Deck 7: Physiologic Adaptations to Pregnancy

Question 1

Which is a positive sign of pregnancy?

A) Amenorrhea
B) Breast changes
C) Fetal movement felt by the woman
D) Visualization of fetus by ultrasound

Answer 1

Visualization of fetus by ultrasound

Question 2

A client, gravida 2, para 1, comes for a prenatal visit at 20 weeks of gestation. Her fundus is palpated 3 cm below the umbilicus. This finding is:

A) appropriate for gestational age.
B) a sign of impending complications.
C) lower than normal for gestational age.
D) higher than normal for gestational age.

Answer 2

lower than normal for gestational age.

Question 3

A client is currently pregnant; she has a 5-year-old son and a 3-year-old daughter. She had one other pregnancy that terminated at 8 weeks. Which are her gravida and para?

A) 3, 2
B) 4, 3
C) 4, 2
D) 3, 3

Answer 3

4, 2

Question 4

A client in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" What is the nurse's best response?

A) "It is due to an increase in gastric motility."
B) "It may be due to changes in hormones."
C) "It is related to an increase in glucose levels."
D) "It is caused by a decrease in gastric secretions."

Question 5

Which is the gravida and para for a client who delivered triplets 2 years ago and is now pregnant again?

A) 2, 3
B) 1, 2
C) 2, 1
D) 1, 3

Question 6

Which suggestion is appropriate for the pregnant client who is experiencing heartburn?

A) Drink plenty of fluids at bedtime.
B) Eat only three meals a day so the stomach is empty between meals.
C) Drink coffee or orange juice immediately on arising in the morning.
D) Use Tums or Alkamints to obtain relief, as directed by the health care provider.

Question 7

Which complaint made by a client at 35 weeks of gestation requires additional assessment?

A) Abdominal pain
B) Ankle edema in the afternoon
C) Backache with prolonged standing
D) Shortness of breath when climbing stairs

Question 8

To relieve a leg cramp, what should the client be instructed to perform?

A) Dorsiflex the foot.
B) Apply a warm pack.
C) Stretch and point the toe.
D) Massage the affected muscle.

Question 9

A pregnant client has come to the emergency department with complaints of nasal congestion and epistaxis. Which is the correct interpretation of these symptoms by the health care provider?

A) Nasal stuffiness and nosebleeds are caused by a decrease in progesterone.
B) These conditions are abnormal. Refer the client to an ear, nose, and throat specialist.
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.

Question 10

A pregnant client's mother is worried that her daughter is not "big enough" at 20 weeks of gestation. The nurse palpates and measures the fundal height at 20 cm, which is even with the woman's umbilicus. Which should the nurse report to the client and her mother?

A) "You're right. We'll inform the practitioner immediately."
B) "Lightening has occurred, so the fundal height is lower than expected."
C) "The body of the uterus is at the belly button level, just where it should be at this time."
D) "When you come for next month's appointment, we'll check you again to make sure that the baby is growing."

Question 11

Which advice to the client is one of the most effective methods for preventing venous stasis?

A) Sit with the legs crossed.
B) Rest often with the feet elevated.
C) Sleep with the foot of the bed elevated.
D) Wear elastic stockings in the afternoon.

Question 12

Why should a woman in her first trimester of pregnancy expect to visit her health care provider every 4 weeks?

A) Problems can be eliminated.
B) She develops trust in the health care team.
C) Her questions about labor can be answered.
D) The conditions of the expectant mother and fetus can be monitored.

Question 13

A gravida client at 32 weeks of gestation reports that she has severe lower back pain. What should the nurse's assessment include?

A) Palpation of the lumbar spine
B) Exercise pattern and duration
C) Observation of posture and body mechanics
D) Ability to sleep for at least 6 hours uninterrupted

Question 14

What is the reason for vascular volume increasing by 40% to 60% during pregnancy?

A) Prevents maternal and fetal dehydration
B) Eliminates metabolic wastes of the mother
C) Provides adequate perfusion of the placenta
D) Compensates for decreased renal plasma flow

Question 15

Physiologic anemia often occurs during pregnancy because of:

A) inadequate intake of iron.
B) the fetus establishing iron stores.
C) dilution of hemoglobin concentration.
D) decreased production of erythrocytes.

Question 16

A client's last menstrual period was June 10. What is her estimated date of birth (EDD)?

