Test Bank - Essentials of Maternity, Newborn, and Women's Health Nursing (4th Edition

Test Bank - Essentials of Maternity, Newborn, and Women's Health Nursing (4th Edition) Chapter 11: Maternal Adaptation during Pregnancy 1. During a vaginal exam, the nurse notes that the cervix has a bluish color. The nurse documents this finding as: A) Hegars sign B) Goodells sign C) Chadwicks sign D) Ortolanis sign Answer: C Explanation: Common probable signs of pregnancy include softening of the lower uterine segment or isthmus (Hegar’s sign), softening of the cervix (Goodell’s sign), and a bluish- purple coloration of the vaginal mucosa and cervix (Chadwick’s sign) 2. The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. The mother will most likely experience which of the following at that time? A) Dysuria B) Dyspnea C) Constipation D) Urinary frequency Answer: D Explanation: The uterus remains in the pelvic cavity for the first 3 months of pregnancy, after which it progressively ascends into the abdomen. As the uterus grows, it presses on the urinary bladder and causes the increased frequency of urination experienced during early pregnancy. 3. 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? 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 no longer be a problem, 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 Explanation: Lying on either side relieves the pressure that the enlarged uterus puts on the vena cava carrying blood from the legs. Subsequently, venous return to the heart increases, leading to increased cardiac output. Increased cardiac output results in increased renal perfusion and glomerular filtration. As a rule, all the physiologic changes maximize by the end of the second trimester and then start to return to the prepregnant level. However, changes in the anatomy take up to 3 months postpartum to subside. 4. 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 integrates which of the following in to the explanation? 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 Explanation: The heavy gravid uterus in the last trimester can fall back against the inferior vena cava in the supine position, resulting in vena cava compression, which reduces venous return and decreases cardiac output and blood pressure, with increasing orthostatic stress. This occurs when the woman changes her position from recumbent to sitting to standing. This acute hemodynamic change, termed supine hypotensive syndrome, causes the woman to experience symptoms of weakness, light-headedness, nausea, dizziness, or syncope. These changes are reversed when the woman is in the side- lying position, which displaces the uterus to the left and off the vena cava. 5. 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? A) Ankle edema B) Urinary frequency C) Backache D) Hemorrhoids Answer: B Explanation: 6. A pregnant client in her second trimester has a hemoglobin level of 11 g/dL. The nurse interprets this as indicating which of the following? A) Iron-deficiency anemia B) A multiple gestation pregnancy C) Greater-than-expected weight gain D) Hemodilution of pregnancy Answer: D Explanation: Blood volume increases by approximately 1,500 mL, or up to 50% above nonpregnant levels, by the 32nd week of gestation, and remains more or less constant thereafter. The increase is made up of 1,000 mL plasma plus 450 mL red blood cells. It begins at weeks 10 to 12, peaks at weeks 32 to 34, and decreases slightly by week 40. The maternal blood volume expansion occurs at a larger proportion than the increase in red blood cell mass, which results in physiologic anemia and hemodilution. Criteria of physiologic anemia include hemoglobin 10 g or less; red blood cells 3.5 million/mm3 and normal morphology with central pallor 7. The nurse is discussing the insulin needs of a primaparous 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 nurses 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 Explanation: After the first trimester, hPL from the placenta and steroids (cortisol) from the adrenal cortex act against insulin. hPL acts as an antagonist against maternal insulin, and thus more insulin must be secreted to counteract the increasing levels of hPL and cortisol during the last half of pregnancy. 8. When teaching a pregnant client about the physiologic changes of pregnancy, the nurse reviews the effect of pregnancy on glucose metabolism. Which of the following would the nurse include as the underlying reason for the effect? 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 Explanation: During early pregnancy, maternal glucose levels decrease because of the heavy fetal demand for glucose. The fetus is also drawing amino acids and lipids from the mother, decreasing the mother’s ability to synthesize glucose. Maternal glucose is diverted across the placenta to assist the growing embryo/fetus during early pregnancy, and thus levels decline in the mother. As a result, maternal glucose concentrations decline to a level that would be considered “hypoglycemic” in a nonpregnant woman. 