhanced during pregnancy. It can be unsafe for the pregnant woman to eat anything she wants and gain too much weight. A woman who gains too much weight during pregnancy is at risk for delivering a macrosomic baby.

A client at 40 weeks' gestation informs the nurse that she is tired of being pregnant. What is the best response from the nurse?

"That is a very normal feeling, especially at this point in pregnancy." Explanation: During the third trimester, the client is preparing for parenthood and is often tired and ready for a break. The woman may feel large and unable to do any normal activities, and may feel ready to have the baby in her arms rather than in her uterus. This is not an abnormal statement, and the provider should not overreact. Deciding to induce labor is something that should be done in consultation with the health care provider and only when it is necessary for the health/safety of the mother or baby.

A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate?

"This discharge is normal during pregnancy." Explanation: During pregnancy, 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 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?

"This is called facial melasma (chloasma) and should fade after the birth." Explanation: 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 (chloasma). 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.

On a prenatal visit, a woman in her second trimester has an ultrasound that confirms that the baby is a girl. Which statement by the mother would be troubling to the nurse concerning this finding?

"We don't want to name her because we don't want to get too attached." Explanation: Having a mother voice concerns about becoming too attached to the fetus she is carrying is concerning. The nurse needs to explore why the mother is reluctant to bond with her fetus. The other responses are all appropriate, taking into personal and cultural beliefs.

A client is about 16 weeks' pregnant and is concerned because she feels her "abdomen" contracting. She calls the primary care provider's office and speaks to the nurse. What is the nurse's most appropriate response to this client's concern?

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." Explanation: Braxton Hicks contractions are the painless, intermittent, "practice" contractions of pregnancy.

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. Explanation: 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.

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. -Increase consumption of fruits, vegetables, and whole grains. -Avoid the intake of alcohol. -Decrease intake of saturated fats, trans fats, and cholesterol. -Consume at least one quart of water daily. -Increase caloric intake.

-Increase consumption of fruits, vegetables, and whole grains. -Avoid the intake of alcohol. -Decrease intake of saturated fats, trans fats, and cholesterol. Explanation: For a pregnant woman to meet recommended DRIs, she should eat according to the U.S. Department of Agriculture (USDA) food guide, MyPlate. Some of these guidelines include eating a variety of foods from all food groups, using portion control; increase intake of vitamins, minerals, and dietary fiber; lower intake of saturated fats, trans fats, and cholesterol; increase intake of fruits, vegetables, and whole grains; and balance calorie intake with exercise to maintain an ideal healthy weight.

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 change -amenorrhea -morning sickness Explanation: 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.)

A nurse is assigned to educate a pregnant client regarding the changes in the structures of the respiratory system taking place during pregnancy. Which conditions are associated with such changes? Select all that apply. -nasal and sinus stuffiness -persistent cough -nosebleed -Kussmaul respirations -thoracic rather than abdominal breathing

-nasal and sinus stuffiness -nosebleed -thoracic rather than abdominal breathing

The nurse is assessing a pregnant client at 20 weeks' gestation and obtains a hemoglobin level. Which result would be a cause for concern?

10.6 g/dl Explanation: The average hemoglobin level at term is 12.5 g/dl. The hemoglobin level is considered normal until it falls below 11 g/dl.

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

2+ Protein in urine Explanation: 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.

Hormone levels of a woman indicate that the corpus luteum stopped functioning and releasing progesterone after 5 weeks. The nurse would recognize that which scenario is the expected outcome?

A spontaneous abortion (miscarriage) would occur. Explanation: If the corpus luteum fails to produce progesterone for approximately 6 to 7 weeks, a spontaneous abortion (miscarriage) will occur. After 7 weeks, the placenta will produce enough progesterone to sustain the pregnancy. There is no connection between multifetal pregnancies and the corpus luteum not functioning long enough in progesterone production.

A woman tells the nurse that she is going to use a home pregnancy test to determine whether she is pregnant. Which precautions should the nurse give her?

Arrange for prenatal care if the test is positive. Explanation: Home pregnancy testing can be accurate as soon as a period is missed; it should not take the place of prenatal care.

A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize?

Blood is trapped in the vena cava in a supine position. Explanation: 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.

A pregnant client in her first trimester of pregnancy reports spontaneous, irregular, painless contractions. What does this indicate?

