NUR 238 PrepU Chapter 11: Maternal Adaptation During Pregnancy
A 17-year-old client arrives for an annual examination and reports no changes since the last exam; however, the nurse assesses a positive Chadwick sign, slightly enlarged uterus, and subsequent positive urine pregnancy test. Which task should the nurse prioritize to assist this client who is denying any possibility that she is pregnant?
Accepting the pregnancy
The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting?
Darkened breast areolae
A client in her 39th week of gestation reports swelling in the legs after standing for long periods of time. The nurse recognizes that this factor increases the client's risk for which condition?
venous thrombosis
A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize?
Blood is trapped in the vena cava in a supine position.
A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucus discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse?
"A one time discharge of bloody mucus in the toilet might have been your mucus plug."
The nurse is caring for a client at 8 weeks' gestation who states, "I did not plan for this right now and I am not happy or excited about this pregnancy. I am not sure what to do." Which response by the nurse is best?
"Many women feel this way during the first trimester."
A client at 40 weeks' gestation informs the nurse that she is tired of being pregnant. What is the best response from the nurse?
"That is a very normal feeling, especially at this point in pregnancy."
A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate?
"This discharge is normal during pregnancy."
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 information should the nurse offer?
"You will experience quickening, and you will actually feel the baby."
The nurse is conducting an annual examination on a young female who reports her last menses was 2 months ago. The client insists she is not pregnant due to a negative home pregnancy test. Which assessment should the nurse use to assess confirm the pregnancy?
fetal heartbeat
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 (0.45 kg)
A urinalysis is done on a client in her third trimester. Which result would be considered abnormal?
2+ Protein in urine
A 23-year-old female has come to the clinic for her first prenatal visit. After the examination reveals no concerns and potential low-risk pregnancy, the nurse discusses nutritional needs for her and her growing baby. As per the Institute of Medicine, the nurse suggests the client take which amount of ferrous iron daily?
27 mg
Which change related to the vital signs is expected in pregnant women?
Blood pressure decreases.
During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings?
Both findings are normal at this point of the pregnancy.
The nurse cares for a pregnant client at the first prenatal visit and reviews expected changes that will occur during pregnancy. Which information will the nurse include in the education?
During pregnancy blood volume can increase by at least 40%.
A community health nurse is leading a discussion at a health fair for college students on the topic of the signs of pregnancy. The nurse determines more teaching is necessary when the students choose which sign as a probable sign of pregnancy?
Fetal movement felt by examiner
A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?
Fundal height has dropped since the last recording.
A 22-year-old client comes to the walk-in clinic complaining of fatigue, breast heaviness and extreme tenderness, and a clear vaginal discharge. What question would the nurse ask this client?
Have you been sexually active in the past 2 months?
The nurse is explaining the latest laboratory results to a pregnant client who is in her third trimester. After letting the client know she is anemic, which heme iron-rich foods should the nurse encourage her to add to her diet?
Meats
A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition?
Place the client in the left lateral position.
The partner of a pregnant client in her first trimester asks the nurse about the client's behavior recently, stating that she is very moody, seems happy one moment and is crying the next and all she wants to talk about is herself. What response would correctly address these concerns?
Pregnant women often experience mood swings and self-centeredness but this is normal.
The nursing instructor is teaching a class on the various hormones necessary for a successful pregnancy and birthing process. The instructor determines the session is successful when the students correctly choose which hormone as being necessary after birth to ensure growth of the newborn?
Prolactin
In assessing the dietary intake over the last 24 hours of a pregnant client, which food would be most concerning to the nurse?
Smoked salmon and bagels
During a routine prenatal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse take next?
Tell the woman that this is entirely normal.
During a physical exam, the physician notates that the pregnant client has a positive Chadwick sign. What client findings would be noted for this symptom?
The cervix has a bluish, purple discoloration.
A pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding?
The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual.
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
A pregnant woman who is a vegetarian asks the nurse, "What would you suggest to make sure that I get enough protein in my diet while I am pregnant?" Which food(s) would be appropriate for the nurse to suggest? Select all that apply.
beans lentils nuts
The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply.
breast changes amenorrhea morning sickness
A nurse is caring for a pregnant client who has been diagnosed with lordosis. The nurse offers preventive measures for which consequence of lordosis when caring for this client?
chronic backache
During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called?
couvade syndrome
On day 3 after a cesarean birth, the client is complaining of soreness in her left leg. On examination the nurse notes the left leg is swollen, and the calf is red, tender and warm to touch. These findings indicate:
deep vein thrombosis.
During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which effect of pregnancy?
influence of estrogen and blood vessel proliferation
A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client?
iron-deficiency anemia
A client who is in her sixth week of gestation is being seen for a routine prenatal care visit. The client asks the nurse about changes in her eating habits that she should make during her pregnancy. The client informs the nurse that she is a vegetarian. The nurse knows that she has to monitor the client for which risks arising from her vegetarian diet? Select all that apply.
iron-deficiency anemia decreased mineral absorption low gestational weight gain
A 27-year-old female was just confirmed to be pregnant. She tells the nurse she just switched to a vegan diet. The nurse explains that she must pay special attention to her intake of which elements to ensure she is getting adequate nutrition for her and the baby? Select all that apply.
protein iron vitamin B12 calcium
A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation (dilatation) and enlargement of the birth canal. What is this hormone?
relaxin
