306 Ricci Chapter 11: Maternal Adaptation
During Pregnancy UPDATED ACTUAL
Exam Questions and CORRECT Answers
A client at 16 weeks' gestation comes to the office for a routine exam. At what location within
the abdomen would the nurse anticipate the uterus to be found? - CORRECT ANSWER -
halfway between the symphysis pubis and the umbilics
As the pregnancy progresses, the uterus enlarges and enters the abdominal cavity. At 16 weeks,
the nurse should be able to palpate the uterus halfway between the symphysis pubis and the
umbilicus.
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? - CORRECT ANSWER - influence of estrogen and blood
vessel proliferation
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.
During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale
while supine. What should the nurse do first? - CORRECT ANSWER - turn the client on
her left side
As the enlarging uterus increases pressure on the inferior vena cava, it compromises venous
return, which can cause dizziness, light-headedness, and pallor when the client is supine. The
nurse can relieve these symptoms by turning the client on her left side, which relieves pressure
,on the vena cava and restores venous return. Although they are valuable assessments, fetal heart
tone and maternal blood pressure measurements do not correct the problem. Because deep
breathing has no effect on venous return, it cannot relieve the client's symptoms.
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? - CORRECT
ANSWER - "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.
In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which
information would the nurse most likely include? - CORRECT ANSWER - over the
counter antacids can be used to treat acid reflux with the healthcare providers knowledge
Elevated progesterone levels cause smooth muscle relaxation, which can result in relaxation of
the cardiac sphincter and reflux of the stomach contents into the lower esophagus. OTC antacids
will usually relieve the symptoms but should be discussed with the health care provider first. The
hormonal changes are necessary for the pregnancy to continue, and the woman will return to her
usual nonpregnant hormonal levels after the baby is born. Taking hormonal replacement therapy
is not recommended. Using herbs should be done only with the knowledge of the health care
practitioner due to the side effects and contraindications of some herbs during pregnancy. Some
herbs will cause a spontaneous abortion (miscarriage).
, A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur
during pregnancy. Which hormones would the nurse most likely identify as being inhibited
during the pregnancy? - CORRECT ANSWER - FSH and LH
During pregnancy, FSH and LH are both inhibited as there is no need to develop a follicle and
release an ovum. There is an increase in the secretion of T4 and MSH. There is a decrease in the
production of GH and MSH but not an inhibition.
A nurse is explaining how hormones affect the pregnancy. Which hormone would the nurse
describe as being responsible for stimulating uterine contractions during labor and birth? -
CORRECT ANSWER - oxytocin
Oxytocin is responsible for stimulating the uterine contractions that bring about delivery.
Progesterone and estrogen help maintain the pregnancy, and prolactin helps with stimulating
milk production after the delivery.
On a routine hematocrit screen during a prenatal visit, the nurse notices that the client is mildly
anemic. When discussing this with the couple, the husband hints that she might be eating unusual
things. The nurse recognizes the need for the woman to be evaluated for which condition? -
CORRECT ANSWER - pica
Pica is the compulsive ingestion of nonfood substances. Pregnant women who develop a pica
habit typically have one or two specific cravings. The three main substances consumed by
women with pica are soil or clay, ice, and laundry starch. These substances replace nutritive
sources and can lead to complications such as iron-deficiency anemia, infection, and
constipation.
The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the
nurse anticipate documenting? - CORRECT ANSWER - darkened breast areolae
As part of the pigment changes that occur with pregnancy, breast areolae become darker. The
breast tissue should not be softer or slacker than before. There should not yet be any lymph
enlargement, and the nipples should not have fissures.
During Pregnancy UPDATED ACTUAL
Exam Questions and CORRECT Answers
A client at 16 weeks' gestation comes to the office for a routine exam. At what location within
the abdomen would the nurse anticipate the uterus to be found? - CORRECT ANSWER -
halfway between the symphysis pubis and the umbilics
As the pregnancy progresses, the uterus enlarges and enters the abdominal cavity. At 16 weeks,
the nurse should be able to palpate the uterus halfway between the symphysis pubis and the
umbilicus.
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? - CORRECT ANSWER - influence of estrogen and blood
vessel proliferation
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.
During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale
while supine. What should the nurse do first? - CORRECT ANSWER - turn the client on
her left side
As the enlarging uterus increases pressure on the inferior vena cava, it compromises venous
return, which can cause dizziness, light-headedness, and pallor when the client is supine. The
nurse can relieve these symptoms by turning the client on her left side, which relieves pressure
,on the vena cava and restores venous return. Although they are valuable assessments, fetal heart
tone and maternal blood pressure measurements do not correct the problem. Because deep
breathing has no effect on venous return, it cannot relieve the client's symptoms.
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? - CORRECT
ANSWER - "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.
In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which
information would the nurse most likely include? - CORRECT ANSWER - over the
counter antacids can be used to treat acid reflux with the healthcare providers knowledge
Elevated progesterone levels cause smooth muscle relaxation, which can result in relaxation of
the cardiac sphincter and reflux of the stomach contents into the lower esophagus. OTC antacids
will usually relieve the symptoms but should be discussed with the health care provider first. The
hormonal changes are necessary for the pregnancy to continue, and the woman will return to her
usual nonpregnant hormonal levels after the baby is born. Taking hormonal replacement therapy
is not recommended. Using herbs should be done only with the knowledge of the health care
practitioner due to the side effects and contraindications of some herbs during pregnancy. Some
herbs will cause a spontaneous abortion (miscarriage).
, A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur
during pregnancy. Which hormones would the nurse most likely identify as being inhibited
during the pregnancy? - CORRECT ANSWER - FSH and LH
During pregnancy, FSH and LH are both inhibited as there is no need to develop a follicle and
release an ovum. There is an increase in the secretion of T4 and MSH. There is a decrease in the
production of GH and MSH but not an inhibition.
A nurse is explaining how hormones affect the pregnancy. Which hormone would the nurse
describe as being responsible for stimulating uterine contractions during labor and birth? -
CORRECT ANSWER - oxytocin
Oxytocin is responsible for stimulating the uterine contractions that bring about delivery.
Progesterone and estrogen help maintain the pregnancy, and prolactin helps with stimulating
milk production after the delivery.
On a routine hematocrit screen during a prenatal visit, the nurse notices that the client is mildly
anemic. When discussing this with the couple, the husband hints that she might be eating unusual
things. The nurse recognizes the need for the woman to be evaluated for which condition? -
CORRECT ANSWER - pica
Pica is the compulsive ingestion of nonfood substances. Pregnant women who develop a pica
habit typically have one or two specific cravings. The three main substances consumed by
women with pica are soil or clay, ice, and laundry starch. These substances replace nutritive
sources and can lead to complications such as iron-deficiency anemia, infection, and
constipation.
The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the
nurse anticipate documenting? - CORRECT ANSWER - darkened breast areolae
As part of the pigment changes that occur with pregnancy, breast areolae become darker. The
breast tissue should not be softer or slacker than before. There should not yet be any lymph
enlargement, and the nipples should not have fissures.
