ADAPTATIONS TO PREGNANCY
Chapter 13: Adaptations to Pregnancy
Test bank
MULTIPLE CHOICE
1. A pregnant woman’s mother is worried that her daughter is not “big enough” at 20 weeks. The
nurse palpates and measures the fundal height at 20 cm, which is even with the woman’s
umbilicus. What should the nurse report to the woman and her mother?
a. “The body of the uterus is at the belly button level, just where it should be at this
time.”
b. “You’re right. We’ll inform the practitioner immediately.”
c. “When you come for next month’s appointment, we’ll check you again to make
sure that the baby is growing.”
d. “Lightening has occurred, so the fundal height is lower than expected.”
ANS: A
Feedback
A At 20 weeks, the fundus is usually located at the umbilical level. Because the
uterus grows in a predictable pattern, obstetric nurses should know that the uterus
of 20 weeks of gestation is located at the level of the umbilicus.
B This is incorrect information. At 20 weeks the uterus should be at the umbilical
level.
C By avoiding the direction question, this might increase the anxiety of both the
mother and grandmother.
D The descent of the fetal head (lightening) occurs in late pregnancy.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 235
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
2. While you are assessing the vital signs of a pregnant woman in her third trimester, the patient
complains of feeling faint, dizzy, and agitated. Which nursing intervention is 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 lie supine for 5 minutes and recheck her blood pressure on both
arms.
d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.
ANS: D
Feedback
A Pressures are significantly higher when the patient is standing. This option causes
an increase in systolic and diastolic pressures.
B The arm should be supported at the same level of the heart.
C The supine position may cause occlusion of the vena cava and descending aorta,
creating hypotension.
D Blood pressure is affected by positions 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.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 237
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
3. A pregnant woman has come to the emergency department with complaints of nasal
congestion and epistaxis. What is the correct interpretation of these symptoms by the
practitioner?
a. These conditions are abnormal. Refer the patient to an ear, nose, and throat
specialist.
b. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone.
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
Feedback
A The patient should be reassured that these symptoms are within normal limits. No
referral is needed at this time.
B Progesterone is responsible for the heightened awareness of the need to breathe in
pregnancy. Progesterone levels increase during pregnancy.
C Progesterone affects relaxation of the smooth muscles in the respiratory tract.
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.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 238
OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
4. Which finding in the urine analysis of a pregnant woman is considered a variation of normal?
a. Proteinuria
b. Glycosuria
c. Bacteria in the urine
d. Ketones in the urine
ANS: B
Feedback
A The presence of protein could indicate kidney disease or preeclampsia.
B Small amounts of glucose may indicate “physiologic spilling.”
C Urinary tract infections are associated with bacteria in the urine.
D An increase in ketones indicates that the patient is exercising too strenuously or
has an inadequate fluid and food intake.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 239
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
, 5. Which suggestion is appropriate for the pregnant woman who is experiencing nausea and
vomiting?
a.Eat only three meals a day so the stomach is empty between meals.
b.Drink plenty of fluids with each meal.
c.Eat dry crackers or toast before arising in the morning.
d.Drink coffee or orange juice immediately on arising in the morning.
ANS: C
Feedback
A Instruct the woman to eat five to six small meals rather than three full meals per
day. Nausea is more intense when the stomach is empty.
B Fluids should be taken separately from meals. Fluids overstretch the stomach and
may precipitate vomiting.
C This will assist with the symptoms of morning sickness. It is also important for
the woman to arise slowly.
D Coffee and orange juice stimulate acid formation in the stomach. It is best to
suggest eating dry carbohydrates when rising in the morning.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 252
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
6. Which statement related to changes in the breasts during pregnancy is the most accurate?
a. During the early weeks of pregnancy there is decreased sensitivity.
b. Nipples and areolae become more pigmented.
c. Montgomery tubercles are no longer visible around the nipples.
d. Venous congestion of the breasts is more visible in the multiparous woman.
ANS: B
Feedback
A Fullness, heightened sensitivity, tingling and heaviness of the breasts occur in the
early weeks of gestation in response to increased levels of estrogen and
progesterone.
B Nipples and areolae become more pigmented, and the nipples become more
erectile and may express colostrum.
C Montgomery tubercles may be seen around the nipples. These sebaceous glands
may have a protective role in that they keep the nipples lubricated for
breastfeeding.
