Exam 1 - Chapter 9/13
A patient reports to the nurse that she had missed her period this month and suspects that she is a pregnant. What would be the most suitable nursing action for this patient? a. Assess for Hegar sign b. Assess for Chadwick sign c. Obtain an order for a urine pregnancy test d. Obtain an order for a serum pregnancy test
Because the woman has missed her period, it is likely that the woman is 4 to 6 weeks pregnant. A serum pregnancy test helps in the earliest detection of pregnancy. This test can be used to detect pregnancy in women who are 4 weeks pregnant. Therefore, the nurse should ask the patient to take the serum pregnancy test. It is performed during weeks 4 to 12 of pregnancy. The Hegar sign and Chadwick sign will be observed during weeks 6 to 12 of pregnancy, and pelvic congestion may be another cause for such signs. A urine pregnancy test gives positive results during weeks 6 to 12 of pregnancy. D
If exhibited by a pregnant woman, what represents a positive sign of pregnancy? A. Morning sickness B. Quickening C. Positive pregnancy test D. Fetal heartbeat auscultated with Doppler/fetoscope
Detection of a fetal heartbeat, palpation of fetal movements and parts by an examiner, and detection of an embryo/fetus with sonographic examination are positive signs diagnostic of pregnancy. Morning sickness and quickening, along with amenorrhea and breast tenderness, are presumptive signs of pregnancy; subjective findings are suggestive but not diagnostic of pregnancy. Other probable signs include changes in integument, enlargement of the uterus, and Chadwick sign. A positive pregnancy test is considered to be a probable sign of pregnancy (objective findings are more suggestive but not yet diagnostic of pregnancy) because error can occur in performing the test or, in rare cases, human chorionic gonadotropin (hCG) may be detected in the urine of nonpregnant women. Chances of error are less likely to occur today because pregnancy tests used are easy to perform and are very sensitive to the presence of the hCG associated with pregnancy. D
The primary health care provider finds that a pregnant client has low hematocrit values but does not consider the woman anemic. Why is the pregnant woman with low hemaotocrit values not considered anemic? A. Hematocrit doesn't relate to anemia. B. Anemia doesn't cause risk during pregnancy. C. Plasma volume expands rapidly during pregnancy. D. Erythrocyte production compensates for the low hematocrit.
During pregnancy, low hematocrit values (37% to 47%) are generally observed due to plasma volume expanding faster than the rate of erythrocyte production. This phenomenon is known as physiologic anemia and is common during pregnancy. Hematocrit, or packed cell volume, is an indicator of anemia. Anemia causes a risk of growth restriction in the fetus, but physiologic anemia is common in pregnant women. Plasma expansion occurs at faster rate than erythrocyte production in pregnant women, resulting in low hematocrit values. C
The nurse is teaching student nurses about the procedure for measuring blood pressure (BP) in pregnant women. Which statement by a student nurse indicates the need for additional teaching? A. "The two readings should be taken at least a minute apart." B. "The cuff should cover approximately half of the upper arm." C "BP should be measured with the woman sitting or in a semi-reclining position." D. "If BP is elevated, the woman should rest for at least 10 minutes before I retake her BP."
