Chapter 6 Questions

27. A pregnant patient comes into the medical clinic stating that her family and friends are telling her that she is always talking about the pregnancy and nothing else. She is concerned that something is wrong with her. What psychological behavior is she exhibiting? a. Antepartum obsession b. Ambivalence c. Uncertainty d. Introversion

d. Introversion

The nurse is teaching a prenatal class for expectant parents and informs the group that oxygen consumption rises by 20% in pregnancy. Which organs account for this increased oxygen requirement? Select all that apply.

-Expanding uterus -Fetus and placenta -Maternal heart and kidneys -Maternal respiratory and breast tissues Rationale: Oxygen consumption increases by 20% in pregnancy, with half of the increase used by the expanding uterus, the fetus, and the placenta; 30% used by the maternal heart and kidneys; and the rest used by the maternal respiratory muscles and breast tissues. The maternal digestive system slows down during pregnancy due to the effects of progesterone, so there is no increased need for oxygen consumption by this system.

The nurse assesses a primipara at 26 weeks of gestation who has always exercised extensively and actively participated in sports. The woman expresses concerns about brown marks on her face and feeling "fat and ugly." After educating the patient and her partner about normal emotional and physical changes during pregnancy, the nurse expects which outcomes for the next prenatal visit? Select all that apply.

-Expresses feelings about body changes to her partner and the health care team -Acknowledges realistic expectations about weight gain and exercise during pregnancy -Continues to report mutually satisfying sexual activity with her partner during pregnancy -Makes statements that demonstrate positive acceptance of expected pregnancy body changes Rationale: Expected outcomes to be evaluated at the patient's next prenatal visit include expressing feelings about body changes to her partner and the health care team; setting realistic expectations for weight gain and exercise during pregnancy; continuing mutually satisfactory sexual activity during pregnancy; and making statements that indicate acceptance of expected body changes during her pregnancy. The patient and the health care team should acknowledge that not all pre-pregnancy exercise may be possible, so they should plan only activities that won't cause injury to the woman and the fetus.

A woman presents to the clinic requesting an early ultrasonography to confirm pregnancy based on symptoms she is experiencing. Which signs and symptoms reported by the patient does the nurse identify as presumptive because they can be caused by conditions other than pregnancy? Select all that apply.

-Fatigue -Urinary frequency -Nausea and vomiting -Absence of menstruation

The nurse is assessing a pregnant woman and observes that the character of the patient's respirations is most likely changed due to pregnancy. In order to compensate for the increased oxygen needs by the pregnant woman, progesterone causes the patient to make which changes in respiration? Select all that apply.

-Maintain usual respiratory rate -Hyperventilate slightly by breathing more deeply Increased respiratory sensitivity to CO2, stimulating ventilation Rationale: Although the respiratory rate remains unchanged, to compensate for the increased oxygen need, progesterone causes the pregnant woman to hyperventilate slightly by breathing more deeply. There is no need for the mother to increase or decrease respiratory rate or to attempt hypoventilation by breathing more shallowly; these actions may cause dizziness, decreased oxygenation, and potential fall injuries for the patient.

Gestational age 25-28 wks

-Period of greatest wt gain -Lowest hemoglobin level begins -lordosis may cause backache

What nursing interventions will help a woman reorder her relationships as she adapts to pregnancy? Select all that apply.

-Promoting sexual expression between the pregnant woman and her partner -Promoting communication between the pregnant woman and her mother Rationale: Pregnancy is a maturational milestone during which the woman prepares for a new level of caring and responsibility. Effective communication and sexual expression between the woman and her partner are important during pregnancy. Effective communication between the pregnant woman and her own mother is also important in reordering another key relationship during pregnancy. Attending parenting classes helps the woman prepare for delivery. Discussing parental qualities would help the couple to accept the pregnancy and identify their parental roles. Physical rest is required in the first trimester when the woman feels very fatigued. However, these interventions are not helpful in reordering the relationships during the process of adaptation to pregnancy.

A pregnant woman and her partner are attending a third trimester prenatal class, and the partner asks the nurse teaching the class why the pregnant woman frequently reports a backache and appears to waddle when she walks. The nurse describes which normal occurrences of pregnancy that account for the changes in the woman's posture and gait? Select all that apply.

-Relaxin and progesterone cause relaxation of ligaments. -Increased mobility of pelvic joints causes a wider stance. -Progressive lordosis during pregnancy often leads to backache. -The enlarging uterus is heavy and causes the mother to lean backward. Rationale: Relaxin and progesterone initiate relaxation of the ligaments from 28 to 30 weeks, then the pelvic symphysis separates. The increased mobility of the pelvic joints causes the pregnant woman to assume a wide stance with the "waddling" gait of pregnancy. Progressive lordosis, or curvature of the lower spine, often leads to backache and is caused by the uterus increasing in size and weight, causing the expectant mother to lean backward to maintain her balance. There is no indication in the scenario that the pregnant woman has gained an excessive amount of weight, although pre-pregnancy obesity and back problems

Gestational age 33-36 wks

-SOB caused by upward pressure on diaphragm; woman may have difficulty finding a comfortable position for sleeping -umbilicus protrudes -varicosities more pronounced; pedal or ankle edema may be present -urinary frequency noted following lightening when presenting part settles into pelvic cavity

Pregnant women spend a great deal of time and energy learning new behaviors to become mothers. As the woman works to establish a relationship with the infant, she must also reorder her relationship with her partner and family through which maternal tasks of pregnancy? Select all that apply.

-Seeking safe passage -Securing acceptance -Learning to give more of herself -Committing herself to the unknown child Rationale: As the woman works to establish a relationship with the infant, she must also reorder her relationship with her partner and family. This psychological work of pregnancy has been grouped into four maternal tasks: seeking safe passage for herself and the baby through pregnancy, labor, and childbirth; securing acceptance of the baby and herself from her partner and family; learning to give more of herself; and developing attachment and interconnection with the unknown child. Resolving problems occurs in conjunction with each of the four maternal tasks; it is not a task on its own.

