Chapter 7: Anatomy and Physiology of Pregnancy

A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have: A) Amenorrhea B) Positive pregnancy test C) Chadwick's sign D) Hegar's sign

A) Amenorrhea Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman. A positive pregnancy test and the presence of the Chadwick and Hegar signs are all probable signs of pregnancy.

Appendicitis may be difficult to diagnose in pregnancy because the appendix is: A) Displaced upward and laterally, high and to the right. B) Displaced upward and laterally, high and to the left. C) Deep at McBurney point. D) Displaced downward and laterally, low and to the right.

A) Displaced upward and laterally, high and to the right. The appendix is displaced high and to the right, not to the left. It is displaced beyond the McBurney's point and is not displaced in a downward direction.

During a woman's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse documents this finding as the: A. Hegar sign. B. McDonald sign. C. Chadwick sign. D. Goodell sign

A) Hegar's 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.

The diagnosis of pregnancy is based on which positive signs of pregnancy? (Select all that apply.) a. Identification of fetal heartbeat b. Palpation of fetal outline c. Visualization of the fetus d. Verification of fetal movement e. Positive hCG test

A) Identification of fetal heartbeat C) Visualization of the fetus D) Verification of fetal movement Identification of a fetal heartbeat, the visualization of the fetus, and verification of fetal movement are all positive, objective signs of pregnancy. Palpation of fetal outline and positive hCG test are probable signs of pregnancy. A tumor also can be palpated. Medication and tumors may lead to false-positive results on pregnancy tests.

What is the correct term used to describe the mucous plug that forms in the endocervical canal? a. Operculum b. Leukorrhea c. Funic souffle d. Ballottement

A) Operculum. The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the umbilical vessels. Ballottement is a technique for palpating the fetus.

Which statement regarding the probable signs of pregnancy is most accurate? a. Determined by ultrasound b. Observed by the health care provider c. Reported by the client d. Confirmed by diagnostic tests

ANS: B Probable signs are those detected through trained examination. Fetal visualization is a positive sign of pregnancy. Presumptive signs are those reported by the client. The term diagnostic tests is open for interpretation. To actually diagnose pregnancy, one would have to see positive signs of pregnancy.

While reviewing the laboratory reports of a pregnant female, the nurse finds that the patient's urine glucose levels fluctuate. What does the nurse infer from the assessment? The patient has: A. A normal pregnancy. B. Decreased fat absorption. C. Decreased glucose metabolism. D. Sensitive pancreatic β-cells.

A In pregnant woman, the tubular reabsorption of glucose is impaired causing glucosuria to occur. This urine glucose level can vary from 0 to 20 mg/dL in a pregnant female. Although glucosuria is a normal finding in pregnancy, the possibility of diabetes should be considered. Decrease in fat absorption does not affect the glucose reabsorption in the kidneys but may lead to malnutrition. A decreased rate of metabolism does not affect glomerular filtration process. β-cells of the islets of Langerhans help in the production of insulin; they are not involved in the glucose absorption by the kidneys.

A patient who is pregnant used a home pregnancy test that showed a negative result. What will the nurse check for in the medication history of the patient? A. Diuretics B. Analgesics C. Tranquilizers D. Anticonvulsants

A Diuretics are the medications that are usually prescribed to a patient with hypertension. These drugs may interfere with the levels of human chorionic gonadotropin (hCG) hormone. This may give a false-negative home pregnancy test result. Analgesics are the group of drugs used for pain relief. These drugs do not affect the hCG levels and therefore do not show a false report in the home pregnancy test. Tranquilizers are the drugs used for reducing anxiety, fear, and tension. The use of a tranquilizer results in a false-positive pregnancy test result because it increases hCG levels. Anticonvulsants are a group of drugs used in treating epileptic seizures; they affect the hCG levels and create a false-positive test result.

What is the correct term for a woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability? a. Primipara b. Primigravida c. Multipara d. Nulligravida

A) Primipara A primipara is a woman who has completed one pregnancy with a viable fetus. To help remember the terms: gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. Therefore, 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; and a nulligravida is a woman who has never been pregnant.

A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that: A) This is a normal respiratory change in pregnancy caused by elevated levels of estrogen. B) This is an abnormal cardiovascular change, and the nosebleeds are an ominous sign. C) The woman is a victim of domestic violence and is being hit in the face by her partner. D) The woman has been using cocaine intranasally.

A) This is a normal respiratory change in pregnancy caused by elevated levels of estrogen. Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract, which may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in the lower extremities. Domestic violence cannot be determined on the basis on the sparse facts provided. If the woman had been hit in the face, then she most likely would have additional physical findings. Cocaine use cannot be determined on the basis on the sparse facts provided.

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 breasts C. Milk discharge from the patient's nipples D. Decreased chest expansion of the patient E. Well-defined pink blotches on the palm

A, B, E High levels of estrogen during pregnancy increase the production of cervical mucus. Therefore pregnant women have copious white or gray cervical discharge. Increased estrogen levels increase the blood supply to the breasts, thereby causing breast heaviness. The presence of well-defined pink blotches on the palm, referred to as palmar erythema, is also the effect of increased estrogen levels during pregnancy. Milk production is possible only 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 the chest expansion.

Which time-based description of a stage of development in pregnancy is correct? a. Viability—22 to 37 weeks of gestation since the last menstrual period (assuming a fetal weight greater than 500 g) b. Term—pregnancy from the beginning of 38 weeks of gestation to the end of 42 weeks of gestation c. Preterm—pregnancy from 20 to 28 weeks of gestation d. Postdate—pregnancy that extends beyond 38 weeks of gestation

ANS: B Term is 38 to 42 weeks of gestation. Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since the last menstrual period. Preterm is 20 to 37 weeks of gestation. Postdate or postterm is a pregnancy that extends beyond 42 weeks of gestation or what is considered the limit of full term.

A pregnant client tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal changes. What is the correct term for this integumentary finding? a. Melasma b. Linea nigra c. Striae gravidarum d. Palmar erythema

ANS: A Melasma, (also called chloasma, the mask of pregnancy), usually fades after birth. This hyperpigmentation of the skin is more common in women with a dark complexion. Melasma appears in 50% to 70% of pregnant women. Linea nigra is a pigmented line that runs vertically up the abdomen. Striae gravidarum are also known as stretch marks. Palmar erythema is signified by pinkish red blotches on the hands.

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

ANS: 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. Although gastric secretions decrease, these secretions are not the primary cause of the nausea and vomiting.

Cardiac output increases from 30% to 50% by the 32nd week of pregnancy. What is the rationale for this change? a. To compensate for the decreased renal plasma flow b. To provide adequate perfusion of the placenta c. To eliminate metabolic wastes of the mother d. To prevent maternal and fetal dehydration

ANS: B The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Renal plasma flow increases during pregnancy. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume.

Which statement best describes the rationale for the physiologic anemia that occurs during pregnancy? a. Physiologic anemia involves an inadequate intake of iron. b. Dilution of hemoglobin concentration occurs in pregnancy with physiologic anemia. c. Fetus establishes the iron stores. d. Decreased production of erythrocytes occur.

ANS: B When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman has physiologic anemia, which is the result of the dilution of hemoglobin concentration rather than inadequate hemoglobin. An inadequate intake of iron may lead to true anemia. The production of erythrocytes increases during pregnancy.

The nurse is providing education to a client regarding the normal changes of the breasts during pregnancy. Which statement regarding these changes is correct? a. The visibility of blood vessels that form an intertwining blue network indicates full function of the Montgomery tubercles and possibly an infection of the tubercles. b. The mammary glands do not develop until 2 weeks before labor. c. Lactation is inhibited until the estrogen level declines after birth. d. Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.

