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.