NUR 365 Chapter 13 PDF

Preview

Summary

study guide...

Description

NUR 365 Chapter 13: Ana Anatomy tomy and Ph Physiology ysiology of Pre Pregnancy gnancy My Nursing T Test est Banks Chapter 13: Anatomy and Physiology of Pregnancy Lowdermilk: Maternity & Womens Health Care, 11th Edition MULTIPLE CHOICE 1. A womans 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

ANS: B

Using the GTPAL system, 4-1-2-0-4 is the correct calculation of this womans gravidity and parity. The numbers reflect the womans gravidity and parity information. Her information is calculated as: G reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies resulted in a fetus at term. P is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L signifies the number of children born who are currently living; the woman has four children. 3-1-1-1-3 is an incorrect calculation of this womans gravidity and parity; 3-0-3-0-3 is an incorrect calculation of this womans gravidity and parity; and 4-2-1-0-3 is an incorrect calculation of this womans gravidity and parity.

DIF: Cognitive Level: Understand REF: p. 284 TOP: Nursing Process: Diagnosis

MSC: Client Needs: Health Promotion and Maintenance

2. Which presumptive sign or symptom of pregnancy would a client experience who is approximately 10 weeks of gestation?

a.

Amenorrhea

b.

Positive pregnancy test

c.

Chadwick sign

d.

Hegar sign

ANS: A

Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman. A positive pregnancy test and the presence of the Chadwick and Hegar signs are all probable signs of pregnancy.

DIF: Cognitive Level: Understand REF: p. 285

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

3. A client is seen at the clinic at 14 weeks of gestation for a follow-up appointment. At which level does the nurse expect to palpate the fundus?

a.

Nonpalpable above the symphysis at 14 weeks of gestation

b.

Slightly above the symphysis pubis

c.

At the level of the umbilicus

d.

Slightly above the umbilicus

ANS: B

In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. At 14

weeks, the uterus is not yet at the level of the umbilicus. The fundus is not palpable above the umbilicus until 22 to 24 weeks of gestation.

DIF: Cognitive Level: Apply REF: p. 286

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. The musculoskeletal system adapts to the changes that occur throughout the pregnancy. Which musculoskeletal alteration should the client expect?

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.

ANS: B

An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain balance. The center of gravity shifts forward. She will have decreased abdominal muscle tone and will notice increased mobility of her pelvic joints.

DIF: Cognitive Level: Understand REF: p. 296 TOP: Nursing Process: Planning

MSC: Client Needs: Physiologic Integrity

5. A 31-year-old woman believes that she may be pregnant. She took an over-the-counter (OTC) pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the womans last menstrual period and asks whether she is taking any medications. The client states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which confirms that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?

a.

The pregnancy test was taken too early.

b.

Anticonvulsant medications may cause the false-positive test result.

c.

The woman has a fibroid tumor.

d.

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

ANS: B

Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests use enzyme-linked immunosorbent assay (ELISA) technology, which can yield positive results as soon as 4 days after implantation. Implantation occurs 6 to 10 days after conception. If the woman were pregnant, then she would be into her third week at this point (having missed her period 1 week ago). Fibroid tumors do not produce hormones and have no bearing on human chorionic gonadotropin (hCG) pregnancy tests. Although stress may interrupt normal hormone cycles (menstrual cycles), it does not affect hCG levels or produce positive pregnancy test results.

DIF: Cognitive Level: Apply REF: p. 285

TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

6. A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. Which statement best describes why this may be happening to this client?

a.

This respiratory change is normal in pregnancy and caused by an elevated level of estrogen.

b.

This cardiovascular change is abnormal, 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 intranasally using cocaine.

ANS: A

Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract, which may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in the lower extremities. Domestic violence cannot be determined on the basis on the sparse facts provided. If the woman had been hit in the face, then she most likely would have additional physical findings. Cocaine use cannot be determined on the basis on the sparse facts provided.

DIF: Cognitive Level: Apply REF: p. 294

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

7. The nurse is providing education to a client regarding the normal changes of the breasts during pregnancy. Which statement regarding these changes is correct?

a.

The visibility of blood vessels that form an intertwining blue network indicates full function of the Montgomery tubercles and possibly an 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.

ANS: C

Lactation is inhibited until after birth. The visible blue network of blood vessels is a normal outgrowth of a richer blood supply. The mammary glands are functionally complete by midpregnancy. Colostrum is a creamy white-to-yellow premilk fluid that can be expressed from the nipples before birth.

DIF: Cognitive Level: Understand REF: p. 290 TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

8. Which hormone is essential for maintaining pregnancy?

a.

Estrogen

b.

hCG

c.

Oxytocin

d.

Progesterone

ANS: D

Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles, which reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. hCG levels rise at implantation but decline after 60 to 70 days. Oxytocin stimulates uterine contractions.

DIF: Cognitive Level: Remember REF: p. 299

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

9. Which clinical finding in a primiparous client at 32 weeks of gestation might be an indication of anemia?

a.

Ptyalism

b.

Pyrosis

c.

Pica

d.

Decreased peristalsis

ANS: C

Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. Cravings include ice, clay, and laundry starch. Ptyalism (excessive salivation), pyrosis (heartburn), and decreased peristalsis are normal findings.

DIF: Cognitive Level: Analyze REF: p. 298

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

10. Why might it be more difficult to diagnose appendicitis during pregnancy?

a.

The appendix is displaced upward and laterally, high and to the right.

b.

The appendix is displaced upward and laterally, high and to the left.

c.

The appendix is deep at the McBurneys point.

d.

The appendix is displaced downward and laterally, low and to the right.

ANS: A

The appendix is displaced high and to the right, not to the left. It is displaced beyond the McBurneys point and is not displaced in a downward direction.

