Chapter 07: Anatomy and Physiology of Pregnancy Perry: Maternal Child Nursing Care, 6th Edition

1. A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?

a. 3-1-1-1-3

b. 4-1-2-0-4

c. 3-0-3-0-3

d. 4-2-1-0-3

b. 4-1-2-0-4

2. A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have:

a. amenorrhea.

b. positive pregnancy test.

c. Chadwick's sign.

d. Hegar's sign.

a. amenorrhea.

3. The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is:

a. a positive pregnancy test.

b. fetal movement palpated by the nurse-midwife.

c. Braxton Hicks contractions.

d. quickening.

b. fetal movement palpated by the nurse-midwife

4. A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level?

a. Not palpable above the symphysis at this time

b. Slightly above the symphysis pubis

c. At the level of the umbilicus

d. Slightly above the umbilicus

b. Slightly above the symphysis pubis.

5. During a patient's physical examination the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as:

a. Hegar's sign.

b. McDonald's sign.

c. Chadwick's sign.

d. Goodell's sign.

a. Hegar's sign.

6. Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?

a. Less audible heart sounds (S1, S2)

b. Increased pulse rate

c. Increased blood pressure

d. Decreased red blood cell (RBC) production

b. Increased pulse rate

7. Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth?

a. Epulis

b. Chloasma

c. Telangiectasia

d. Striae gravidarum

d. Striae gravidarum

8. The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change?

a. Her center of gravity will shift backward.

b. She will have increased lordosis.

c. She will have increased abdominal muscle tone.

d. She will notice decreased mobility of her pelvic joints.

b. She will have increased lordosis.

9. A 31-year-old woman believes that she may be pregnant. She took an OTC pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse enquires about the woman's last menstrual period and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan that reveals she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?

a. She took the pregnancy test too early.

b. She takes anticonvulsants.

c. She has a fibroid tumor.

d. She has been under considerable stress and has a hormone imbalance.

b. She takes anticonvulsants.

10. A woman is in her seventh month of pregnancy. She has been reporting nasal congestion and occasional epistaxis. The nurse suspects that:

a. this is a normal respiratory change in pregnancy caused by elevated levels of estrogen.

b. this is an abnormal cardiovascular change, and the nosebleeds are an ominous sign.

c. the woman is a victim of domestic violence and is being hit in the face by her partner.

d. the woman has been using cocaine intranasally.

a. this is a normal respiratory change in pregnancy caused by elevated levels of estrogen

11. The nurse caring for the pregnant patient must understand that the hormone essential for maintaining pregnancy is:

a. estrogen.

b. human chorionic gonadotropin (hCG).

c. oxytocin.

d. progesterone.

d. progesterone.

12. A patient at 24 weeks of gestation contacts the nurse at her obstetric provider's office to complain that she has cravings for dirt and gravel. The nurse is aware that this condition is known as ________ and may indicate anemia.

a. ptyalism

b. pyrosis

c. pica

d. decreased peristalsis

c. pica

13. Appendicitis may be difficult to diagnose in pregnancy because the appendix is:

a. displaced upward and laterally, high and to the right.

b. displaced upward and laterally, high and to the left.

c. deep at McBurney point.

d. displaced downward and laterally, low and to the right.

a. displaced upward and laterally, high and to the right.

14. A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a:

a. primipara.

b. primigravida.

c. multipara.

d. nulligravida.

a. primipara.

15. Which time-based description of a stage of development in pregnancy is accurate?

a. Viability—22 to 37 weeks since the last menstrual period (LMP) (assuming a fetal weight >500 g).

b. Full Term—Pregnancy from the beginning of week 39 of gestation to the end of week 40.

c. Preterm—Pregnancy from 20 to 28 weeks.

d. Postdate—Pregnancy that extends beyond 38 weeks.

b. Full Term—Pregnancy from the beginning of week 39 of gestation to the end of week 40.

16. Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and the basis for many tests. A maternity nurse should be aware that:

a. hCG can be detected 2.5 weeks after conception.

b. the hCG level increases gradually and uniformly throughout pregnancy.

c. much lower than normal increases in the level of hCG may indicate a postdate pregnancy.

d. a higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

d. a higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

17. To reassure and educate pregnant patients about changes in the uterus, nurses should be aware that:

a. lightening occurs near the end of the second trimester as the uterus rises into a different position.

b. the woman's increased urinary frequency in the first trimester is the result of exaggerated uterine anteflexion caused by softening.

c. Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise.

d. the uterine souffle is the movement of the fetus.

b. the woman's increased urinary frequency in the first trimester is the result of exaggerated uterine anteflexion caused by softening.