ANS: C Lactation is inhibited until after birth. The visible blue network of blood vessels is a normal outgrowth of a richer blood supply. The mammary glands are functionally complete by mid-pregnancy. Colostrum is a creamy white-to-yellow pre-milk fluid that can be expressed from the nipples before birth.

The nurse is assessing a pregnant female who has signs of ballottement and increased pulse rate. The nurse is able to visualize the fetus by radiography images, but the laboratory reports show a negative urine pregnancy report. What is the most probable age of the fetus? A. 6 weeks B. 16 weeks C. 26 weeks D. 36 weeks

B An increase in the pulse rate is seen in between 14 and 20 weeks of gestation in a pregnant female. Ballottement is a sign of passive movements in the fetus, which is generally observed between weeks 16 and 18 of pregnancy. The fetus can be visualized by radiographic images during week 16 of pregnancy. Human chorionic gonadotropin (hCG) levels in the urine decline after 60 days of pregnancy (week 12), which results in a negative urine pregnancy test. Therefore the probable age of the fetus is 16 weeks. In week 6 of pregnancy, the fetus is not visualized by radiography. In weeks 26 and 36, signs of ballottement and increased pulse are not seen, but fetal movements are observed.

The nurse observes that a patient has severe itching during pregnancy. Which function in the patient is affected? A. Renal function B. Hepatic function C. Respiratory function D. Gastrointestinal function

B Severe itching in the pregnant woman is a condition called pruritus gravidarum. It is the result of intrahepatic cholestasis (accumulation of bile in the liver) caused by placental steroids. Hence, the hepatic function was affected in the patient. Itching is not indicative of renal, pulmonary, or gastrointestinal function. Glucosuria and proteinuria indicate that the renal function is affected. Nasal stuffiness, sinus stuffiness, and epistaxis indicate that the upper respiratory function is impaired. Pyrosis or heartburn indicates that the gastrointestinal function is impaired.

The nurse reviews the medical records of a patient and suggests the patient avoid becoming pregnant. Why does the nurse suggest so? The patient: A. Has excess proteins in the urine. B. Is using isotretinoin (Accutane). C. Has increased blood sugar levels. D. s taking promethazine (Phenergan).

B The nurse suggests the patient avoid pregnancy because the patient is using isotretinoin (Accutane) for the treatment of acne. This medication is teratogenic and is associated with fetal malformations. Proteinuria and increased blood glucose levels are the common conditions during pregnancy, although they disappear after childbirth. Promethazine (Phenergan) therapy can cause only false-negative results for pregnancy tests. This drug is not a contraindication for pregnancy.

The nurse is assessing a 3-month pregnant patient who is given folic acid supplement. The patient is worried because of the appearance of reddish spider-like rashes on the face and neck. What does the nurse tell the patient about these rashes? A. "This is a side effect of folic acid." B. "This disappears after pregnancy." C. "This is caused by a food allergy." D. "This is caused by decreased estrogen."

B Vascular spider-like rashes are tiny, star-shaped or branched, slightly raised, and pulsating end-arterioles usually found on the neck, thorax, face, and arms during pregnancy. These spider-like rashes usually disappear after pregnancy. The appearance of vascular spider-like rashes is common during the 2 to 5 months of pregnancy and is not a result of a food allergy. Folic acid supplementation is given in pregnancy to reduce birth defects. Folic acid does not cause vascular or skin changes. Vascular spider-like rashes are not caused by elevated estrogen levels.