DIF: Cognitive Level: Understand REF: p. 298 TOP: Nursing Process: Diagnosis

MSC: Client Needs: Physiologic Integrity

11. The nurse is providing health education to a pregnant client regarding the cardiovascular system. Which information is correct and important to share?

a.

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

b.

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

c.

Palpitations are twice as likely to occur in twin gestations.

d.

All of the above changes will likely occur.

ANS: B

These auscultatory changes should be discernible after 20 weeks of gestation. A healthy woman with no underlying heart disease does not need any therapy. The maternal heart rate increases in the third trimester, but palpitations may not necessarily occur, let alone double. Auditory changes are discernible at 20 weeks of gestation.

DIF: Cognitive Level: Understand REF: p. 290 TOP: Nursing Process: Planning

MSC: Client Needs: Physiologic Integrity

12. Which statement regarding the probable signs of pregnancy is most accurate?

a.

Determined by ultrasound

b.

Observed by the health care provider

c.

Reported by the client

d.

Confirmed by diagnostic tests

ANS: B

Probable signs are those detected through trained examination. Fetal visualization is a positive sign of pregnancy. Presumptive signs are those reported by the client. The term diagnostic tests is open for interpretation. To actually diagnose pregnancy, one would have to see positive signs of pregnancy.

DIF: Cognitive Level: Understand REF: p. 285

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

13. Which time-based description of a stage of development in pregnancy is correct?

a.

Viability22 to 37 weeks of gestation since the last menstrual period (assuming a fetal weight greater than 500 g)

b.

Termpregnancy from the beginning of 38 weeks of gestation to the end of 42 weeks of gestation

c.

Pretermpregnancy from 20 to 28 weeks of gestation

d.

Postdatepregnancy that extends beyond 38 weeks of gestation

ANS: B

Term is 38 to 42 weeks of gestation. Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since the last menstrual period. Preterm is 20 to 37 weeks of gestation. Postdateor postterm is a pregnancy that extends beyond 42 weeks of gestation or what is considered the limit of full term.

DIF: Cognitive Level: Remember REF: p. 283 TOP: Nursing Process: Diagnosis

MSC: Client Needs: Health Promotion and Maintenance

14. hCG is an important biochemical marker for pregnancy and therefore the basis for many tests. Which statement regarding hCG is true?

a.

hCG can be detected as early as weeks after conception.

b.

hCG levels gradually and uniformly increase throughout pregnancy.

c.

Significantly lower-than-normal increases in the levels of hCG may indicate a postdate pregnancy.

d.

Higher-than-normal levels of hCG may indicate an ectopic pregnancy or Down syndrome.

ANS: D

Higher hCG levels also could be a sign of a multiple gestation. hCG can be detected as early as 7 to 10 days after conception. The hCG levels fluctuate during pregnancy, peaking, declining, stabilizing, and then increasing again. Abnormally slow increases may indicate impending miscarriage.

DIF: Cognitive Level: Understand REF: p. 284 TOP: Nursing Process: Diagnosis

MSC: Client Needs: Health Promotion and Maintenance

15. Of which physiologic alteration of the uterus during pregnancy is it important for the nurse to alert the patient?

a.

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

b.

Womans increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening.

c.

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

d.

Uterine souffle is the movement of the fetus.

ANS: B

The softening of the lower uterine segment is called the Hegar sign. In this position, the uterine fundus presses on the bladder, causing urinary frequency that is a normal change of pregnancy. Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

DIF: Cognitive Level: Understand REF: p. 287 TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

16. What is the correct term used to describe the mucous plug that forms in the endocervical canal?

a.

Operculum

b.

Leukorrhea

c.

Funic souffle

d.

Ballottement

ANS: A

The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the umbilical vessels. Ballottement is a technique for palpating the fetus.

DIF: Cognitive Level: Remember REF: p. 289

TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

17. Some pregnant clients may complain of changes in their voice and impaired hearing. What should the nurse explain to the client concerning these findings?

a.

Voice changes are caused by decreased estrogen levels.

b.

Displacement of the diaphragm results in thoracic breathing.

c.

Voice changes and impaired hearing are due to the results of congestion and swelling of the upper respiratory tract.

d.

Increased blood volume causes changes in the voice.

ANS: C

Although the diaphragm is displaced and the volume of blood is increased, neither causes changes in the voice nor impairs hearing. The key is that estrogen levels increase, not decrease, which causes the upper respiratory tract to become more vascular, which produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing.

DIF: Cognitive Level: Understand REF: p. 294 TOP: Nursing Process: Planning

MSC: Client Needs: Physiologic Integrity

18. Which renal system adaptation is an anticipated anatomic change of pregnancy?

a.

Increased urinary output makes pregnant women less susceptible to urinary infections.

b.

Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even when the bladder is almost empty.

c.

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

d.

Using diuretic agents during pregnancy can help keep kidney function regular.

ANS: B

Bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often, even when the bladder is almost empty. A number of anatomic changes in pregnancy make a woman more susceptible to urinary tract infections. Renal function is more efficient when the woman lies in the lateral recumbent position and is less efficient when she is supine. Diuretic use during pregnancy can overstress the system and cause problems.

DIF: Cognitive Level: Understand REF: pp. 294-295 TOP: Nursing Process: Planning

MSC: Client Needs: Physiologic Integrity

19. A pregnant client tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal changes. What is the correct term for this integumentary finding?

a.

Melasma

b.

Linea nigra

c.

Striae gravidarum

d.

Palmar erythema

ANS: A

Melasma, (also called chloasma, the mask of pregnancy), usually fades after birth. This hyperpigmentation of the skin is more comm...