Maternal Adaptation during pregnancy

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence? quickening placenta previa linea nigra lightening

A The fluttering sensation that can be confused with gas is called "quickening." In the 2 weeks leading up to the 20-week mark, she may feel "flutters" that she may confuse with gas. Lightening is the descent of the presenting part of the fetus into the pelvis. Placenta previa is the implantation of the placenta so that it covers part or all of the cervical os. Linea nigra is a hyperpigmented line that appears on the maternal abdomen between the symphysis pubis and top of the fundus.

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

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

A client at 24 weeks' gestation is seen for a routine monthly check up. She reports concerns to the nurse about rest periods. She states that when she awakens she feels weak and lightheaded. What is the most appropriate initial action by the nurse? Inquire about the client's sleeping positions. Make a referral for a cardiac evaluation. Request testing to assess the client's serum glucose levels. Assess the client for manifestations of preeclampsia. Complete neurological assessment.

A When a pregnant woman lies on her back she can experience vena cava syndrome. This results when the weight of the pregnant uterus presses against the vena cava. Additional symptoms of this include weakens nausea and dizziness. To manage this condition, pregnant women are encouraged to assume side lying positions instead of lying on their backs. There is no indication that the client is experiencing cardiac, preeclamptic or diabetes-related manifestations.

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

A,D,F 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 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? tooth fracture iron-deficiency anemia inefficient protein metabolism constipation

B

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? 18 24 22 20

B 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. Therefore for this client, the additional 4 cm would be the equivalent of 4 additional weeks making the gestational age of 24 weeks.

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

B 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.

The nurse is assessing a primigravida woman at a routine prenatal visit. Which assessment finding is reinforcing to the client that she is definitely pregnant? continued amenorrhea ultrasound picture of her fetus positive hCG blood result uterine growth

B A positive sign of pregnancy is visualization of the fetus by ultrasound at 6+ weeks. Amenorrhea is a presumptive sign and can be caused by a variety of factors. Positive hCG in the blood and uterine growth are both probable signs but can be caused by hydatidiform or tumors.

A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucus discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse? "It might be nothing. If it happens again call your provider who is on-call." "A one time discharge of bloody mucus in the toilet might have been your mucus plug." "Bloody mucus is a sign you are in labor. Please come to the hospital." "If the provider did an exam, it might be just normal vaginal secretions, so don't worry about it."

B Bloody mucus can either be a mucus plug or bloody show. The one-time occurrence would be more likely to be the mucus 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.

What is the major concern for a lactose intolerant woman who is pregnant? vitamin D deficiency calcium deficiency nausea and vomiting dangerous symptom of abdominal cramping

B 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.

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? cretinism couvade syndrome pseudo pregnancy pregnancy syndrome

B 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 22-year-old client comes to the walk-in clinic complaining of fatigue, breast heaviness and extreme tenderness, and a clear vaginal discharge. What question would the nurse ask this client? Do you have a family history of breast cancer? Have you been sexually active in the past 2 months? Are you taking oral contraceptives? Do you have vaginal itching?

B The client is presenting with presumptive or subjective symptoms of pregnancy. Given her symptoms and age, asking about sexual activity is the most appropriate question. Whether she is taking an oral contraceptive will not assist in identifying the cause of her symptoms. If she has vaginal itching, the underlying cause of her symptoms needs to be identified before treatment can be prescribed. Asking about family history is part of a comprehensive health history, but is not the priority based on the client's presentation.

A client who has just given a blood sample for pregnancy testing in the health care provider's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy? laboratory test of a urine specimen for hCG visualization of the fetus by ultrasound laboratory test of a blood serum specimen for hCG absence of a period

B There are only three documented or positive signs of pregnancy: 1) demonstration of a fetal heart separate from the mother's, 2) fetal movements felt by an examiner, and 3) visualization of the fetus by ultrasound. The absence of a period is an example of a presumptive symptom, which is a symptom that, when taken as a single entity, could easily indicate other conditions. Laboratory tests of either urine or blood serum for human chorionic gonadotropin (hCG) are examples of probable signs of pregnancy, which are objective and so can be verified by an examiner.

What are the probable signs of pregnancy that would be noted in a woman? Select all that apply. Breast tenderness Ballottement Amenorrhea Positive Goodell sign Visualization of the gestational sac

B,D Probable signs of pregnancy include objective data such as the Goodell sign, which is cervical softening. Another probable sign is ballottement, which is when the examiner pushes against the uterine wall and it bounces back. Breast tenderness and amenorrhea are presumptive signs and visualization of the gestational sac is a positive sign of pregnancy.

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? edema in lower extremities melasma (chloasma) chronic backache diastasis recti

C

A 17-year-old client arrives for an annual examination and reports no changes since the last exam; however, the nurse assesses a positive Chadwick sign, slightly enlarged uterus, and subsequent positive urine pregnancy test. Which task should the nurse prioritize to assist this client who is denying any possibility that she is pregnant? Preparing for parenthood Accepting the baby Accepting the pregnancy Telling her partner and family

C Acceptance of pregnancy is multi-factorial, and how the woman responds to the pregnancy is certainly influenced by her age and if the pregnancy was planned. As a teenager, she may not have been trying to get pregnant and may not want to accept the role and experience. Baby and parenthood decisions should all occur later.

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

C 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).

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding? striae linea nigra bruising darkening of the umbilicus

C Bruising would not be a normal finding. Evidence of bruising might suggest domestic violence. Linea nigra, striae, and darkening of the umbilicus are normal findings.

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? T4 and GH FSH and T4 FSH and LH LH and MSH

C 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: hear the fetal heartbeat with a stethoscope. palpate the fetal outline. detect fetal heart sounds with a Doppler. feel fetal movements.

C 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 pregnant client in her second trimester reports feeling tired all the time. The nurse notes pale skin and low normal hemoglobin on assessment. Which recommendation should the nurse prioritize for this client? More seafood and organ meats in her diet More meat in her diet An iron supplement A calcium supplement

C Iron is necessary for the formation of hemoglobin; therefore, it is essential to the oxygen-carrying capacity of the blood. Women who have normal hemoglobin may need increased iron to carry more oxygen. Calcium supplementation is essential for normal fetal development. The use of measured supplements would ensure a steady amount, whereas the use of meat and seafood would not allow this.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition? Keep the client's legs slightly elevated. Keep the head of the client's bed slightly elevated. Place the client in the left lateral position. Place the client in an orthopneic position.

C The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

A nurse is leading a discussion in a prenatal class for a group of primigravida clients. Which factor would the nurse include when explaining the changes that are expected to occur in the uterus during the pregnancy? Uterine growth occurs because of an increase in the number of cells in the uterus. The uterus reaches its maximum height in the abdomen at 39 weeks. The uterus changes from a pear-shaped organ to an oval one. The uterus moves into the abdomen by the second month of pregnancy.

C The uterus starts as a pear-shaped organ and becomes oval as length increases over width. Uterine growth is primarily related to an increase in size of the myometrial cells. The uterus remains in the pelvic cavity for the first 3 months, after which it progressively ascends into the abdomen. The uterus reaches its highest level at the xiphoid process at approximately 36 weeks. Between 38 to 40 weeks, fundal height drops as the fetus begins to descend and engage into the pelvis.

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

D Progesterone interferes with normal gallbladder contractions, which leads to stasis of bile. This stasis results in cholestasis, either seen in the gallbladder or the liver.

A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem? Umbilical hernia Varicose veins Gastrointestinal reflux Hemorrhoids

D 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 lb (0.90 kg) 2/3 lb (0.30 kg) 1.5 lb (0.68 kg) 1 lb (0.45 kg)

D The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (0.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (0.45 kg) per week. Overweight women should gain about 2/3 lb (0.30 kg) per week.