During the measurement of BP, the correct cuff size should be used, and the cuff should cover approximately 80% of the upper arm, or the cuff should be 1.5 times the length of the upper arm. The two readings should be taken at least a minute apart to avoid errors. In order to avoid fluctuations, BP should be measured with the woman sitting or semi-reclining with her feet flat, not dangling. If the BP is elevated, the woman should rest for 5 to 10 minutes before the nurse retakes her BP. B
A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system to describe this woman's current obstetric history, the nurse records what? A. 4-1-2-0-2 B. 4-2-1-0-2 C. 4-1-1-0-2 D. 4-1-2-2-0
Gravida (the first number) is 4 because this woman is now pregnant and was pregnant 3 times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and is described as: 4T: 1 = Term birth at 41 weeks of gestation (son) 4P: 2 = Preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter) 4A: 0 = Abortion: none occurred 4L: 2 = Living children: her son and her daughter. A
A client is in the 21st week of her third pregnancy. The client's first pregnancy ended in fetal death in the 24th week of pregnancy, and the second one was terminated during the third month of gestation. How does the nurse denote the obstetric history of this patient? A. Gravida 1 para 1 B. Gravida 2 para 2 C. Gravida 3 para 2 D. Gravida 2 para 1
Gravidity and parity information is obtained during history-taking interviews. The term gravidity indicates the number of pregnancies. The term parity indicates the number of pregnancies in which the fetus reached 20 weeks of gestation (the fetus may have been alive or stillborn). In this case, the client had a total of three pregnancies, denoted by gravidity 3. Among the three pregnancies, two of them reached 20 weeks of gestation, denoted by para 2. Gravida 1 Para 1 would indicate that the client had one pregnancy, which completed 20 weeks of gestation. Gravida 2 para 2 indicates that the client had two pregnancies, and both fetuses completed 20 weeks of gestation. Gravida 2 Para 1 indicates that the client had two pregnancies, and only one fetus reached 20 weeks of gestation. C
The laboratory reports of a client in the 8th week of pregnancy show a very high level of human chorionic gonadotropin (hCG). What does the nurse infer from the reports? A. The pregnancy is normal and has no risk. B. There is a risk of an impending miscarriage due to teratogenic exposure. C. The client is at decreased risk for developing an ectopic pregnancy. D. There is a potential risk of the fetus having Down syndrome.
High levels of hCG indicate abnormal gestation, resulting from the fetus having Down syndrome or gestational trophoblastic disease. Human chorionic gonadotropin (hCG) is present at the onset of pregnancy and increases for 60 days, and then starts to decline at about 16 weeks. The presence of high levels of hCG even at the 8th week of pregnancy is not a normal parameter. An abnormally low level of hCG may lead to ectopic pregnancy or impending miscarriage. Ectopic pregnancy is a complication of pregnancy in which the embryo gets implanted outside the uterine cavity. D
A pregnant client was found to have higher-than-normal levels of human chorionic gonadotropin (hCG). The client also reports excessive vomiting and mild vaginal bleeding. What risk does the nurse suspect in the client? A. Miscarriage B. Ectopic pregnancy C. Intrauterine growth restriction D. Gestational trophoblastic disease
Higher-than-normal levels of hCG are associated with abnormal gestation, such as a fetus with gestational trophoblastic disease, multiple gestation, or a fetus with Down syndrome. An abnormally slow increase in hCG, or lower levels of hCG, indicates miscarriage or ectopic pregnancy. Intrauterine growth restriction occurs due to poor placental perfusion or lack of adequate oxygen supply to the fetus. D
The nurse reviews the lab reports of a female client and infers that the client has an ectopic pregnancy. What finding would prompt the nurse to consider this clinical diagnosis? A. Very low levels of insulin B. Very low levels of anemia C. Very low levels of thrombocytopenia D. Very low levels of human chorionic gonadotropin (hCG)
Human chorionic gonadotropin (hCG) is produced by the fertilized ovum. Abnormally low levels of hCG indicate impending miscarriage or ectopic (tubal) pregnancy. Decreased levels of insulin are indicative of diabetes. Lower levels of RBC indicate anemia. Low levels of platelets indicate that the client may have impaired clotting ability. Diabetes, anemia, and thrombocytopenia are not conditions predisposing for ectopic pregnancy. D
The nurse reviews the obstetric history of a pregnant woman and notes the GTPAL (gravidity, term, preterm, abortions, living children) for the woman is "1-0-1-0-1." What does the nurse infer from this? A. The woman was pregnant twice, gave birth at the 35th week, and the baby survived. B. The woman was pregnant once and gave birth to twins at the 36th week of pregnancy. C. The woman was pregnant once, gave birth at the 35th week, and the baby survived. D. The woman was pregnant twice and had miscarriage at 10 weeks during second pregnancy.
If the woman was pregnant only (gravidity-1), gave birth at week 35 (term-0), had one preterm delivery (preterm-1), had no abortions (abortion-0), and the baby survived (living children-1), then the GTPAL should be "1-0-1-0-1." If the woman was pregnant twice, gave birth at the 35th week during both pregnancies, and both babies survived, then the GTPAL would be "2-0-2-0-2." If the woman was pregnant once, gave birth to twins at the 36th week, then the GTPAL would be "1-0-2-0-2." The GTPAL would be "2-1-0-1-1" if the woman was pregnant twice, had one term pregnancy, but the second pregnancy ended in miscarriage at 10 weeks. C
The nurse is teaching a group of women about home pregnancy tests. Which instruction does the nurse include in the lesson? Select all that apply. A. Use the last-voided evening urine specimen. B. Follow the manufacturer's instructions carefully. C. Contact your primary health care provider for follow-up if the test result is negative. D. Repeat the test (if negative) after a week, if amenorrhea persists. E. Contact your primary health care provider for follow-up if the test result is positive.
