3 - Normal Physiological Changes During Pregnancy

Question 1

Presumptive Signs of Pregnancy

Answer 1

◯ Amenorrhea

◯ Fatigue

◯ Nausea and vomiting

◯ Urinary frequency

◯ Breast changes – darkened areolae, enlarged Montgomery’s glands

◯ Quickening – slight fluttering movements of the fetus felt by a woman, usually between 16to20weeks of gestation

◯ Uterine enlargement

Question 2

Probably signs of Pregnancy

Answer 2

◯ Abdominal enlargement related to changes in uterine size, shape, and position

◯ Hegar’s sign – softening and compressibility of lower uterus

◯ Chadwick’s sign – deepened violet-bluish color of cervix and vaginal mucosa

◯ Goodell’s sign – softening of cervical tip

◯ Ballottement – rebound of unengaged fetus

◯ Braxton Hicks contractions – false contractions; painless, irregular, and usually relieved by walking

◯ Positive pregnancy test

◯ Fetal outline felt by examiner

Question 3

When does hCG production start?

Answer 3

day of implantation

Question 4

When can hCG be detected?

Answer 4

7-10 days after conception

Question 5

When does hCG peak?

Answer 5

60-70 days of gestation

declines around 80 days

gradually increases from there

Question 6

What can high levels of hCG indicate?

Answer 6

multifetal pregnancy

ectopic preg

hydatidiform mole

Downs Syndrome

Question 7

What can low levels of hCG indicate?

Answer 7

miscarriage

Question 8

When do we start taking measurements of fundal height?

Answer 8

~ 18 weeks

Question 9

GPTAL

Answer 9

Gravidity

Term births (38 wks or more)

Preterm births (viability up to 37 wks)

Abortions / Miscarriages (prior to viability)

Living Children

Question 10

Cardiac output and volume increase by — during pregnancy.

Answer 10

45-50%

*** heart rate also increases

Question 11

During first trimester, what to BP measurements look like?

Answer 11

normal range during prepragnancy

Question 12

During the second trimester, what can happen to BP?

Answer 12

decreases by 5-10 mmHg for both diastole and systolic

Question 13

After 20 weeks gestation, what happens to BP?

Answer 13

returns to normal prepregnancy baseline

Question 14

When mother is supine, what could happen to BP?

Answer 14

may appear low due to pressure lying on IVC, decreasing vascular return

Question 15

Around 20 weeks gestation, what happens to pulse?

Answer 15

increases 10-15 / min

***remains elevated throughout remainder of pregnancy

Question 16

What happens to Respiratory Rate during pregnancy?

Answer 16

increases by 1-2 / min

***attributed to elevation of diaphragm by as much as 4 cm

***some SOB may be noted

Question 17

What happens to pregnant mom’s heart sounds?

Answer 17

splitting of S1 and S2 with S3 more easily heard following 20 weeks gestation

murmurs

Question 18

By 36 weeks, where will the top of the uterus (fundal height) be?

Answer 18

the xiphoid process

Question 19

— is pigmentation of the face.

Answer 19

Chloasma

Question 20

— is a dark line from the umbilicus to the pubic area.

Answer 20

Linea nigra

Question 21

— are stretch marks found on the abdomen and thighs.

Answer 21

Striae gravidarum

Question 22

1A nurse is caring for a client who is pregnant and states that her last menstrual period was April 1, 2013. Which of the following is the client’s estimated date of delivery?

A. Jan. 8, 2014
B. Jan. 15, 2014
C. Feb. 8, 2014
D. Feb. 15, 2014

Answer 22

A. Jan. 8, 2014

Question 23

A nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy. The client’s health record includes this data: G3 T1 P0 A1 L1. How should the nurse interpret this information? (Select all that apply.)

A. Client has delivered one newborn at term.

B. Client has experienced no preterm labor.

C. Client has been through active labor.

D. Client has had two prior pregnancies.

E. Client has one living child.

Answer 23

A. Client has delivered one newborn at term.

D. Client has had two prior pregnancies.

E. Client has one living child.

Question 24

A nurse is reviewing the health record of a client who is pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following would be included? (Select all that apply.)

   A. Montgomery’s glands
   B. Goodell’s sign
   C. Ballottement
   D. Chadwick’s sign
   E. Quickening

Answer 24

B. Goodell’s sign
C. Ballottement
D. Chadwick’s sign

Question 25

A nurse in a prenatal clinic is caring for a client who is pregnant and experiencing episodes of maternal hypotension. The client asks the nurse what causes these episodes. Which of the following is an appropriate response by the nurse? A. “This is due to an increase in blood volume.” B. “This is due to pressure from the uterus on the diaphragm.” C. “This is due to the weight of the uterus on the vena cava.” D. “This is due to increased cardiac output.”

Answer 25

C. “This is due to the weight of the uterus on the vena cava.”

Question 26

A nurse in a clinic receives a phone call from a client who believes she is pregnant and would like to be tested in the clinic to confirm her pregnancy. Which of the following information should the nurse provide to the client? A. “You should wait until 4 weeks after conception to be tested.” B. “You should be off any medications for 24 hours prior to the test.” C. “You should be NPO for at least 8 hours prior to the test.” D. “You should collect urine from the first morning void.”

Answer 26

D. “You should collect urine from the first morning void.”