9. When assessing a woman in her first trimester, which emotional response would the nurse most likely expect to find? A) Ambivalence B) Introversion C) Acceptance D) Emotional lability Answer: A Explanation: Ambivalence, or having conflicting feelings at the same time, is a universal feeling and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester. Introversion, or focusing on oneself, is common during the early part of pregnancy. The woman may withdraw and become increasingly preoccupied with herself and her fetus. As a result, she may participate less with the outside world, and she may appear passive to her family and friends. This introspective behavior is a normal psychological adaptation to motherhood for most women. Introversion seems to heighten during the first and third trimesters, when the woman’s focus is on behaviors that will ensure a safe and health pregnancy outcome. During the second trimester, the physical changes of the growing fetus, including an enlarging abdomen and fetal movement, bring reality and validity to the pregnancy. 10. The nurse is assessing a pregnant woman in the second trimester. Which of the following tasks would indicate to the nurse that the client is incorporating the maternal role into her personality? A) The woman demonstrates concern for herself and her fetus as a unit. B) The client identifies what she must give up to assume her new role. C) The woman acknowledges the fetus as a separate entity within her. D) The client demonstrates unconditional acceptance without rejection. Answer: C Explanation: At second trimester, woman develops attachment of great value to her fetus, with sensation of fetal movement (quickening), mother acknowledges fetus as a separate entity within her, and identifies with infant, learns how to delay own desires. The woman demonstrates concern for herself and her fetus as a unit, and demonstrates unconditional acceptance without rejection take place during third trimester while identifying what she must give up to assume her new role happens in first trimester. 11. 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.) A) Positive pregnancy test B) Ultrasound visualization of the fetus C) Auscultation of a fetal heart beat D) Ballottement E) Absence of menstruation F) Softening of the cervix Answer: A, D, F Explanation: Probable signs of pregnancy are: Braxton Hicks contractions (16–28 wks); Positive pregnancy test (4–12 wks); Abdominal enlargement (14 wks); Ballottement (16–28 wks); Goodell’s sign (5 wks); Chadwick’s sign (6–8 wks); Hegar’s sign (6–12 wks). Absence of menstruation is a presumptive sign while ultrasound visualization of the fetus is a positive sign of pregnancy. 12. The nurse is teaching a pregnant woman about recommended weight gain. The woman has a prepregnancy body mass index of 26. The nurse determines that the teaching was successful when the woman states that she should gain no more than which amount during pregnancy? A) 35 to 40 pounds B) 25 to 35 pounds C) 28 to 40 pounds D) 15 to 25 pounds Answer: D Explanation: Underweight (BMI 18.5) total weight gain range = 28–40 lb; Normal weight (BMI = 18.5–24.9) total weight gain range = 25–35 lb.; Overweight (BMI = 25–29.9) total weight gain range = 15–25 lb.; Obese (BMI = 30 or higher) total weight gain range = 11–20 lb. 13. A nurse strongly encourages a pregnant client to avoid eating swordfish and tilefish because these fish contain which of the following? 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 Explanation: 14. 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? A) Ligament tightening B) Decreased swayback C) Increased lordosis D) Joint contraction Answer: C Explanation: By the 10th to 12th week of pregnancy, the ligaments that hold the sacroiliac joints and the pubis symphysis in place begin to soften and stretch, and the articulations between the joints widen and become more movable. The postural changes of pregnancy—an increased swayback and an upper spine extension to compensate for the enlarging abdomen—coupled with the loosening of the sacroiliac joints may result in lower back pain. The woman’s center of gravity shifts forward, requiring a realignment of the spinal curvatures. An increase in the normal lumbosacral curve (lordosis) occurs and a compensatory curvature in the cervicodorsal area develops to assist her in maintaining her balance. In addition, relaxation and increased mobility of joints occur because of the hormones progesterone and relaxin, which lead to the characteristic “waddle” gait that pregnant women demonstrate toward term. 15. Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen. The nurse documents this as which of the following? A) Linea nigra B) Striae gravidarum C) Melasma D) Vascular spiders Answer: A Explanation: The skin in the middle of the abdomen may develop a pigmented line called linea nigra, which extends from the umbilicus to the pubic area. Striae gravidarum, or stretch marks, are irregular reddish streaks that appear on the abdomen, breasts, and buttocks in up to 90% of pregnant women. Striae are most prominent by 6 to 7 months. 