During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criteria? A) Leukorrhea B) Development of the operculum C) Quickening D) Ballottement E) Lightening

C) Quickening D) Ballottement E) Lightening

A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? A) 3-1-1-1-3 B) 4-1-2-0-4 C) 3-0-3-0-3 D) 4-2-1-0-3

B) 4-1-2-0-4 The numbers reflect the woman's gravidity and parity information. Her information is calculated as: G reflects the total number of times the woman has been pregnant, she is pregnant for the fourth time, so G = 4 T indicates the number of pregnancies carried to term; only one of her pregnancies (39 weeks) carried to term, so T = 1 P indicates the number of pregnancies tat resulted in a preterm birth; the woman had two pregnancies (34 weeks and 35 weeks) in which she delivered preterm, so P = 2 A indicates whether the woman has had any abortions or miscarriages before the period of viability; she has not, so A = 0 L indicates the number of children born who are currently living; the woman has 4, so L = 4 Therefore, GTPAL = 4-1-2-0-4

The nurse is providing health education to a pregnant client regarding the cardiovascular system. Which information is correct and important to share? a. A pregnant woman experiencing disturbed cardiac rhythm, such as sinus arrhythmia, requires close medical and obstetric observation no matter how healthy she may appear otherwise. b. Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks of gestation to term. c. Palpitations are twice as likely to occur in twin gestations. d. All of the above changes will likely occur.

B) Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks to term. These auscultatory changes should be discernible after 20 weeks of gestation. A healthy woman with no underlying heart disease does not need any therapy. The maternal heart rate increases in the third trimester, but palpitations may not necessarily occur, let alone double. Auditory changes are discernible at 20 weeks of gestation.

Which finding in the urine analysis of a pregnant woman is considered a variation of normal? A) Proteinuria B) Glycosuria C) Bacteria in the urine D) Ketones in the urine

B) Glycosuria Small amounts of glucose may indicate physiologic spilling. The presence of protein could indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

Which renal system adaptation is an anticipated anatomic change of pregnancy? a. Increased urinary output makes pregnant women less susceptible to urinary infections. b. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even when the bladder is almost empty. c. Renal (kidney) function is more efficient when the woman assumes a supine position. d. Using diuretic agents during pregnancy can help keep kidney function regular.

B) Increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty. Bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often, even when the bladder is almost empty. A number of anatomic changes in pregnancy make a woman more susceptible to urinary tract infections. Renal function is more efficient when the woman lies in the lateral recumbent position and is less efficient when she is supine. Diuretic use during pregnancy can overstress the system and cause problems.

Cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman in her second trimester? A. Less audible heart sounds (S1, S2) B. Increased pulse rate C. Increased blood pressure D. Decreased red blood cell (RBC) production

B) Increased pulse rate Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. In the first trimester, blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.

A 31-year-old woman believes that she may be pregnant. She took an OTC pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the woman's last menstrual period and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which reveals that she is not pregnant. What is the most likely cause of the false- positive pregnancy test result? A) She took the pregnancy test too early. B) She takes anticonvulsants. C) She has a fibroid tumor. D) She has been under considerable stress and has a hormone imbalance.

B) She takes anticonvulsants. Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests use enzyme-linked immunosorbent assay (ELISA) technology, which can yield positive results as soon as 4 days after implantation. Implantation occurs 6 to 10 days after conception. If the woman were pregnant, then she would be into her third week at this point (having missed her period 1 week ago). Fibroid tumors do not produce hormones and have no bearing on human chorionic gonadotropin (hCG) pregnancy tests. Although stress may interrupt normal hormone cycles (menstrual cycles), it does not affect hCG levels or produce positive pregnancy test results.

The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change? A) Her center of gravity will shift backward. B) She will have increased lordosis. C) She will have increased abdominal muscle tone. D) She will notice decreased mobility of her pelvic joints.

B) She will have increased lordosis. An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain balance. The center of gravity shifts forward. She will have decreased abdominal muscle tone and will notice increased mobility of her pelvic joints.

A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level? A) Not palpable above the symphysis at this time B) Slightly above the symphysis pubis C) At the level of the umbilicus D) Slightly above the umbilicus

B) Slightly above the symphysis pubis In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. At 14 weeks, the uterus is not yet at the level of the umbilicus. The fundus is not palpable above the umbilicus until 22 to 24 weeks of gestation.