A) April 7
B) March 17
C) March 27
D) April 17

Question 17

A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth 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 five-digit system to describe this woman's current obstetric history, what should the nurse record?

A) 4-1-2-0-2
B) 3-1-2-0-2
C) 4-2-1-0-1
D) 3-1-1-1-3

Question 18

A client notices that the health care provider writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. Which is the nurse's best response?

A) "It means the cervix is softening."
B) "That refers to a positive sign of pregnancy."
C) "It refers to the bluish color of the cervix in pregnancy."
D) "The doctor was able to flex the uterus against the cervix."

Question 19

While providing education to a primiparous client regarding the normal changes of pregnancy, what is important for the nurse to explain about Braxton Hicks contractions?

A) These contractions may indicate preterm labor.
B) These are contractions that never cause any discomfort.
C) Braxton Hicks contractions only start during the third trimester.
D) These occur throughout pregnancy, but you may not feel them until the third trimester.

Question 20

While the vital signs of a pregnant client in her third trimester are being assessed, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?

A) Have the client stand up and retake her blood pressure.
B) Have the client sit down and hold her arm in a dependent position.
C) Have the client turn to her left side and recheck her blood pressure in 5 minutes.
D) Have the client lie supine for 5 minutes and recheck her blood pressure on both arms.

Question 21

Which physiologic findings are seen with respect to gallbladder function that might lead to the development of gallstones during pregnancy?

A) Decrease in alkaline phosphatase levels compared with nonpregnant women
B) Increase in albumin and total protein as a result of hemodilution
C) Hypertonicity of gallbladder tissue
D) Prolonged emptying time

Question 22

A client who smokes one pack of cigarettes daily has a positive pregnancy test. The nurse will explain that smoking during pregnancy increases the risk of which condition?

A) Congenital anomalies
B) Death before or after birth
C) Neonatal hypoglycemia
D) Neonatal withdrawal syndrome

Question 23

A pregnant client complains that since she has been pregnant, her nose is always stuffed and she feels like she has a cold. Past medical history is negative for respiratory problems such as hay fever, sinusitis, or other allergies. What is the most likely cause for the client's presentation?

A) Increased effects of progesterone to maintain the pregnancy
B) Effects of estrogen on the respiratory tract
C) Development of allergies as a result of pregnancy because of altered immunity
D) Increase in fluid consumption during pregnancy leading to overhydration

Question 24

Which of these findings would indicate a potential complication related to renal function during pregnancy?

A) Increase in glomerular filtration rate (GFR)
B) Increase in serum creatinine level
C) Decrease in blood urea nitrogen (BUN)
D) Mild proteinuria

Question 25

A pregnant client notices that she is beginning to develop dark skin patches on her face. She denies using any different type of facial products as a cleansing solution or makeup. What would the priority nursing intervention be in response to this situation?

A) Refer the client to a dermatologist for further examination.
B) Ask the client if she has been eating different types of foods.
C) Take a culture swab and send to the lab for culture and sensitivity (C&S).
D) Let the client know that this is a common finding that occurs during pregnancy.

Question 26

When documenting a client encounter, what term will the nurse use to describe the woman who is in the 28th week of her first pregnancy?

A) Multigravida
B) Multipara
C) Nullipara
D) Primigravida

Question 27

When a pregnant woman develops ptyalism, what should the nurse advise?

A) Chew gum or suck on lozenges between meals.
B) Eat nutritious meals that provide adequate amounts of essential vitamins and minerals.
C) Take short walks to stimulate circulation in the legs and elevate the legs periodically.
D) Use pillows to support the abdomen and back during sleep.

Question 28

Which physiologic event may lead to increased constipation during pregnancy?

A) Increased emptying time in the intestines
B) Abdominal distention and bloating
C) Decreased absorption of water
D) Decreased motility in the intestines

Question 29

A pregnant client complains of frequent heartburn. The client states that she has never had these symptoms before and wonders why this is occurring now. The best response that the nurse can provide is:

A) examine her dietary intake pattern and tell her to avoid certain foods.
B) tell her that this is a normal finding during early pregnancy and will resolve as she gets closer to term.
C) explain to the client that physiologic changes caused by the pregnancy make her more likely to experience these types of symptoms.
D) refer her to her health care provider for additional testing because this is an abnormal finding.

Question 30

Which physiologic finding is consistent with normal pregnancy?

