c6maternaladapationstopregnancy Flashcards
(31 cards)
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.
ANS: 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.
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.
ANS: 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.
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.
ANS: 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.
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
ANS: 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.
ANS: 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.
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
ANS: 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.
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.”
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. Gastric secretions decrease, but this is not the main cause of nausea and vomiting.
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.”
ANS: 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 Chadwick’s sign, 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.
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.
ANS: 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 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.
ANS: 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.
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.
ANS: 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.
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.
ANS: 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.
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
ANS: 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.
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
ANS: 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.
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
ANS: 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.
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.
ANS: 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.
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.
ANS: 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 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.”
ANS: 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 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.”
ANS: 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.
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
ANS: 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.
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
ANS: 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.
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
ANS: 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 couvade.
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
ANS: 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.
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.”
ANS: 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.