The nurse is teaching a prenatal class and discusses the four maternal tasks of pregnancy. The nurse assists the expectant mothers in understanding how their feelings and behaviors correlate with these tasks. Which behaviors best demonstrate the "committing herself to the unborn child" task? Select all that apply.

-The pregnant woman integrates the role of mother into the image of herself. -Expectant mothers report feedback from their unborn infants during the third trimester. -The mother's love for the infant becomes possessive and leads to feelings of vulnerability. -The pregnant woman becomes comfortable with the idea of herself as a mother and finds pleasure in contemplating the new role. Rationale: The behaviors that best demonstrate the "committing herself to the unborn child" task include integrating the role of mother into the image of herself; reporting feedback from the unborn infant during the third trimester; loving the infant, becoming possessive and leading to feelings of vulnerability; becoming comfortable with the idea of being a mother and finding pleasure in contemplating the new role; and describing unique characteristics of the fetus about sleep-wake cycles, temperament, and communication. Expressing concern about the ability to mother the infant is not one of the normal behaviors of a pregnant woman demonstrating the commitment of herself to the unborn child. Instead, these feelings are a part of ambivalence from the first trimester.

The nursing instructor is educating a student nurse about the hormone human chorionic somatomammotropin (hCS) or human placental lactogen (hPL). What points should the instructor teach the student nurse? Select all that apply.

-facilitates glucose transport across the placental membrane -stimulates breast development in order to prepare for lactation -stimulates maternal metabolism to supply nutrients to the fetus -Present early in pregnancy and increases steadily throughout -Primary function: to increase glucose availability to fetus +hCS reduces the sensitivity of maternal cells to insulin and decrease maternal metabolism of glucose. the fetus needs constant supply of glucose -encourages quick metabolism of free fatty acids to provide energy for the pregnant woman -helps prepare breasts for lactation -may act as a growth hormone -stimulates metabolism of fat to provide maternal energy, antagonistic to insulin, promotes sodium retention, prepares breasts for lactation, acts as growth hormone rationale: Human chorionic somatomammotropin is a protein hormone produced by the placenta. It facilitates glucose transport across the placental membrane, stimulates breast development to prepare for lactation, and accelerates maternal metabolism to supply needed nutrients to the fetus. -Estrogen produced by the placenta stimulates uterine growth and uteroplacental blood flow. -Progesterone, which maintains the endometrium and decreases the contractility of the uterus, is another proteinaceous hormone produced by the placenta.

Gestational age 17-20 wks

-fetal mvts felt -heartbeat can be heard with fetoscope -skin pigmentaiton increases; areolae darken, melasma and linea nigra may be obvious -braxton hicks contractions palpable -fundus at level of umbilicus at about 20 wks

Gestational age 13-16 wks

-fetal mvts may be felt at about 16 wks -uterus has risen into the abdomen; fundus midway b/w symphysis pubis and umbilicus -colostrum present; blood volume increases

Gestational age 29-32 wks

-heartburn common as uterus presses on diaphragm and displaces stomach -braxton hicks contractions are more noticeable -lordosis increases; waddling gait develops due to increased mobility of pelvic joints

A woman who is 26 weeks pregnant asks the nurse why she has to urinate so frequently. After verifying that the patient's urine sample indicates no urinary tract infection, the nurse explains which factors increase urinary frequency during pregnancy? Select all that apply.

-hormonal influences -increased blood volume -changes in renal blood flow -uterine expansion within the pelvis Rationale:Progesterone influences the relaxation of the smooth muscle tissue of the urinary tract, which results in a urinary urgency and frequency during pregnancy. The total blood volume increase reaches an average of 30% to 45% during pregnancy. Renal plasma flow increases by 50% to 80% during pregnancy. This change results from an increase in plasma volume and cardiac output. The flow is highest when the woman is in the left side-lying position. The glomerular filtration rate rises by as much as 50% because of the higher renal blood flow. Pressure from the expanded uterus pushes the base of the bladder forward and upward near the end of the pregnancy. Consuming too much liquid is not a typical problem during pregnancy since pregnant women are encouraged to drink at least six to eight glasses of water each day. Consuming liquids is not responsible for the pregnant woman's increased urinary frequency during pregnancy.

Gestational age 9-12 wks

-nausea usually ends by 10-12 wks -uterus is size of an orange; palpable above symphysis pubis -vulvar varicosities may appear -fetal heartbeat may be heard with doppler

Gestational age 21-24 wks

-relaxation of smooth muscles of veins and bladder increases the chance of varicose veins and urinary tract infections -woman is more aware of fetal mvts

Gestational age 37-40 wks

-woman is uncomfortable; -looking forward to birth of baby -cervix softens, begins to efface; mucous plug is often lost

In which order should the developmental tasks required to achieve maternal adaptation be achieved?

1. Accepting the pregnancy 2. Identifying with the role of mother 3. Reordering relationship between herself and mother 4.Between herself and her partner 5. Establishing a relationship with the unborn child 6.. Preparing for the birth experience

The nursing instructor reminds students who are providing care for pregnant patients that the total blood volume increase reaches an average of 30-45% during pregnancy. This average is related to which maternal and fetal requirements? Select all that apply.

1. Meeting the demands of the expanded maternal tissue in the uterus and breasts 2. Assuring transportation of nutrients and oxygen to the placenta, where they become available for the growing fetus 3. Providing a reserve to protect the pregnant woman from the adverse effects of blood loss that can occur during childbirth Rationale: Total blood volume increase begins by 6 weeks of gestation and reaches an average of 30-45% during pregnancy. The increased blood volume during pregnancy is needed to meet the demands of the expanded maternal tissue in the uterus and breasts; transport nutrients and oxygen to the placenta, where they become available for the growing fetus; and provide a reserve to protect the pregnant woman from the adverse effects of blood loss that occur during childbirth. The increased blood volume does not increase the energy reserve for the pregnant woman; this is accomplished through adequate nutrition, exercise, and rest. Systemic vascular resistance, not increased vascular resistance, is normal during pregnancy because of vasodilation, the utero-placental unit, increased heat production, decreased sensitivity of angiotensin II, and relaxant factors.

The capacity of the uterus in a term pregnancy is how many times its prepregnant capacity? Record your answer as a whole number. __ times

500 The prepregnant capacity of the uterus is about 10 mL, and it reaches 5000 mL (5 L) by the end of the pregnancy, which reflects a 500-fold increase

Hegar's sign

6 to 8 weeks after last menses, the lower uterine segment is so soft it can be compressed to the thinness of paper -the body of the uterus can be easily flexed against the cervix

The nurse is teaching a pregnant patient about signs of possible pregnancy complications. Which should the nurse include in the teaching plan? (Select all that apply.) a. Report watery vaginal discharge b. Report puffiness of the face or around the eyes c. Report any bloody show when you go into labor d. Report visual disturbances, such as spots before the eyes e. Report any dependent edema that occurs at the end of the day

A,B,D Watery vaginal discharge could mean that the membranes have ruptured. Puffiness of the face or around the eyes and visual disturbances may indicate preeclampsia or eclampsia. These three signs should be reported. Bloody show as labor starts may mean the mucus plug has been expelled. One of the earliest signs of labor may be bloody show, which consists of the mucus plug and a small amount of blood. This is a normal occurrence. Up to 70% of women have dependent edema during pregnancy. This is not a sign of a pregnancy complication

Which findings are presumptive signs of pregnancy? a. Quickening b. Amenorrhea c. Ballottement d. Goodell's sign e. Chadwick's sign

A,B,E. Quickening, amenorrhea, and Chadwick's sign are presumptive signs of pregnancy. Ballottement and Goodell's sign are probable signs of pregnancy

The nurse is assessing a patient in her 37th week of pregnancy for the psychological responses commonly experienced as birth nears. Which psychological responses should the nurse expect to evaluate? (Select all that apply.) a. The patient is excited to see her baby. b. The patient has not started to prepare the nursery for the new baby. c. The patient expresses concern about how to know if labor has started d. The patient and her spouse are concerned about getting to the birth center in time e. The patient and her spouse have not discussed how they will share household tasks

A,C,D As birth nears, the expectant patient will express a desire to see the baby. Most pregnant patients are concerned with their ability to determine when they are in labor. Many couples are anxious about getting to the birth facility in time for the birth. As birth nears, a nesting behavior occurs, which means getting the nursery ready. Not preparing the nursery at this stage is not a response that the nurse should expect to assess. Negotiation of tasks is done during this stage. Discussion regarding the division of household chores is not a response that the nurse should expect to assess at this stage.

A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old daughter is expecting her first child. Which is a major factor in determining how this woman will respond to becoming a grandmother? a. Her age b. Her career c. Being divorced d. Age of the daughter

A. Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old. Career responsibilities may have demands that make the grandparents not as accessible but are not a major factor in determining the woman's response to becoming a grandmother. Being divorced is not a major factor that determines the adaptation of grandparents. The age of the daughter is not a major factor that determines the adaptation of grandparents. The age of the grandparent is a major factor

16. A pregnant woman notices that she is beginning to develop dark skin patches on her face. She denies using any different type of facial products as a cleansing solution or makeup. What would the priority nursing intervention be in response to this situation? a. Refer the patient to a dermatologist for further examination. b. Ask the patient if she has been eating different types of foods. c. Take a culture swab and send to the lab for culture and sensitivity (C&S). d. Let the patient know that this is a common finding that occurs during pregnancy.

d. Let the patient know that this is a common finding that occurs during pregnancy.

The nurse prepares to teach a pregnant patient about the importance of having a healthy store and intake of calcium. What does the nurse include in the teaching?

Absorption of calcium from the intestine doubles during pregnancy. Rationale: The nurse includes the fact that absorption of calcium from the intestine doubles during pregnancy, and it is important to have a healthy store and intake of calcium throughout the pregnancy. Maternal bone stores only provide about 28 to 30 g of calcium, which is small in comparison to the entire body's stores of calcium. Maternal stores of calcium are not depleted in order to meet fetal calcium needs. Calcium is still absorbed by the body during pregnancy, and it is used during the third trimester.

14. Which physiologic findings related to gallbladder function may lead to the development of gallstones during pregnancy? a. Decrease in alkaline phosphatase levels compared with nonpregnant women b. Increase in albumin and total protein as a result of hemodilution c. Hypertonicity of gallbladder tissue d. Prolonged emptying time

d. Prolonged emptying time

Which physiologic finding is consistent with normal pregnancy? a. Systemic vascular resistance increases as blood pressure decreases b. Cardiac output increases during pregnancy c. Blood pressure remains consistent independent of position changes d. Maternal vasoconstriction occurs in response to increased metabolism

B. Cardiac output increases during pregnancy as a result of increased stroke volume and heart rate. Systemic vascular resistance decreases while blood pressure remains the same. Maternal blood pressure changes in response to patient positioning. In response to increased metabolism, maternal vasodilation is seen during pregnancy

An expectant patient in her third trimester reports that she developed a strong tie to her baby from the beginning and now is really in tune to her baby's temperament. The nurse interprets this as the development of which maternal task of pregnancy? a. Learning to give of herself b. Developing attachment with the baby c. Securing acceptance of the baby by others d. Seeking safe passage for herself and her baby

B. Developing a strong tie in the first trimester and progressing to be in tune is the process of commitment, attachment, and interconnection with the infant. This stage begins in the first trimester and continues throughout the neonatal period. Learning to give of herself is the task that occurs during pregnancy as the woman allows her body to give space to the fetus. She continues with giving to others in the form of food and presents. Securing acceptance of the baby is a process that continues throughout pregnancy as the woman reworks relationships. Seeking safe passage is the task that ends with birth. During this task, the woman seeks health care and carries out cultural practices.

A patient who is 7 months pregnant states, "I'm worried that something will happen to my baby." Which is the nurse's best response? a. "Your baby is doing fine." b. "Tell me about your concerns." c. "There is nothing to worry about." d. "The doctor is taking good care of you and your baby."

B. Encouraging the patient to discuss her feelings is the best approach. The nurse should not disregard or belittle the patient's feelings. Responding that your baby is doing fine disregards the patient's feelings and treats them as unimportant. Responding that there is nothing to worry about does not answer the patient's concerns. Saying that the doctor is taking good care of you and your baby is belittling the patient's concerns

Which comment made by a new mother to her own mother is most likely to encourage the grandmother's participation in the infant's care? a. "Could you help me with the housework today?" b. "The baby is spitting up a lot. What should I do?" c. "I know you are busy, so I'll get John's mother to help me." d. "The baby has a stomachache. I'll call the nurse to find out what to do."

B. Looking to the grandmother for advice encourages her to become involved in the care of the infant. Housework does not encourage the grandmother to participate in the infant's care. Getting John's mother to help and calling the nurse about advice excludes the grandmother.

A patient in her first trimester complains of nausea and vomiting. The patient asks, "Why is this happening?" What is the nurse's best response? a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."

B. Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Gastric secretions decrease, but this is not the main cause of nausea and vomiting.

An expected change during pregnancy is a darkly pigmented vertical midabdominal line. The nurse recognizes this alteration as a. epulis b. linea nigra c. melasma d. striae gravidarum

B. The linea nigra is a dark pigmented line from the fundus to the symphysis pubis. Epulis refers to gingival hypertrophy. Melasma is a different kind of dark pigmentation that occurs on the face. Striae gravidarum (stretch marks) are lines caused by lineal tears that occur in connective tissue during periods of rapid growth

What is the term for the step in maternal role attainment that relates to the woman giving up certain aspects of her previous life? a. Fantasy b. Grief work c. Role playing d. Looking for a fit

B. The woman experiences sadness as she realizes that she must give up certain aspects of her previous self and that she can never go back. This is called grief work. Fantasies allow the woman to try on a variety of possibilities or behaviors. This usually deals with how the child will look and the characteristics of the child. Role playing involves searching for opportunities to provide care for infants in the presence of another person. Looking for a fit is when the woman observes the behaviors of mothers and compares them with her own expectations.

Which of these findings would indicate a potential complication related to renal function during pregnancy? a. Increase in glomerular filtration rate (GFR) b. Increase in serum creatinine level c. Decrease in blood urea nitrogen (BUN) d. Mild proteinuria

B. With pregnancy, one would expect the serum creatinine and BUN levels to decrease. An elevation in the serum creatinine level should be investigated. With pregnancy, the GFR increases because of increased renal blood flow and is thus a normal expected finding. A decrease in the blood urea nitrogen level and mild proteinuria is expected findings in pregnancy.

3. While providing education to a primiparous patient regarding the normal changes of pregnancy, what is an important information for the nurse to share regarding Braxton Hicks contractions? a. These contractions may indicate preterm labor. b. These are contractions that never cause any discomfort. c. Braxton Hicks contractions only start during the third trimester. d. These occur throughout pregnancy, but you may not feel them until the third trimester.

d. These occur throughout pregnancy, but you may not feel them until the third trimester.

during vital sign assessment of a pregnant patient in her 3rd trimester, the patient complains of feeling faint, dizzy, and agitated. which nursing intervention is most appropriate? a. have the pt stand up and retake her blood pressure b. have the pt sit down and hold her arm in a dependent position c. have the pt turn to her left side and recheck her blood pressure in 5 min d. have the pt lie supine for 5 min and recheck her bp on both arms

C. Blood pressure is affected by positioning during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This would cause an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

Which situation best describes a man trying on fathering behaviors? a. Reading books on newborn care b. Spending more time with his siblings c. Coaching a little league baseball team d. Exhibiting physical symptoms related to pregnancy

C. Coaching a little league baseball team shows interaction with children and assuming the behavior and role of a father. This best describes a man trying on the role of being a father. Men do not normally read information that is provided in advance. The nurse should be prepared to present information after the baby is born, when it is more relevant. The man will normally seek closer ties with his father. Exhibiting physical symptoms related to pregnancy is called <i>couvade</i>

A patient relates a story of how her boyfriend is feeling her aches and pains associated with her pregnancy. She is concerned that her boyfriend is making fun of her concerns. How would you respond to this patient statement? a. Tell her not to worry because it is natural for her boyfriend to make her feel better by identifying with her pregnancy. b. Refer the patient to a psychologist for counseling to deal with this problem because it is clearly upsetting her c. Explain that her boyfriend may be experiencing couvade syndrome and that this is a normal finding seen with male partners d. Ask the patient specifically to define her concerns related to her relationship with her boyfriend and suggest methods to stop this type of behavior by her significant other

C. Provide factual information that will help reduce stress and modify acceptance. Telling her not to worry does not address the possibility that her boyfriend may be experiencing couvade syndrome. The patient is expressing concern but does not have all the facts related to couvade syndrome and requires education, rather than referral. Couvade syndrome is not an abnormal condition and should be treated with acceptance and understanding

What is the best explanation that the nurse can provide to a patient who is concerned that she has "pseudoanemia" of pregnancy? a. Have her write down her concerns and tell her that you will ask the physician to respond once the lab results have been evaluated b. Tell her that this is a benign self-limiting condition that can be easily corrected by switching to a high-iron diet. c. Inform her that because of the pregnancy, her blood volume has increased, leading to a substantial dilution effect on her serum blood levels, and that most women experience this condition. d. Contact the physician and get a prescription for iron pills to correct this condition.