18. To reassure and educate pregnant patients about changes in the cervix, vagina, and position of the fetus, nurses should be aware that:

a. because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are much easier to evaluate.

b. Quickening is a technique of palpating the fetus to engage it in passive movement.

c. the deepening color of the vaginal mucosa and cervix (Chadwick's sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor.

d. increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

d. increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

19. The mucous plug that forms in the endocervical canal is called the:

a. operculum.

b. leukorrhea.

c. funic souffle.

d. ballottement.

a. operculum

20. To reassure and educate pregnant patients about changes in their breasts, nurses should be aware that:

a. the visibility of blood vessels that form an intertwining blue network indicates full function of Montgomery's tubercles and possibly infection of the tubercles.

b. the mammary glands do not develop until 2 weeks before labor.

c. lactation is inhibited until the estrogen level declines after birth.

d. colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.

c. lactation is inhibited until the estrogen level declines after birth.

21. To reassure and educate pregnant patients about changes in their cardiovascular system, maternity nurses should be aware that:

a. a pregnant woman experiencing disturbed cardiac rhythm, such as sinus arrhythmia requires close medical and obstetric observation, no matter how healthy she otherwise may appear.

b. changes in heart size and position and increases in blood volume create auditory changes from 20 weeks to term.

c. palpitations are twice as likely to occur in twin gestations.

d. all of the above changes will likely occur.

b. changes in heart size and position and increases in blood volume create auditory changes from 20 weeks to term.

22. To reassure and educate their pregnant patients about changes in their blood pressure, maternity nurses should be aware that:

a. a blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high.

b. shifting the patient's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit.

c. the systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant.

d. compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.

d. compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy..

23. Some pregnant patients may complain of changes in their voice and impaired hearing. The nurse can tell these patients that these are common reactions to:

a. a decreased estrogen level.

b. displacement of the diaphragm, resulting in thoracic breathing.

c. congestion and swelling, which occur because the upper respiratory tract has become more vascular.

d. increased blood volume.

c. congestion and swelling, which occur because the upper respiratory tract has become more vascular.

24. To reassure and educate pregnant patients about the functioning of their kidneys in eliminating waste products, maternity nurses should be aware that:

a. increased urinary output makes pregnant women less susceptible to urinary infection.

b. increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty.

c. renal (kidney) function is more efficient when the woman assumes a supine position.

d. using diuretics during pregnancy can help keep kidney function regular.

b. increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty.

25. Which statement about a condition of pregnancy is accurate?

a. Insufficient salivation (ptyalism) is caused by increases in estrogen.

b. Acid indigestion (pyrosis) begins early but declines throughout pregnancy.

c. Hyperthyroidism often develops (temporarily) because hormone production increases.

d. Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

d. Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

26. A first-time mother at 18 weeks of gestation comes for her regularly scheduled prenatal visit. The patient tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that this is the Braxton Hicks sign and teaches the patient that this type of contraction:

a. is painless.

b. increases with walking.

c. causes cervical dilation.

d. impedes oxygen flow to the fetus.

a. is painless.

27. 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

b. Glycosuria

28. The maternity nurse understands that vascular volume increases 40% to 45% during pregnancy to:

a. compensate for decreased renal plasma flow.

b. provide adequate perfusion of the placenta.

c. eliminate metabolic wastes of the mother.

d. prevent maternal and fetal dehydration.

b. provide adequate perfusion of the placenta.

29. 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.

b. dilution of hemoglobin concentration.

30. A patient in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" The nurse's best response is:

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."

b. "It may be due to changes in hormones."

1. The diagnosis of pregnancy is based on which positive signs of pregnancy? (Select all that apply.)

a. Identification of fetal heartbeat

b. Palpation of fetal outline

c. Visualization of the fetus

d. Verification of fetal movement

e. Positive hCG test

.a Identification of fetal heartbeat

c. Visualization of the fetus

d. Verification of fetal movement

2. During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criterion? (Select all that apply.)

a. Leukorrhea

b. Development of the operculum

c. Quickening

d. Ballottement

e. Lightening

c. Quickening

d. Ballottement

e. Lightening