Prep-U Points Chapter 11

*PREP-U POINTS CHAPTER 11* CHAPTER 11: A client who has just given a blood sample for pregnancy testing in the health care provider's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy? o Correct response: Visualization of the fetus by ultrasound  Explanation: There are only three documented or positive signs of pregnancy :  1) demonstration of a fetal heart separate from the mother's  2) fetal movements felt by an examiner.  3) visualization of the fetus by ultrasound.  The absence of a period is an example of a presumptive symptom, which is a symptom that, when taken as a single entity, could easily indicate other conditions.  Laboratory tests of either urine or blood serum for human chorionic gonadotropin (hCG) are examples of probable signs of pregnancy, which are objective and so can be verified by an examiner. A client's menstrual period is two weeks late. She has been feeling tired and has had episodes of nausea in the morning. What classification of pregnancy symptoms is this client experiencing? o Correct response: Presumptive  Explanation: The most common presumptive signs of pregnancy is a  Missed menstrual period (Amenorrhea).  Nausea  Fatigue  Swollen / Tender breasts  Frequent urination. A pregnant client in her first trimester of pregnancy reports spontaneous, irregular, painless contractions. What does this indicate? o Correct response: Braxton Hicks contractions  Explanation: 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. Chapter 11: A nurse is conducting a nutrition class for a group of pregnant women. What information accurately addresses this issue? Select all that apply. o Correct response:  Total iron requirements equal 1,000 mg, with the greatest need being in the second trimester.  Calcium supplements may decrease the chance of developing pre-eclampsia in women who had a pre-existing deficiency.  Since an iodine deficiency can cause intellectual deficits in infants, mothers are recommended to use iodized salt. o Incorrect response:  Folic acid is needed during the third trimester to reduce the chance of birth defects such as neural tube defects and cleft lip/palate.  The baby will require increased protein for development, so the mother needs to ingest 8 to 9 g of additional protein per day above her non-pregnant requirements.  Explanation: o Pregnant women need an increase of 5 to 6 g (not 8 to 9 g) of protein above their pre-pregnancy amounts to support fetal growth. o The iron requirements increase dramatically after 20 weeks' gestation to build the fetus’s RBC supply. o Women who take calcium supplements during pregnancy may have a reduced chance of pre-eclampsia, if they had a prepregnancy deficit. o Iodine deficiencies can lead to cretinism, which causes mental deficits and stunted growth, so an easy fix is to use iodized salt while pregnant until there are other health issues that contradict its use. o Folic acid is needed in the first trimester, not the third one, to reduce the incidence of neural tube defects because her fetus’s spinal column forms early in the pregnancy. Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks' pregnant. The nurse would expect this woman's heart rate to be approximately: o Correct response: 85 beats per minute.  Explanation: During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a pre-pregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute. The nurse is preparing to teach a community class to a group of first-time parents. Which information should the nurse include concerning what the pregnant woman's partner may experience as a normal response? o Correct response: Physical symptoms similar to the mother.  Explanation: Couvade syndrome is the occurrence of physical symptoms by the partner, similar to the physical symptoms of the mother. Other emotional symptoms may occur, but they are typically on a person-to-person basis. Chapter 11: A client who is entering her third trimester comes to the prenatal clinic for a follow-up examination. When assessing the breasts, which findings would the nurse expect? Select all that apply. o Correct response:  Prominent veins  Hyperpigmentation of the nipple  Increased sensitivity o Incorrect response:  Pallor of the areolae  Warmth  Explanation: Normal breast findings include prominent veins, nodular breasts, increased sensitivity to touch, and hyperpigmentation of the nipples and areolae. Warmth would suggest possible infection. 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? o Correct response: Inform the client this is a normal response to pregnancy that many women experience.  Explanation: 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 pregnant client is reporting shortness of breath. To ensure there are no developing complications, a tidal volume is obtained. What type of results will the nurse expect? o Correct response: Increase between 30% and 40%  Explanation: Enlargement of the uterus shifts the diaphragm up to 4 cm above its usual position. As muscles and cartilage in the thoracic region relax, the chest broadens with conversion from abdominal breathing to thoracic breathing. This leads to a 50% increase in air volume per minute. Tidal volume, or the volume of air inhaled, increases gradually by 30% to 40% (from 500 to 700 ml) as the pregnancy progresses. During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which effect of pregnancy? o Correct response: Influence of estrogen and blood vessel proliferation  Explanation: During pregnancy, the gums become hyperemic, swollen, and friable and tend to bleed easily. This change is influenced by estrogen and increased proliferation of blood vessels and circulation to the mouth.  