Chapter 13 Adaptations to Pregnancy

Chapter 13  Adaptations to Pregnancy

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A pregnant woman’s mother is worried that her daughter is not “big enough” at 20 weeks. The

nurse palpates and measures the fundal height at 20 cm, which is even with the woman’s
umbilicus. What should the nurse report to the woman and her mother?
a. “The body of the uterus is at the belly button level, just where it should be at this

time.”
b. “You’re right. We’ll inform the practitioner immediately.”
c. “When you come for next month’s appointment, we’ll check you again to make

sure that the baby is growing.”
d. “Lightening has occurred, so the fundal height is lower than expected.”

ANS: A
At 20 weeks, the fundus is usually located at the umbilical level. Because the uterus grows in
a predictable pattern, obstetric nurses should know that the uterus of 20 weeks of gestation is
located at the level of the umbilicus. There is no need to inform the practitioner. The nurse
should reassure both mother and patient that the findings are normal. The descent of the fetal
head (lightening) occurs in late pregnancy.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 214 | p. 229 OBJ: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance

2. While the nurse assesses the vital signs of a pregnant woman in her third trimester, the patient

complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?
a. Have the patient stand up and retake her blood pressure.
b. Have the patient sit down and hold her arm in a dependent position.
c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both

arms.
d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

ANS: D
Blood pressure is affected by positions during pregnancy. The supine position may cause
occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral
recumbent position alleviates pressure on the blood vessels and quickly corrects supine
hypotension. Pressures are significantly higher when the patient is standing. This option
causes an increase in systolic and diastolic pressures. The arm should be supported at the
same level of the heart. The supine position may cause occlusion of the vena cava and
descending aorta, creating hypotension.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 216 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity

3. A pregnant woman has come to the emergency department with complaints of nasal

congestion and epistaxis. What action by the nurse is best?
a. Refer the patient to an ear, nose, and throat specialist.

b. Explain that nasal stuffiness and nosebleeds are caused by a decrease in
progesterone.

c. Attach the woman to a cardiac monitor, and draw blood for hemoglobin and
hematocrit.

d. Teach that the increased blood supply to the mucous membranes and can result in
congestion and nosebleeds.

ANS: D
As capillaries become engorged, the upper respiratory tract is affected by the subsequent
edema and hyperemia, which causes these conditions, seen commonly during pregnancy. No
referral is needed. The patient does not need to be attached to a cardiac monitor or have lab
drawn. The patient should be taught that estrogen causes these changes, not progesterone.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 218 OBJ: Integrated Process: Teaching-Learning
MSC: Client Needs: Physiologic Integrity

4. Which finding in the urine analysis of a pregnant woman is considered a variation of normal?

a. Proteinuria
b. Glycosuria
c. Bacteria
d. Ketonuria

ANS: B
Small amounts of glucose may indicate “physiologic spilling,” which occurs because the
filtered load exceeds the renal tubules’ ability to absorb them. The presence of protein could
indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria
in the urine. An increase in ketones indicates that the patient is exercising too strenuously or
has an inadequate fluid and food intake.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 219 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

5. Which suggestion is appropriate for the pregnant woman who is experiencing nausea and

vomiting?
a. Eat only three meals a day so the stomach is empty between meals.
b. Drink plenty of fluids with each meal.
c. Eat dry crackers or toast before arising in the morning.
d. Drink coffee or orange juice immediately on arising in the morning.

ANS: C
This will assist with the symptoms of morning sickness. It is also important for the woman to
arise slowly. Instruct the woman to eat five to six small meals rather than three full meals per
day. Nausea is more intense when the stomach is empty. Fluids should be taken separately
from meals. Fluids overstretch the stomach and may precipitate vomiting. Coffee and orange
juice stimulate acid formation in the stomach. It is best to suggest eating dry carbohydrates
when rising in the morning.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 230 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity