Ricci, Kyle & Carman: Maternity and Pediatric Nursing, Second Edition: PrepU; Chapter 11: Maternal Adaptation During Pregnancy

Amanda is about 16 weeks pregnant and is concerned because she feels her "abdomen" contracting. She calls the primary care provider's office and speaks to the nurse. What is the nurse's most appropriate response to Amanda's concern?

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

Braxton Hicks contractions are the painless, intermittent, "practice" contractions of pregnancy.

A woman tells the nurse that she is going to use a home pregnancy test to determine whether she is pregnant. Which precautions should the nurse give her?

Arrange for prenatal care if the test is positive.

Home pregnancy testing can be accurate as soon as a period is missed; it should not take the place of prenatal care.

During a routine antepartal visit, a pregnant woman reports a white, thick vaginal discharge. What would the nurse do next?

Ask the woman if she is having any itching or irritation.

Although vaginal secretions increase during pregnancy, the nurse would need to ascertain if this discharge is the normal leukorrhea of pregnancy or if it is a monilial vaginitis, which is common during pregnancy. The nurse needs additional information to conclude that the woman's report is normal. A culture may or may not be necessary. There is no evidence to suggest that her membranes have ruptured.

Morning sickness is associated with rising levels of human chorionic gonadotropin (hCG) and progesterone.

True

Known as morning sickness, nausea and vomiting begins to be noticed at the same time levels of hCG and progesterone begin to rise so these may contribute to its cause. Another reason may be a systemic reaction to increased estrogen levels or decreased glucose levels, because glucose is being used in such great quantities by the growing fetus.

During a prenatal visit, a client in her second trimester of pregnancy verbalizes positive feelings about the pregnancy and conceptualizes the fetus. Which is the most appropriate nursing intervention when the client expresses such feelings?

Offer support and validation about the client's feelings.

During the second trimester, many women will verbalize positive feelings about the pregnancy and will conceptualize the fetus. The woman may accept her new body image and talk about the new life within her. Generating a discussion about the woman's feelings and offering support and validation at prenatal visits are important nursing interventions. The nurse should encourage the client in her first trimester to focus on herself, not on the fetus; this is not required when the client is in her second trimester. The client's feelings are normal for the second trimester of pregnancy; hence, it is not necessary either to inform the primary health care provider about the client's feelings or to tell the client that it is too early to conceptualize the fetus.

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called?

couvade syndrome

Some fathers actually experience some of the physical symptoms of pregnancy, such as nausea and vomiting, along with their partner. This phenomenon is called couvade syndrome.

While providing an education to a prenatal class for first-time mothers and fathers during the first trimester, the nurse includes information that the father may experience which occurrence as normal during the pregnancy?

physical symptoms similar to the mother

Couvade syndrome is the occurrence of physical symptoms by the male, similar to the physical symptoms of the mother. Other emotional symptoms may occur, but they are typically on a person-to-person basis.

Which assessment finding in a woman is a positive sign of pregnancy?

visualization of the fetus by ultrasound at 6+ weeks

A positive sign of pregnancy is visualization of the fetus by ultrasound at 6+ weeks. Amenorrhea is a presumptive sign and can be caused by a variety of factors. Positive hCG in the blood and uterine growth are both probable signs but can be caused by hydatidiform or tumors.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition?

Place the client in the left lateral position.

The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

A client in her second trimester of pregnancy is anxious about the blotchy, brown pigmentation appearing on her forehead and cheeks. She also reports increased pigmentation on her breasts and genitalia. Which statement by the nurse is most appropriate?

"This is called facial melanoma and should fade after the birth."

The skin and complexion of pregnant women undergo hyperpigmentation, primarily as a result of estrogen, progesterone, and melanocyte stimulating hormone levels. The increased pigmentation that occurs on the breasts and genitalia also develops on the face to form the "mask of pregnancy," or facial melasma (cholasma). This is a blotchy, brownish pigment that covers the forehead and cheeks in dark-haired women. The nurse would inform the client that this is a normal occurrence in pregnancy and should fade after birth.

Some women are lactose intolerant. Lactose intolerance occurs more frequently in individuals of African, Hispanic, Native American, Ashkenazic Jewish, and Asian descent. What is the major concern for a lactose intolerant woman who is pregnant?

c

calcium deficiency

Calcium deficiency is a major concern for the pregnant woman who is lactose intolerant. There are several ways to address this concern. Some lactose-intolerant individuals are able to tolerate cooked forms of milk, such as pudding or custard. Cultured or fermented dairy products, such as buttermilk, yogurt, and some cheeses may also be tolerated. A chewable lactase tablet may be taken with milk. Lactase-treated milk is available in most supermarkets and may be helpful. Other options are to drink calcium-enriched orange juice or soy milk or to take a calcium supplement. If the woman is infrequently exposed to sunlight, she will need a vitamin D supplement (Marchiano & Ural, 2005).

During her 12 week prenatal check up, the client informs the nurse on interview that she has developed bumps on the dark part of her nipples. She wants to know what these bumps are. What is the nurse's appropriate answer?

Montgomery's tubercles, secrete lubricant for the nipples

All woman have Montgomery's tubercles; they become more prominent during pregnancy and help to prepare the nipples for breastfeeding. The bumps are not specific to pregnancy and are not a sign of cancer. They are not the result of stretching.

At 40 weeks' gestation, a woman in for her prenatal visits states to the nurse "I am tired of being pregnant." What is the appropriate response by the nurse?

"That is a very normal feeling, especially at this point in pregnancy."

During the third trimester, the client is preparing for parenthood and is often tired and ready for a break. The woman may feel large and unable to do any normal activities and be ready to have her baby in her arms rather than in her uterus. This is not an abnormal statement, and the provider should not overreact. Deciding to induce is something that should be done in consultation with the care provider, and only when it failing to do so would have a negative impact on the mother or baby.

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence?

quickening

The fluttering sensation that can be confused with gas is called "quickening." In the 2 weeks leading up to the 20-week mark, she may feel "flutters" that she may confuse with gas. Lightening is the descent of the presenting part of the fetus into the pelvis. Placenta previa is the implantation of the placenta so that it covers part or all of the cervical os. Linea nigra is a hyperpigmented line that appears on the maternal abdomen between the symphysis pubis and top of the fundus.

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse?

"The hormones of pregnancy may cause anxiety or depression postpartum."
The "raging hormones"of pregnancy can keep the woman slightly out of touch with her usual methods of coping. Although she may normally interact and communicate in quite mature ways, during a pregnancy, she may become depressed, anxious, withdrawn, or angry as she accomplishes her own developmental tasks. Siblings often react to a pregnancy by regression in behavior and attitude because they fear that they will be replaced or unloved. In addition to anticipatory guidance concerning the alterations in family structure and functioning, prenatal preparation for first-time parents involves learning the basics of infant care and preparing for infant feeding, particularly for women who plan to breastfeed.

A woman in the second trimester of pregnancy reports that she is "tired all the time." She appears pale and her hematocrit, though within the normal range, is low. Which recommendation would be most helpful for this woman?

an iron supplement

Iron is necessary for the formation of hemoglobin; therefore, it is essential to the oxygen-carrying capacity of the blood. Women who have normal hematocrit may need increased iron to carry more oxygen. Calcium supplementation is essential for normal fetal development. Meat and seafood are not specifically needed.

The hormone responsible for the initiation of lactation is what?

prolactin

Prolactin is the hormone responsible for the initiation of lactation, the production of breastmilk. Oxytocin is responsible for the let down of milk and contraction, and estrogen and progesterone are responsible for uterine and pregnancy maintenance.

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week?

1 lb (.45 kg)

The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (.45 kg) per week. Overweight women should gain about 2/3 lb (.30 kg) per week.

A 22-year-old primagravida comes to the office for a prenatal visit. She is in her second trimester and has had prenatal care since she was 8 weeks pregnant. Her only report is a new brownish line straight down her abdomen. Vital signs are unremarkable. Urine has no protein, glucose, or leukocytes. Fetal heart rate is 140; the client's uterus is palpated to the umbilicus. What physical finding is responsible for her new "brown line?"

linea nigra

The linea nigra is a hyperpigmented area of skin linear along the midline of the abdomen. It results from the hormonal changes of pregnancy and is considered an expected finding.

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding?

bruising

Bruising would not be a normal finding. Evidence of bruising might suggest domestic violence. Linea nigra, striae, and darkening of the umbilicus are normal findings.

A pregnant woman is experiencing morning sickness. Which response indicates a need for further teaching?

"I'll take antacid between meals."

The client should avoid use of medications unless prescribed by the provider. Avoiding an empty stomach, snacking on a cracker, or eating small servings of bland food are better options and may manage the morning sickness.

The nurse teaches a pregnant woman about breastfeeding, stating that stimulation of the breast through sucking or touching stimulates the secretion of which hormone?

oxytocin

Oxytocin is responsible for milk ejection during breastfeeding. Its secretion is stimulated by stimulation of the breasts via sucking or touching. Secretion of follicle-stimulating hormone is inhibited during pregnancy. The secretion of antidiuretic hormone has no effect on breastfeeding. Cortisol secretion regulates carbohydrate and protein metabolism and is helpful in times of stress.

The nurse is teaching the pregnant woman about nutrition for herself and her baby. Which statement by the woman indicates that the teaching was effective?

"I will need to take iron supplementation throughout my pregnancy even if I am not anemic."

Iron is recommended for all pregnant women because it is almost impossible for the pregnant woman to get what is required from diet alone, especially after 20 weeks' gestation when the requirements of the fetus increase. Pregnant women can get many nutrients from seafood including phosphorus, but there are specific recommendations about types of fish to avoid because of the risk of mercury poisoning. Milk production actually requires higher levels of zinc, which can be obtained from a healthy diet. Calcium requirements do not increase above prepregnancy levels during pregnancy because calcium absorption is enhanced during pregnancy. It can be unsafe for the pregnant woman to eat anything she wants and gain too much weight. A woman who gains too much weight during pregnancy is at risk for delivering a macrosomic baby.

A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?

Fundal height has dropped since the last recording.

Between 38 and 40 weeks of gestation, the fundal height drops as the fetus begins to descend and engage into the pelvis. Because it pushes against the diaphragm, many women experience shortness of breath. By 40 weeks, the fetal head begins to descend and engage into the pelvis. Although breathing becomes easier because of this descent, the pressure on the urinary bladder now increases, and women experience urinary frequency. The fundus reaches its highest level at the xiphoid process at approximately 36, not 39, weeks. By 20 weeks' gestation, the fundus is at the level of the umbilicus and measures 20 cm. At between 6 and 8 weeks of gestation, the cervix begins to soften (Goodell sign) and the lower uterine segment softens (Hegar's sign).

Early in pregnancy, frequent urination results mainly from which cause?

pressure on the bladder from the uterus

Early in pregnancy, the expanding uterus presses on the bladder. During the second trimester there is some relief when the uterus lifts, but the pressure returns again as the fetus continues to grow. Urine concentration does not affect frequency. Fetal urine does not enter the mother's renal system, except through increases in circulatory volume. The glomeruli should not be affected by pregnancy.

A nurse conducting a presentation for a group of nurses working at the family health clinic describes the changes in various body systems related to pregnancy. The nurse determines that additional teaching is needed when the group identifies which component as contributing to the pregnant woman's hypercoagulable state?

increased number of red blood cells

The increase in red blood cells is necessary to transport the additional oxygen required during pregnancy. It has no effect on the hypercoagulable state. Both fibrin and plasma fibrinogen levels increase, along with various blood clotting factors, leading to a hypercoagulable state.

A nurse is caring for a pregnant client who has been diagnosed with lordosis. The nurse offers preventive measures for which consequence of lordosis when caring for this client?

chronic backache

The nurse should provide preventive measures for chronic backache as a consequence of lordosis when caring for this client. Chloasma is characterized by darkened areas on the face, particularly over the nose and cheeks. It is also known as the mark of pregnancy. Chloasma is not caused by lordosis. Diastasis occurs as the pregnancy progresses when the rectus muscle stretches to the point that it separates. It is not caused by lordosis. Edema in lower extremities occurs due to an impeded venous return caused by pressure of growing fetus on pelvic and femoral areas. It is not caused by lordosis.

A client in her second trimester of pregnancy reports discomfort during sexual activity. Which instruction should a nurse provide?

Modify sexual positions to increase comfort.

The nurse should instruct the client to change sexual positions to increase comfort as the pregnancy progresses. Although the nurse should also encourage her to engage in alternative, noncoital modes of sexual expression, such as cuddling, caressing, and holding, the client need not restrict herself to such alternatives. It is not advisable to perform frequent douching, because this is believed to irritate the vaginal mucosa and predispose the client to infection. Using lubricants or performing stress-relieving and relaxation exercises will not alleviate discomfort during sexual activity.

Amanda's menstrual period is two weeks late. She has been feeling tired and has had bouts of nausea in the morning. What classification of pregnancy symptoms is Amanda experiencing?

presumptive

The most common presumptive sign of pregnancy is a missed menstrual period, or amenorrhea. Other presumptive signs include nausea, fatigue, swollen, tender breasts, and frequent urination.

A pregnant vegan reports that she eats lots of dark green leafy vegetables, legumes, citrus fruits, and berries. To ensure that her infant's nervous system will develop properly, what foods should the nurse recommend that she add to her diet?

fortified cereals

Vegans need increased grains to meet the amino acid needs during pregnancy. She should be encouraged to consume grains with legumes to meet these needs. The inclusion of dairy, fruit, vegetables, and nuts are necessary for a healthy diet.

What is a positive sign of pregnancy?

fetal movement felt by examiner

The positive signs of pregnancy are fetal image on sonogram, hearing a fetal heart rate, and examiner feeling fetal movement. A pregnancy test may come back as a false positive. Hegar's sign is a softening of the uterine isthmus. Uterine contractions may occur at any time.

A woman calls the clinic to schedule an appointment because "I think I might be pregnant." Upon further assessment gathering of information from the woman, which finding would be a probable sign of pregnancy?

positive home pregnancy test

A positive home pregnancy test is confirmed by hCG in the urine. This is considered a probable sign of pregnancy. Fatigue, amenorrhea, and vomiting can all have other causes.

A patient is in her 22nd week of pregnancy and is preparing to have her fundal height measured. Given the patient's stage of gestation and following McDonald's rule, what result does the nurse expect?

22 cm

McDonald's rule, a symphysis-fundal height measurement, although not documented to be thoroughly reliable, is an easy method of determining midpregnancy growth. Typically, tape measurement from the notch of the symphysis pubis to over the top of the uterine fundus as a woman lies supine is equal to the week of gestation in centimeters between the 20th and 31st weeks of pregnancy or in a pregnancy of 22 weeks, for example, the fundal height should be 22 cm.

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client?

iron-deficiency anemia

Pica is characterized by a craving for substances that have no nutritional value. Consumption of these substances can be dangerous to the client and her developing fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation of the client's compulsion to consume soil. Consumption of ice due to pica is likely to lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the client has been consuming laundry starch as a result of pica. The nurse should monitor for constipation in the client if she has been consuming clay.

A pregnant woman is experiencing morning sickness. Which response indicates a need for further teaching?

"I'll take antacid between meals."

The client should avoid use of medications unless prescribed by the provider. Avoiding an empty stomach, snacking on a cracker, or eating small servings of bland food are better options and may manage the morning sickness.

A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which information should the nurse offer?

"You will experience quickening, and you will actually feel the baby."

The nurse should inform the client that quickening occurs in the second trimester. The client will be able to physically feel the fetal movements, which will help her bond with her developing fetus. Physical discomfort actually starts to increase in the third trimester as the fetus grows rapidly. The client feels conscious of the changes taking place in her body due to her pregnancy primarily in the first trimester, not the second. The client is likely to have mood swings in the first trimester of the pregnancy, which can be very overwhelming for the client as well as her partner.

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply.

morning sickness
amenorrhea
breast changes

Presumptive signs are possible signs of pregnancy that appear in the first trimester, often only noted subjectively by the mother (e.g., breast changes, amenorrhea, morning sickness). Probable signs are signs that appear in the first and early second trimesters, seen via objective criteria, but can also be indicators of other conditions (e.g., hydatidiform mole). Positive signs affirm that proof exists that there is a developing fetus in any trimester and are objective criteria seen by a trained observer or diagnostic study, (e.g., ultrasound.)

A pregnant client in her first trimester of pregnancy reports spontaneous, irregular, painless contractions. What does this indicate?

Braxton Hicks contractions

Spontaneous, irregular, painless contractions, called Braxton Hicks contractions, begin during the first trimester. These contractions are not the signs of preterm labor, infection of the GI tract, or acid indigestion. Acid indigestion causes heartburn. Acid indigestion or heartburn (pyrosis) is caused by regurgitation of the stomach contents into the upper esophagus and may be associated with the generalized relaxation of the entire digestive system.

Many factors influence how a woman adapts psychologically to pregnancy. What is the psychological adaptation the woman must come to terms with during the second trimester?

accept the baby

Gradually, as the pregnancy progresses, she comes to have a sense of the child as his or her own separate entity. This acceptance may be enhanced when she first hears the fetal heartbeat, when she feels the baby move inside her, or when she sees the fetal image during a sonogram.

The nurse explains to a pregnant client, who is anemic, that she will need to take vitamins with iron during her pregnancy. What foods would the nurse include on the client's diet plan?

meats

Grains are a source of iron but not as good a source as the heme iron of meats. The other choices should be avoided when taking the iron and vitamin supplement as milk and legumes decrease the absorption of iron.

During pregnancy, there are many psychological changes. What is the most critical component for a positive psychological experience with pregnancy by the woman?

social support

All options are correct and play a role pregnancy, but the most critical for a positive psychological experience is for the woman to have a social support system. Early care, maternal age, and planned pregnancy all affect fetal and maternal health, but are not necessarily linked to positive psychological experiences.

Which assessment finding in the pregnant woman at 12 weeks of gestation should the nurse find most concerning? The inability to:

detect fetal heart sounds with a Doppler.

Fetal heart sounds are audible with a Doppler at 10 to 12 weeks of gestation but cannot be heard through a stethoscope until 18 to 20 weeks of gestation. Fetal movements can be felt by a woman as early as 16 weeks of pregnancy and felt by the examiner around 20 weeks' gestation. The fetal outline is also palpable around 20 weeks of gestation.

A 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She expresses feeling proud and excited about her pregnancy while at the same time feeling fearful and anxious of its implications. Which action should the nurse do next?

Inform the client this is a normal response to pregnancy that many women experience.

The maternal emotional response experienced by the client is ambivalence. Ambivalence, or having conflicting feelings at the same time, is universal and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester.

A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation and enlargement of the birth canal. What is this hormone?

relaxin

Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for dilatation at birth; softening of collagen allows for laxness in the lower spine and so helps enlarge the birth canal. The effect of estrogen is to cause breast and uterine enlargement. Progesterone has a major role in maintaining the endometrium, inhibiting uterine contractility, and aiding in the development of the breasts for lactation. Human placental lactogen (hPL), also known as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective, thereby allowing more glucose to become available for fetal growth.

Which change related to the vital signs is expected in pregnant women?

Blood pressure decreases.

Pulse and temperature often increase, while lung space is decreased in pregnant women. It is common for blood pressure to decrease during pregnancy.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition?

Place the client in the left lateral position.

The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

During pregnancy, which situation would interfere with mother-child bonding?

A woman's father has been very ill during the pregnancy.

Any event during pregnancy that has the potential to reduce the time the woman spends working through the developmental tasks of pregnancy can interfere with bonding.

Pregnant women seem to be more susceptible to carpal tunnel syndrome than others.

True

The nurse is performing an assessment of a woman who has come to a health care facility for a diagnosis of pregnancy. The women is positive for breast changes, nausea, and amenorrhea. On physical exam, it is noted that the client has softening of the cervix. How should the nurse document this in her notes?

Goodell's sign

The description of Goodell's sign is softening of the cervix. Ballottement is when tapping the lower uterine segment on a bimanual exam illicits the fetus to rise against the abdominal wall. Chadwick's sign is when the vagina changes color from pink to violet, and Hegar's sign is softening of the lower uterine segment.

A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate?

"This discharge is normal during pregnancy."

During pregnancy, the vaginal secretions become more acidic, white, and thick. Most women experience an increase in a whitish vaginal discharge, called leukorrhea, during pregnancy. The nurse should inform the client that the vaginal discharge is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans infection, a monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Monilial vaginitis is a benign fungal condition and is treated with local antifungal agents. The client need not refrain from sexual activity when there is an increase in a thick, whitish vaginal discharge.

During pregnancy, there are many psychological changes. What is the most critical component for a positive psychological experience with pregnancy by the woman?

social support

All options are correct and play a role pregnancy, but the most critical for a positive psychological experience is for the woman to have a social support system. Early care, maternal age, and planned pregnancy all affect fetal and maternal health, but are not necessarily linked to positive psychological experiences.

Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy?

dilation of the renal pelvis

The renal pelvis becomes dilated during pregnancy, possibly due to the effect of progesterone on smooth muscle. The glomerular filtration rate increases during pregnancy. The kidneys enlarge during pregnancy. The ureters elongate, widen, and become more curved above the pelvic rim.

A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which information should the nurse offer?

"You will experience quickening, and you will actually feel the baby."

The nurse should inform the client that quickening occurs in the second trimester. The client will be able to physically feel the fetal movements, which will help her bond with her developing fetus. Physical discomfort actually starts to increase in the third trimester as the fetus grows rapidly. The client feels conscious of the changes taking place in her body due to her pregnancy primarily in the first trimester, not the second. The client is likely to have mood swings in the first trimester of the pregnancy, which can be very overwhelming for the client as well as her partner.

Which change in the breasts should a nurse recognize as a normal change associated with pregnancy?

tingling sensations and tenderness

Normal changes in the breasts associated with pregnancy include tingling sensations and tenderness, enlargement of the breast and nipples, hyperpigmentation of the areola and nipples, enlargement of Montgomery tubercles, prominence of superficial veins, development of striae, and expression of colostrum in the second and third trimesters.

A 28-year-old primigravida client with diabetes mellitus, in her first trimester, comes to the health care clinic for a routine visit. The client reports frequent episodes of sweating, giddiness, and confusion. What should the nurse tell the client about these experiences?

increased secretion of insulin occurs in the first trimester

Increased secretion of insulin in the maternal body in the first trimester is due to the rise in serum levels of estrogen, progesterone, and other hormones. During the second half of pregnancy, tissue sensitivity to insulin progressively decreases, producing hyperglycemia and hyperinsulinemia. Use of insulin needs to be increased not reduced as pregnancy advances. Insulin resistance becomes maximal not minimal in the latter half of the pregnancy.

A woman in the last trimester of pregnancy reports sleeping poorly. She becomes light-headed and dizzy whenever she sleeps on her back, but she cannot sleep at all if she lies on her side. How would the nurse suggest she try sleeping?

with a pillow under her right hip

Pregnancy places strain on the cardiovascular system with increased fluid in the lungs and heart. When the woman lies flat on her back the uterus and contents can compress the vena cava and aorta and reduce blood flow resulting in the light-headed and dizzy spells. Removal of the pillow would not affect the effects on the vena cava. A pillow under the shoulders would hurt the neck, and a pillow under both hips would exacerbate the light-headedness.

As a pregnant woman lies on the examining table, she grows very short of breath and dizzy. This phenomenon probably happens because:

blood is trapped in the vena cava in a supine position.

Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava. Cerebral arteries should not be affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in any orientation. The sympathetic nervous system will not be affected by the supine position.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition?

Place the client in the left lateral position.

The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

A woman is at 20 weeks' gestation. The nurse would expect to find the fundus at which area?

at the level of the umbilicus

The uterus, which starts as a pear-shaped organ, becomes ovoid as length increases over width. By 20 weeks' gestation, the fundus, or top of the uterus, is at the level of the umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in centimeters, which corresponds to the number of gestational weeks, is commonly used to date the pregnancy.

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy?

visualization of the gestational sac or fetus

The positive sign that can be elicited earliest in the pregnancy is visualization of the gestational sac or fetus. With transvaginal ultrasound, the gestational sac can be seen as early as 10 days after implantation.

A student nurse asks the instructor about maternal pulse and blood pressure changes during the prenatal period. Which response from the nurse about cardiovascular changes during the first and second trimesters is accurate?

"Women experience increased pulse rate and decreased blood pressure."

Pulse rate frequently increases during pregnancy, although the amount varies from a slight increase to 10 to 15 beats per minute. Blood pressure generally decreases slightly during pregnancy, reaching its lowest point during the second trimester.

The blood volume in pregnant women increases by what percent?

40 to 50 percent

Blood volume increase by approximately 40 to 50 percent above prepregnancy levels by the end of the third trimester.

A client in her 10th week of gestation arrives at the maternity clinic reporting morning sickness. The nurse needs to inform the client about the body system adaptations during pregnancy. Which factors correspond to the morning sickness period during pregnancy? Select all that apply.

reduced stomach acidity
elevated human chorionic gonadotropin (hCG)
increased estrogen level

The hCG levels in a normal pregnancy usually double every 48 to 72 hours, until they reach a peak at approximately 60 to 70 days after fertilization. This elevation of hCG corresponds to the morning sickness period of approximately 6 to 12 weeks during early pregnancy. Reduced stomach acidity and high levels of circulating estrogens are also believed to cause morning sickness. Elevation of hPL and RBC production do not cause morning sickness. hPL increases during the second half of pregnancy, and it helps in the preparation of mammary glands for lactation and is involved in the process of making glucose available for fetal growth by altering maternal carbohydrate, fat, and protein metabolism. The increase in RBCs is necessary to transport the additional oxygen required during pregnancy.

The nurse is teaching a pregnant woman about recommended weight gain. The woman has a prepregnancy body mass index (BMI) of 21. The nurse determines that the teaching was successful when the woman states that she should gain no more than which amount during pregnancy?

25 to 35 pounds (11 to 18 kilograms)

Women with a body mass index of 18.5 to 24.9 (considered healthy weight) should gain 25 to 35 pounds (11 to 18 kilograms). This client's BMI is 21 and is thus considered normal. A woman with a body mass index of 25 to 29.9 is considered overweight and should gain no more than 15 to 25 pounds (7 to 11 kilograms) during pregnancy. A woman with a body mass index less than 18.5 should gain 28 to 40 pounds (13 to 18 kilograms).

A teenager in the clinic is refusing to eat during her pregnancy because she does not want to "get fat." What information should the nurse provide on the outcomes of the infant related to poor maternal weight gain?

The infant will be small and could have problems.

Women who gain less than 16 pounds (7,257 grams) are at risk for giving birth to small infants, which is associated with poor neonatal outcomes.

At her 16-week checkup, a client's blood pressure is slightly decreased from her prepregnancy level. The nurse evaluates this change based on which statements concerning blood pressure during pregnancy?

A decrease in the second trimester may occur because of placental growth.

Because the placenta "traps" a great deal of blood for fetal circulation as it expands at about 3 months, maternal blood pressure may temporarily be slightly decreased. Otherwise, blood pressure stays fairly constant throughout pregnancy.

During a routine visit to the clinic, a client tells the nurse that she thinks she may be pregnant. The physician prescribes a pregnancy test. The nurse should know the purpose of this test is to determine which change in the client's hormone level?

increase in human chorionic gonadotropin (hCG)

hCG increases in a woman's blood and urine to fairly large concentrations until the 15th week of pregnancy. The other hormone values are not indicative of pregnancy.

The nurse midwife is performing a pelvic examination on a client who came to her following a positive home pregnancy test. The nurse checks the woman's cervix for the probable sign of pregnancy known as Goodell's sign. Which description illustrates this alteration?

The cervix softens.

At about the eighth week of gestation, the cervix softens, a probable sign known as Goodell's sign. The cervix also looks blue or purple when examined; this is Chadwick's sign, and may occur as early as the sixth week of pregnancy. At about 6 weeks, the lower uterine segment softens, a probable sign called Hegar's sign. A softening of the uterine fundus, where the embryo has implanted, also occurs by about the seventh week, and the fundus enlarges by the eighth week.

Amanda makes an appointment with an obstetrician. During the exam, the obstetrician notes that the uterine isthmus is soft. What is the name of this sign, and how is it classified?

Hegar's sign; probable

Probable signs of pregnancy are those detected by a trained examiner. The examiner identifies Hegar's sign, softening of the uterine isthmus, and Goodell's sign, softening of the cervix, during the speculum and digital pelvic examinations.

Place the following events in the sequence the pregnant woman would experience them, from first to last. All options must be used.

amennorhea
uterine enlargement
quickening
Braxton Hicks contractions
labor

The correct sequence is amenorrhea, uterine enlargement, quickening, Braxton Hicks contractions, and labor.

When caring for a newborn, the nurse observes that the neonate has developed white patches on the mucus membranes of the mouth. Which condition is the newborn most likely experiencing?

thrush

Monilial vaginitis is a benign fungal condition that is uncomfortable for women; it can be transmitted from an infected mother to her newborn at birth. Neonates develop an oral infection known as thrush, which presents as white patches on the mucus membranes of the mouth. Although rubella, toxoplasmosis, and cytomegalovirus are infections transmitted to the newborn by the mother, this newborn is not experiencing any of these infections. Rubella causes fetal defects, known as congenital rubella syndrome; common defects of rubella are cataracts, deafness, congenital heart defects, cardiac disease, and intellectual disability. Possible fetal effects due to toxoplasmosis include stillbirth, premature delivery, microcephaly, hydrocephaly, seizures, and intellectual disability, whereas possible effects of cytomegalovirus infection include small for gestational age (SGA), microcephaly, hydrocephaly, and intellectual disability.