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Pregnancy Changes - Ch 4 Questions With
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- Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a. Proteinuria b. Glycosuria c. Bacteria d. Ketonuria correct answer: ANS: B Small amounts of glucose may indicate "physiologic spilling," which occurs because the filtered load exceeds the renal tubules' ability to absorb them. The presence of protein could indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake. 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. correct answer: ANS: C This will assist with the symptoms of morning sickness. It is also important for the woman to arise slowly. 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.
Fluids should be taken separately from meals. Fluids overstretch the stomach and may precipitate vomiting.Coffee and orange juice stimulate acid formation in the stomach. It is best to suggest eating dry carbohydrates when rising in the morning. 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. correct answer: ANS: B Nipples and areolae become more pigmented, and the nipples become more erectile and may express colostrum. 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. 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. Venous congestion in the breasts is more obvious in primigravidas. A student nurse reads a patient's chart and sees the term "striae gravidarum," The student asks the registered nurse what this means. What response by the nurse is accurate? a. Stretch marks on the abdomen and breasts b. Dark pigmentation on the woman's face c. Bluish-purple discoloration of the vagina and labia
d. Retake the pulse in 15 minutes correct answer: ANS: B The pulse of a pregnant woman increases about 15 to 20 beats/minute throughout the pregnancy. The nurse should document the findings, but no other actions are needed as this is a normal finding. Physiologic anemia often occurs during pregnancy as a result of a. inadequate intake of iron. b. dilution of hemoglobin concentration. c. the fetus establishing iron stores. d. decreased production of erythrocytes. correct answer: ANS: B When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may lead to true anemia. If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. There is an increased production of erythrocytes during pregnancy. While assessing her patient, what does the nurse interpret as a positive sign of pregnancy? a. Fetal movement felt by the woman b. Amenorrhea c. Breast changes d. Visualization of fetus by ultrasound correct answer: ANS: D The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner. Fetal movement felt by the
woman, amenorrhea, and breast changes are all presumptive signs. A woman is currently pregnant; she has a 5-year-old son and a 3-year-old daughter born at full term. She had one other pregnancy that terminated at 8 weeks. Her gravida and para are a. gravida 3 para 2. b. gravida 4 para 3. c. gravida 4 para 2. d. gravida 3 para 3. correct answer: ANS: C She has had four pregnancies, including the current one (gravida 4). She had two pregnancies that terminated after 20 weeks (para 2). The pregnancy that terminated at 8 weeks is classified as an abortion, which is not included in the gravida-para classification. A woman's last menstrual period was June 10. The nurse estimates the date of delivery (EDD) to be a. April 7. b. March 17. c. March 27. d. April 17. correct answer: ANS: B To determine the EDD, the nurse uses the first day of the last menstrual period (June 10), subtracts 3 months (March 10), and adds 7 days (March 17). The year is corrected if needed. April 7 would be subtracting 2 months instead of 3 months and then subtracting 3 days instead of adding 7 days. March is the correct month, but instead of adding 7 days, 17 days were added to get March 27. April 17 is subtracting 2 months instead of 3 months.
The nurse teaches a pregnant woman that one of the most effective methods for preventing venous stasis is to a. wear elastic stockings in the afternoons. b. sleep with the foot of the bed elevated. c. rest often with the feet elevated. d. sit with the legs crossed. correct answer: ANS: C Elevating the feet and legs improves venous return and prevents venous stasis. Elastic stockings should be applied before lowering the legs in the morning. Elevating the legs at night may cause pressure on the diaphragm and increase breathing problems. Sitting with the legs crossed will decrease circulation in the legs and increase venous stasis. A patient notices that the doctor writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. The nurse's best response is a. "It refers to the bluish color of the cervix in pregnancy." b. "It means the cervix is softening." c. "The doctor was able to flex the uterus against the cervix." d. "That refers to a positive sign of pregnancy." correct answer: ANS: A Increased vascularity of the pelvic organs during pregnancy results in the bluish color of the cervix, vagina, and labia, called Chadwick's sign. The nurse should also know that this is a presumptive, not positive, sign of pregnancy. Softening of the cervix is Goodell's sign. The softening of the lower segment of the uterus (Hegar's sign) can allow the uterus to be flexed against the cervix. A woman is at her first prenatal visit and is distressed at needing an HIV test. What response by the nurse is best?
