Jarvis ch. 30 - the pregnant

Question 1

Which of these statements best describes the action of the hormone progesterone during pregnancy?

a. Progesterone produces the hormone human chorionic gonadotropin.
b. Duct formation in the breast is stimulated by progesterone.
c. Progesterone promotes sloughing of the endometrial wall.
d. Progesterone maintains the endometrium around the fetus

Answer 1

ANS: D
Progesterone prevents the sloughing of the endometrial wall and maintains the endometrium around the fetus. Progesterone increases the alveoli in the breast and keeps the uterus in a quiescent state

Question 2

A female patient has nausea, breast tenderness, fatigue, and amenorrhea. Her last menstrual period was 6 weeks ago. The nurse interprets that this patient is experiencing __________ signs of pregnancy.

a. Positive
b. Possible
c. Probable
d. Presumptive

Answer 2

ANS: D
Presumptive signs of pregnancy are those that the woman experiences and include amenorrhea, breast tenderness, fatigue, nausea, and increased urinary frequency. Probable signs are those that are detected by the examiner, such as an enlarged uterus or changes in the cervix. Positive signs of pregnancy are those that document direct evidence of the fetus, such as fetal heart tones (FHTs) or positive cardiac activity on ultrasonography

Question 3

A woman who is 8 weeks pregnant is visiting the clinic for a checkup. Her systolic blood pressure is 30 mm Hg higher than her pre-pregnancy systolic blood pressure. The nurse should:

a. Consider this a normal finding
b. Expect the blood pressure to decrease because the estrogen levels increase throughout the pregnancy
c. Consider this an abnormal finding because blood pressure is typically lower at this point in the pregnancy
d. Recommend that she decrease her salt intake in an attempt to decrease her peripheral vascular resistance

Answer 3

ANS: C
During the seventh week of pregnancy, blood pressure begins to drop as a result of falling peripheral vascular resistance. Early in the first trimester, blood pressure values are similar to those of pre-pregnancy measurements. In this case, the woman’s blood pressure is higher than it should be.

Question 4

A patient is being seen at the clinic for her 10-week prenatal visit. She asks when she will be able to hear the baby’s heartbeat. The nurse should reply:

a. “The baby’s heartbeat is not usually heard until the second trimester.”
b. “The baby’s heartbeat may be heard any time between 9 and 12 weeks.”
c. “It is often difficult to hear the heartbeat at this point, but we can try.”
d. “It is normal to hear the heartbeat at 6 weeks. We may be able to hear it today.

Answer 4

ANS: B

FHTs can be heard with the use of the Doppler device between 9 and 12 weeks.

Question 5

A patient who is in her first trimester of pregnancy tells the nurse that she is experiencing significant nausea and vomiting and asks when it will improve. The nurse’s response should be:

a. “Did your mother have significant nausea and vomiting?”
b. “Many women experience nausea and vomiting until the third trimester.”
c. “Usually by the beginning of the second trimester, the nausea and vomiting decrease.”
d. “At approximately the time you begin to feel the baby move, the nausea and vomiting will subside.”

Answer 5

ANS: C
The nausea, vomiting, and fatigue of pregnancy improve by week 12. Quickening, when the mother recognizes fetal movement, occurs at approximately 18 to 20 weeks.

Question 6

During the examination of a woman in her second trimester of pregnancy, the nurse notices the presence of a small amount of yellow drainage from the nipples. The nurse knows that this is:

a. An indication that milk secretion is beginning
b. A sign of possible breast cancer in a pregnant woman
c. Most likely colostrum and considered a normal finding at this stage of the pregnancy
d. Too early in the pregnancy for lactation to begin and refers the woman to a specialist

Answer 6

ANS: C
During the second trimester, colostrum, the precursor of milk, may be expressed from the nipples. Colostrum is yellow and contains more minerals and protein but less sugar and fat compared with mature milk

Question 7

A woman in her second trimester of pregnancy complains of heartburn and indigestion. When discussing this with the woman, the nurse considers which explanation for these problems?

a. Tone and motility of the gastrointestinal tract increase during the second trimester.
b. Sluggish emptying of the gallbladder, resulting from the effects of progesterone, often causes heartburn.
c. Lower blood pressure at this time decreases blood flow to the stomach and gastrointestinal tract.
d. Enlarging uterus and altered esophageal sphincter tone predispose the woman to have heartburn

Answer 7

ANS: D
Stomach displacement from the enlarging uterus plus altered esophageal sphincter and gastric tone as a result of progesterone predispose the woman to heartburn. The tone and motility of the gastrointestinal tract are decreased, not increased, during pregnancy. Emptying of the gallbladder may become more sluggish during pregnancy but is not related to indigestion. Rather, some women are predisposed to gallstone formation. A lower blood pressure may occur during the second semester, but it does not affect digestion

Question 8

A patient who is 20 weeks pregnant tells the nurse that she feels more shortness of breath as her pregnancy progresses. The nurse recognizes which statement to be true?

a. High levels of estrogen cause shortness of breath.
b. Feelings of shortness of breath are abnormal during pregnancy.
c. Hormones of pregnancy cause an increased respiratory effort.
d. The patient should get more exercise in an attempt to increase her respiratory reserve.

Answer 8

ANS: C
Progesterone and estrogen cause an increase in respiratory effort during pregnancy by increasing tidal volume. Increased tidal volume causes a slight drop in partial pressure of arterial carbon dioxide (PaCO2), causing the woman to have dyspnea occasionally.

Question 9

The nurse auscultates a functional systolic murmur, grade II/IV, on a woman in week 30 of her pregnancy. The remainder of her physical assessment is within normal limits. The nurse would:

a. Consider this finding abnormal, and refer her for additional consultation
b. Ask the woman to run briefly in place and then assess for an increase in intensity of the murmur
c. Know that this finding is normal and is a result of the increase in blood volume during pregnancy
d. Ask the woman to restrict her activities and return to the clinic in 1 week for re-evaluation

Answer 9

ANS: C
Because of the increase in blood volume, a functional systolic murmur, grade II/IV or less, can be heard in 95% of pregnant women

Question 10

A woman who is 28 weeks pregnant has bilateral edema in her lower legs after working 8 hours a day as a cashier at a local grocery store. She is worried about her legs. What is the nurse’s best response?

a. “You will be at risk for development of varicose veins when your legs are edematous.”
b. “I would like to listen to your heart sounds. Edema can indicate a problem with your heart.”
c. “Edema is usually the result of too much salt and fluids in your diet. You may need to cut down on salty foods.”
d. “As your baby grows, it slows blood return from your legs, causing the swelling. This often occurs with prolonged standing.

Answer 10

ANS: D
Edema of the lower extremities occurs because of the enlarging fetus, which impairs venous return. Prolonged standing worsens the edema. Typically, the bilateral, dependent edema experienced with pregnancy is not the result of a cardiac pathological condition

Question 11

When assessing an adolescent female who is in her third trimester of pregnancy, the nurse assesses for the classic symptoms associated with pre-eclampsia, which include:

a. Edema, headaches, and seizures
b. Elevated blood pressure and proteinuria
c. Elevated liver enzymes and high platelet counts
d. Decreased blood pressure and edema

Answer 11

ANS: B
The classic symptoms of pre-eclampsia are hypertension and proteinuria. Headaches may occur with worsening symptoms, and seizures may occur if preeclampsia is left untreated and leads to eclampsia. Pregnant adolescents are also at risk for pre-eclampsia, a multisystem disease specific to pregnancy characterized by new-onset hypertension, proteinuria, or both, usually after 20 weeks’ gestation. A serious variant of pre-eclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), is an ominous picture. Edema is a common occurrence in pregnancy

Question 12

The nurse knows that the best time to assess a woman’s blood pressure during an initial prenatal visit is:

a. Before the physical examination but after she has been sitting quietly for some time
b. At the beginning of the interview as a nonthreatening method of gaining rapport
c. During the middle of the physical examination when she is the most comfortable
d. Before beginning the pelvic examination because her blood pressure will be higher after the pelvic examination

Answer 12

ANS: A
Measure the blood pressure after the patient has been sitting quietly and before the physical examination, when the patient is most relaxed.

Question 13

When examining the face of a woman who is 28 weeks pregnant, the nurse notices the presence of a butterfly-shaped increase in pigmentation on the face. The proper term for this finding in the documentation is:

a. Striae
b. Chloasma
c. Linea nigra
d. Mask of pregnancy

Answer 13

ANS: B
Chloasma is a butterfly-shaped increase in pigmentation on the face. It is known as the mask of pregnancy, but when documenting, the nurse should use the correct medical term, chloasma

Question 14

Which finding is considered normal and expected when the nurse is performing a physical examination on a pregnant woman?

a. Palpable, full thyroid
b. Edema in one lower leg
c. Significant diffuse enlargement of the thyroid
d. Pale mucous membranes of the mouth

Answer 14

ANS: A
The thyroid may be palpable during pregnancy. It should feel full, but smooth. Significant diffuse enlargement occurs with hyperthyroidism, thyroiditis, and hypothyroidism. Pale mucous membranes may indicate anemia. Bilateral lower extremity edema is common in pregnancy, but edema with pain in only one leg occurs with deep vein thrombosis

Question 15

When auscultating the anterior thorax of a pregnant woman, the nurse notices the presence of a murmur over the second, third, and fourth intercostal spaces. The murmur is continuous but can be obliterated by pressure with the stethoscope or finger on the thorax just lateral to the murmur. The nurse interprets this finding to be:

a. Murmur of aortic stenosis
b. Most likely a mammary soufflé
c. Associated with aortic insufficiency
d. Indication of a patent ductus arteriosus

Answer 15

ANS: B
Blood flow through the blood vessels, specifically the internal mammary artery, can often be heard over the second, third, and fourth intercostal spaces. This finding is called a mammary soufflé, but it may be mistaken for a cardiac murmur

Question 16

When the nurse is assessing the deep tendon reflexes (DTRs) on a woman who is 32 weeks pregnant, which of these would be considered a normal finding on a 0 to 4+ scale?

a. Absent DTRs
b. 2+
c. 4+
d. Brisk reflexes and the presence of clonus

Answer 16

ANS: B
Normally during pregnancy, the DTRs are 1+ to 2+ and bilaterally equal. Brisk or greater than 2+ DTRs and the presence of clonus are abnormal and may be associated with an elevated blood pressure and cerebral edema in a woman with pre-eclampsia

Question 17

When performing an examination of a woman who is 34 weeks pregnant, the nurse notices a midline linear protrusion in the abdomen over the area of the rectus abdominis muscles as the woman raises her head and shoulders off of the bed. Which response by the nurse is correct?

a. The presence of diastasis recti should be documented.
b. This condition should be discussed with the physician because it will most likely need to be surgically repaired.
c. The possibility that the woman has a hernia attributable to the increased pressure within the abdomen from the pregnancy should be suspected.
d. The woman should be told that she may have a difficult time with delivery because of the weakness in her abdominal muscles

Answer 17

ANS: A
The separation of the abdominal muscles is called diastasis recti and frequently occurs during pregnancy. The rectus abdominis muscles will return together after pregnancy with abdominal exercise. This condition is not a true hernia.

Question 18

The nurse is palpating the fundus of a pregnant woman. Which statement about palpation of the fundus is true?

a. The fundus should be hard and slightly tender to palpation during the first trimester.
b. Fetal movement may not be felt by the examiner until the end of the second trimester.
c. After 20 weeks’ gestation, the number of centimetres should approximate the number of weeks of gestation.
d. Fundal height is usually less than the number of weeks of gestation, unless an abnormal condition, such as excessive amniotic fluid, is present.

Answer 18

ANS: C
After 20 weeks’ gestation, the number of centimetres should approximate the number of weeks of gestation. In addition, at 20 weeks’ gestation, the examiner may be able to feel fetal movement, and the head can be balloted

Question 19

The nurse is palpating the uterus of a woman who is 8 weeks pregnant. Which finding would be considered to be most consistent with this stage of pregnancy?

a. The uterus seems slightly enlarged and softened.
b. It reaches the pelvic brim and is approximately the size of a grapefruit.
c. The uterus rises above the pelvic brim and is approximately the size of a cantaloupe.
d. It is about the size of an avocado, approximately 8 cm across the fundus.

Answer 19

ANS: D
The 8-week pregnant uterus is approximately the size of an avocado, 7 to 8 cm across the fundus. The 6-week pregnant uterus is slightly enlarged and softened. The 10-week pregnant uterus is approximately the size of a grapefruit and may reach the pelvic brim. The 12-week pregnant uterus will fill the pelvis. At 12 weeks, the uterus size is measured from the abdomen.

Question 20

Which of these correctly describes the average length of pregnancy?

a. 38 weeks
b. 9 lunar months
c. 280 days from the last day of the last menstrual period
d. 280 days from the first day of the last menstrual period

Answer 20

ANS: D
The average length of pregnancy is 280 days from the first day of the last menstrual period, which is equal to 40 weeks, 10 lunar months, or roughly 9 calendar months

Question 21

A patient’s pregnancy test yields a positive result, and she wants to know when the baby is due. The first day of her last menstrual period was June 14, and that period ended June 20. Using Nägele’s rule, what is her expected date of delivery?

a. March 7
b. March 14
c. March 21
d. March 27

Answer 21

ANS: C
To determine the expected date of delivery using Nägele’s rule, 7 days are added to the first day of the last menstrual period; then 3 months are subtracted. Therefore adding 7 days to June 14 would be June 21, and subtracting 3 months would make the expected delivery date March 21.

Question 22

During the assessment of a woman in her 22nd week of pregnancy, the nurse is unable to hear FHTs with the fetoscope. The nurse should:

a. Immediately notify the physician and then wait 10 minutes and try again
b. Ask the woman if she has felt the baby move today
c. Wait 10 minutes and try again
d. Use ultrasonography to verify cardiac activity

Answer 22

ANS: D
If no FHTs are heard during auscultation with a fetoscope, then the nurse should verify cardiac activity by using ultrasonography. This should be done immediately, before notifying the physician or causing the woman distress by asking about fetal movement

Question 23

A patient who is 24 weeks pregnant asks about wearing a seat belt while driving. Which response by the nurse is correct?

a. “Seat belts should not be worn during pregnancy.”
b. “Place the lap belt below the uterus, and use the shoulder strap at the same time.”
c. “Place the lap belt below the uterus, but omit the shoulder strap during pregnancy.”
d. “Place the lap belt at your waist above the uterus, and use the shoulder strap at the same time.”

Answer 23

ANS: B
For maternal and fetal safety, the nurse should instruct the woman to place the lap belt below the uterus and to use the shoulder strap

Question 24

During a health history interview, a 38-year-old woman shares that she is thinking about having another baby. The nurse knows which statement regarding pregnancy after 35 years of age to be true?

a. Fertility does not start to decline until age 40 years.
b. Occurrence of Down’s syndrome is significantly more frequent after age 35 years.
c. Genetic counselling and prenatal screening are not routine until after age 40 years.
d. Pregnant women older than 35 years of age have the same rate of pregnancy-related complications as those who are younger than 35 years of age

Answer 24

ANS: B

Question 25

A woman who is 25 weeks pregnant comes to the clinic for her prenatal visit. The nurse notices that her face and lower extremities are swollen, and her blood pressure is 154/94 mm Hg. The woman states that she has had headaches and blurry vision but thought she was just tired. What should the nurse suspect?

a. Eclampsia
b. Pre-eclampsia
c. Diabetes type 1
d. Preterm labour

Answer 25

ANS: B
Classic symptoms of pre-eclampsia include elevated diastolic blood pressure of greater than 90 mm Hg in a woman with previously normal blood pressure and proteinuria. Onset and worsening symptoms may be sudden, and subjective signs include headaches and visual changes. Eclampsia is manifested by generalized tonic-clonic seizures. These symptoms are not indicative of diabetes mellitus (type 1 or 2) or preterm labour

Question 26

During a group prenatal teaching session, the nurse teaches Kegel exercises. Which statements would be appropriate for this teaching session? (Select all that apply.)

a. “Kegel exercises help keep your uterus strong during the pregnancy.”
b. “Kegel exercises should be performed twice a day.”
c. “Kegel exercises should be performed several times a day in sets of 10 or more.”
d. “To perform Kegel exercises, identify the correct muscles by stopping the flow of urine midstream.”
e. “To perform Kegel exercises, rapidly perform alternating squeeze-release exercises up to the count of eight.”

Answer 26

ANS: C, D
Kegel exercises can be performed to prepare for and to recover from delivery. Kegel exercises are encouraged to strengthen the pubococcygeus muscles to prevent, reduce, or improve pelvic floor issues, such as urinary incontinence, uterine prolapse, and sexual dysfunction. Women can identify the muscle by inserting a finger into the vagina. Alternatively, these muscles can be identified by stopping the flow of urine midstream. The patient contracts and relaxes the muscle group in sets of 10 or more, several times a day

Question 27

A woman in her second trimester of pregnancy states, “I’m so glad the morning sickness is gone, but I feel so tired!” What action by the nurse is appropriate at this time? (Select all that apply.)

a. Order a test of the woman’s vitamin D level.
b. Instruct her to get more rest during the day.
c. Order a complete blood cell count.
d. Order thyroid function studies.
e. Offer human immunodeficiency virus (HIV) screening

Answer 27

ANS: A, C, D
Vitamin D is essential for maternal response to the calcium demands of the fetus for growth and bone development. Maternal anorexia and malaise are often associated with vitamin D deficiency. In addition, iron deficiency is a common cause of anemia in pregnancy; a complete blood cell count will indicate whether this deficiency is present. Thyroid function testing should be performed to check for maternal hypothyroidism, which can cause symptoms of lethargy in the mother and can also have severe effects on the developing fetus. HIV screening should have been offered at the onset of her pregnancy. Instructing her to get more rest will not help find the possible causes of her tiredness