D Venous congestion in the breasts is more obvious in primigravidas.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 236
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
7. Alterations in hormonal balance and mechanical stretching are responsible for several changes
in the integumentary system during pregnancy. Stretch marks often occur on the abdomen and
breasts. These are referred to as
a. Chloasma
Chapter 13: Adaptations to Pregnancy
Test bank
MULTIPLE CHOICE
1. A pregnant woman’s mother is worried that her daughter is not “big enough” at 20 weeks. The
nurse palpates and measures the fundal height at 20 cm, which is even with the woman’s
umbilicus. What should the nurse report to the woman and her mother?
a. “The body of the uterus is at the belly button level, just where it should be at this
time.”
b. “You’re right. We’ll inform the practitioner immediately.”
c. “When you come for next month’s appointment, we’ll check you again to make
sure that the baby is growing.”
d. “Lightening has occurred, so the fundal height is lower than expected.”
ANS: A
Feedback
A At 20 weeks, the fundus is usually located at the umbilical level. Because the
uterus grows in a predictable pattern, obstetric nurses should know that the uterus
of 20 weeks of gestation is located at the level of the umbilicus.
B This is incorrect information. At 20 weeks the uterus should be at the umbilical
level.
C By avoiding the direction question, this might increase the anxiety of both the
mother and grandmother.
D The descent of the fetal head (lightening) occurs in late pregnancy.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 235
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
2. While you are assessing the vital signs of a pregnant woman in her third trimester, the patient
complains of feeling faint, dizzy, and agitated. Which nursing intervention is 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 lie supine for 5 minutes and recheck her blood pressure on both
arms.
d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.
ANS: D
Feedback
A Pressures are significantly higher when the patient is standing. This option causes
an increase in systolic and diastolic pressures.
B The arm should be supported at the same level of the heart.
C The supine position may cause occlusion of the vena cava and descending aorta,
creating hypotension.
D Blood pressure is affected by positions 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.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 237
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
3. A pregnant woman has come to the emergency department with complaints of nasal
congestion and epistaxis. What is the correct interpretation of these symptoms by the
practitioner?
a. These conditions are abnormal. Refer the patient to an ear, nose, and throat
specialist.
b. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone.
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
Feedback
A The patient should be reassured that these symptoms are within normal limits. No
referral is needed at this time.
B Progesterone is responsible for the heightened awareness of the need to breathe in
pregnancy. Progesterone levels increase during pregnancy.
C Progesterone affects relaxation of the smooth muscles in the respiratory tract.
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.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 238
OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
4. Which finding in the urine analysis of a pregnant woman is considered a variation of normal?
a. Proteinuria
b. Glycosuria
c. Bacteria in the urine
d. Ketones in the urine
ANS: B
Feedback
A The presence of protein could indicate kidney disease or preeclampsia.
B Small amounts of glucose may indicate “physiologic spilling.”
C Urinary tract infections are associated with bacteria in the urine.
D An increase in ketones indicates that the patient is exercising too strenuously or
has an inadequate fluid and food intake.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 239
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
, 5. Which suggestion is appropriate for the pregnant woman who is experiencing nausea and
vomiting?
a.Eat only three meals a day so the stomach is empty between meals.
b.Drink plenty of fluids with each meal.
c.Eat dry crackers or toast before arising in the morning.
d.Drink coffee or orange juice immediately on arising in the morning.
ANS: C
Feedback
A Instruct the woman to eat five to six small meals rather than three full meals per
day. Nausea is more intense when the stomach is empty.
B Fluids should be taken separately from meals. Fluids overstretch the stomach and
may precipitate vomiting.
C This will assist with the symptoms of morning sickness. It is also important for
the woman to arise slowly.
D Coffee and orange juice stimulate acid formation in the stomach. It is best to
suggest eating dry carbohydrates when rising in the morning.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 252
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
6. Which statement related to changes in the breasts during pregnancy is the most accurate?
a. During the early weeks of pregnancy there is decreased sensitivity.
b. Nipples and areolae become more pigmented.
c. Montgomery tubercles are no longer visible around the nipples.
d. Venous congestion of the breasts is more visible in the multiparous woman.
ANS: B
Feedback
A Fullness, heightened sensitivity, tingling and heaviness of the breasts occur in the
early weeks of gestation in response to increased levels of estrogen and
progesterone.
B Nipples and areolae become more pigmented, and the nipples become more
erectile and may express colostrum.
C Montgomery tubercles may be seen around the nipples. These sebaceous glands
may have a protective role in that they keep the nipples lubricated for
breastfeeding.
D Venous congestion in the breasts is more obvious in primigravidas.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 236
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
7. Alterations in hormonal balance and mechanical stretching are responsible for several changes
in the integumentary system during pregnancy. Stretch marks often occur on the abdomen and
breasts. These are referred to as
a. Chloasma