Braxton Hicks contractions Explanation: Spontaneous, irregular, painless contractions, called Braxton Hicks contractions, begin during the first trimester. These contractions are not the signs of preterm labor, infection of the GI tract, or acid indigestion. Acid indigestion causes heartburn. Acid indigestion or heartburn (pyrosis) is caused by regurgitation of the stomach contents into the upper esophagus and may be associated with the generalized relaxation of the entire digestive system.

A client presents to the clinic because she thinks she may be pregnant. On examination, the nurse notes that the client's cervix and vaginal mucosa appear a bluish-purple color. The nurse interprets this finding as which sign?

Chadwick sign Explanation: Common probable signs of pregnancy include a bluish-purple coloration of the vaginal mucosa and cervix (Chadwick sign), softening of the lower uterine segment or isthmus (Hegar sign), and softening of the cervix (Goodell sign). There is no such thing as Braxton sign; however, there are the Braxton Hicks contractions, which occur throughout the pregnancy preparing the uterus for delivery.

The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting?

Darkened breast areolae Explanation: As part of the pigment changes that occur with pregnancy, breast areolae become darker. The breast tissue should not be softer or slacker than before. There should not yet be any lymph enlargement, and the nipples should not have fissures.

The nurse cares for a pregnant client at the first prenatal visit and reviews expected changes that will occur during pregnancy. Which information will the nurse include in the education?

During pregnancy blood volume can increase by at least 40%. Explanation: The pregnant woman can experience a blood volume increase by approximately 40% to 50% above prepregnancy levels by the end of the third trimester. Pregnancy results in an increased respiratory rate to provide oxygen to both the mother and fetus. Hemoglobin levels are usually low during pregnancy because of hemodilution of red blood cells, which is termed physiologic anemia of pregnancy. Blood pressure usually reaches a low point mid-pregnancy and, thereafter, increases to prepregnancy levels by the third trimester.

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

Dyspnea Explanation: In the third trimester, a 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.

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 Explanation: 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.

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. Explanation: 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 mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem?

Hemorrhoids Explanation: 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 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She expresses feeling proud and excited about her pregnancy while at the same time feeling fearful and anxious of its implications. Which action should the nurse do next?

Inform the client this is a normal response to pregnancy that many women experience. Explanation: The maternal emotional response experienced by the client is ambivalence. Ambivalence, or having conflicting feelings at the same time, is universal and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester.

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?

Keep the appointment. Explanation: 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.

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

Lie down and rest and see if the contractions stop and pain subsides. Explanation: If a client is less than 37 weeks and having contractions that will not go away, she may be in preterm labor and this needs to be reported. The first thing for her to do is lie down and rest to see if the contractions go away. Lower backache and cramping or pain need to be taken seriously and reported to the health care provider if they persist.

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?

Meats Explanation: 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.

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. Explanation: 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 (miscarriage).

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?

The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. Explanation: Slight bleeding after a pelvic exam in a pregnant woman is common due to the vascularity of her cervix during pregnancy. Suggesting a bleeding disorder is frightening and not substantiated by the data. Bleeding is not a normal finding during pregnancy and losing the mucus plug occurs at the end of pregnancy, just prior to labor.

A client takes a home pregnancy test. While she is waiting to read the results, her phone rings. When she gets off the phone 15 minutes have passed. The package instructions are to read the pregnancy test result at 3 minutes and warn that waiting longer may result in a false positive. What is a false positive?

The test reads positive but the client is not pregnant. Explanation: A false positive is a test result which incorrectly indicates that a particular condition or attribute is present; for example, a positive home pregnancy test when the client is not pregnant.

The nurse has just informed a client that the pregnancy test is positive and the client will need further assessment to determine the complete status of the situation. Which initial emotional response does the nurse expect the client to exhibit?

ambivalence Explanation: Initially, the pregnant client commonly experiences ambivalence, with conflicting feelings at the same time. Introversion heightens during the first and third trimesters when the client's focus is on behaviors that will ensure a safe and healthy pregnancy outcome. Acceptance usually occurs during the second trimester. Emotional lability (mood swings) is characteristic throughout a pregnancy.