In her teaching about home pregnancy tests, the nurse should reinforce the need to follow the manufacturer's instructions carefully in order to get correct results. The test should be repeated after a week if a woman has still not had a period after a negative result. If the test result is positive, the woman should contact her primary health care provider for follow-up. The first-voided, not the last-voided, morning urine specimen should be used for pregnancy testing. If the test result is negative and the women still has not had a period, the women should contact her primary health care provider. B, D, E
The nurse is assessing a client who is 7 months pregnant. The nurse observes that there are increased chest movements and decreased abdominal movements while breathing. How does the nurse interpret this finding? A. Normal finding during pregnancy. B. Impaired diaphragm function. C. Decreased abdominal muscle tone. D. Presence of obstructive lung disorder.
Pregnant women have distended abdomens. This makes it difficult for the diaphragm to descend down during inspiration. Therefore, pregnant women have chest breathing. Thoracic breathing in advanced pregnancy occurs due to the action of the diaphragm. It does not mean that the patient has impaired diaphragm function. Abdominal muscle tone is decreased in pregnant women. The diaphragm is the primary muscle responsible for abdominal movements while breathing. Therefore, chest breathing would not indicate that the client has decreased abdominal muscle tone. Obstructive lung disorder may weaken the diaphragm. Chest breathing does not indicate that the patient has obstructive lung disorder. A
What are the characteristics of the Goodell sign? Select all that apply. A. Hypertrophy B. Hyperplasia C. Decreased friability D. Decreased vascularity E. Softening of the cervical tip
The Goodell sign is a probable sign of pregnancy, which is observed beginning in the sixth week of pregnancy. Hypertrophy refers to the enlargement of the preexisting elastic tissue. Hyperplasia refers to formation of new fibroelastic tissue. Hypertrophy and hyperplasia of the cervix, in addition to softening of the cervical tip, are the main observations of the Goodell sign. Friability of the cervix is increased, which may result in slight bleeding after vaginal examination. Increased vascularity of the cervix and vagina is also a characteristic feature of the Goodell sign. A, B, E
During the prenatal examination of a pregnant woman, the nurse finds that the client has hemorrhoids. What does the nurse interpret from this finding? A. The estrogen and progesterone levels are increased in the pregnant client. B. The fetal blood is coursing through the umbilical cord in the pregnant client. C. The estrogen and progesterone have caused cervical stimulation in the client. D. The venous pressure has increased and there is reduced blood flow to the legs.
The causes of hemorrhoids in the pregnant client are increased venous pressure and reduced blood flow to the legs. The enlarged uterus compresses the iliac veins and the inferior vena cava results in increased venous pressure. This increases the blood pressure in the anal vasculature, and predisposes a pregnant woman to have hemorrhoids. Increased levels of estrogen and progesterone cause fullness, heightened sensitivity, tingling, and heaviness of the breasts. The fetal blood coursing through the umbilical cord in the client causes the funic souffle sign of fetal heart rate. Cervical stimulation by estrogen and progesterone results in leucorrhea, which is the white or slightly gray mucoid discharge from the vagina with a faint musty odor. D
A client who is in the second trimester of pregnancy reports dizziness and fatigue. Which laboratory findings indicate that the client is anemic? A. Hematocrit value of 35% B. Hematocrit value of 40% C. Hemoglobin value of 11 g/dl D. Hemoglobin value of 10 g/dl
The decrease in normal hemoglobin values (12 to 16 g/dl blood) and hematocrit values (37% to 47%) due to rapid expansion of plasma is referred to as physiologic anemia. If the hemoglobin value drops to 11 g/dl or less during the first or third trimester, or less than 10.5 g/dl during the second trimester, or if the hematocrit decreases to 32% or less, the woman is considered anemic. A hemoglobin value of 10 g/dl indicates that the patient is anemic. A hematocrit value of 35% does not indicate that the patient is anemic, and 40% is a normal value. In the first or third trimester, a hemoglobin value of 11% indicates that the patient is not anemic. Hemoglobin value of more than 10.5g/dl in the second trimester is not considered anemia. D
The GTPAL (gravidity, term, preterm, abortions, and living children) of a patient is 3-1-2-1-3. What does the nurse infer about the client's obstetric history from this? A. 3 pregnancies with 1 miscarriage, 1 preterm birth and 3 living children. B. 3 pregnancies with 2 miscarriages, 1 preterm birth and 3 living children. C. 3 pregnancies with 1 miscarriage, 2 preterm birth and 3 living children. D. 3 pregnancies with no miscarriage, 2 preterm birth and 3 living children.