16. A nurse is assessing a pregnant woman on a routine checkup. When assessing the woman's gastrointestinal tract, which of the following would the nurse expect to find? (Select all that apply.) A) Hyperemic gums B) Increased peristalsis C) Complaints of bloating D) Heartburn E) Nausea Answer: A, C, D, E Explanation: During pregnancy, the gums become hyperemic, swollen, and friable and tend to bleed easily. This change is influenced by estrogen and increased proliferation of blood vessels and circulation to the mouth. Smooth muscle relaxation and decreased peristalsis occur related to the influence of progesterone. Elevated progesterone levels cause smooth muscle relaxation, which results in delayed gastric emptying and decreased peristalsis. Transition time of food throughout the gastrointestinal tract may be so much slower that more water than normal is reabsorbed, leading to bloating and constipation. The slowed gastric emptying combined with relaxation of the cardiac sphincter allows reflux, which causes heartburn. Acid indigestion or heartburn (pyrosis) seems to be a universal problem for pregnant women. Nausea and vomiting, better known as morning sickness, plague about 80% of pregnant women. This condition is usually self-limiting, but the symptoms can be distressing and interfere with work, social activities, and interrupt sleep. 17. A woman suspecting she is pregnant asks the nurse about which signs would confirm her pregnancy. The nurse would explain that which of the following would confirm the pregnancy? A) Absence of menstrual period B) Abdominal enlargement C) Palpable fetal movement D) Morning sickness Answer: C Explanation: positive s/s of pregnancy are ultrasound verification of embryo or fetus (4–6 wks), fetal movement felt by experienced clinician (20 wks), and auscultation of fetal heart tones via doppler (10–12 wks) 18. A nurse is developing a teaching plan about nutrition for a group of pregnant women. Which of the following would the nurse include in the discussion? (Select all that apply.) A) Keep weight gain to 15 lb 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 Explanation: Teaching to promote optimal nutrition during pregnancy: Follow the USDA Food Guide MyPlate and select a variety of foods from each group. Gain between 15 and 40 lb in a gradual and steady manner depending on prepregnancy weight. Take your prenatal vitamin/mineral supplementation daily. Avoid weight-reduction diets during pregnancy. Do not skip meals; eat three meals with one or two snacks daily. Limit the intake of sodas and caffeine-rich drinks. Avoid the use of diuretics during pregnancy. Do not restrict the use of salt unless instructed to do so by your health care provider. Engage in reasonable physical activity daily. 19. Assessment of a pregnant woman reveals that she compulsively craves ice. The nurse documents this finding as which of the following? A) Quickening B) Pica C) Ballottement D) Linea nigra Answer: B Explanation: 20. 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 Explanation: Emotional liability 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. 21. While talking with a woman in her third trimester, which behavior indicates to the nurse 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 Explanation: 22. A group of students are reviewing the signs of pregnancy. The students demonstrate understanding of the information when they identify which as presumptive signs? (Select all that apply.) A) Amenorrhea B) Nausea C) Abdominal enlargement D) Braxton-Hicks contractions E) Fetal heart sounds Answer: A, B Explanation: Presumptive signs of pregnancy are: Fatigue (12 wks), Breast tenderness (3–4 wks), Nausea and vomiting (4–14 wks), Amenorrhea (4 wks), Urinary frequency (6–12 wks), Hyperpigmentation of the skin (16 wks), Fetal movements (quickening; 16–20 wks), Uterine enlargement (7–12 wks), Breast enlargement (6 wks). Abdominal enlargement and Braxton-Hicks contractions are probable signs while fetal heart sound is a positive sign. 23. A nursing instructor is teaching a class to a group of students about pregnancy, insulin, and glucose. Which of the following would the instructor least likely include as opposing insulin? A) Prolactin B) Estrogen C) Progesterone D) Cortisol Answer: D Explanation: Prolactin, estrogen, and progesterone are also 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. 24. A woman is at 20 weeks gestation. The nurse would expect to find the fundus at which of the following? A) Just above the symphysis pubis B) Mid-way between the pubis and umbilicus C) At the level of the umbilicus D) Mid-way between the umbilicus and xiphoid process Answer: C Explanation: 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. 25. 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 Explanation: Most women experience an increase in a whitish vaginal discharge, called leukorrhea, during pregnancy. 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