Elevated progesterone levels cause smooth muscle relaxation, which results in delayed gastric emptying and decreased peristalsis.  Increased venous pressure contributes to the formation of hemorrhoids. Relaxation of the cardiac sphincter, in conjunction with slowed gastric emptying, leads to reflux due to regurgitation of the stomach contents into the upper esophagus. Chapter 11: A urinalysis is done on a client in her third trimester. Which result would be considered abnormal? o Correct response: 2+ Protein in urine  Explanation: During pregnancy, there may be a slight amount of glucose found in the urine due to the fact that the kidney tubules are not able to absorb as much glucose as there were before pregnancy. However, there should be minimal protein in the urine. A specific gravity of 1.010 and a straw- like color are both normal findings. What physiological changes would be noted in a pregnant woman? Select all that apply. o Correct response:  Enlarged pituitary gland  Lordosis  Delayed gastric emptying and decreased peristalsis o Incorrect response:  Decreased prolactin levels  Increased hemoglobin and hematocrit  Explanation: o During pregnancy, the pituitary gland increases in size ~35% to accommodate the increased need of the hormones being produced. o Lordosis occurs to counterbalance the protuberant abdomen of the pregnant woman. o Due to the increased uterine size that protrudes into the abdominal cavity and decreased motility, decreased gastric emptying may occur leading to heartburn and decreased peristalsis, which leads to constipation. 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? o Correct response: Place the client in the left lateral position.  Explanation:  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. Chapter 11: The nurse is counseling a client with a BMI of 23 about weight gain during pregnancy. The nurse teaches the client that during the second and third trimester of pregnancy, dietary intake should be increase by how many calories per day above what she was eating prior to the pregnancy? o Correct response: 300  Explanation: A BMI of 23 is considered a healthy weight. For clients at a healthy weight, 300 additional calories are needed to support fetal growth in the second and third trimester of the pregnancy. If the client had been underweight, more calories would have been recommended; if the client had been obese, less calories would have been recommended. Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called? o Correct response: Melasma (chloasma)  Explanation: The so-called mask of pregnancy, melasma (also known as chloasma) can appear as brown blotchy areas on the forehead, cheeks, and nose of the pregnant woman. This condition may be permanent, or it may regress between pregnancies. 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 (dilatation) and enlargement of the birth canal. What is this hormone? o Correct response: Relaxin  Explanation: 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 dilation (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 known8d as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective and thereby allowing more glucose to become available for fetal growth. The nurse is assessing a pregnant client in her third trimester who is reporting a first-time occurrence of constipation. When asked why this is happening, what is the best response from the nurse? o Correct response: The intestines are displaced by the growing fetus.  Explanation: The growing fetus is displacing the intestines and interfering with peristalsis, delaying the passage of fecal matter and resulting in constipation. This is common and expected; however, the client should take measures to prevent hemorrhoids that can occur as the result of the pressure and straining. Progesterone, not hCG, can delay gastric emptying and decrease peristalsis. Chapter 11: 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? o Correct response: Goodell sign  Explanation: The description of a Goodell sign is softening of the cervix.  Ballottement is when tapping the lower uterine segment on a bimanual exam elicits the fetus to rise against the abdominal wall.  Chadwick sign is when the vagina changes color from pink to violet.  Hegar sign is softening of the lower uterine segment. An obstetrical nurse is conducting a program for pregnant women who are in their first trimester. The program focuses on the changes occurring in the woman's body as a result of the pregnancy. When describing the effect of changing hormonal levels, which information would the nurse most likely include? Select all that apply. o Correct response:  Maintenance of the endometrium so that the embryo can implant  Maternal metabolic changes to make nutrients available for mother and fetus  Relaxation of the ligaments that connect the pelvic bones, allowing them to spread slightly  Preparing the breasts for lactation, keeping the milk from coming in until birth occurs o Incorrect response:  Decrease in maternal blood volume and red blood cell mass to increase oxygen delivery  Decrease in blood supply to the gastrointestinal tract and slowing of peristaltic waves  Explanation: The hormonal effects of pregnancy include the following: o Maintaining the endometrium so that the embryo can implant, causing changes in the mother's metabolism so that nutrients are available for both o Relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly o Preparing the breasts for lactation, keeping the milk from coming in until birth occurs o Increasing the mother's blood volume and red blood cell mass to increase oxygen o Increasing the blood supply to the gastrointestinal tract and slowing peristaltic waves