C. Providing factual information based on physiologic mechanisms is the best option. Although having the patient write down her concerns is reasonable, the nurse should not refer this conversation to the physician but rather address the patient's specific concerns. Switching to a high-iron diet will not correct this condition. This physiologic pattern occurs during pregnancy as a result of hemodilution from excess blood volume. Iron medication is not indicated for correction of this condition. There is no need to contact the physician for a prescription.

A pregnant woman complains of frequent heartburn. The patient states that she has never had these symptoms before and wonders why this is happening now. The most appropriate response by the nurse is to a. examine her dietary intake pattern and tell her to avoid certain foods b. tell her that this is a normal finding during early pregnancy and will resolve as she gets closer to term c. explain to the patient that physiologic changes caused by the pregnancy make her more likely to experience these types of symptoms d. refer her to her health care provider for additional testing because this is an abnormal finding

C. The presentation of heartburn is a normal abnormal finding that can occur in pregnant woman because of relaxation of the lower esophageal sphincter as a result of the physiologic effects of pregnancy. Although foods may contribute to the heartburn, the patient is asking why this presentation is occurring, so the nurse should address the cause first. It is independent of gestation. There is no need to refer to the physician at this time because this is a normal abnormal finding. There is no evidence of complications ensuing from this presentation.

What is the physiologic reason for vascular volume increasing by 40% to 60% during pregnancy? a. Prevents maternal and fetal dehydration b. Eliminates metabolic wastes of the mother c. Provides adequate perfusion of the placenta d. Compensates for decreased renal plasma flow

C. The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Preventing maternal and fetal dehydration is not the primary reason for the increase in volume. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. Renal plasma flow increases during pregnancy.

Physiologic anemia often occurs during pregnancy due to a. inadequate intake of iron b. the fetus establishing iron stores c. dilution of hemoglobin concentration d. decreased production of erythrocytes

C. When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may lead to true anemia. If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. There is increased production of erythrocytes during pregnancy

Goodell's sign of pregnancy

Cervical softening of the isthmus of the cervix. In the early wks of pregnancy, the cervix softens bc of pelvic vasocongestion

6. Which finding is a positive sign of pregnancy? a. Amenorrhea b. Breast changes c. Fetal movement felt by the woman d. Visualization of fetus by ultrasound

d. Visualization of fetus by ultrasound

Positive Indicators

signs are confirmed by HCP 1. Auscultation of fetal heart sounds (10-12 wks) 2. Fetal movements detected by an examiner (20 wks) 3. Visualization of embryo or fetus (via ultrasound normally)

Which comment made by a patient in her first trimester indicates ambivalent feelings? a. "My body is changing so quickly." b. "I haven't felt well since this pregnancy began." c. "I'm concerned about the amount of weight I've gained." d. "I wanted to become pregnant, but I'm scared about being a mother."

D. Ambivalence refers to conflicting feelings. Expressing a concern about being a mother indicates possible ambivalent feelings. Not feeling well since the pregnancy began does not reflect conflicting feelings. The woman is trying to confirm the pregnancy when she is stating the rapid changes to her body. She is not expressing conflicting feelings. By expressing concerns over gaining weight, which is normal, the woman is trying to confirm the pregnancy.

A pregnant patient comes into the medical clinic stating that her family and friends are telling her that she is always talking about the pregnancy and nothing else. She is concerned that something is wrong with her. What psychological behavior is she exhibiting? a. Antepartum obsession b. Ambivalence c. Uncertainty d. Introversion

D. The patient is exhibiting behaviors associated with introversion and/or narcissism. These are normal findings during pregnancy as long as they do not become obsessive to the exclusion of everything else. The patient is talking about the pregnancy but there is no evidence that it is affecting her perception of reality and/or ability to perform ADLs. It is normal for pregnant women to focus on the self as being of prime importance in their life initially during the pregnancy. Some women may feel ambivalent about their pregnancy, which is a normal reaction. However, this patient's behavior does not support this finding. Some women react with uncertainty at the news of being pregnant, which is a normal reaction. However, this patient's behavior does not support this finding

Probable Indicators

signs are more objective -Positive pregnancy test -abdominal enlargement -Goodell's sign -Hegar's sign -Ballottement -Braxton Hicks contractions:intestinal gas -Palpation of fetal outline -Uterine souffle:confusion w/ mother's pulse

Presumptive Indications

signs are subjective - Amenorrhea -N/V -Fatigue -urinary frequency -breast and skin changes, breast tenderness -Chadwick's sign -Quickening -wt gain

Gestational age 5-8 wks

woman misses period -Nausea: fatigue -Tingling of breasts -uterus size of a lemon -Positive chadwick, goodell, and hegar signs -urinary frequency -increased vag discharge

Which physiologic adaptation of pregnancy may lead to increased constipation during the pregnancy? a. Increased emptying time in the intestines b. Abdominal distention and bloating c. Decreased absorption of water d. Decreased motility in the intestines

D. Decreased motility in the intestines leading to increased water absorption would cause constipation. Increased emptying time in the intestines leads to increased nutrient absorption. Abdominal distention and bloating are a result of increased emptying time in the intestines. Decreased absorption of water would not cause constipation

An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. What information should the nurse provide? a. Intercourse is safe until the third trimester b. Safer sex practices should be used once the membranes rupture c. Intercourse should be avoided if any spotting from the vagina occurs afterward. d. Intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present

D. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman is at risk for or has a history of preterm labor. Intercourse can continue as long as the pregnancy is progressing normally. Rupture of the membranes may require abstaining from intercourse. Safer sex practices are always recommended. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy.

A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. Which is the correct interpretation of these symptoms by the health care provider? a. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. b. These conditions are abnormal. Refer the patient to an ear, nose, and throat specialist c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds

D. As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy. Progesterone is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone levels increase during pregnancy. The patient should be reassured that these symptoms are within normal limits. No referral is needed at this time. Relaxation of the smooth muscles in the respiratory tract is affected by progesterone

A patient reports to the clinic nurse that she has not had a period in over 12 weeks, she is tired, and her breasts are sore all of the time. The patient's urine test is positive for hCG. What is the correct nursing action related to this information? a. Ask the patient if she has had any nausea or vomiting in the morning b. Schedule the patient to be seen by a health care provider within the next 4 weeks c. Send the patient to the maternity screening area of the clinic for a routine ultrasound d. Determine if there are any factors that might prohibit her from seeking medical care

D. The patient has presumptive and probable indications of pregnancy. However, she has not sought out health care until late in the first or early in the second trimester. The nurse must assess for barriers to seeking health care, physical or emotional, because regular prenatal care is key to a positive pregnancy outcome. Asking if the patient has nausea or vomiting will only add to the list of presumptive signs of pregnancy, and this information will not add to the assessment data to determine whether the patient is pregnant. The patient needs to see a health care provider before the next 4 weeks because she is late in seeking early prenatal care. Ultrasound testing must be prescribed by a health care provider

Which finding is a positive sign of pregnancy? a. Amenorrhea b. Breast changes c. Fetal movement felt by the woman d. Visualization of fetus by ultrasound

D. The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner. Amenorrhea is a presumptive sign of pregnancy. Breast changes are a presumptive sign of pregnancy. Fetal movement is a presumptive sign of pregnancy

The patient has just learned that she is pregnant and overhears the gynecologist saying that she has a positive Chadwick's sign. When the patient asks the nurse what this means, how would the nurse respond? a. "Chadwick's sign signifies an increased risk of blood clots in pregnant women because of a congestion of blood." b. "That sign means the cervix has softened as the result of tissue changes that naturally occur with pregnancy." c. "This means that a mucus plug has formed in the cervical canal to help protect you from uterine infection." d. "This sign occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix."

D. Increasing levels of estrogen cause hyperemia (congestion with blood) of the cervix, resulting in the characteristic bluish purple color that extends to include the vagina and labia. This discoloration, referred to as <i>Chadwick's sign</i>, is one of the earliest signs of pregnancy. Although Chadwick's sign occurs with hyperemia (congestion with blood), the sign does not signify an increased risk of blood clots. The softening of the cervix is called Goodell's sign, not Chadwick's sign. Although the formation of a mucus plug protects from infection, it is not called Chadwick's sign.

Which comment made by a new mother exhibits understanding of her toddler's response to a new sibling? a. "I can't believe he is sucking his thumb again." b. "He is being difficult and I don't have time to deal with him." c. "When we brought the baby home, we made Michael stop sleeping in the crib." d. "My husband is going to stay with the baby so I can take Michael to the park tomorrow."

D. It is important for a mother to seek time alone with her toddler to reassure him that he is loved. It is normal for a child to regress when a new sibling is introduced into the home. The toddler may have feelings of jealousy and resentment toward the new baby taking attention away from him. Frequent reassurance of parental love and affection is important. Changes in sleeping arrangements should be made several weeks before the birth so the child does not feel displaced by the new baby.

Which physiologic findings related to gallbladder function may lead to the development of gallstones during pregnancy? a. Decrease in alkaline phosphatase levels compared with nonpregnant women b. Increase in albumin and total protein as a result of hemodilution c. Hypertonicity of gallbladder tissue d. Prolonged emptying time

D. Prolonged emptying time is seen during pregnancy and may lead to the development of gallstones. In pregnancy, there is a twofold to fourfold time increase in alkaline phosphatase levels as compared with those in nonpregnant woman. During pregnancy, a decrease in albumin level and total protein is seen as a result of hemodilution. Gallbladder tissue becomes hypotonic during pregnancy.

A pregnant woman notices that she is beginning to develop dark skin patches on her face. She denies using any different type of facial products as a cleansing solution or makeup. What would the priority nursing intervention be in response to this situation? a. Refer the patient to a dermatologist for further examination b. Ask the patient if she has been eating different types of foods c. Take a culture swab and send to the lab for culture and sensitivity d. Let the patient know that this is a common finding that occurs during pregnancy

D. This condition is known as chloasma or melasma (mask of pregnancy) and is a result of pigmentation changes relative to hormones. It can be exacerbated by exposure to the sun. There is no need to refer to a dermatologist. Intake of foods is not associated with exacerbation of this process. There is no need for a C&S to be taken. The patient should be assured that this is a normal finding of pregnancy

While providing education to a primiparous patient regarding the normal changes of pregnancy, what is an important information for the nurse to share regarding Braxton Hicks contractions? a. These contractions may indicate preterm labor b. These are contractions that never cause any discomfort c. Braxton Hicks contractions only start during the third trimester d. These occur throughout pregnancy, but you may not feel them until the third trimester

D. Throughout pregnancy, the uterus undergoes irregular contractions called Braxton Hicks contractions. During the first two trimesters, the contractions are infrequent and usually not felt by the woman until the third trimester. Braxton Hicks contractions do not indicate preterm labor. Braxton Hicks contractions can cause some discomfort, especially in the third trimester. Braxton Hicks contractions occur throughout the whole pregnancy.

26. An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. What information should the nurse provide? a. Intercourse is safe until the third trimester. b. Safer sex practices should be used once the membranes rupture. c. Intercourse should be avoided if any spotting from the vagina occurs afterward. d. Intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present.

d. Intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present.

Ballottement

Near midpregnancy, a sudden tap on the cervix during vag exam may cause the fetus to float upward in the amniotic fluid, a rebound is felt by the examiner when the fetus falls back. Strong indication of pregnancy; however, could be caused b uterine or cervical polyps

The nurse provides care to a pregnant patient at 15 weeks of gestation. The patient is experiencing vascular changes in the skin, including hyperpigmentation. What does the nurse understand about this physiological change?

