Test Bank - Essentials of A) Pressure of the gravid uterus on the vena cava
B) A 50% increase in blood volume
Maternity, Newborn, and C) Physiologic anemia due to hemoglobin decrease
D) Pressure of the presenting fetal part on the diaphragm
Women's Health Nursing
(4th Edition)
Chapter 11: Maternal Adaptation during Pregnancy
1. During a vaginal exam, the nurse notes that the cervix has
a bluish color. The nurse documents this finding as:
A) Hegars sign
B) Goodells sign
C) Chadwicks sign
D) Ortolanis sign
Answer: C
Explanation: Common probable signs of pregnancy include
softening of the lower uterine segment or isthmus (Hegar’s
sign), softening of the cervix (Goodell’s sign), and a bluish-
purple coloration of the vaginal mucosa and cervix (Chadwick’s
sign)
2. The nurse teaches a primigravida client that lightening
occurs about 2 weeks before the onset of labor. The mother will
most likely experience which of the following at that time?
A) Dysuria
B) Dyspnea
C) Constipation
D) Urinary frequency
Answer: D
Explanation: The uterus remains in the pelvic cavity for the first
3 months of pregnancy, after which it progressively ascends
into the abdomen. As the uterus grows, it presses on the
urinary bladder and causes the increased frequency of urination
experienced during early pregnancy.
3. A gravida 2 para 1 client in the 10th week of her pregnancy
says to the nurse, “I’ve never urinated as often as I have for
the past three weeks.” Which response would be most
appropriate for the nurse to make?
A) Having to urinate so often is annoying. I suggest that
you watch how much fluid you are drinking and limit it.
B) You shouldn't be urinating this frequently now; it usually
stops by the time you’re eight weeks pregnant. Is there anything
else bothering you?
C) By the time you are 12 weeks pregnant, this frequent
urination should no longer be a problem, but it is likely to
return toward the end of your pregnancy.
D) Women having their second child generally don't
have frequent urination. Are you experiencing any
burning sensations?
Answer: C
Explanation: Lying on either side relieves the pressure that the
enlarged uterus puts on the vena cava carrying blood from the
legs. Subsequently, venous return to the heart increases,
leading to increased cardiac output. Increased cardiac output
results in increased renal perfusion and glomerular filtration. As
a rule, all the physiologic changes maximize by the end of the
second trimester and then start to return to the prepregnant
level. However, changes in the anatomy take up to 3 months
postpartum to subside.
4. In a client’s seventh month of pregnancy, she reports feeling
dizzy, like I'm going to pass out, when I lie down flat on my
back. The nurse integrates which of the following in to the
explanation?
, Answer: A
Explanation: The heavy gravid uterus in the last trimester can
fall back against the inferior vena cava in the supine position,
resulting in vena cava compression, which reduces venous
return and decreases cardiac output and blood pressure, with
increasing orthostatic stress. This occurs when the woman
changes her position from recumbent to sitting to standing.
This acute hemodynamic change, termed supine hypotensive
syndrome, causes the woman to experience symptoms of
weakness, light-headedness, nausea, dizziness, or syncope.
These changes are reversed when the woman is in the side-
lying position, which displaces the uterus to the left and off the
vena cava.
5. A primiparous client is being seen in the clinic for her first
prenatal visit. It is determined that she is 11 weeks pregnant.
The nurse develops a teaching plan to educate the client
about what she will most likely experience during this period.
Which of the following would the nurse include?
A) Ankle edema
B) Urinary frequency
C) Backache
D) Hemorrhoids
Answer: B
Explanation
:
6. A pregnant client in her second trimester has a hemoglobin
level of 11 g/dL. The nurse interprets this as indicating which
of the following?
A) Iron-deficiency anemia
B) A multiple gestation pregnancy
C) Greater-than-expected weight gain
D) Hemodilution of pregnancy
Answer: D
Explanation: Blood volume increases by approximately 1,500
mL, or up to 50% above nonpregnant levels, by the 32nd week
of gestation, and remains more or less constant thereafter. The
increase is made up of 1,000 mL plasma plus 450 mL red
blood cells. It begins at weeks 10 to 12, peaks at weeks 32 to
34, and decreases slightly by week 40. The maternal blood
volume expansion occurs at a larger proportion than the
increase in red blood cell mass, which results in physiologic
anemia and hemodilution. Criteria of physiologic anemia
include hemoglobin 10 g or less; red blood cells 3.5
million/mm3 and normal morphology with central pallor
7. The nurse is discussing the insulin needs of a primaparous
client with diabetes who has been using insulin for the past
few years. The nurse informs the client that her insulin needs
will increase during pregnancy based on the nurses
understanding that the placenta produces:
A) hCG, which increases maternal glucose levels
B) hPL, which deceases the effectiveness of insulin
C) Estriol, which interferes with insulin crossing the placenta
D) Relaxin, which decreases the amount of insulin produced
Answer: B
Explanation: After the first trimester, hPL from the placenta and
steroids (cortisol) from the adrenal cortex act against insulin.
hPL acts as an antagonist against maternal insulin, and thus
more insulin must be secreted to counteract the increasing
levels of hPL and cortisol during the last half of pregnancy.
B) A 50% increase in blood volume
Maternity, Newborn, and C) Physiologic anemia due to hemoglobin decrease
D) Pressure of the presenting fetal part on the diaphragm
Women's Health Nursing
(4th Edition)
Chapter 11: Maternal Adaptation during Pregnancy
1. During a vaginal exam, the nurse notes that the cervix has
a bluish color. The nurse documents this finding as:
A) Hegars sign
B) Goodells sign
C) Chadwicks sign
D) Ortolanis sign
Answer: C
Explanation: Common probable signs of pregnancy include
softening of the lower uterine segment or isthmus (Hegar’s
sign), softening of the cervix (Goodell’s sign), and a bluish-
purple coloration of the vaginal mucosa and cervix (Chadwick’s
sign)
2. The nurse teaches a primigravida client that lightening
occurs about 2 weeks before the onset of labor. The mother will
most likely experience which of the following at that time?
A) Dysuria
B) Dyspnea
C) Constipation
D) Urinary frequency
Answer: D
Explanation: The uterus remains in the pelvic cavity for the first
3 months of pregnancy, after which it progressively ascends
into the abdomen. As the uterus grows, it presses on the
urinary bladder and causes the increased frequency of urination
experienced during early pregnancy.
3. A gravida 2 para 1 client in the 10th week of her pregnancy
says to the nurse, “I’ve never urinated as often as I have for
the past three weeks.” Which response would be most
appropriate for the nurse to make?
A) Having to urinate so often is annoying. I suggest that
you watch how much fluid you are drinking and limit it.
B) You shouldn't be urinating this frequently now; it usually
stops by the time you’re eight weeks pregnant. Is there anything
else bothering you?
C) By the time you are 12 weeks pregnant, this frequent
urination should no longer be a problem, but it is likely to
return toward the end of your pregnancy.
D) Women having their second child generally don't
have frequent urination. Are you experiencing any
burning sensations?
Answer: C
Explanation: Lying on either side relieves the pressure that the
enlarged uterus puts on the vena cava carrying blood from the
legs. Subsequently, venous return to the heart increases,
leading to increased cardiac output. Increased cardiac output
results in increased renal perfusion and glomerular filtration. As
a rule, all the physiologic changes maximize by the end of the
second trimester and then start to return to the prepregnant
level. However, changes in the anatomy take up to 3 months
postpartum to subside.
4. In a client’s seventh month of pregnancy, she reports feeling
dizzy, like I'm going to pass out, when I lie down flat on my
back. The nurse integrates which of the following in to the
explanation?
, Answer: A
Explanation: The heavy gravid uterus in the last trimester can
fall back against the inferior vena cava in the supine position,
resulting in vena cava compression, which reduces venous
return and decreases cardiac output and blood pressure, with
increasing orthostatic stress. This occurs when the woman
changes her position from recumbent to sitting to standing.
This acute hemodynamic change, termed supine hypotensive
syndrome, causes the woman to experience symptoms of
weakness, light-headedness, nausea, dizziness, or syncope.
These changes are reversed when the woman is in the side-
lying position, which displaces the uterus to the left and off the
vena cava.
5. A primiparous client is being seen in the clinic for her first
prenatal visit. It is determined that she is 11 weeks pregnant.
The nurse develops a teaching plan to educate the client
about what she will most likely experience during this period.
Which of the following would the nurse include?
A) Ankle edema
B) Urinary frequency
C) Backache
D) Hemorrhoids
Answer: B
Explanation
:
6. A pregnant client in her second trimester has a hemoglobin
level of 11 g/dL. The nurse interprets this as indicating which
of the following?
A) Iron-deficiency anemia
B) A multiple gestation pregnancy
C) Greater-than-expected weight gain
D) Hemodilution of pregnancy
Answer: D
Explanation: Blood volume increases by approximately 1,500
mL, or up to 50% above nonpregnant levels, by the 32nd week
of gestation, and remains more or less constant thereafter. The
increase is made up of 1,000 mL plasma plus 450 mL red
blood cells. It begins at weeks 10 to 12, peaks at weeks 32 to
34, and decreases slightly by week 40. The maternal blood
volume expansion occurs at a larger proportion than the
increase in red blood cell mass, which results in physiologic
anemia and hemodilution. Criteria of physiologic anemia
include hemoglobin 10 g or less; red blood cells 3.5
million/mm3 and normal morphology with central pallor
7. The nurse is discussing the insulin needs of a primaparous
client with diabetes who has been using insulin for the past
few years. The nurse informs the client that her insulin needs
will increase during pregnancy based on the nurses
understanding that the placenta produces:
A) hCG, which increases maternal glucose levels
B) hPL, which deceases the effectiveness of insulin
C) Estriol, which interferes with insulin crossing the placenta
D) Relaxin, which decreases the amount of insulin produced
Answer: B
Explanation: After the first trimester, hPL from the placenta and
steroids (cortisol) from the adrenal cortex act against insulin.
hPL acts as an antagonist against maternal insulin, and thus
more insulin must be secreted to counteract the increasing
levels of hPL and cortisol during the last half of pregnancy.
