Deck 14: Physical and Psychologic Changes of Pregnancy

Question 1

The patient in the prenatal clinic tells the nurse that she is sure she is pregnant because she has not had a menstrual cycle for 3 months, and her breasts are getting bigger. What response by the nurse is best?

A) "Lack of menses and breast enlargement are presumptive signs of pregnancy."
B) "The changes you are describing are definitely indicators that you are pregnant."
C) "Lack of menses can be caused by many things. We need to do a pregnancy test."
D) "You're probably not pregnant, but we can check it out if you like."

Answer 1

"Lack of menses can be caused by many things. We need to do a pregnancy test."

Question 2

A patient with a normal prepregnancy weight asks why she has been told to gain 25-35 pounds during her pregnancy while her underweight friend was told to gain more weight. The nurse should tell the patient that recommended weight gain during pregnancy should be:

A) 25-35 pounds, regardless of a patient's prepregnant weight.
B) More than 25-35 pounds for an overweight woman.
C) Up to 40 pounds for an underweight woman.
D) The same for a normal weight woman as for an overweight woman.

Answer 2

Up to 40 pounds for an underweight woman.

Question 3

The nurse is examing a pregnant woman in the third trimester. What skin changes should the nurse highlight as an alteration for the woman's healthcare provider?

A) Linea nigra
B) Melasma
C) Petechiae
D) Spider nevi

Answer 3

Petechiae

Question 4

A patient at 16 weeks' gestation has a hematocrit of 35%. Her prepregnancy hematocrit was 40%. Which statement by the nurse best explains this change?

A) "Because of your pregnancy, you're not making enough red blood cells."
B) "Because your blood volume has increased, your hematocrit count is lower."
C) "This change could indicate a serious problem that might harm your baby."
D) "You're not eating enough iron-rich foods like meat."

Question 5

The nurse understands that a patient's pregnancy is progressing normally when what physiologic changes are documented on the prenatal record of a woman at 36 weeks' gestation?

A) The joints of the pelvis have relaxed, causing a waddling gait.
B) The cervix is firm and blue-purple in color.
C) The uterus vasculature contains one sixth of the total maternal blood volume.
D) Gastric emptying time is prolonged, and the patient complains of constipation and bloating.
E) Supine hypotension, creating dizziness, occurs when the patient lies on her back.

Question 6

Type: HOTSPOT A patient at 28 weeks' gestation asks the nurse why she has backaches. To help explain the changes, the nurse shows her a picture of the shape of her back. Which picture does the nurse use?Standard Text: Click on the correct area on the image.

Question 7

During her first months of pregnancy, a patient tells the nurse, "It seems like I have to go to the bathroom every 5 minutes." The nurse explains to the patient that this is because:

A) The patient probably has a urinary tract infection.
B) Bladder capacity increases throughout pregnancy.
C) The growing uterus puts pressure on the bladder.
D) Some women are very sensitive to body function changes.

Question 8

The nurse is assessing a new patient in the clinic. The nurse knows that the subjective (presumptive) signs and symptoms of pregnancy include:

A) Positive urine pregnancy test, enlarged abdomen, and Braxton Hicks contractions.
B) Positive urine pregnancy test, amenorrhea, fatigue, and softening of the cervix.
C) Increase in urination, amenorrhea, fatigue, breast enlargement, and quickening.
D) Enlarged abdomen and fetal heartbeat.

Question 9

A patient who is in the second trimester of pregnancy tells the nurse that she has developed a darkening of the line in the midline of her abdomen from the symphysis pubis to the umbilicus. What other expected changes during pregnancy might she also notice?

A) Lightening of the nipples and areolas
B) Reddish streaks called striae on her abdomen
C) A decrease in hair thickness
D) Small purplish dots on her face and arms

Question 10

A patient at 32 weeks' gestation comes to the clinic with urinary burning and frequency. The nurse explains that urinary tract infections are common in pregnancy due to:

A) Ureteral atonia.
B) Stasis of urine.
C) Increased glomerular filtration rate.
D) Excretion of amino acids.
E) Increased clearance of urea.

Question 11

The nurse is assessing a patient who is at 35 weeks' gestation. What does the nurse expect the patient to report at this phase of pregnancy?

A) Nausea and vomiting
B) Maternal ambivalence
C) Emotional shifts from highs to lows
D) Stretch marks on the abdomen

Question 12

It is 1 week before a pregnant patient's due date. The nurse notes on the chart that the patient's pulse rate was 74-80 before pregnancy. Today, the patient's pulse rate at rest is 90. What action should the nurse should take?

A) Chart the findings.
B) Notify the physician of tachycardia.
C) Prepare the patient for an electrocardiogram (EKG).
D) Prepare the patient for transport to the hospital.

Question 13

A patient who is experiencing her first pregnancy has just completed the initial prenatal examination with a certified nurse-midwife. Which statement indicates that the patient needs additional information?

A) "Because we heard the baby's heartbeat, I am undoubtedly pregnant."
B) "Since I haven't felt the baby move yet, we don't know whether I'm pregnant."
C) "My last period was 2 months ago, which means I'm 2 months along."
D) "The increased size of my uterus means that I am finally pregnant."

Question 14

The nurse is listening to the fetal heart tones of a patient at 37 weeks' gestation while the patient is in a supine position. The patient states, "I'm getting lightheaded and dizzy." The best action by the nurse is to:

A) Assist the patient to sit up.
B) Remind the patient that she needs to lie still to hear the baby.
C) Help the patient turn onto her side.
D) Check the patient's blood pressure.

Question 15

On examination of the prenatal patient, the nurse is aware that she will assess for a bluish pigmentation of the vagina. This objective (probable) sign of pregnancy is also known as:

A) Hegar's sign.
B) Chadwick's sign.
C) Nightingale's sign.
D) Goodell's sign.

Question 16

The nurse has completed a community presentation about the changes of pregnancy, and knows that the lesson was successful when a community member states, "One probable or objective change of pregnancy is:

A) "Enlargement of the uterus."
B) "Hearing the baby's heart rate."
C) "Increased urinary frequency."
D) "Nausea and vomiting."

Question 17

The nurse notes the following findings in a 12-weeks'-gestation patient. Which of the findings would enable the nurse to tell the patient that she is diagnostically pregnant?

A) Fetal heart rate by Doppler
B) Positive pregnancy test
C) Positive Chadwick's sign
D) Montgomery gland enlargement

Question 18

A 16-year-old is seen at her 10-weeks'-gestation visit. She tells the nurse that she felt the baby move that morning. What response by the nurse is appropriate?

A) "That is very exciting. The baby must be very healthy."
B) "Would you please describe what you felt for me?"
C) "That is impossible. The baby is not big enough yet."
D) "Would you please let me see whether I can feel the baby?"

Question 19

The nurse in the prenatal clinic will tell the 38-weeks'-gestation patient to lie on her left side when the patient complains of:

A) Nausea.
B) Pallor.
C) Clamminess.
D) Constipation.
E) Dizziness.

Question 20

The nurse has received a phone call from a multigravida who is 21 weeks pregnant and has not felt fetal movement yet. The best action for the nurse to take would be to:

A) Reassure the patient that this is a normal finding in multigravidas.
B) Suggest that she should feel for movement with her fingertips.
C) Schedule an appointment for her with her physician for that same day.
D) Tell her gently that her fetus is probably dead.

Question 21

The postpartum nurse is mentoring a new graduate nurse. They are working with a Muslim family who had their first child yesterday. The new graduate asks the family what supplies they have at home. The husband responds that they have not yet purchased anything for their baby. How should the mentoring nurse explain this finding to the new graduate nurse?

A) This family is irresponsible, and should have acquired all the items they will need for the new baby prior to going into labor.
B) The woman did not communicate what her due date was to her husband because of cultural issues.
C) Income seems to be a problem for this family; social services should be contacted to assist the family.
D) Muslims don't buy baby items prior to birth because they believe it is God's will, not their own decision, whether a baby will live.

Question 22

The partner of a pregnant patient comes to the clinic with her. He complains to the nurse that he is experiencing different physical changes. The nurse determines he is experiencing couvade when he describes:

A) Fatigue.
B) Increased appetite.
C) Headache.
D) Backache.
E) High anxiety level.

Question 23

The nurse asks a woman how her husband is dealing with the pregnancy. The nurse concludes that counseling is needed when the woman makes which statement?

A) "My husband is ready for the pregnancy to end so that we can have sex again."
B) "My husband has gained quite a bit of weight during this pregnancy."
C) "My husband seems more worried about our finances now than he was before the pregnancy."
D) "My husband plays his favorite music for my belly so the baby will learn to like it."

Question 24

The nurse recognizes that subjective pregnancy changes such as amenorrhea can be caused by:

A) Goodell's sign.
B) Anemia.
C) Pseudocyesis.
D) Thyroid dysfunction.
E) Fetal heartbeat.

Question 25

The pregnant patient at 14 weeks' gestation is in the clinic for a regular prenatal visit. Her mother also is present. The grandmother-to-be states that she is quite uncertain about how she can be a good grandmother to this baby, because she works full-time. Her own grandmother was retired, and was always available when needed by a grandchild. The best response to this concern would be:

A) "Don't worry. You'll be a wonderful grandmother. It will all work out fine."
B) "What are your thoughts on what your role as grandmother will include?"
C) "As long as there is another grandmother available, you don't have to worry."
D) "Grandmothers are supposed to be available. You should retire from your job."

Question 26

A prenatal educator is asking a partner about normal psychological adjustment of an expectant mother during the second trimester of pregnancy. Which answer by the partner would indicate a typical expectant mother's response to pregnancy?

A) "She is very body-conscious, and hates every little change."
B) "She daydreams about what kind of parent she is going to be."
C) "I haven't noticed anything. I just found out she was pregnant."
D) "She has been having dreams at night about misplacing the baby."

Question 27

The patient is at 6 weeks' gestation, and is spotting. The patient had an ectopic pregnancy 1 year ago, so the nurse anticipates that the physician will order:

A) A urine pregnancy test.
B) The patient to be seen next week for a full examination.
C) A serum pregnancy test.
D) An ultrasound to be done.

Question 28

To answer a patient's about home pregnancy tests and their accuracy, the nurse must know that accuracy is affected by:

A) Unclear directions.
B) Language above the 4th-grade level.
C) Blood in the specimen giving a false reading.
D) Completing the test too late.
E) Tagged antibodies becoming outdated.

Question 29

The clinic nurse is culturally sensitive when, while assessing the pregnant patient, he asks about:

A) The family's expectations of the healthcare system.
B) Which cultural practices should be incorporated into care.
C) Any alternative healer who should be consulted.
D) Positive consequences of the patient's healthcare beliefs.
E) The patient's giving up her practices and adopting the practices of the dominant culture.

Question 30

The partner of a patient at 16 weeks' gestation accompanies her to the clinic. The partner tells you that the baby just doesn't seem real to him, and he is having a hard time relating to his partner's fatigue and food aversions. Which statement would be best for the nurse to make?

A) "If you would concentrate harder, you'd be aware of the reality of this pregnancy."
B) "My husband had no problem with this. What was your childhood like?"
C) "You might need professional psychological counseling. Ask your physician."
D) "Many men feel this way. Feeling the baby move will help make it real."

Question 31

A woman calls the clinic and tells a nurse that she thinks she might be pregnant. She wants to use a home pregnancy test before going to the clinic, and asks the nurse how to use it correctly. What instruction should the nurse give?

A) Use a urine specimen just before going to bed at night.
B) Drink a lot of fluids and wait at least 4 hours before voiding and taking a specimen.
C) If the patient is diabetic, the urine pregnancy test will not be accurate.
D) Use the first voided specimen when first getting up in the morning.

Question 32

The pregnant patient has moved to the United States from another country. She states that her grandmother has provided herbs for her to take during pregnancy. The patient asks the nurse whether the herbs are safe. How should the nurse respond?

A) "Some herbs are not safe for use during pregnancy."
B) "Herbal supplements during pregnancy do not cause problems."
C) "Your grandmother wouldn't give you anything that was dangerous."
D) "Natural supplements should not be used during pregnancy or labor."

Question 33

The patient at 30 weeks' gestation with her first child is upset. She tells the prenatal clinic nurse that she is excited to become a mother, and has been thinking about what kind of parent she will be. But her mother has told her that she doesn't want to be a grandmother because she doesn't feel old enough, while her husband has said that the pregnancy doesn't feel real to him yet, and he will become excited when the baby is actually here. What is the most likely explanation for what is happening within this family?

A) Her husband will not attach with this child and will not be a good father.
B) Her mother is rejecting the role of grandparent, and will not help out.
C) The patient is not progressing through the developmental tasks of pregnancy.
D) The family members are adjusting to the role change at their own paces.

Question 34

The clinic nurse is assessing how the prenatal patient is meeting developmental tasks. The nurse uses Rubin's tasks, which include:

A) Ensuring safe passage through pregnancy, labor, and birth.
B) Turning in on oneself to focus on the child.
C) Seeking commitment and acceptance of self as mother to the infant.
D) Completing the tasks of nesting at the appropriate time.
E) Seeking acceptance of the child by others.

Question 35

The nurse is caring for a pregnant patient who speaks little English. Which action should the nurse take to make certain that the patient understands the plan of care?

A) Write all of the instructions down and send them home with the patient.
B) Obtain a medical interpreter of the language the patient speaks.
C) Ask a housekeeper who speaks this language to interpret.
D) Use gestures and facial expressions to get the plan across.

Question 36

The adolescent patient reports to the clinic nurse that her period is late, but that her home pregnancy test is negative. What should the nurse explain that these findings most likely indicate?

A) "This means you are not pregnant."
B) "You might be pregnant, but it might be too early for your home test to be accurate."
C) "We don't trust home tests. Come to the clinic for a blood test."
D) "Most people don't use the tests correctly. Did you read the instructions?"