Pg. 109-110 The patient is experiencing a reaction to the increase of estrogen in the body. Rationale: This patient is experiencing a reaction to the increase of estrogen in the body, which can result in hyperpigmentation. **Estrogen is the hormone that is responsible for causing vascular changes in the skin, uterus, respiratory tract, and even the bladder. -Prolactin is the hormone responsible for milk production and also acts as an insulin antagonist. -Aldosterone is the hormone responsible for conserving sodium and maintaining fluid balance. -Oxytocin is the hormone responsible for stimulating uterine contractions and milk ejection after birth.

The nurse is teaching a prenatal class and tells the group that because immune function is altered during pregnancy in order to allow the fetus to grow without being rejected by the woman's body, which autoimmune conditions may improve during pregnancy? Select all that apply.

Pg. 111 -Rheumatoid arthritis -Multiple Sclerosis -Resistance to some infections is decreased, and some viral and fungal infections occur more often during pregnancy. The herpes simplex virus, cytomegalovirus, and varicella-zoster virus are among those of particular concern during pregnancy because they can cause congenital viral infections.

The nurse is teaching prenatal classes and is asked by several of the expectant partners why the pregnant women seem to be excessively dependent on them during the third trimester of pregnancy. Which is the best explanation by the nurse for this psychological response during the third trimester?

The pregnant woman has a need to be reassured of her partner's concern and willingness to provide assistance, so that she feels more secure and able to cope. Rationale: The expectant mother's need for love and attention from her partner is even more pronounced in late pregnancy. When she is reassured of her partner's concern and willingness to provide assistance, she feels more secure and able to cope. Although the woman may worry about the added responsibility and feel unsure of her ability to be a good parent, this concern is commonly addressed and resolved during the first trimester, not the third trimester. Expectant mothers examine their relationships with others and how these ties will change after the birth primarily during the second trimester. Pregnant women become increasingly concerned about their ability to protect and provide for the fetus, which is manifested as narcissism and introversion, during the second trimester.

The nurse discusses the developmental tasks of expectant fathers with a prenatal class group. Which issues must the father address to assume the identity as a parent? Select all that apply.

_Making efforts to be seen as relevant to childbearing -Struggling for recognition as a parent from friends and family -Incorporating the concepts that the pregnancy and the baby are real into his own life Rationale: The responses of the expectant father are dynamic and progress through phases that are subject to individual variation. An expectant father must address making an effort to be seen as relevant to childbearing; struggling for recognition as a parent from his family and social network; and grappling with the reality of pregnancy and the new child. Seeking closer ties with his own father and knowing that his experiences and feelings are shared by other men in the same situation are strategies for resolving the issues that must be addressed by men to become fathers, but they are not among the three actual issues that a man must address to assume the identity of a father.

23. A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old daughter is expecting her first child. Which is a major factor in determining how this woman will respond to becoming a grandmother? a. Her age b. Her career c. Being divorced d. Age of the daughter

a. Her age

3. Which findings are presumptive signs of pregnancy? (Select all that apply.) a. Quickening b. Amenorrhea c. Ballottement d. Goodell's sign e. Chadwick's sign

a. Quickening b. Amenorrhea e. Chadwick's sign

2. The nurse is teaching a pregnant patient about signs of possible pregnancy complications. Which should the nurse include in the teaching plan? (Select all that apply.) a. Report watery vaginal discharge. b. Report puffiness of the face or around the eyes. c. Report any bloody show when you go into labor. d. Report visual disturbances, such as spots before the eyes. e. Report any dependent edema that occurs at the end of the day.

a. Report watery vaginal discharge. b. Report puffiness of the face or around the eyes. d. Report visual disturbances, such as spots before the eyes.

1. The nurse is assessing a patient in her 37th week of pregnancy for the psychological responses commonly experienced as birth nears. Which psychological responses should the nurse expect to evaluate? (Select all that apply.) a. The patient is excited to see her baby. b. The patient has not started to prepare the nursery for the new baby. c. The patient expresses concern about how to know if labor has started. d. The patient and her spouse are concerned about getting to the birth center in time. e. The patient and her spouse have not discussed how they will share household tasks.

a. The patient is excited to see her baby. c. The patient expresses concern about how to know if labor has started. d. The patient and her spouse are concerned about getting to the birth center in time.

7. A patient in her first trimester complains of nausea and vomiting. The patient asks, "Why is this happening?" What is the nurse's best response? a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions.

b. "It may be due to changes in hormones."

19. A patient who is 7 months pregnant states, "I'm worried that something will happen to my baby." Which is the nurse's best response? a. "Your baby is doing fine." b. "Tell me about your concerns." c. "There is nothing to worry about." d. "The doctor is taking good care of you and your baby."

b. "Tell me about your concerns."

24. Which comment made by a new mother to her own mother is most likely to encourage the grandmother's participation in the infant's care? a. "Could you help me with the housework today?" b. "The baby is spitting up a lot. What should I do?" c. "I know you are busy, so I'll get John's mother to help me." d. "The baby has a stomachache. I'll call the nurse to find out what to do."

b. "The baby is spitting up a lot. What should I do?"

11. Which physiologic finding is consistent with normal pregnancy? a. Systemic vascular resistance increases as blood pressure decreases. b. Cardiac output increases during pregnancy. c. Blood pressure remains consistent independent of position changes. d. Maternal vasoconstriction occurs in response to increased metabolism.

b. Cardiac output increases during pregnancy.

