Maternity & Pediatric Nursing Ch 6

Amanda is about 16 weeks pregnant and is concerned because she feels her "abdomen" contracting. She calls the doctors office and speaks to the nurse. What is the most appropriate response to Amanda's concern?

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

Which of the following changes related to the vital signs is expected in pregnant women?

Blood pressure decreases.

Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen. The nurse documents this as which of the following?

Linea nigra

A gravida 2 para 1 client in the 10th week of her pregnancy says to the nurse, "I've never urinated as often as I have for the past three weeks." Which response would be most appropriate for the nurse to make?

"By the time you are 12 weeks pregnant, this frequent urination should no longer be a problem, but it is likely to return toward the end of your pregnancy."

The nurse is teaching a prenatal class about preparing for their expanding families. Which of the following is helpful advice from the nurse?

"The hormones of pregnancy may cause anxiety or depression postpartum."

A client at 36 weeks' gestation comes in for her weekly physician visit. She tells the nurse, "I am having contractions, but they are irregular and go away when I rest. Do you think I am going into labor?" The best response by the nurse would be:

"These are called Braxton-Hicks contractions and are preparing your body for labor but are not 'true' labor contractions."

A student nurse asks the instructor about maternal pulse and blood pressure changes during the prenatal period. Which of the following responses from the nurse about cardiovascular changes during the first and second trimesters is accurate?

"Women experience increased pulse rate and decreased blood pressure."

A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which of the following information should the nurse offer?

"You will experience quickening, and you will actually feel the baby."

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week?

1 lb

The nurse is teaching a pregnant woman with a prepregnancy body mass index of 26 about recommended weight gain. The nurse determines that the teaching was successful when the woman states that she should gain no more than which amount during pregnancy?

15 to 25 lbs

A nurse should teach a client who is pregnant for the first time that she should be able to feel the baby move at about how many weeks gestation?

18 to 20

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks pregnant. The nurse would expect this woman's heart rate to be approximately:

85 beats per minute

At her 16-week checkup, a patient's blood pressure is slightly decreased from her pre-pregnancy level. You evaluate this change based on which of the following statements concerning blood pressure during pregnancy?

A decrease in the second trimester may occur because of placental growth.

Many factors influence how a woman adapts psychologically to pregnancy. What is the psychological adaptation the woman must come to terms with during the second trimester?

Accept the baby

When assessing a woman in her first trimester, which emotional response would the nurse most likely expect to find?

Ambivalence

Place the following events in the sequence the pregnant woman would experience them, from first to last.

Amennorhea Uterine enlargement Quickening Braxton Hicks contractions Labor

A friend tells you that she is going to use a home pregnancy test to determine whether she is pregnant. Which of the following precautions would you give her?

Arrange for prenatal care if the test is positive.

A woman from Brazil and her husband are visiting the office for a prenatal check-up. Which of the following would be the best nursing intervention to show respect to the couple and their cultural and individual values related to childbirth?

Ask the couple whether there is anything they believe should or should not be done to make the pregnancy successful

Some women are lactose intolerant. Lactose intolerance occurs more frequently in individuals of African, Hispanic, Native American, Ashkenazic Jewish, and Asian descent. What is the major concern for a lactose intolerant woman who is pregnant?

Calcium deficiency

During a vaginal exam, the nurse notes that the cervix has a bluish color. The nurse documents this finding as:

Chadwick's sign

A nurse assesses a primigravida client and observes darkening of the skin on the client's face. How should the nurse document this pigmentation?

Chloasma

Increased pigmentation on the face of some pregnant women is called:

Chloasma

Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called?

Chloasma

A couple is talking with a nurse about the pregnant woman's current experience with morning sickness in the first trimester. While they are talking, the nurse notes that the woman's husband appears clammy and pale. After a moment, he excuses himself to go to the restroom. When he returns, he jokes that he has "caught" his wife's morning sickness. He also remarks that he has gained weight recently. The nurse should explain to the couple that the husband is experiencing which of the following?

Couvade syndrome

A pregnant woman is concerned about the recent onset of a midline swelling that is soft and nontender. What does this represent?

Diastasis recti

Which of the following is NOT a probable sign of pregnancy?

Fetal movement felt by examiner

After teaching a group of students about the signs of pregnancy, which of the following if stated by the group as a presumptive sign indicates the need for additional teaching?

Hearing a fetal heart rate on auscultation

Amanda makes an appointment with an obstetrician. During the exam, the obstetrician notes that the uterine isthmus is soft. What is the name of this sign, and how is it classified?

Hegar's sign; probable

Pregnancy tests (both urine and blood) measure levels of which hormone to validate the existence of pregnancy?

Human chorionic gonadotropin (hCG)

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

Increase in human chorionic gonadotropin (HCG)

Which of the following changes in the musculoskeletal system would the nurse mention when teaching a group of pregnant women about the physiologic changes of pregnancy?

Increased lordosis

When describing the pregnant woman's hypercoagulable state, which of the following would the nurse identify as being least likely related?

Increased number of red blood cells

A 28-year-old primigravida client with diabetes mellitus, in her first trimester, comes to the health care clinic for a routine visit. The client reports frequent episodes of sweating, giddiness, and confusion. What should the nurse tell the client about these experiences?

Increased secretion of insulin occurs in the first trimester

Which change in respiratory function during pregnancy is considered normal?