The five-digit system GTPAL provides information on a woman's obstetric history. The GTPAL 3-1-2-1-3 indicates that the client had 3 pregnancies, 1 term birth 1, 2 preterm births, 1 miscarriage, and 3 living children. If the client has 3 pregnancies with 1 miscarriage, 1 preterm birth, and 3 living children, the GTPAL is denoted as 3-1-1-1-3. If the client has 3 pregnancies with 2 miscarriages, 1 preterm birth, and 3 living children, the GTPAL is denoted as 3-1-1-2-3. If the client has 3 children with no miscarriage, 2 preterm births, and 3 living children, the GTPAL is denoted as 3-1-2-0-3. C
After reviewing the lab reports of a 5-month pregnant female, the nurse tells the patient that her condition is normal. Which findings enabled the nurse to conclude that the patient is healthy? Select all that apply. A. The patient's bladder has a capacity of 1000 ml. B. The hemoglobin value is 13 g/dl in the patient. C. The total serum protein value is 5.1 g/dl in the patient. D. The mean corpuscular hemoglobin value is 30 pg. E. The mean corpuscular hemoglobin concentration is 34 g/dl.
The laboratory findings may indicate the health condition of the patient. The hemoglobin value is 13 g/dl, which is within the normal range (greater than 11 g/dl). The mean corpuscular hemoglobin value of 30 pg (normal range = 27-31 pg) and the mean corpuscular hemoglobin concentration of 34 g/dl (normal range = 32-36 g/dl) also imply normal findings. The bladder capacity of 1000 ml is less than the normal value (1500 ml). The total serum protein value of 5.1 g/dl is not within the normal range (5.5-7.5 g/dl). These findings would not indicate that the patient is normal. B, D, E
Which hematocrit (HCT) and hemoglobin (HGB) results represent the lowest acceptable values for a woman in the third trimester of pregnancy? A. 38% HCT; 14 g/dl HGB B. 35% HCT; 13 g/dl HGB C. 33% HCT; 11 g/dl HGB D. 32% HCT; 10.5 g/dl HGB
33% HCT and 11 g/dl HGB represents the lowest acceptable value during the first and the third trimesters. 38% HCT; 14 g/dl HGB is within normal limits in a nonpregnant woman. 35% HCT; 13 g/dl HGB is within normal limits in a nonpregnant woman. 32% HCT; 10.5 g/dl HGB represents the lowest acceptable value for the second trimester, when the hemodilution effect of blood volume expansion is at its peak. C
A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called what? A. Primipara. B. Primigravida. C. Multipara. D. Nulligravida.
A primipara is a woman who has completed one pregnancy with a viable fetus. Gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant. A
The nurse is assessing a pregnant woman who has a child and is in the 25th week of pregnancy. What term is used to describe the woman? A. Primipara B. Multipara C. Primigravida D. Multigravida
A woman who has completed two or more pregnancies to 20 weeks of gestation or more is called a multipara. A woman who has completed one pregnancy with a fetus who reached 20 weeks of gestation is primipara. A woman who is pregnant for first time is primigravida. A woman who has completed two or more pregnancies is called a multigravida. B
Which presumptive sign (felt by woman) or probable sign (observed by the examiner) of pregnancy is matched with another possible cause? Select all that apply. A. Amenorrhea-stress, endocrine problems B. Quickening-gas, peristalsis C. Goodell sign-Cervical polyps D. Chadwick sign-Pelvic congestion E. Urinary frequency-Infection
Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be mimicked by gas or peristalsis. Chadwick sign might be the result of pelvic congestion. Urinary frequency can be caused by infection. Goodell sign might be the result of pelvic congestion, not polyps. A, B, D, E
During a woman's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse documents this finding as what? A. Hegar sign. B. McDonald sign. C. Chadwick sign. D. Goodell sign
At approximately six weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The McDonald sign is flexibility of the uterus at the junction of the cervix and uterus and usually can be detected at seven to eight weeks of gestation. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy. A
To reassure and educate pregnant women about changes in their blood pressure, maternity nurses should be aware that: A. a blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. B. shifting the woman's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. C. the systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. D. compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy.
