Ch. 7 - Anatomy & Physiology of Pregnancy Nclex questions and answers

Ch. 7 - Anatomy & Physiology of Pregnancy Nclex questions If exhibited by a pregnant woman, what represents a positive sign of pregnancy? A. Morning sickness B. Quickening C. Positive pregnancy test D. Fetal heartbeat auscultated with Doppler/ fetoscope ans: D. Fetal heartbeat auscultated with Doppler/fetoscope Morning sickness and quickening, along with amenorrhea and breast tenderness, are presumptive signs of pregnancy; subjective findings are suggestive but not diagnostic of pregnancy. Other probable signs include changes in integument, enlargement of the uterus, and Chadwick sign. A positive pregnancy test is still considered to be a probable sign of pregnancy (objective findings are more suggestive but not yet diagnostic of pregnancy) since error can occur in performing the test or in rare cases human chorionic gonadotropin (hCG) may be detected in the urine of nonpregnant women. Chances of error are less likely to occur today since pregnancy tests used are easy to perform and are very sensitive to the presence of the hCG associated with pregnancy. Detection of a fetal heartbeat, palpation of fetal movements and parts by an examiner, and detection of an embryo/fetus with sonographic examination would be positive signs diagnostic of pregnancy. Which hematocrit (Hct) and hemoglobin (Hgb) results represent(s) the lowest acceptable values for a woman in the third trimester of pregnancy? A. 38% Hct; 14 g/dL Hgb B. 35% Hct; 13 g/dL Hgb C. 33% Hct; 11 g/dL Hgb D. 32% Hct; 10.5 g/dL Hgb ans: C. 33% Hct; 11 g/dL Hgb This is within normal limits in the nonpregnant woman. This is within normal limits for a nonpregnant woman. Represents the lowest acceptable value during the first and the third trimesters. This represents the lowest acceptable value for the second trimester when the hemodilution effect of blood volume expansion is at its peak. When assessing the fetal heart rate (FHR) of a woman at 30 weeks of gestation, the nurse counts a rate of 82 beats/min. Initially the nurse should: A. Recognize that the rate is within normal limits and record it. B. Assess the woman's radial pulse. C. Notify the physician. D. Allow the woman to hear the heartbeat. ans: B. Assess the woman's radial pulse. The expected FHR is 120 to 160 beats/min. The nurse may have inadvertently counted the uterine souffle, the beatlike sound of blood flowing through the uterine blood vessels, which corresponds to the mother's heartbeat. The physician should be notified if the FHR is confirmed to be 82 beats/min. Allow the woman to hear the heart beat as soon as a full assessment is made. Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)? A. Radioimmunoassay B. Radioreceptor assay C. Latex agglutination test D. Enzyme-linked immunosorbent assay (ELISA) ans: D. Enzyme-linked immunosorbent assay (ELISA) The radioimmunoassay tests for the summit of hCG in serum or urine samples. This test must be performed in the laboratory. The radioreceptor assay is a serum test that measures the ability of a blood sample to inhibit the binding of hCG to receptors. The latex agglutination test in no way determines pregnancy. Rather, it is done to detect specific antigens and antibodies. OTC pregnancy tests use ELISA for its one-step, accurate results. A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates an understanding of the nurse's instructions if she states that a positive sign of pregnancy is: A. A positive pregnancy test. B. Fetal movement palpated by the nurse-midwife. C. Braxton Hicks contractions. D. Quickening. ans: B. Fetal movement palpated by the nurse-midwife. A positive pregnancy test is a probable sign of pregnancy. Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. Braxton Hicks contractions are a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy. During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as the: A. Hegar sign. B. McDonald sign. C. Chadwick sign. D. Goodell sign. ans: A. Hegar sign. At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The McDonald sign indicates a fast-food restaurant. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy. Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? A. Less audible heart sounds (S1, S2) B. Increased pulse rate C. Increased blood pressure D. Decreased red blood cell (RBC) production ans: B. Increased pulse rate Splitting of S1 and S2 is more audible. Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. In the first trimester blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy. A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: A. Primipara. B. Primigravida. C. Multipara. D. Nulligravida. ans: A. Primipara. A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind that gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant. Which presumptive signs (felt by the woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause? A. Amenorrhea: stress, endocrine problems B. Quickening: gas, peristalsis C. Goodell sign: cervical polyps D. Chadwick sign: pelvic congestion ans: C. Goodell sign: cervical polyps Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be gas or peristalsis. Goodell sign might be the result of pelvic congestion, not polyps. Chadwick sign might be the result of pelvic congestion. In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that: A. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. B. Shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. C. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. D. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy. ans: D. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy. The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases. This compression also leads to varicose veins in the legs and vulva. A pregnant woman is the mother of two children. Her first pregnancy ended in a still birth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system to describe this woman's current obstetric history, the nurse would record ____________________________ ans: 4-1-3-0-2 Gravida (the first number) is 4 since this woman is now pregnant and was pregnant 3 times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and would be described as: 4T: 1 = Term birth at 41 weeks of gestation (son) 4P: 2 = Preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter) 4A: 0 = Abortion: none occurred 4L: 2 = Living children: her son and her daughter A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? _____________ ans: 3-1-0-1-0 Using the GPTAL system, this woman's gravidity and parity information is calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time) T: Number of pregnancies carried to term (she has one stillborn) P: Number of pregnancies that resulted in a preterm birth (she has none) A: Abortions or miscarriages before the period of viability (she has had one) L: Number of children born who are currently living (she has no living children)