A) Systemic vascular resistance increases as blood pressure decreases.
B) Cardiac output increases during pregnancy.
C) Blood pressure remains consistent independent of position changes.
D) Maternal vasoconstriction occurs in response to increased metabolism.

Question 31

A pregnant immigrant has an unknown immunization history. When she presents for routine vaccinations, which will the nurse administer?

A) Hepatitis B
B) Measles
C) Rubella
D) Varicella

Question 32

Which of the client health behaviors in the first trimester would the nurse identify as a risk factor in pregnancy?

A) Sexual intercourse two or three times weekly
B) Moderate exercise for 30 minutes daily
C) Working 40 hours a week as a secretary in a travel agency
D) Relaxing in a hot tub for 30 minutes a day, several days a week

Question 33

You are performing assessments for an obstetric client who is 5 months pregnant with her third child. Which finding would cause you to suspect that the client was at risk?

A) Client states that she doesn't feel any Braxton Hicks contractions like she had in her prior pregnancies.
B) Fundal height is below the umbilicus.
C) Cervical changes, such as Goodell's sign and Chadwick's sign, are present.
D) She has increased vaginal secretions.

Question 34

What is the best explanation that you can provide to a pregnant client who is concerned that she has "pseudoanemia" of pregnancy?

A) Have her write down her concerns and tell her that you will ask the physician to respond once the lab results have been evaluated.
B) Tell her that this is a benign self-limiting condition that can be easily corrected by switching to a high-iron diet.
C) Inform her that because of the pregnancy, her blood volume has increased, leading to a substantial dilution effect on her serum blood levels, and that most women experience this condition.
D) Contact the physician and get a prescription for iron pills to correct this condition.

Question 35

Use Nägele's rule to determine the EDD (estimated day of birth) for a client whose last menstrual period started on April 12.

A) February 19
B) January 19
C) January 21
D) February 7

Question 36

The client has just learned she is pregnant and overhears the gynecologist saying that she has a positive Chadwick's sign. When the client asks the nurse what this means, how should the nurse respond?

A) "Chadwick's sign signifies an increased risk of blood clots in pregnant women because of a congestion of blood."
B) "That sign means the cervix has softened as the result of tissue changes that naturally occur with pregnancy."
C) "This means that a mucous plug has formed in the cervical canal to help protect you from uterine infection."
D) "This sign occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix."

Question 37

Determine the obstetric history of a client in her fifth pregnancy who had two spontaneous abortions in the first trimester, one infant at 32 weeks' gestation, and one infant at 38 weeks' gestation.

A) G5 T1 P2 A2 L 2
B) G5 T1 P1 A1 L2
C) G5 T0 P2 A2 L2
D) G5 T1 P1 A2 L2

Question 38

A client in her third trimester of pregnancy is asking about safe travel. Which statement should the nurse give about safe travel during pregnancy?

A) "Only travel by car during pregnancy."
B) "Avoid use of the seat belt during the third trimester."
C) "You can travel by plane until your 38th week of gestation."
D) "If you are traveling by car stop to walk every 1 to 2 hours."

Question 39

When the pregnant woman develops changes caused by pregnancy, the nurse recognizes that the darkly pigmented vertical midabdominal line is the:

A) epulis.
B) linea nigra.
C) melasma.
D) striae gravidarum.

Question 40

Which laboratory result would be a cause for concern if exhibited by a client at her first prenatal visit during the second month of her pregnancy?

A) Rubella titer, 1:6
B) Platelets, 300,000/mm3
C) White blood cell count, 6000/mm3
D) Hematocrit 38%, hemoglobin 13 g/dL

Question 41

A pregnant client 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. As the nurse, you are aware that some immunizations are safe to administer during pregnancy, whereas others are not. Which vaccines could this client receive? (Select all that apply.)

A) Tetanus
B) Varicella
C) Influenza
D) Hepatitis A and B
E) Measles, mumps, rubella (MMR)

Question 42

Calculate the estimated date of birth (EDD) in October using Nägele's rule for a client whose last normal menstrual period (LNMP) began on January 1. Record your answer as a whole number.
_______

Question 43

The nurse is teaching a pregnant client about signs of possible pregnancy complications. Which should the nurse include in the teaching plan? (Select all that apply.)

A) Report watery vaginal discharge.
B) Report puffiness of the face or around the eyes.
C) Report any bloody show when you go into labor.
D) Report visual disturbances, such as spots before the eyes.
E) Report any dependent edema that occurs at the end of the day.

Question 44

The health care provider reports that the primigravida's fundus can be palpated at the umbilicus. Which priority question will the nurse include in the client's assessment?

A) "Have you noticed that it is easier for you to breathe now?"
B) "Would you like to hear the baby's heartbeat for the first time?"
C) "Have you felt a fluttering sensation in your lower pelvic area yet?"
D) "Have you recently developed any unusual cravings, such as for chalk or dirt?"

Question 45

The client with an IUD has a positive pregnancy test. When planning care, the nurse will base decisions on which anticipated action?

A) A therapeutic abortion will need to be scheduled because fetal damage is inevitable.
B) Hormonal analyses will be done to determine the underlying cause of the false-positive test result.
C) The IUD will need to be removed to avoid complications such as miscarriage or infection.
D) The IUD will need to remain in place to avoid injuring the fetus.

Question 46

The clinic nurse confirms that a patient is pregnant. She reports to the nurse that she has regular periods, and the first day of her last period was on January 20. Using Nägele's rule, what due date will the nurse relay to the patient?

A) September 23
B) September 27
C) October 23
D) October 27

Question 47

A patient at 24 week' gestation reports to the clinic nurse that she is tired all the time. What is the nurse's best response?

A) "Everyone has chronic anemia at this time in pregnancy."
B) "I'll make sure your health care provider is informed of your concern."
C) "Your urine is clean of protein and sugar. You are doing well at this time."
D) "Make sure you are drinking enough fluid to keep up with the demands of your body."

Question 48

A nurse is conducting a prenatal history with a patient who is new to the clinic. The woman reports that she had one healthy baby at term, and a miscarriage at 8 weeks. What will the nurse document as the patient's GTPAL?

A) 21011
B) 20111
C) 30111
D) 31011

Question 49

A patient reports to the clinic nurse that she has not had a period in over 12 weeks, she is tired, and her breasts are sore all of the time. The patient's urine test is positive for hCG. What is the best nursing action related to this information?

A) Ask the patient if she has had any nausea or vomiting in the morning.
B) Schedule the patient to be seen by a health care provider within the next 4 weeks.
C) Send the patient to the maternity screening area of the clinic for a routine ultrasound.
D) Determine if there are any factors that might prohibit her from seeking medical care.

Question 50

The capacity of the uterus in a term pregnancy is how many times its prepregnant capacity? Record your answer as a whole number.
______ times

Question 51

The patient reports that the first day of her last normal menstrual period was December 8. Using Nägele's rule, what date will the nurse identify as the estimated date of birth?

A) March 1
B) March 15
C) September 1
D) September 15

Question 52

The nurse is scheduling the next appointment for a healthy primigravida currently at 28 weeks gestation. When will the nurse schedule the next prenatal visit?

A) 1 week
B) 2 weeks
C) 3 weeks
D) 4 weeks

Question 53

The nurse is planning care for a client in her first trimester of pregnancy who is experiencing nausea and vomiting. Which interventions should the nurse plan to teach this client? (Select all that apply.)

A) Suck on hard candy.
B) Take prenatal vitamins in the morning.
C) Try some herbal tea to relieve the nausea.
D) Drink fluids frequently but separate from meals.
E) Eat crackers or dry cereal before arising in the morning.

Question 54

Which factors contribute to the presence of edema in the pregnant client? (Select all that apply.)

A) Diet consisting of processed foods
B) Hemoconcentration
C) Increase in colloid osmotic pressure
D) Last trimester of pregnancy
E) Decreased venous return

Question 55

The nurse is assessing a patient during a routine prenatal visit. Her pregnancy has been unremarkable, and at her last visit her fundal height measurement was 23 cm. The nurse measures the patient's fundal height at 24 cm. What is the next nursing action?

A) Ask the patient when she last felt fetal movement.
B) Palpate the patient's bladder to determine if it is full.
C) Review the patient's chart for her pattern of weight gain.
D) Assess the patient's deep tendon reflexes (DTRs) bilaterally at the patella.

Question 56

Which are presumptive signs of pregnancy? (Select all that apply.)

A) Quickening
B) Amenorrhea
C) Ballottement
D) Goodell's sign
E) Chadwick's sign