21. An expectant patient in her third trimester reports that she developed a strong tie to her baby from the beginning and now is really in tune to her baby's temperament. The nurse interprets this as the development of which maternal task of pregnancy? a. Learning to give of herself b. Developing attachment with the baby c. Securing acceptance of the baby by others d. Seeking safe passage for herself and her baby

b. Developing attachment with the baby

20. What is the term for the step in maternal role attainment that relates to the woman giving up certain aspects of her previous life? a. Fantasy b. Grief work c. Role playing d. Looking for a fit

b. Grief work

15. Which of these findings would indicate a potential complication related to renal function during pregnancy? a. Increase in glomerular filtration rate (GFR) b. Increase in serum creatinine level c. Decrease in blood urea nitrogen (BUN) d. Mild proteinuria

b. Increase in serum creatinine level

9. An expected change during pregnancy is a darkly pigmented vertical midabdominal line. The nurse recognizes this alteration as a. epulis. b. linea nigra. c. melasma. d. striae gravidarum.

b. linea nigra.

22. Which situation best describes a man trying on fathering behaviors? a. Reading books on newborn care b. Spending more time with his siblings c. Coaching a little league baseball team d. Exhibiting physical symptoms related to pregnancy

c. Coaching a little league baseball team

28. A patient relates a story of how her boyfriend is feeling her aches and pains associated with her pregnancy. She is concerned that her boyfriend is making fun of her concerns. How would you respond to this patient statement? a. Tell her not to worry because it is natural for her boyfriend to make her feel better by identifying with her pregnancy. b. Refer the patient to a psychologist for counseling to deal with this problem because it is clearly upsetting her. c. Explain that her boyfriend may be experiencing couvade syndrome and that this is a normal finding seen with male partners. d. Ask the patient specifically to define her concerns related to her relationship with her boyfriend and suggest methods to stop this type of behavior by her significant other.

c. Explain that her boyfriend may be experiencing couvade syndrome and that this is a normal finding seen with male partners.

1. During vital sign assessment of a pregnant patient in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is most appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient turn to her left side and recheck her blood pressure in 5 minutes. d. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms.

c. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

10. What is the best explanation that the nurse can provide to a patient who is concerned that she has "pseudoanemia" of pregnancy? a. Have her write down her concerns and tell her that you will ask the physician to respond once the lab results have been evaluated, b. Tell her that this is a benign self-limiting condition that can be easily corrected by switching to a high-iron diet. c. Inform her that because of the pregnancy, her blood volume has increased, leading to a substantial dilution effect on her serum blood levels, and that most women experience this condition, d. Contact the physician and get a prescription for iron pills to correct this condition.

c. Inform her that because of the pregnancy, her blood volume has increased, leading to a substantial dilution effect on her serum blood levels, and that most women experience this condition,

4. What is the physiologic reason for vascular volume increasing by 40% to 60% during pregnancy? a. Prevents maternal and fetal dehydration b. Eliminates metabolic wastes of the mother c. Provides adequate perfusion of the placenta d. Compensates for decreased renal plasma flow

c. Provides adequate perfusion of the placenta

5. Physiologic anemia often occurs during pregnancy due to a. inadequate intake of iron. b. the fetus establishing iron stores. c. dilution of hemoglobin concentration. d. decreased production of erythrocytes.

c. dilution of hemoglobin concentration.

12. A pregnant woman complains of frequent heartburn. The patient states that she has never had these symptoms before and wonders why this is happening now. The most appropriate response by the nurse is to a. examine her dietary intake pattern and tell her to avoid certain foods. b. tell her that this is a normal finding during early pregnancy and will resolve as she gets closer to term. c. explain to the patient that physiologic changes caused by the pregnancy make her more likely to experience these types of symptoms. d. refer her to her health care provider for additional testing because this is an abnormal finding.

c. explain to the patient that physiologic changes caused by the pregnancy make her more likely to experience these types of symptoms.

18. Which comment made by a patient in her first trimester indicates ambivalent feelings? a. "My body is changing so quickly." b. "I haven't felt well since this pregnancy began." c. "I'm concerned about the amount of weight I've gained." d. "I wanted to become pregnant, but I'm scared about being a mother."

d. "I wanted to become pregnant, but I'm scared about being a mother."

25. Which comment made by a new mother exhibits understanding of her toddler's response to a new sibling? a. "I can't believe he is sucking his thumb again." b. "He is being difficult and I don't have time to deal with him." c. "When we brought the baby home, we made Michael stop sleeping in the crib." d. "My husband is going to stay with the baby so I can take Michael to the park

d. "My husband is going to stay with the baby so I can take Michael to the park

8. The patient has just learned that she is pregnant and overhears the gynecologist saying that she has a positive Chadwick's sign. When the patient asks the nurse what this means, how would the nurse respond? a. "Chadwick's sign signifies an increased risk of blood clots in pregnant women because of a congestion of blood." b. "That sign means the cervix has softened as the result of tissue changes that naturally occur with pregnancy." c. "This means that a mucus plug has formed in the cervical canal to help protect you from uterine infection." d. "This sign occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix."

d. "This sign occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix."

13. Which physiologic adaptation of pregnancy may lead to increased constipation during the pregnancy? a. Increased emptying time in the intestines b. Abdominal distention and bloating c. Decreased absorption of water d. Decreased motility in the intestines

d. Decreased motility in the intestines

17. A patient reports to the clinic nurse that she has not had a period in over 12 weeks, she is tired, and her breasts are sore all of the time. The patient's urine test is positive for hCG. What is the correct nursing action related to this information? a. Ask the patient if she has had any nausea or vomiting in the morning. b. Schedule the patient to be seen by a health care provider within the next 4 weeks. c. Send the patient to the maternity screening area of the clinic for a routine ultrasound. d. Determine if there are any factors that might prohibit her from seeking medical care.

d. Determine if there are any factors that might prohibit her from seeking medical care.

2. A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. Which is the correct interpretation of these symptoms by the health care provider? a. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. b. These conditions are abnormal. Refer the patient to an ear, nose, and throat specialist. c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits. d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds.

d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds.