Chapter 11 Flashcards
(31 cards)
During a vaginal exam, the nurse notes that the lower uterine segment is softened. The nurse
documents this finding as:
A. Hegar sign.
B. Goodell sign.
C. Chadwick sign.
D. Ortolani sign.
Answer: A
Rationale: Hegar sign refers to the softening of the lower uterine segment or isthmus. Bluish
coloration of the cervix is termed Chadwick sign. Goodell sign refers to the softening of the
cervix. Ortolani sign is a maneuver done to identify developmental dysplasia of the hip in
infants.
The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset
of labor. What will the mother likely experience at that time?
A. dysuria
B. dyspnea
C. constipation
D. urinary frequency
Answer: D
Rationale: Lightening refers to the descent of the fetal head into the pelvis and engagement. With
this descent, pressure on the diaphragm decreases, easing breathing, but pressure on the bladder
increases, leading to urinary frequency. Dysuria might indicate a urinary tract infection.
Constipation may occur throughout pregnancy due to decreased peristalsis, but it is unrelated to
lightening.
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?
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A. “Having to urinate so often is annoying. I suggest that you watch how much fluid you are
drinking and limit it.”
B. “You shouldn’t be urinating this frequently now; it usually stops by the time you’re eight
weeks pregnant. Is there anything else bothering you?”
C. “By the time you are 12 weeks pregnant, this frequent urination should really decrease, but it
is likely to return toward the end of your pregnancy.”
D. “Women having their second child generally don’t have frequent urination. Are you
experiencing any burning sensations?”
Answer: C
Rationale: As the uterus grows, it presses on the urinary bladder, causing the increased frequency
of urination during the first trimester. This complaint lessens during the second trimester only to
reappear in the third trimester as the fetus begins to descend into the pelvis, causing pressure on
the bladder.
In a client’s seventh month of pregnancy, she reports feeling “dizzy, like I’m going to pass out,
when I lie down flat on my back.” The nurse explains that this is due to:
A. pressure of the gravid uterus on the vena cava.
B. a 50% increase in blood volume.
C. physiologic anemia due to hemoglobin decrease.
D. pressure of the presenting fetal part on the diaphragm.
Answer: A
Rationale: The client is describing symptoms of supine hypotension syndrome, which occurs
when the heavy gravid uterus falls back against the superior vena cava in the supine position.
The vena cava is compressed, reducing venous return, cardiac output, and blood pressure, with
increased orthostasis. The increased blood volume and physiologic anemia are unrelated to the
client’s symptoms. Pressure on the diaphragm would lead to dyspnea.
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 possible effect would the nurse
include?
A. ankle edema
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B. urinary frequency
C. backache
D. hemorrhoids
Answer: B
Rationale: The client is in her first trimester and would most likely experience urinary frequency
as the growing uterus presses on the bladder. Ankle edema, backache, and hemorrhoids would be
more common during the later stages of pregnancy.
The nurse is discussing the insulin needs of a primiparous client with diabetes who has been
using insulin for the past few years. The nurse informs the client that her insulin needs will
increase during pregnancy based on the nurse’s understanding that the placenta produces:
A. hCG, which increases maternal glucose levels.
B. hPL, which deceases the effectiveness of insulin.
C. estriol, which interferes with insulin crossing the placenta.
D. relaxin, which decreases the amount of insulin produced.
Answer: B
Rationale: Human placental lactogen (hPL) acts as an antagonist to insulin, so the mother must
produce more insulin to overcome this resistance. If the mother has diabetes, then her insulin
need would most likely increase to meet this demand. Human chorionic gonadotropin (hCG)
does not affect insulin and glucose level. Estrogen, not estriol, is believed to oppose insulin. In
addition, insulin does not cross the placenta. Relaxin is not associated with insulin resistance.
When teaching a pregnant client about the physiologic changes of pregnancy, the nurse
reviews the effect of pregnancy on glucose metabolism. Which underlying reason for the effect
would the nurse include?
A. Pancreatic function is affected by pregnancy.
B. Glucose is utilized more rapidly during a pregnancy.
C. The pregnant woman increases her dietary intake.
D. Glucose moves through the placenta to assist the fetus.
Answer: D
Rationale: The growing fetus has large needs for glucose, amino acids, and lipids, placing
demands on maternal glucose stores. During the first half of pregnancy, much of the maternal
glucose is diverted to the growing fetus. The pancreas continues to function during pregnancy.
However, the placental hormones can affect maternal insulin levels. The demand for glucose by
the fetus during pregnancy is high, but it is not necessarily used more rapidly. Placental
hormones, not the woman’s dietary intake, play a major role in glucose metabolism during
pregnancy.
A nurse strongly encourages a pregnant client to avoid eating swordfish and tilefish because
these fish contain which component?
A. excess folic acid, which could increase the risk for neural tube defects
B. mercury, which could harm the developing fetus if eaten in large amounts
C. lactose, which leads to abdominal discomfort, gas, and diarrhea
D. low-quality protein that does not meet the woman’s requirements
Answer: B
Rationale: Nearly all fish and shellfish contain traces of mercury, and some contain higher levels
of mercury that may harm the developing fetus if ingested by pregnant women in large amounts.
Among these fish are shark, swordfish, king mackerel, and tilefish. Folic acid is found in dark
green vegetables, baked beans, black-eyed peas, citrus fruits, peanuts, and liver. Folic acid
supplements are needed to prevent neural tube defects. Women who are lactose-intolerant
experience abdominal discomfort, gas, and diarrhea if they ingest foods containing lactose. Fish
and shellfish are an important part of a healthy diet because they contain high-quality proteins,
are low in saturated fat, and contain omega-3 fatty acids.
Which change in the musculoskeletal system would the nurse mention when teaching a group
of pregnant women about the physiologic changes of pregnancy?
A. ligament tightening
B. decreased swayback
C. increased lordosis
D. joint contraction
Answer: C
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Rationale: With pregnancy, the woman’s center of gravity shifts forward, requiring a realignment
of the spinal curvatures. There is an increase in the normal lumbosacral curve (lordosis).
Ligaments of the sacroiliac joints and pubis symphysis soften and stretch. Increased swayback
and an upper spine extension to compensate for the enlarging abdomen occur. Joint relaxation
and increased mobility occur due to the influence of the hormones relaxin and progesterone.
Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen.
The nurse documents this as which finding?
A. linea nigra
B. striae gravidarum (stretch marks)
C. melasma (chloasma)
D. vascular spiders
Answer: A
Rationale: Linea nigra refers to the darkened line of pigmentation down the middle of the
abdomen in pregnant women. Striae gravidarum refers to stretch marks, irregular reddish streaks
on the abdomen, breasts, and buttocks. Melasma (chloasma) refers to the increased pigmentation
on the face, also known as the “mask of pregnancy.” Vascular spiders are small, spiderlike blood
vessels that appear usually above the waist and on the neck, thorax, face, and arms.
A nurse is assessing a pregnant woman on a routine checkup. When assessing the woman’s
gastrointestinal tract, what would the nurse expect to find? Select all that apply.
A. hyperemic gums
B. increased peristalsis
C. reports of bloating
D. heartburn
E. nausea
Answer: A, C, D, E
Rationale: Gastrointestinal system changes include hyperemic gums due to estrogen and
increased proliferation of blood vessels and circulation to the mouth; slowed peristalsis; acid
indigestion and heartburn; bloating and nausea and vomiting.
A woman suspecting she is pregnant asks the nurse about which signs would confirm her
pregnancy. The nurse would explain that which sign would confirm the pregnancy?
A. absence of menstrual period
B. abdominal enlargement
C. palpable fetal movement
D. morning sickness
Answer: C
Rationale: Only positive signs of pregnancy would confirm a pregnancy. The positive signs of
pregnancy confirm that a fetus is growing in the uterus. Visualizing the fetus by ultrasound,
palpating for fetal movements, and hearing a fetal heartbeat are all signs that make the pregnancy
a certainty. Absence of menstrual period and morning sickness are presumptive signs, which can
be due to conditions other than pregnancy. Abdominal enlargement is a probable sign.
A nurse is developing a teaching plan about nutrition for a group of pregnant women. Which
recommendations would the nurse include in the discussion? Select all that apply.
A. Keep weight gain to 15 lb (6.8 kg).
B. Eat three meals with snacking.
C. Limit the use of salt in cooking.
D. Avoid using diuretics.
E. Participate in physical activity.
Answer: B, D, E
Rationale: To promote optimal nutrition, the nurse would recommend gradual and steady weight
gain based on the client’s prepregnant weight, eating three meals with one or two snacks daily,
not restricting the use of salt unless instructed to do so by the health care provider, avoiding the
use of diuretics, and participating in reasonable physical activity daily.
Assessment of a pregnant woman reveals that she compulsively craves ice. The nurse
documents this finding as:
A. quickening.
B. pica.
C. ballottement.
D. linea nigra.
Answer: B
Rationale: Pica refers to the compulsive ingestion of nonfood substances such as ice. Quickening
refers to the mother’s sensation of fetal movement. Ballottement refers to the feeling of rebound
from a floating fetus when an examiner pushes against the woman’s cervix during a pelvic
examination. Linea nigra refers to the pigmented line that develops in the middle of the woman’s
abdomen.
A woman in her second trimester comes for a follow-up visit and says to the nurse, “I feel
like I’m on an emotional roller-coaster.” Which response by the nurse would be most
appropriate?
A. “How often has this been happening to you?”
B. “Maybe you need some medication to level things out.”
C. “Mood swings are completely normal during pregnancy.”
D. “Have you been experiencing any thoughts of harming yourself?”
Answer: C
Rationale: Emotional lability is characteristic throughout most pregnancies. One moment a
woman can feel great joy, and within a short time she can feel shock and disbelief. Frequently,
pregnant women will start to cry without any apparent cause. Some women feel as though they
are riding an “emotional roller-coaster.” These extremes in emotion can make it difficult for
partners and family members to communicate with the pregnant woman without placing blame
on themselves for their mood changes. Clear explanations about how common mood swings are
during pregnancy are essential.
- While talking with a woman in her third trimester, the nurse understands that which behavior
indicates that the woman is learning to give of oneself?
A. showing concern for self and fetus as a unit
B. unconditionally accepting the pregnancy without rejection
C. longing to hold infant
D. questioning ability to become a good mother
Answer: D
Rationale: Learning to give of oneself would be demonstrated when the woman questions her
ability to become a good mother to the infant. Showing concern for herself and fetus as a unit
reflects the task of ensuring safe passage throughout pregnancy and birth. Unconditionally
accepting the pregnancy reflects the task of seeking acceptance of the infant by others. Longing
to hold the infant reflects the task of seeking acceptance of self in the maternal role to the infant.
A nurse is assessing a client who may be pregnant. The nurse reviews the client’s history for
presumptive signs. Which signs would the nurse most likely note? Select all that apply.
A. amenorrhea
B. nausea
C. abdominal enlargement
D. Braxton-Hicks contractions
E. fetal heart sounds
Answer: A, B
Rationale: Presumptive signs include amenorrhea, nausea, breast tenderness, urinary frequency
and fatigue. Abdominal enlargement and Braxton-Hicks contractions are probable signs of
pregnancy. Fetal heart sounds are a positive sign of pregnancy.
After teaching a refresher class to a group of prenatal clinic nurses about pregnancy, insulin,
and glucose, the nurse determines that additional teaching is needed when the group identifies
which hormone as being involved with opposing insulin?
A. prolactin
B. estrogen
C. progesterone
D. aldosterone
Answer: D
Rationale: Prolactin, estrogen, and progesterone are all thought to oppose insulin. As a result,
glucose is less likely to enter the mother’s cells and is more likely to cross over the placenta to
the fetus. Aldosterone does not oppose insulin.
A pregnant woman comes to the clinic and tells the nurse that she has been having a whitish
vaginal discharge. The nurse suspects vulvovaginal candidiasis based on which assessment
finding?
A. fever
B. vaginal itching
C. urinary frequency
D. incontinence
Answer: B
Rationale: Vaginal secretions become more acidic, white, and thick during pregnancy. Most
women experience an increase in a whitish vaginal discharge, called leukorrhea. This is normal
except when it is accompanied by itching and irritation, possibly suggesting Candida albicans, a
monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Fever
would suggest a more serious infection. Urinary frequency occurs commonly in the first
trimester, disappears during the second trimester, and reappears during the third trimester.
Incontinence would not be associated with a vulvovaginal candidiasis. Incontinence would
require additional evaluation.
A woman is at 20 weeks’ gestation. The nurse would expect to find the fundus at which area?
A. just above the symphysis pubis
B. midway between the pubis and umbilicus
C. at the level of the umbilicus
D. midway between the umbilicus and xiphoid process
Answer: C
Rationale: The uterus, which starts as a pear-shaped organ, becomes ovoid as length increases
over width. By 20 weeks’ gestation, the fundus, or top of the uterus, is at the level of the
umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in
centimeters, which corresponds to the number of gestational weeks, is commonly used to date
the pregnancy.
A woman comes to the prenatal clinic for an evaluation because she thinks that she may be
pregnant. The nurse is assisting the health care provider with the vaginal examination. The exam
reveals a vaginal mucosa and cervix that are bluish-purple in color. Based on this information,
the nurse suspects that the client is most likely how many weeks pregnant?
A. 5 weeks
B. 6 weeks
C. 14 weeks
D. 16 weeks
Answer: B
Rationale: The finding indicates Chadwick’s sign, a bluish-purple discoloration of the vaginal
mucosa and cervix. This typically occurs between 6 to 8 weeks. Goodell’s sign (softening of the
cervix) occurs at about 5 weeks. Abdominal enlargement typically begins at about 14 weeks and
ballottement (when the examiner pushes against the woman’s cervix during a pelvic examination
and feels a rebound from the floating fetus) usually occurs at about 16 weeks.
A nurse is monitoring a client’s hCG levels because she has had a previous ectopic pregnancy
and one spontaneous abortion. Which finding would the nurse interpret as indicating that the
pregnancy is progressing appropriately?
A. doubling of the level every 2 to 3 days
B. plateauing of the level at 7 days
C. gradually increasing levels every month
D. abruptly declining levels after 60 days
Answer: A
Rationale: Human chorionic gonadotropin (hCG) is a glycoprotein and the earliest biochemical
marker for pregnancy. Many pregnancy tests are based on the recognition of hCG or a beta
subunit of hCG. hCG levels in normal pregnancy usually double every 48 to 72 hours until they
peak approximately 60 to 70 days after fertilization. At this point, they decrease to a plateau at
100 to 130 days of pregnancy.
A nurse is providing nutritional counseling to a pregnant woman and gives her suggestions
about consuming foods that are high in folic acid. As part of the plan of care, the client is to keep
a food diary that the client and nurse will review at the next visit. When reviewing the client’s
diary, which meals would indicate to the nurse that the client is increasing her intake of folic
acid? Select all that apply.
A. chicken breast with baked potato and broccoli
B. cheeseburger with spinach and baked beans
C. pork chop with mashed potatoes and green beans
D. strawberry walnut salad with romaine lettuce
E. fried chicken sandwich with mayonnaise and avocado
Answer: A, B, D
Rationale: Good food sources of folic acid include dark green vegetables, such as broccoli,
romaine lettuce, and spinach; baked beans; black-eyed peas; citrus fruits; peanuts; and liver. So
the meals containing chicken breast with baked potato and broccoli, cheeseburger with spinach
and baked beans, and the strawberry walnut salad with romaine lettuce demonstrate an intake of
foods high in folic acid.
A pregnant woman asks the nurse, “I’ve heard that I should avoid eating certain types of fish.
So what fish can I eat?” Which type of fish would the nurse recommend? Select all that apply.
A. shark
B. tilefish
C. shrimp
D. salmon
E. catfish
Answer: C, D, E
Rationale: The nurse should recommend eating up to 12 ounces (two average meals) weekly of
low-mercury-level fish such as shrimp, canned light tuna, salmon, pollock, and catfish and avoid
eating shark, swordfish, king mackerel, orange roughy, ahi tuna, and tilefish because they are
high in mercury levels.