Of which physiologic alteration of the uterus during pregnancy is it important for the nurse to alert the patient? a. Lightening occurs near the end of the second trimester as the uterus rises into a different position. b. Woman's increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening. c. Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise. d. Uterine souffle is the movement of the fetus.

B) The woman;s increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening. The softening of the lower uterine segment is called the Hegar sign. In this position, the uterine fundus presses on the bladder, causing urinary frequency that is a normal change of pregnancy. Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

The nurse is assessing a patient who is pregnant and has diabetes. The Doppler ultrasound examination shows that there is a decrease in the uterine blood flow velocity. Which is the reason for reduced uterine blood flow in the patient? A. Reduced estrogen levels B. Lying in the lateral position C. Low arterial blood pressure D. Relaxation of the uterine muscles

C An increase in the arterial pressure increases the velocity of blood flow to the uterus. Therefore low arterial pressure decreases the uterine blood flow velocity and thereby decreases the blood supply to the fetus. Supine position of the mother decreases the intervillous blood flow. Therefore lateral position is preferred for sleeping. The blood flow would be the highest in this position, compared with the supine and prone positions. Estrogen has a vasodilator effect. Therefore reduced estrogen levels would decrease the velocity of the uterine blood flow. Contraction of the uterine muscles reduces the blood flow, whereas relaxation of the uterine muscles increases the blood flow.

The laboratory reports of a pregnant female reveal severe hyponatremia. Which hormone supplementation helps in normalizing sodium levels in the patient? A. Insulin B. Oxytocin C. Aldosterone D. Serum prolactin

C Hyponatremia is a condition in which the body has low levels of sodium because of excess excretion of sodium. Aldosterone is a hormone that stimulates excess sodium reabsorption from the renal tubules of the kidneys. Therefore the administration of aldosterone is useful for treating hyponatremia. Insulin is the hormone that is used to control blood sugar levels in the body. The hormone oxytocin stimulates uterine contractions and milk ejection from the breasts. Oxytocin is also used to induce labor pain in pregnant women. Serum prolactin prepares the pregnant woman for lactation.

Following an assessment, the nurse finds that a pregnant female is alcoholic and a smoker. What advice does the nurse give the patient? "Avoid these behaviors because they can: A. Elevate stress during the pregnancy." B. Lead to hemolytic anemia in pregnancy." C. Elevate blood pressure in pregnancy." D. Increase the risk for bleeding during delivery."

C Smoking and alcohol stimulates the sympathetic nervous system. Thus the heart rate and blood pressure gets increased, which may also affect the fetus. Alcohol and smoking are usually consumed to relieve stress and are not known to induce stress in pregnancy. Hemolytic anemia is a form of anemia that occurs because of hemolysis of red blood cell (RBC). Smoking and alcohol does not cause hemolysis. Bleeding may be caused as a side effect of anticoagulants; it may not be a harmful effect of smoking and alcohol.

The nurse is assessing a pregnant female in the second trimester. The patient informs the nurse that she feels like eating clay. The nurse refers the patient for a blood test. What could be the reason for this referral? To check for: A. Sodium levels in the blood B. The white blood cell (WBC) count C. Hemoglobin levels in the blood D. Human chorionic gonadotropin (hCG) levels

C Some pregnant women tend to have nonfood cravings, such as for clay and ice. This condition is referred as pica. This condition is a manifestation of iron deficiency. Iron deficiency can be determined by reduced hemoglobin levels in the blood. Therefore the most likely reason for referring the patient for a blood test is to check for the patient's hemoglobin levels. Alterations in sodium, WBC, and human chorionic gonadotropin levels are not known to be associated with nonfood cravings. Sodium levels are usually checked to assess the filtration ability of the kidney. WBC count is generally increased during pregnancy to around 15,000 cells/mm3 of blood. An increase of WBC count of more than 15,000 cells/mm3 would be suggestive of infection. Increasing levels of hCG in the blood early in pregnancy causes nausea and vomiting.

