Chapter 8 Physical and Psychologic Changes of Pregnancy

Chapter 8   Physical and Psychologic Changes of Pregnancy

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1) The nurse is auscultating fetal heart tones in a client who is 37 weeks’ gestation. While in a supine position, the client states, “I’m getting lightheaded and dizzy, and I feel clammy.” Which of the following nursing actions is most appropriate?

1. Place a wedge beneath the client’s right hip.
2. Prepare for administration of packed red blood cells (PRBCs).
3. Help the client turn onto her right side.
4. Administer supplemental oxygen.

Answer:  1

Explanation:  1. The client is verbalizing symptoms consistent with supine hypotension syndrome, in which compression of the vena cava by the uterus reduces right atrial blood flow. Signs and symptoms include decreased blood pressure, dizziness, pallor, and clamminess. Appropriate interventions include having the woman lie on her left side, or placing a pillow or wedge under her right hip as she lies in a supine position.

2. The client is verbalizing symptoms consistent with supine hypotension syndrome, in which compression of the vena cava by the uterus reduces right atrial blood flow. Repositioning the client onto her left side or placing a pillow or wedge under her right hip are appropriate interventions.
3. The client is verbalizing symptoms consistent with supine hypotension syndrome, in which compression of the vena cava by the uterus reduces right atrial blood flow. Positioning the client on her right side would likely exacerbate the reduction in right atrial blood flow.
4. The client is verbalizing symptoms consistent with supine hypotension syndrome, in which compression of the vena cava by the uterus reduces right atrial blood flow. Priority interventions include repositioning the client onto her left side, or placing a pillow or wedge under her right hip.

Page Ref: 138, 139

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 8.1-Identify the anatomic and physiologic changes that occur during pregnancy.

MNL LO:  Determine factors to consider when providing care during the antepartum period.

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

1. 25 to 35 pounds, regardless of a client’s pre-pregnancy weight.
2. More than 25 to 35 pounds for an overweight patient.
3. More than 25 to 35 pounds for an underweight woman.
4. The same for a normal-weight woman as for an overweight woman.

Answer:  3

Explanation:  1. Prepregnancy weight determines the recommended weight gain during pregnancy. Women of normal weight should gain 25 to 35 pounds during pregnancy for optimal fetal outcome.

2. Overweight women should gain 15 to 25 pounds during pregnancy.
3. Underweight women are encouraged to gain 28 to 40 pounds during pregnancy.
4. Overweight women should gain 15 to 25 pounds during pregnancy.

Page Ref: 141

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Essential III: Scholarship for evidence-based practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 8.1-Identify the anatomic and physiologic changes that occur during pregnancy.

MNL LO:  Implement strategies to promote health maintenance throughout pregnancy.

3) The nurse is reviewing the assessment findings of a client who is 35 weeks’ gestation. Which of the following data suggests the need for further investigation?

1. Melasma gravidarum
2. Pseudoanemia
3. Funic souffle
4. Glycosuria

Answer:  4

Explanation:  1. Facial chloasma or melasma gravidarum (also known as the “mask of pregnancy”) is a harmless darkening of the skin over the cheeks, nose, and forehead that sometimes accompanies pregnancy.

2. Physiologic anemia of pregnancy or pseudoanemia is common during pregnancy and is an expected finding.
3. Funic souffle is a normal assessment finding associated with the pulsing of blood through the umbilical cord.
4. Glycosuria (glucose in the urine) during pregnancy may be normal or may indicate gestational diabetes, so it always warrants further testing.

Page Ref: 139

Cognitive Level:  Analyzing

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Health teaching and health promotion

Learning Outcome:  LO 8.1-Identify the anatomic and physiologic changes that occur during pregnancy.

MNL LO:  Assess maternal data for potential risk factors.

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

1. “Lack of menses and breast enlargement are presumptive signs of pregnancy.”
2. “The changes you are describing are definitely indicators that you are pregnant.”
3. “Lack of menses can be caused by many things. We need to do a pregnancy test.”
4. “Breast and menstrual changes are positive signs of pregnancy. Congratulations.”

Answer:  3

Explanation:  1. Although this is true, amenorrhea and breast enlargement also can be caused by weight gain and other conditions. A pregnancy test is needed to determine whether the client is pregnant.

2. This statement is false because amenorrhea and breast enlargement are presumptive signs of pregnancy because they can be caused by other conditions.
3. This is a true statement and addresses that these changes could be caused by things other than pregnancy.
4. This statement is false because amenorrhea and breast enlargement are presumptive signs. It is too early to determine if congratulations are in order.

Page Ref: 142

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 8.3-Assess the subjective (presumptive), objective (probable), and diagnostic (positive) changes of pregnancy in patients.

MNL LO:  Differentiate between subjective, objective, and diagnostic indicators of pregnancy.

5) The nurse has completed a presentation for newly-pregnant women about the changes of pregnancy. Which participant’s statement reflects accurate comprehension of the information?

1. “A positive Goodell’s sign is a probable change of pregnancy.”
2. “Three positive pregnancy tests in a one week period is considered to be a positive change of pregnancy.”
3. “Uterine souffle is a positive change of pregnancy.”
4. “Changes in the pelvic organs are presumptive signs of pregnancy.”

Answer:  1

Explanation:  1. A positive Goodell’s sign can be objectively identified but may also be caused by conditions other than pregnancy; therefore, it is considered to be a probable change of pregnancy.

2. Because other conditions may cause elevated hCG, pregnancy tests are considered probable changes of pregnancy.
3. Because uterine souffle can be objectively identified but may be caused by conditions other than pregnancy, it is considered to be a probable change of pregnancy.
4. Changes in the pelvic organs can be objectively identified; however, because some pelvic organ changes may be associated with conditions other than pregnancy, they are considered to be probable changes of pregnancy.

Page Ref: 142—144

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 8.3-Assess the subjective (presumptive), objective (probable), and diagnostic (positive) changes of pregnancy in patients.

MNL LO:  Differentiate between subjective, objective, and diagnostic indicators of pregnancy