Compression of the iliac veins and inferior vena cava by the uterus also can lead to varicose veins in the legs and vulva. The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases. D
The nurse is caring for a pregnant client who reports constipation. What does the nurse suspect is causing the client's constipation? Select all that apply. A. Increased physical activity B. Uterine distention C. Iron supplementation D. Decreased intake of fluids E. Increased progesterone levels
Constipation can result from abdominal distention by the pregnant uterus, displacement and compression of the intestine, iron supplementation, and lack of fluids. Smooth muscle relaxation and reduced peristalsis caused by increased progesterone and estrogen levels result in increased water absorption, thereby resulting in constipation. Increased physical activity facilitates bowel elimination. It does not cause constipation. B, C, D, E
The nurse is teaching student nurses about acid-base values in the arterial blood of pregnant women. Which statement made by a student nurse indicates the need for additional teaching? A. "Blood pH increases during pregnancy." B. "Partial pressure of oxygen increases during pregnancy." C. "Sodium bicarbonate levels increase during pregnancy." D. "Partial pressure of carbon dioxide decreases during pregnancy."
During pregnancy, acid-base values change in the arterial blood. Sodium bicarbonate levels decrease during pregnancy. Hence, the student nurse stating that sodium bicarbonate levels increase during pregnancy indicates the need for additional teaching. Blood pH increases during pregnancy due to decrease in base excess. Partial pressure of oxygen increases, and partial pressure of carbon dioxide decreases during pregnancy due to increased sensitivity of the respiratory center. Along with changes in partial pressures, the base excess also decreases due to increased sensitivity of the respiratory center. C
The nurse finds low levels of estrogen in a pregnant client. What could be the consequences of low estrogen levels in the client? Select all that apply. A. Peristalsis increases B. Pepsin secretion decreases C. Fat deposition is reduced D. An epulis develops on the gum line E. End arterioles branch
Estrogen and progesterone should be maintained in the body for healthy pregnancy. Estrogen causes a decrease in peristalsis and gastrointestinal secretions. Estrogen causes an increase in the deposition of fat for the protection of the fetus. Therefore, low estrogen levels would cause increased peristalsis and reduced fat deposition. Estrogen causes a decrease in the release of pepsin and hydrochloric acid. Estrogen may also cause the development of an epulis (gingival granuloma) on the gum line. It also increases the branching of end arterioles for increasing placental perfusion. A, C,
A patient with dark complexion has brownish pigmentation over the cheeks, the nose, and the forehead. The patient reports that this pigmentation was present during pregnancy, which faded and has recurred now. What relevant drug history does the nurse assess in the patient? A. Antibiotics B. Antipsoriatics C. Antihistamines D. Contraceptives
Facial pigmentation that occurs during pregnancy and fades away with childbirth is referred to as melasma. This occurs due to increased production of melanotropin during pregnancy. Oral contraceptive use can also cause stimulation of melanotropin production. This may cause melasma to recur. Antibiotics are the drugs used for treating bacterial infection. They do not trigger the recurrence of melasma. Antipsoriatics are used to treat the itchy and scaly patches in psoriasis. Antihistamines, antipsoriatics, and antibiotics do not affect the anterior pituitary gland. Antihistamines are used to relieve itching in mild pruritis; they do not cause pigmentation. D
The hormonal reports of a pregnant female reveal increased estrogen levels in the body. Which related signs would the nurse find in the patient? Select all that apply. A. Mucoid discharge from the cervix B. Heaviness in the patient's breast C. Milk discharge from the patient's nipples D. Decreased chest expansion of the patient E. Well-defined pink blotches on the palm
High levels of estrogen during pregnancy increase the production of cervical mucus. Therefore, pregnant women have copious white or gray cervical discharges. Increased estrogen levels increase the blood supply to the breasts, thereby causing breast heaviness. Well-defined pink blotches on the palm, which are referred to as palmar erythema, are also an effect of increased estrogen levels during pregnancy. Milk production is only possible when the baby has been delivered and there is a decreased estrogen level in the body. High levels of estrogen cause laxity of the ligaments of the rib cage, which increases chest expansion. A, B, E
After reviewing the lab reports of a female client, the nurse infers that the client is pregnant. Which lab finding indicates that the female is pregnant? A. Decreased levels of insulin in the client B. Increased levels of thyroxine in the client C. Increased levels of follicle-stimulating hormone (FSH) D. Increased levels of human chorionic gonadotropin (hCG)
Human chorionic gonadotropin is the earliest biologic marker for pregnancy. The production of the β-subunit of hCG can be detected in the maternal serum or urine within 7 or 8 days after fertilization. Thus, the nurse can confirm the pregnancy status of a female by the increased levels of hCG. Decreased levels of insulin indicate the presence of diabetes. Thyroid abnormalities are confirmed by the increased levels of thyroxine hormone. A follicle-stimulating hormone (FSH) blood test is used in diagnosing abnormal menstrual bleeding and infertility. D
The nurse is caring for a 3-month pregnant woman who reports, "I always feel very thirsty." What does the nurse infer from the patient's statement? A. The patient consumes less fiber in the diet. B. The patient consumes a high amount of fat in the diet. C. The patient has high sodium content in the blood. D. The patient has increased loss of water from the body.
In early pregnancy, the kidneys have increased capacity to excrete water. Therefore, the patient may feel thirsty due to increased loss of water. A low-fiber diet may cause constipation in pregnant females. Fiber does not interfere with the water levels in the body. Consumption of fatty food in the proper amount is necessary in pregnancy and fatty foods usually do not cause excess thirst. Sodium ions trigger fluid retention in the body; they do not cause thirst. D
Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)? A. Radioimmunoassay B. Radioreceptor assay C. Latex agglutination test D. Enzyme-linked immunosorbent assay (ELISA)
OTC pregnancy tests use ELISA for its one-step, accurate results. The radioimmunoassay tests for the summit of hCG in serum or urine samples. This test must be performed in the laboratory. The radioreceptor assay is a serum test that measures the ability of a blood sample to inhibit the binding of hCG to receptors. The latex agglutination test in no way determines pregnancy. Rather, it is done to detect specific antigens and antibodies. D
A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates an understanding of the nurse's instructions if she states that a positive sign of pregnancy is what? A. a positive pregnancy test. B. fetal movement palpated by the nurse-midwife. C. Braxton Hicks contractions. D. quickening.
Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. A positive pregnancy test is a probable sign of pregnancy. Braxton Hicks contractions are a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy. B
A student nurse measures the blood pressure (BP) of a client and records it as 170/90 mm Hg. On reassessment the charge nurse finds that the BP of the client is 110/70 mm Hg. What could be the reason for the error made by the student nurse in recording BP of the client? A. Using a very large-sized cuff for measuring BP B. Using a very small-sized cuff for measuring BP C. Measuring the BP with the client in lying position D. Measuring the BP 30 minutes after tobacco consumption
Proper cuff size is essential for obtaining accurate readings of blood pressure. False-high readings might be obtained when using a very small-sized cuff. Because the student nurse used a very small-sized cuff for measuring BP, the BP reading was falsely measured as 170/90 mm Hg. False-low readings can be a result of using a very large-sized cuff. BP readings would be low if the patient is in the lying position. Tobacco consumption also affects the blood pressure reading, and the client should be advised to not to consume tobacco 30 minutes before the BP measurement. B
A client had an abortion in her first pregnancy, gave birth at 39 weeks gestation during the second pregnancy, and gave birth to twins at 36 weeks gestation in her third pregnancy. How does the nurse denote the obstetric history of the patient in the GTPAL (gravidity, term, preterm, abortions, living children) system? A. 3-2-0-0-3 B. 3-1-1-1-3 C. 3-1-0-2-3 D. 3-1-1-0-2
The GTPAL system provides information about a woman's obstetric history. The first digit represents gravidity, the second digit represents the total number of term births, the third indicates the number of preterm births, the fourth identifies the number of abortions, and the fifth is the number of children currently alive. In this case, the client had three pregnancies, so gravidity is 3. The client had one term birth, so the second digit is 1. The client had a preterm birth in her third pregnancy, so the third digit is 1. The fourth digit is 1, because the client had an abortion in her first pregnancy, and the fifth digit is 3, because the client has three living children. B
What factors change significantly during pregnancy? Select all that apply. A. Bilirubin levels B. Albumin levels C. Platelet count D. Hematocrit value E. Gastric secretions
The albumin levels in urine increase during pregnancy. This is because of increased glomerular filtration rate (GFR) and impaired proximal tubular function. Hematocrit value decreases due to rapid expansion of plasma volume, leading to physiologic anemia. Due to the influence of estrogen and progesterone, gastric secretions, such as pepsin and hydrochloric acid, may decrease significantly. Bilirubin levels and platelet count do not change significantly during pregnancy. B, D, E
A 5-month pregnant woman reports to the nurse that she feels dizzy after waking up in the morning. What advice does the nurse give to the client? A. "Keep your legs elevated while sleeping." B. "Try to spend less of your time sleeping." C. "Try sleeping in the side lying (lateral) position." D. "Use two pillows for your head while sleeping."
The client has supine hypotensive syndrome due to compression of the superior vena cava. This condition occurs in pregnant women who tend to sleep in the supine position. In order to avoid this compression, the nurse should ask the client to sleep in the lateral position. Elevation of the limbs will help in preventing limb edema in pregnant females. This would not be helpful in preventing the compression of the vena cava. A pregnant female needs adequate rest. Therefore, the nurse should not advise the client to spend less time sleeping. Using two pillows for the head is not advisable, because this can cause neck pain. C
While examining a pregnant client, the nurse-midwife places a finger in the client's vagina and taps gently upward. What is the nurse looking for in the client? A. Operculum B. Fetal palpation C. Chadwick sign D. Softening of cervix
The nurse-midwife places a finger in the client's vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the nurse-midwife feels a gentle tap on the finger. This technique is referred to ballottement. This type of movement can be identified generally between the 16th and 18th weeks of gestation. Operculum is the mucus plug formed at the junction of the cervix and the vagina. Chadwick sign is the violet-bluish coloration of the vagina and vulva due to increased vascularization. Softening of the cervix is not assessed by the technique of ballottement. B
A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? A. 3-0-1-0-1 B. 3-1-0-1-0 C. 3-1-2-0-1 D. 3-0-2-0-1
Using the GPTAL system, this woman's gravidity and parity information is calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time); T: Number of pregnancies carried to term (she has one stillborn); P: Number of pregnancies that resulted in a preterm birth (she has none); A: Abortions or miscarriages before the period of viability (she has had one); L: Number of children born who are currently living (she has no living children) B
What hepatic changes are considered normal during pregnancy? Select all that apply. A. Increased serum albumin B. Decreased serum creatinine C. Increased serum cholesterol D. Increased blood urea nitrogen E. Increased nonprotein nitrogen
During pregnancy, hepatic changes are observed. Serum albumin increases, serum creatinine decreases, and serum cholesterol increases. The increase in serum albumin is due to increased synthesis of proteins during pregnancy. Decreased serum creatinine levels are due to increased protein utilization by the fetus. There is increased breakdown of fatty acids during pregnancy, which results in increased serum cholesterol levels. Blood urea nitrogen and nonprotein nitrogen levels decrease in pregnancy. A, B, C,
The laboratory reports of a client who is in the 8th week of gestation and reports abdominal cramps and pain, shows an abnormally slow increase in the client's levels of human chorionic gonadotropin (hCG). What risk does this finding indicate? A. Multiple fetuses B. Down syndrome C. Ectopic pregnancy D. Gestational trophoblastic disease
The earliest biomarker of pregnancy is hCG. A woman's hCG levels peak after 60 to 70 days of pregnancy and decline to the lowest level at 100 to 130 days of pregnancy. An abnormally slow rise in hCG levels accompanied by abdominal pain and cramping indicates the risk of ectopic pregnancy or miscarriage. hCG levels higher than the normal range indicate the risk for multiple fetuses, Down syndrome, or gestational trophoblastic disease.C
