Question 1

The patient in the prenatal clinic tells the nurse that she is sure she is pregnant because she has not had a menstrual cycle for 3 months, and her breasts are getting bigger. What response by the nurse is best?

Accepted Answer

Lack of menstrual cycle and breast enlargement are presumptive signs of pregnancy, but they are not definitive. A pregnancy test is necessary to confirm pregnancy. The nurse should suggest the patient take a pregnancy test to accurately determine if she is pregnant. Option B is incorrect because it is not possible to know for sure that the changes are due to pregnancy without a pregnancy test. Option D is incorrect and not helpful to the patient, as it does not address her concern or offer any assistance.

Question 2

A patient with a normal prepregnancy weight asks why she has been told to gain 25-35 pounds during her pregnancy while her underweight friend was told to gain more weight. The nurse should tell the patient that recommended weight gain during pregnancy should be:

Accepted Answer

Underweight women are generally advised to gain more weight during pregnancy, up to 40 pounds, to support fetal development and maternal health.

Question 3

The nurse is examing a pregnant woman in the third trimester. What skin changes should the nurse highlight as an alteration for the woman's healthcare provider?

Accepted Answer

Petechiae, or small red or purple spots caused by burst blood vessels, can be a sign of a bleeding disorder or other underlying health issue and should be reported to the healthcare provider. Linea nigra, melasma, and spider nevi are common and normal skin changes during pregnancy.

Question 4

A patient at 16 weeks' gestation has a hematocrit of 35%. Her prepregnancy hematocrit was 40%. Which statement by the nurse best explains this change?

Accepted Answer

During pregnancy, the volume of blood in a woman's body increases to support the growth and development of the fetus. However, the total number of red blood cells does not increase at the same rate, resulting in a lower hematocrit count. This is a normal and expected change in pregnancy.

Question 5

The nurse understands that a patient's pregnancy is progressing normally when what physiologic changes are documented on the prenatal record of a woman at 36 weeks' gestation?

Accepted Answer

At 36 weeks' gestation, it is normal for the pelvic joints to relax, causing a waddling gait (A). The uterus contains a significant portion of maternal blood volume (C). Prolonged gastric emptying and constipation are common due to hormonal changes (D). Supine hypotension can occur due to the weight of the uterus compressing the vena cava when lying on the back (E). The cervix is typically soft, not firm, and may be blue-purple due to increased blood flow, but firmness is not expected (B).

Question 6

A patient at 28 weeks' gestation asks the nurse why she has backaches. To help explain the changes, the nurse shows her a picture of the shape of her back. Which picture does the nurse use?Standard Text: Click on the correct area on the image.

Accepted Answer

The answer of A patient at 28 weeks' gestation asks...

Question 7

During her first months of pregnancy, a patient tells the nurse, "It seems like I have to go to the bathroom every 5 minutes." The nurse explains to the patient that this is because:

Accepted Answer

During pregnancy, the growing uterus puts pressure on the bladder, reducing its capacity and causing frequent urination. This is a normal symptom of pregnancy and not necessarily a sign of a urinary tract infection.

Question 8

The nurse is assessing a new patient in the clinic. The nurse knows that the subjective (presumptive) signs and symptoms of pregnancy include:

Accepted Answer

Subjective or presumptive signs of pregnancy are those reported by the patient, which may suggest pregnancy but are not definitive alone. These include amenorrhea (missed period), fatigue, increased urination, breast enlargement, and quickening (the first feeling of fetal movement by the mother). Options A, B, and D include either objective signs (those that can be confirmed by a healthcare provider, such as a positive pregnancy test, softening of the cervix, enlarged abdomen, and fetal heartbeat) or are not exclusively indicative of pregnancy (like Braxton Hicks contractions, which can occur later in pregnancy).

Question 9

A patient who is in the second trimester of pregnancy tells the nurse that she has developed a darkening of the line in the midline of her abdomen from the symphysis pubis to the umbilicus. What other expected changes during pregnancy might she also notice?

Accepted Answer

Reddish streaks called striae on the abdomen are a common occurrence during pregnancy due to stretching of the skin. Lightening of the nipples and areolas may also occur, but this is not directly related to the midline darkening. Decrease in hair thickness and small purplish dots on the face and arms are not typical changes during pregnancy.

Question 10

A patient at 32 weeks' gestation comes to the clinic with urinary burning and frequency. The nurse explains that urinary tract infections are common in pregnancy due to:

Accepted Answer

Urinary tract infections (UTIs) are common during pregnancy due to ureteral atonia and stasis of urine. Ureteral atonia, which is a decrease in the tone of the ureter, leads to reduced urine flow. This, combined with the compression of the ureters by the enlarging uterus, can cause stasis of urine, providing an environment conducive to bacterial growth and infection. Increased glomerular filtration rate, excretion of amino acids, and increased clearance of urea are physiological changes in pregnancy that do not directly contribute to the increased risk of UTIs.

Question 11

The nurse is assessing a patient who is at 35 weeks' gestation. What does the nurse expect the patient to report at this phase of pregnancy?

Accepted Answer

At 35 weeks' gestation, the patient may likely report the presence of stretch marks on the abdomen due to the baby's growth and stretching of the skin. Nausea and vomiting tend to subside in the second trimester, emotional shifts are common throughout pregnancy, and maternal ambivalence may occur at any point in pregnancy but is not necessarily expected at 35 weeks.

Question 12

It is 1 week before a pregnant patient's due date. The nurse notes on the chart that the patient's pulse rate was 74-80 before pregnancy. Today, the patient's pulse rate at rest is 90. What action should the nurse should take?

Accepted Answer

During pregnancy, especially in the third trimester, it is normal for the resting pulse rate to increase due to the increased blood volume and cardiac output needed to support the fetus. A pulse rate of 90 is within the expected range for a pregnant patient close to their due date, so the nurse should simply chart the findings.

Question 13

A patient who is experiencing her first pregnancy has just completed the initial prenatal examination with a certified nurse-midwife. Which statement indicates that the patient needs additional information?

Accepted Answer

Feeling the baby move, known as quickening, typically occurs between 18-20 weeks of pregnancy, so not feeling movement yet does not indicate whether or not the patient is pregnant.

Question 14

The nurse is listening to the fetal heart tones of a patient at 37 weeks' gestation while the patient is in a supine position. The patient states, "I'm getting lightheaded and dizzy." The best action by the nurse is to:

Accepted Answer

The patient's symptoms of lightheadedness and dizziness may indicate supine hypotensive syndrome, which can occur when the pregnant uterus compresses the vena cava in a supine position. Turning the patient onto her side can relieve this compression and improve blood flow to the fetus and maternal organs. Assisting the patient to sit up may not be appropriate if she is feeling lightheaded and dizzy, and reminding her to lie still may not address the issue of supine hypotensive syndrome. Checking the patient's blood pressure may be indicated, but turning the patient onto her side is the most immediate and effective action to address her symptoms.

Question 15

On examination of the prenatal patient, the nurse is aware that she will assess for a bluish pigmentation of the vagina. This objective (probable) sign of pregnancy is also known as:

Accepted Answer

Chadwick's sign refers to the bluish-purple color of the cervix, vagina, and vulva that occurs due to increased blood flow and increased vascularity as a result of pregnancy. This occurs as early as 6-8 weeks into the pregnancy and is an important objective sign of pregnancy. Hegar's sign refers to softening of the cervix, Goodell's sign refers to softening of the cervix tip, and Nightingale's sign is not a recognized sign of pregnancy.

Question 16

The nurse has completed a community presentation about the changes of pregnancy, and knows that the lesson was successful when a community member states, "One probable or objective change of pregnancy is:

Accepted Answer

Enlargement of the uterus is a probable or objective change of pregnancy as the uterus grows rapidly during pregnancy to accommodate the developing fetus. Hearing the baby's heart rate, increased urinary frequency, and nausea and vomiting are also common changes in pregnancy, but they may not be considered objective or probable changes by all individuals.

Question 17

The nurse notes the following findings in a 12-weeks'-gestation patient. Which of the findings would enable the nurse to tell the patient that she is diagnostically pregnant?

Accepted Answer

Fetal heart rate detection by Doppler ultrasound is a definitive diagnostic sign of pregnancy, as it directly indicates the presence of a living embryo or fetus. Positive pregnancy tests, Chadwick's sign, and Montgomery gland enlargement are indicative of pregnancy but are not diagnostic on their own, as they can be influenced by other factors or conditions.

Question 18

A 16-year-old is seen at her 10-weeks'-gestation visit. She tells the nurse that she felt the baby move that morning. What response by the nurse is appropriate?

Accepted Answer

The nurse should ask the patient to describe what she felt to confirm that it was fetal movement and not something else. It is possible for a pregnant woman to feel fetal movement as early as 10 weeks, although it is more common for first-time mothers to feel movement closer to 18-20 weeks. Option A is not an appropriate response as fetal movement does not necessarily indicate the baby's overall health. Option C is incorrect as fetal movement can be felt at 10 weeks. Option D is not necessary as the patient has already felt fetal movement, but the nurse may still perform a fetal assessment to confirm the baby's wellbeing.

Question 19

The nurse in the prenatal clinic will tell the 38-weeks'-gestation patient to lie on her left side when the patient complains of:

Accepted Answer

The answer of The nurse in the prenatal clinic will...

Question 20

The nurse has received a phone call from a multigravida who is 21 weeks pregnant and has not felt fetal movement yet. The best action for the nurse to take would be to:

Accepted Answer

Any change in fetal movement patterns should be reported to a healthcare provider promptly. The patient should be scheduled for an appointment with her physician for assessment of fetal well-being. A lack of fetal movement does not necessarily mean that the fetus has died, but it is important to have the fetus assessed. Option A is incorrect because fetal movement should be present, regardless of maternal parity. Option B is incorrect because it is not likely that the patient will be able to feel fetal movement with her fingertips at 21 weeks. Option D is incorrect because it is not appropriate to provide such a devastating diagnosis over the phone without first assessing the patient and performing diagnostic tests.

Quiz 14: Physical and Psychologic Changes of Pregnancy