a. "We ask all women to be tested for HIV during their pregnancy." b. "This test is required by law for pregnant women." c. "Infection with HIV will make your pregnancy very high risk." d. "You could have been exposed and not know it." correct answer: ANS: A A voluntary HIV test should be conducted on all women, regardless of risk factors. This explanation is accurate and helps lessen the woman's feeling of stigma. It also lets the woman know it is voluntary. The test is not required by law. Although an HIV infection will increase the risk of complications, this explanation is too limited to be a good answer. It is true the woman may have been exposed, but that comment is demeaning and could be offensive. To relieve a leg cramp, the patient should be instructed to a. massage the affected muscle. b. stretch and point the toe. c. dorsiflex the foot. d. apply a warm pack. correct answer: ANS: C Dorsiflexion of the foot stretches the leg muscle and relieves the painful muscle contraction. Since she is prone to blood clots in the legs, massaging the affected leg muscle is contraindicated. Pointing the toes will contract the muscle and not relieve the pain. Warm packs can be used to relax the muscle, but more immediate relief is necessary, such as dorsiflexion of the foot. The multiple marker screen is used to assess the fetus for which condition? a. Down syndrome
important to assess as are posture and body mechanics, which can contribute to the pain. A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would require further discussion with the nurse? a. "My husband and I have agreed that my sister will be my coach." b. "We plan to use Lamaze to reduce the pain during labor." c. "We want the labor and birth to take place in a birthing room with our son present. d. "We will not use the fetal monitor during labor." correct answer: ANS: D A birth plan consists of what the woman and partner wish to have happen during labor and delivery. Intermittent or continuous fetal monitoring is one aspect of care for consideration; however, it is unrealistic to state that monitoring will not be used. The nurse should explain the purpose to ensure the couple is making an informed decision. The woman can refuse this procedure but would need to understand how this might negatively impact her child. The couple also need to understand that the entire plan is tentative depending on what events actually occur. The other statements are appropriate for a birth plan. A couple ask the prenatal nurse to explain centering pregnancy. Which statement accurately applies to this model of care? a. A way to control labor pain and remain centered during the process
b. A philosophy of making the pregnancy the center of the family's life c. Education and support sessions are provided to small cohorts of women d. Labor practice where the woman is surrounded by an extensive network of people correct answer: ANS: C This method involves ten 1.5- to 2-hour sessions with small groups of women and health care providers beginning at 12 to 16 weeks of pregnancy and ending in early postpartum. Sessions include assessment, education, and social support. It is not a way to control labor pain, a philosophy of making the pregnancy the center of the family's life, or the use of a large network of people during labor. Which comment by a woman in her first trimester indicates ambivalent feelings? a. "I wanted to become pregnant, but I'm scared about being a mother." b. "I haven't felt well since this pregnancy began." c. "I'm concerned about the amount of weight I've gained." d. "My body is changing so quickly." correct answer: ANS: A Ambivalence refers to conflicting feelings. This woman is demonstrating this conflict. The other statements do not indicate ambivalence. A patient who is 7 months pregnant states, "I'm worried that something will happen to my baby." The nurse's best response is a. "There is nothing to worry about." b. "The doctor is taking good care of you and your baby." c. "Tell me about your concerns." d. "Your baby is doing fine." correct answer: ANS: C
The woman experiences sadness as she realizes that she must give up certain aspects of her previous self and that she can never go back. Looking for a fit is when the woman observes the behaviors of mothers and compares them with her own expectations. Role playing involves searching for opportunities to provide care for infants in the presence of another person. Fantasies allow the woman to try on a variety of behaviors. This usually deals with how the child will look and the characteristics of the child. The maternal task that begins in the first trimester and continues throughout the neonatal period is called a. seeking safe passage for herself and her baby. b. securing acceptance of the baby by others. c. learning to give of herself. d. developing attachment with the baby. correct answer: ANS: D Developing attachment (strong ties of affection) to the unborn baby begins in early pregnancy when the woman accepts that she is pregnant. By the second trimester, the baby becomes real, and feelings of love and attachment surge. Seeing safe passage is a task that ends with delivery. During this task the woman seeks health care and cultural practices. Securing acceptance continues throughout pregnancy as the woman reworks relationships. Learning to give of herself occurs during pregnancy and is sometimes noticed as the woman gives to others in the form of food or presents. Which situation best describes a man "trying on" fathering behaviors? a. Spending more time with his siblings
b. Taking a nephew to the park to play c. Reading books on newborn care d. Exhibiting physical symptoms related to pregnancy correct answer: ANS: B Interacting with children and assuming the behavior and role of a father best describe a man "trying on" being a father. The man normally will seek closer ties with his father during this time, not his siblings. While some fathers do everything they can to learn about infant care, others are not ready to learn when the information is presented, so the nurse should provide the information again after the baby is born and it is more relevant. Exhibiting symptoms related to pregnancy is called couvade. A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old married daughter is expecting her first child. What is a major factor in determining how the woman will respond to becoming a grandmother? a. Her career b. Being divorced c. Her age d. Age of the daughter correct answer: ANS: C Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old. Career responsibilities may have demands that make the grandparents not as accessible, but it is not a major factor in determining the woman's response to becoming a grandmother. Being divorced is not a major factor that determines adaptation of grandparents. The age of the daughter is not a major factor that determines adaptation of grandparents. The age of the grandparent is a major factor.
A nurse in labor and delivery is caring for a Muslim woman during the active phase of labor. You note that when you touch her, she quickly draws away. Which response by the nurse is best? a. Continue to touch her as much as you need to while providing care. b. Assume that she doesn't like you and decrease your time with her. c. Limit touching to a minimum, as this may not be acceptable in her culture. d. Ask the charge nurse to reassign you to another patient. correct answer: ANS: C Touching is an important component of communication in various cultures, but if the patient appears to find it offensive, the nurse should respect her cultural beliefs and limit touching her. By continuing to touch her, the nurse is showing disrespect for her cultural beliefs. A cultural response to touch does not reflect like or dislike. Being assigned to another patient is inappropriate; all nurses must be able to provide culturally appropriate care. A nurse is encouraging a patient to attend an early pregnancy class for the second trimester. What topic would be inconsistent with the nurse's knowledge of topics presented in this class? a. Fetal development b. Body mechanics c. Childbirth choices d. Managing morning sickness correct answer: ANS: D
Managing morning sickness would be taught in a first trimester early pregnancy class. The other topics are appropriate for second trimester classes. A pregnant patient of 28 weeks' gestation complains of pain in the right inguinal area. What action by the nurse is best? a. Assess the woman for early labor. b. Position the woman on the right side. c. Palpate the woman's abdomen. d. Document the findings in the chart. correct answer: ANS: B Pain in the right inguinal area is most likely due to the round ligament. The nurse can position the woman on her right side to see if that relieves the pain. Heat can also help. There is no need to assess for labor or palpate the abdomen. The findings should be documented after the nurse responds. A student nurse is teaching a pregnant woman ways to manage constipation. Which instruction by the student causes the nurse to provide a correction? a. Drink at least 8 glasses of liquids a day. b. The fat in cheese helps lubricate the bowels. c. You do need to continue your iron pills. d. Add extra fiber, which can be found in fruit. correct answer: ANS: B Cheese tends to cause constipation, so this statement by the student needs correction by the nurse. The other statements are all correct. The nurse is caring for a patient whose English is limited. When the nurse provides information, the patient smiles and nods her
nursing staff are appropriate for this patient? (Select all that apply.) a. Obtaining frequent urinalysis collections b. Providing larger equipment for exams c. Astute assessments for pain during procedures d. Monitoring for infections e. Draping the woman maximally correct answer: ANS: A, C, D, E Female genital mutilation, cutting, or circumcision, also called infibulation, involves removal of some or all of the external female genitalia. The labia majora are often stitched together over the vaginal and urethral opening as part of this practice. The woman is at risk for many issues including urinary tract and other genital infections and pain. Often the woman will not give any verbal or nonverbal signs of pain so the nurse must be astute in assessing for it. Draping the woman should be done as completely as possible. The equipment for exams must be smaller, such as a pediatric speculum. A pregnant woman reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. Which vaccines could this patient receive? (Select all that apply.) a. Tetanus b. Hepatitis A and B c. Measles, mumps, rubella (MMR) d. Influenza e. Varicella correct answer: ANS: A, B, D Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe to administer for women who have a risk for contracting or developing the disease.
Immunizations with live virus vaccines such as MMR, varicella (chickenpox), or smallpox are contraindicated during pregnancy because of the possible teratogenic effects on the fetus. During pregnancy there are a number of changes that occur as a direct result of the presence of the fetus. Which of these adaptations meet these criteria? (Select all that apply.) a. Leukorrhea b. Development of a mucous plug c. Quickening d. Ballottement e. Lightening correct answer: ANS: A, C, E Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Quickening is the first recognition of fetal movements, or "feeling life." Quickening is often described as a flutter and is felt earlier in multiparous women than in primiparas. Lightening occurs when the fetus begins to descent into the pelvis. This occurs 2 weeks before labor in the nullipara and at the start of labor in the multipara. Mucus fills the cervical canal, creating a plug that acts as a barrier against bacterial invasion during pregnancy. Passive movement of the unengaged fetus is referred to as ballottement. A pregnant woman asks the nursing student what to do about her frequent heartburn. What suggestions can the student make that are appropriate? (Select all that apply.) a. Try chewing gum during the day. b. Take Alka-Seltzer or other antacid. c. Drink a small sip of cream before meals. d. Eat small amounts of dry crackers.