The nurse is assessing several pregnant women in a clinic setting. Which assessment finding would alert the nurse to notify the health care provider?

blood pressure measured at 170/88 mm Hg Explanation: During pregnancy, women may expertise increased nasal stuffiness, increased urination, fatigue, and skin pigment increases. Elevated blood pressure is a concern during pregnancy and would be reported.

What is the major concern for a lactose intolerant woman who is pregnant?

calcium deficiency Explanation: Calcium deficiency is a major concern for the pregnant woman who is lactose intolerant. There are several ways to address this concern. Some lactose-intolerant individuals are able to tolerate cooked forms of milk, such as pudding or custard. Cultured or fermented dairy products, such as buttermilk, yogurt, and some cheeses may also be tolerated. A chewable lactase tablet may be taken with milk. Lactase-treated milk is available in most supermarkets and may be helpful. Other options are to drink calcium-enriched orange juice or soy milk or to take a calcium supplement. If the woman is infrequently exposed to sunlight, she will need a vitamin D supplement.

A nurse is caring for a pregnant client who has been diagnosed with lordosis. The nurse offers preventive measures for which consequence of lordosis when caring for this client?

chronic backache Explanation: The nurse should provide preventive measures for chronic backache as a consequence of lordosis when caring for this client. Melasma (chloasma) is characterized by darkened areas on the face, particularly over the nose and cheeks. It is also known as the mark of pregnancy. Chloasma is not caused by lordosis. Diastasis recti occurs as the pregnancy progresses when the rectus muscle stretches to the point that it separates. It is not caused by lordosis. Edema in lower extremities occurs due to an impeded venous return caused by the pressure of the growing fetus on pelvic and femoral areas. It is not caused by lordosis.

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?

couvade syndrome Explanation: 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.

A pregnant client comes to the prenatal clinic complaining of urinary frequency and lower back pain on the right, stating that this has never happened before. An exam validates the diagnosis of pyelonephritis. Which factor would contribute to this condition?

decreased peristalsis of urinary tract Explanation: Renal and ureteral dilation (dilatation) occurs due to hormonal changes during pregnancy. This dilation causes the kidney size to increase, especially on the right. Additionally, peristalsis decreases in the urinary tract, leading to urinary stasis and increased risk of infection. The renal pelvis does not dilate due to the hormones. Increased glomerular filtration rate leads to urinary frequency, not pyelonephritis. Intake of caffeinated beverages may cause urinary tract infections, but since the client has never had urinary problems previously, this should not be the cause.

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. Explanation: Fetal heart sounds are audible with a Doppler at 10 to 12 weeks' gestation but cannot be heard through a stethoscope until 18 to 20 weeks' 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' gestation.

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:

encourage her to identify someone that she can talk to and share the pregnancy experience. Explanation: A pregnant woman without social support needs to identify someone with whom she can share the experience of pregnancy because social support is a crucial part of adapting to parenthood. Telling her to move home and telling her that she will feel better as the pregnancy progresses do not address the issue of isolation. Also, moving home may not be a possibility for this woman. The nurse should maintain a professional relationship and not commit to a long-term relationship with a client.

A nurse assessing the laboratory results of a pregnant client in the second trimester notes that the client has a hemoglobin level of 11 g/dl (110 g/l). How will the nurse likely interpret this finding?

hemodilution of pregnancy (physiologic anemia of pregnancy) Explanation: During pregnancy, the red blood cell (RBC) count increases along with an increase in plasma volume. However, there is a greater increase in the plasma volume as a result of hormonal factors and sodium and water retention. Thus, the plasma increase exceeds the increase in RBCs, resulting in hemodilution of pregnancy, which is also called physiologic anemia of pregnancy. Changes in the pregnant client's iron levels would be more indicative of iron-deficiency anemia. Although anemia may be present with a multiple gestation pregnancy, an ultrasound would be a more reliable method of identifying it. Weight gain does not correlate with hemoglobin levels.

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. What is the name of this phenomenon?

linea nigra Explanation: Extra pigmentation generally appears on the abdominal wall because of melanocyte-stimulating hormone from the pituitary. A narrow, brown line (linea nigra) may form, running from the umbilicus to the symphysis pubis and separating the abdomen into right and left halves. The other answers are other changes that occur in the integumentary system during pregnancy, including melasma (darkened or reddened areas on the face - also known as chloasma), diastasis recti (separation of the rectus muscles under the skin), and striae gravidarum (stretch marks; pink or reddish streaks on the sides of the abdominal wall and sometimes on the thighs).

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 Explanation: 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 nurse is explaining how hormones affect the pregnancy. Which hormone would the nurse describe as being responsible for stimulating uterine contractions during labor and birth?

oxytocin Explanation: Oxytocin is responsible for stimulating the uterine contractions that bring about delivery. Progesterone and estrogen help maintain the pregnancy, and prolactin helps with stimulating milk production after the delivery.

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?

physical symptoms similar to the mother Explanation: 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.

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?

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

presumptive Explanation: The most common presumptive sign of pregnancy is a missed menstrual period, or amenorrhea. Other presumptive signs include nausea, fatigue, swollen, tender breasts, and frequ

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. Explanation: 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 Hicks 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 client in her 39th week of gestation reports swelling in the legs after standing for long periods of time. The nurse recognizes that this factor increases the client's risk for which condition?

venous thrombosis Explanation: During pregnancy, there is an increase in the client's blood components. These changes, coupled with venous stasis secondary to venous pooling, which occurs during late pregnancy after standing long periods of time (with the pressure exerted by the uterus on the large pelvic veins), contribute to slowed venous return, pooling, and dependent edema. These factors also increase the woman's risk for venous thrombosis. The symptoms experienced by the client do not indicate that she is at risk for hemorrhoids, embolism, or supine hypotension syndrome. Supine hypotension syndrome occurs when the uterus expands and exerts pressure on the inferior vena cava, which causes a reduction in blood flow to the heart. A client with supine hypotension syndrome experiences dizziness, clamminess, and a marked decrease in blood pressure.

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. Explanation: 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.

Which information provided by a client would be considered a presumptive sign of pregnancy?

Breast tenderness Explanation: Presumptive signs of pregnancy are things reported by the woman to the health care provider and occur early in pregnancy. Breast tenderness is a common sign reported by women in early pregnancy but is not a definitive sign. Reports of increased hunger and weight gain could be caused by any disorder or could be normal responses to eating cycles. Ballottement occurs late in the pregnancy and is a probable sign.

During a prenatal visit, a client in her second trimester of pregnancy verbalizes positive feelings about the pregnancy and conceptualizes the fetus. Which is the most appropriate nursing intervention when the client expresses such feelings?

Offer support and validation about the client's feelings. Explanation: During the second trimester, many women will verbalize positive feelings about the pregnancy and will conceptualize the fetus. The woman may accept her new body image and talk about the new life within her. Generating a discussion about the woman's feelings and offering support and validation at prenatal visits are important nursing interventions. The nurse should encourage the client in her first trimester to focus on herself, not on the fetus; this is not required when the client is in her second trimester. The client's feelings are normal for the second trimester of pregnancy; hence, it is not necessary either to inform the primary health care provider about the client's feelings or to tell the client that it is too early to conceptualize the fetus.

A pregnant client at 33 weeks' gestation 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 feels lightheaded; her blood pressure is 82/58 mm Hg. What is the most likely explanation for this problem?

She is experiencing supine hypotension syndrome Explanation: 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.

During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to avoid what condition?

Supine hypotension syndrome Explanation: 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. Urinary frequency in the third trimester is due to the enlarged uterus pressing on the bladder and is not influenced by position. Remaining in an upright position for 1 to 2 hours after meals helps to decrease heartburn.

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?

Tell the woman that this is entirely normal. Explanation: 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.

During a routine visit to the clinic, a client tells the nurse that she thinks she may be pregnant. The physician prescribes a pregnancy test. The nurse should know the purpose of this test is to determine which change in the client's hormone level?

increase in human chorionic gonadotropin (hCG) Explanation: Human chorionic gonadotropin (hCG) increases in a woman's blood and urine to fairly large concentrations until the 15th week of pregnancy. The other hormone values are not indicative of pregnancy.

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 Explanation: 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.

A new mother voices concerns about breastfeeding her infant. The nurse would explain to the mother the two hormones that control lactation and letdown are:

prolactin and oxytocin. Explanation: Prolactin and oxytocin are both important hormones in regulation of breastfeeding. Prolactin helps in producing the breast milk and oxytocin stimulates letdown during breastfeeding. The other hormones do not play a role in breastfeeding or milk production.