Increased tidal volume

A 16-year-old girl arrives at the office for her first prenatal visit. After missing her period, she took two home pregnancy tests, both of which were positive, and came in a week ago for a blood test. The blood test also was positive. Today she appears pale and apprehensive, and asks, "Is there any other kind of test I can take, just to make sure?" Which of the following would be the most accurate nursing diagnosis of this patient?

Ineffective denial of pregnancy due to apprehension and fear

The husband of a pregnant woman tells the nurse that his wife is increasingly preoccupied with herself and her fetus. The woman is in her first trimester of pregnancy. The nurse interprets this as which of the following?

Introversion

A 22-year-old primagravida comes to the office for a prenatal visit. She is in her second trimester and has had prenatal care since she was 8 weeks pregnant. Her only complaint is a new brownish line straight down her abdomen. Vital signs are unremarkable. Urine has no protein, glucose, or leukocytes. Fetal heart rate is 140; the client's uterus is palpated to the umbilicus. What physical finding is responsible for her new "brown line?"

Linea nigra

A woman in her third trimester shows the nurse a narrow, brown line that has formed on her abdomen, running from her belly button down to her pubic region. She expresses concern about this and asks the nurse whether it is normal. The nurse explains that this is a normal occurrence of pregnancy and that it results from the release of melanocyte-stimulating hormone from the pituitary, causing the appearance of extra pigmentation on the skin. This phenomenon is known as which of the following?

Linea nigra

During pregnancy a woman's breasts change from their pre-pregnant state. What is one of these changes?

Montgomery's tubercles become more prominent

The nurse teaches a pregnant woman about breastfeeding, stating that stimulation of the breast through sucking or touching stimulates the secretion of which hormone?

Oxytocin

The nurse correctly identifies which of the following as the hormone that plays a central role in the release of milk from the breast (ie, the let-down reflex)?

Oxytocin.

Amanda's menstrual period is two weeks late. She has been feeling tired and has had bouts of nausea in the morning. What classification of pregnancy symptoms is Amanda experiencing?

Presumptive

The nursing instructor is teaching students about normal changes of pregnancy. The instructor talks about diastasis recti. What is the instructor presenting?

Separation of the muscles of the abdominal wall

The cardiovascular system of a pregnant woman copes with the increasing demands of organ systems that are working harder as well as an increased blood volume. The heart itself is pushed upward and to the left. What can this repositioning of the heart cause?

Systolic murmurs

The nurse midwife is performing a pelvic examination on a client who came to her following a positive home pregnancy test. The nurse checks the woman's cervix for the probable sign of pregnancy known as Goodell's sign. Which of the following describes this alteration?

The cervix softens.

Which of the following statements would the nurse include in the teaching plan for a pregnant woman related to changes in the uterus?

The uterus changes from a pear-shaped organ to an oval one.

A woman's physician has suggested that she eat iodized salt during pregnancy. On which of the following would you base your explanation for this suggestion?

Thyroid activity, which depends on iodine intake, increases during pregnancy.

Which change in the breasts should a nurse recognize as a normal change associated with pregnancy?

Tingling sensations and tenderness

A nurse urges a pregnant patient at the first prenatal office visit to begin taking iron supplements immediately. What is the rationale for this intervention?

To avoid anemia

Morning sickness is associated with rising levels of human chorionic gonadotropin (hCG) and progesterone.

True

During an examination, a client who's 32 weeks pregnant becomes dizzy, lightheaded, and pale while supine. What should the nurse do first?

Turn the client on her left side.

A primiparous client is being seen in the clinic for her first prenatal visit. It is determined that she is 11 weeks pregnant. The nurse develops a teaching plan to educate the client about what she will most likely experience during this period. Which of the following would the nurse include?

Urinary frequency

A patient who has just given a blood sample for pregnancy testing in the doctor's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. Which of the following should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy?

Visualization of the fetus by ultrasound

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy?

Visualization of the gestational sac or fetus

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which of the following data collected by the nurse are presumptive signs of her pregnancy? Select all that apply.

• Breast changes • Morning sickness • Amenorrhea

The nurse is counseling a young woman who has just entered her second trimester. The patient had an uneventful first trimester, with no symptoms of morning sickness. She tells the nurse, "It still doesn't seem real. It's just hard to believe that I will really have a baby." From experience, the nurse knows that which of the following are likely to help the woman accept the fact that she is having a baby? (Select all that apply.)

• Feeling the baby kick • Setting up a crib for the baby • Seeing an ultrasound image of the baby

A client comes to the prenatal clinic for a follow-up examination. When assessing the breasts, which of the following would the nurse expect to find? Select all that apply.

• Increased sensitivity • Hyperpigmentation of the nipple • Prominent veins

A woman comes to the prenatal clinic suspecting that she is pregnant, and assessment reveals probable signs of pregnancy. Which of the following would be included as part of this assessment? Select all that apply.

• Positive pregnancy test • Ballottement • Softening of the cervix

The obstetrical nurse knows that a woman's hormone levels change dramatically during pregnancy. Which of the following hormonal actions accurately represent these changes? Select all that apply.

• Relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly • Causing changes in the mother's metabolism so that nutrients are available for both • Maintaining the endometrium so that the embryo can implant • Preparing the breasts for lactation, keeping the milk from coming in until birth occurs