Some pregnant clients may complain of changes in their voice and impaired hearing. What should the nurse explain to the client concerning these findings? a. Voice changes are caused by decreased estrogen levels. b. Displacement of the diaphragm results in thoracic breathing. c. Voice changes and impaired hearing are due to the results of congestion and swelling of the upper respiratory tract. d. Increased blood volume causes changes in the voice.

C) Congestion and swelling, which occur because the upper respiratory tract has become more vascular. Although the diaphragm is displaced and the volume of blood is increased, neither causes changes in the voice nor impairs hearing. The key is that estrogen levels increase, not decrease, which causes the upper respiratory tract to become more vascular, which produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing.

A patient at 24 weeks of gestation contacts the nurse at her obstetric providers office to complain that she has cravings for dirt and gravel. The nurse is aware that this condition is known as ________ and may indicate anemia. A) Ptyalism B) Pyrosis C) Pica D) Decreased peristalsis

C) Pica Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. Cravings include ice, clay, and laundry starch. Ptyalism (excessive salivation), pyrosis (heartburn), and decreased peristalsis are normal findings.

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.

D 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. Hegar sign and Chadwick signs will be observed during weeks 6 to 12 of pregnancy, and pelvic congestion may be the other cause for such signs. Urine pregnancy test gives positive results during weeks 6 to 12 of pregnancy.

To reassure and educate their pregnant clients regarding changes in their blood pressure, nurses should be cognizant of what? 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 client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. c. Systolic blood pressure slightly increases as the pregnancy advances; diastolic pressure remains constant. d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy.

D Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy. This compression also leads to varicose veins in the legs and vulva. The tightness of a blood pressure 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 the pregnancy advances. The diastolic blood pressure first decreases and then gradually increases.

A patient with a 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

D Facial pigmentation that occurs during pregnancy and fades away with childbirth is referred to as melasma. This occurs because of 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 pruritus and they do not cause pigmentation.

The biochemical reports of a pregnant woman show an increase in the metabolism of glucose and increased fatty acid deposition of the body. Which hormone is responsible for these changes in the patient? A. Insulin B. Estrogen C. Parathyroid D. Human chorionic somatotropin

D Human chorionic somatotropin decreases the maternal metabolism of glucose and increases the production of fatty acids for metabolic needs. A decrease in the metabolism of glucose and increased fatty acid deposition is caused by the decrease in human chorionic somatotropin. The metabolism of glucose and fatty acid deposition is not affected by the defect in insulin, estrogen, and parathyroid. In pregnant females, insulin is produced to repress the effect of insulin antagonism by placental hormones. A defect in insulin does not lead to the increase of metabolism in glucose. Estrogen is responsible for fatty acid deposition but is not involved in glucose metabolism. Parathyroid hormone controls the metabolism of calcium and magnesium.

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? The patient: A. Consumes less fiber in the diet. B. Takes high amounts of fat in the diet. C. Has high sodium content in the blood. D. Has increased loss of water from the body.

D In early pregnancy, the kidneys have increased capacity to excrete water. Therefore the patient may feel thirsty because of 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 foods in proper amounts is necessary in pregnancy, and fatty foods usually do not cause excess thirst. Sodium ions trigger fluid retention in the body and do not cause thirst.

The nurse is caring for a pregnant patient who is in the third trimester. The patient reports a burning sensation starting from the hands to the elbow. On further evaluation, the nurse finds compression in the carpal ligament of the wrist. What finding does the nurse infer from examining the patient? A. Sciatica B. Neuralgia C. Acroesthesia D. Paresthesia

D Paresthesia is an abnormal sensation that is perceived as a burning and tingling in the skin. This is caused by edema that compresses the nerves. Edema in carpal ligament of the wrist causes carpal tunnel syndrome, which is characterized by paresthesia. Sciatica is a burning pain that is felt in the back, buttocks, and leg when the sciatic nerve is irritated. Neuralgia is a stabbing, burning pain that occurs along a damaged nerve. Acroesthesia is the numbness and tingling of the hands caused by stoop-shouldered stance.

Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and the basis for many tests. A maternity nurse should be aware that: A) hCG can be detected 2.5 weeks after conception. B) The hCG level increases gradually and uniformly throughout pregnancy. C) Much lower than normal increases in the level of hCG may indicate a postdate pregnancy. D) A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

D) A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome. Higher hCG levels also could be a sign of a multiple gestation. hCG can be detected as early as 7 to 10 days after conception. The hCG levels fluctuate during pregnancy, peaking, declining, stabilizing, and then increasing again. Abnormally slow increases may indicate impending miscarriage.

Which gastrointestinal alteration of pregnancy is a normal finding? a. Insufficient salivation (ptyalism) is caused by increases in estrogen. b. Acid indigestion (pyrosis) begins early but declines throughout pregnancy. c. Hyperthyroidism often develops (temporarily) because hormone production increases. d. Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

D) Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial. Normal nausea and vomiting rarely produce harmful effects and may be less likely to result in miscarriage or preterm labor. Ptyalism is excessive salivation that may be caused by a decrease in unconscious swallowing or by stimulation of the salivary glands. Pyrosis begins as early as the first trimester and intensifies through the third trimester. Increased hormone production does not lead to hyperthyroidism in pregnant women.

The nurse caring for the pregnant client must understand that the hormone essential for maintaining pregnancy is: A) Estrogen. B) Human chorionic gonadotropin (hCG). C) Oxytocin. D) Progesterone.

D) Progesterone. Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles, which reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. hCG levels rise at implantation but decline after 60 to 70 days. Oxytocin stimulates uterine contractions.

Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth? a. Epulis b. Chloasma c. Telangiectasia d. Striae gravidarum

D) Striae gravidarum Striae gravidarum, or stretch marks, reflect a separation within the underlying connective tissue of the skin. They usually fade after birth, although they never completely disappear. An epulis is a red, raised nodule on the gums that easily bleeds; it disappears or shrinks after giving birth. Chloasma, or the mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in dark-complexioned pregnant women. Chloasma usually fades after the birth. Telangiectasia, or vascular spiders, are tiny, star-shaped or branchlike, slightly raised, pulsating end-arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen and usually disappear after birth.

A first-time mother at 18 weeks of gestation is in for her regularly scheduled prenatal visit. The client tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that these are Braxton Hicks contractions. What other information is important for the nurse to share? a. Braxton Hicks contractions should be painless. b. They may increase in frequency with walking. c. These contractions might cause cervical dilation. d. Braxton Hicks contractions will impede oxygen flow to the fetus.

a. Braxton Hicks contractions should be painless. Soon after the fourth month of gestation, uterine contractions can be felt through the abdominal wall. Braxton Hicks contractions are regular and painless and continue throughout the pregnancy. Although they are not painful, some women complain that they are annoying. This type of contraction usually ceases with walking or exercise. Braxton Hicks contractions can be mistaken for true labor; however, they do not increase in intensity, frequency, or cause cervical dilation. These contractions facilitate uterine blood flow through the intervillous spaces of the placenta and thereby promote oxygen delivery to the fetus.

Pregnancy hormones prepare the vagina for stretching during labor and birth. Which change related to the pelvic viscera should the nurse share with the client? a. Because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are easier to evaluate. b. Quickening is a technique of palpating the fetus to engage it in passive movement. c. The deepening color of the vaginal mucosa and cervix (Chadwick sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor. d. Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

d. Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester. Increased sensitivity and an increased interest in sex sometimes go together and frequently occur during the second trimester. These cervical changes make evaluation of abnormal Pap tests more difficult. Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus. The Chadwick sign appears from the 6 to 8 weeks of gestation.