TB-Chapter 31 The Pregnant Woman jarvis PDF

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this is the javis test bank practice questions for the chapter listed above, eighth edition version of the textbook....

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK

TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

457

Chapter31:ThePregnantWoman MULTIPLECHOICE 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.

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.Theotheroptionsare notcorrect. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:General 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. NURSINGTB.COM a.

Positive

b.

Possible

c.

Probable

d.

Presumptive

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orpositivecardiacactivityonultrasound. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 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prepregnancysystolicbloodpressure.Thenurseshould: a.

Considerthisanormalfinding.

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

458

b.

Expectthebloodpressuretodecreaseas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.

ANS:C Duringtheseventhgestationalweek,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prepregnancy measurements.Inthiscase,thewomansbloodpressureishigherthanitshouldbe. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:HealthPromotionandMaintenance 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 babysheartbeat.Thenurseshouldreply: a.

Thebabysheartbeatisnotusuallyhearduntilthesecondtrimester.

b.

Thebabysheartbeatmaybeheardanywherefromtheninthtothetwelfthweek.

c.

NURSINGTB.COM 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.

ANS:B FetalhearttonescanbeheardwiththeuseoftheDopplerdevicebetween9and12weeks.Theotherresponses areincorrect. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 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shouldreply: 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improve.

d.

Atapproximatelythetimeyoubegintofeelthebabymove,thenauseaandvomitingwillsubside.

ANS:C

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

459

Thenausea,vomiting,andfatigueofpregnancyimprovebythe12thweek.Quickening,whenthemother recognizesfetalmovement,occursatapproximately18to20weeks. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 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thewomansmilkiscomingin.

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.

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thanmaturemilk.Theotheroptionsare incorrect. DIF:CognitiveLevel:Analyzing(Analysis) NURSINGTB.COM

MSC:ClientNeeds:HealthPromotionandMaintenance 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.

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. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

460

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.

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.Theotheroptionsarenotcorrect. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 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. NURSINGTB.COM

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.

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.Theotheractionsarenotappropriate. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:HealthPromotionandMaintenance 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nurses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.

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

d.

461

Asyourbabygrows,itslowsbloodreturnfromyourlegs,causingtheswelling.Thisoftenoccurs withprolongedstanding.

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pathologiccondition. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 11.Whenassessingawomanwhoisinherthirdtrimesterofpregnancy,thenurselooksfortheclassic symptomsassociatedwithpreeclampsia,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. NURSINGTB.COM

ANS:B Theclassicsymptomsofpreeclampsiaarehypertensionandproteinuria.Headachesmayoccurwithworsening symptoms,andseizuresmayoccurifpreeclampsiaisleftuntreatedandleadstoeclampsia.Aseriousvariantof preeclampsia,thehemolysis,elevatedliverenzymes,lowplateletcount(HELLP)syndrome,isanominous picture.Edemaisacommonoccurrenceinpregnancy. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 12.Thenurseknowsthatthebesttimetoassessawomansbloodpressureduringaninitialprenatalvisitis: a.

Attheendoftheexaminationwhenshewillbethemostrelaxed.

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.

ANS:A Assessingthewomansbloodpressureattheendoftheexamination,whenitishopedthatshewillbemost relaxed,isthebesttimetoassessbloodpressure.Theotheroptionsarenotcorrect.

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

462

DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 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.

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.Striaeisthetermforstretch marks.Thelineanigraisahyperpigmentedlinethatbeginsatthesternalnotchandextendsdowntheabdomen throughtheumbilicustothepubis. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare NURSINGTB.COM 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

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. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 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:

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

a.

Murmurofaorticstenosis.

b.

Mostlikelyamammarysouffle.

c.

Associatedwithaorticinsufficiency.

d.

Indicationofapatentductusarteriosus.

463

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souffle,butitmaybemistaken foracardiacmurmur.Theotheroptionsareincorrect. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:HealthPromotionandMaintenance 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+ NURSINGTB.COM

c.

4+

d.

Briskreflexesandthepresenceofclonus

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thepreeclampticwoman. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 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.

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

d.

464

Thewomanshouldbetoldthatshemayhaveadifficulttimewithdeliverybecauseofthe weaknessinherabdominalmuscles.

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. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 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centimetersshouldapproximatethenumberofweeks gestation.

d.

Fundalheightisusuallylessthanthenumberofweeksgestation,unlessanabnormalcondition NURSINGTB.COM suchasexcessiveamnioticfluidispresent.

ANS:C After20weeksgestation,thenumberofcentimetersshouldapproximatethenumberofweeksgestation.In addition,at20weeksgestation,theexaminermaybeabletofeelfetalmovementandtheheadcanbeballoted. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:HealthPromotionandMaintenance 19.Thenurseispalpatingtheabdomenofawomanwhois35weekspregnantandnoticesthatthefetalheadis facingdownwardtowardthepelvis.Thenursewoulddocumentthisasfetal: a.

Lie.

b.

Variety.

c.

Attitude.

d.

Presentation.

ANS:D Fetalpresentationdescribesthepartofthefetusthatisenteringthepelvisfirst.Fetallieisorientationofthe fetalspinetothematernalspine.Fetalattitudeisthepositionoffetalpartsinrelationtoeachother,andfetal

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

465

varietyisthelocationofthefetalbacktothematernalpelvis. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 20.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.

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approximat...