Chapter 8: Physiological and Psychosocial Changes During Pregnancy Nursing School Test Banks

Chapter 8: Physiological and Psychosocial Changes During Pregnancy

MULTIPLE CHOICE

1. The nurse has learned that which hormone is primarily responsible for maintaining a pregnancy?
A. Estrogen
B. Human chorionic gonadotropin
C. Oxytocin
D. Progesterone
ANS: D
Progesterone is the hormone primarily responsible for maintaining a pregnancy. Estrogen promotes hyperplasia and hypertrophy during pregnancy. After implantation, the trophoblast secretes human chorionic gonadotropin, which prompts the corpus luteum to continue progesterone production until the placenta takes over the job. Oxytocin stimulates uterine contractions during labor.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

2. A patient who is 28 weeks pregnant calls the obstetrical clinic and complains of irregular, painless contractions that last for 10 to 15 seconds. What response by the nurse is best?
A. If they last more than 60 seconds or become regular, come in.
B. Oh, you are just having what are called Braxton Hicks contractions.
C. Pregnant women often experience this type of contraction.
D. You should come in to the clinic as soon as possible today.
ANS: A
Braxton Hicks contractions are irregular and painless and last less than 60 seconds. Their function is to prepare the uterine muscles for effective labor. If they become regular or last longer than 60 seconds, the woman needs medical attention. The other statements all contain some truthful information, but none provides the woman with the knowledge she needs to remain healthy.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

3. The nurse caring for perinatal patients understands the term decidua to mean which of the following?
A. Collateral uterine circulation
B. Endometrial lining of the uterus
C. Endometrial tissue covering the embryo
D. Placental remnants left in the uterus
ANS: B
The decidua is the endometrium lining the uterus and consists of three layers. The decidua capsularis is the endometrial tissue that covers the embryo. Decidua does not refer to collateral circulation or placental remains.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

4. A nurse is assessing a patient in the womens clinic for Chadwicks sign. How does the nurse perform this assessment?
A. Auscultates the womans abdomen for fetal heart tones
B. Inspects the vulva and vagina for a bluish tint
C. Palpates the womans abdomen for a fluid wave
D. Percusses the womans abdomen for uterine margins
ANS: B
Chadwicks sign is one of the earliest signs of pregnancy and consists of a bluish discoloration of the cervix, vulva, and vagina. The nurse would inspect the woman for this discoloration.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

5. An instructor is explaining to students in the OB rotation that Goodells sign is which of the following?
A. Bluish cervical discoloration
B. Cervical softening
C. False labor contractions
D. Slowed fetal heart tones
ANS: B
Goodells sign is softening of the cervix that occurs due to hormonal influences. It is not related to fetal heart tones or contractions. Chadwicks sign is a bluish discoloration of the cervix, vulva, and vagina.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

6. A nurse is teaching a woman who is in her first trimester of pregnancy about physical changes she can expect. Which information should the nurse provide?
A. Diminishing sexual interest occurs.
B. Harmful agents are able to invade the uterus.
C. Leukorrhea is an abnormal condition.
D. Pregnant women are more susceptible to yeast infections.
ANS: D
Glycogen levels are increased in vaginal cells during pregnancy, and this change creates an environment more hospitable to Candida albicans. Thus pregnant women are more susceptible to yeast infections. For some women, the increased pelvic congestion leads to increased sexual interest and orgasmic ability. Harmful agents are kept out of the uterus by the mucus plug. Leukorrhea is a normal finding in pregnancy due to hyperplasia of the vaginal mucosa and increased mucus production from the endocervical glands.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

7. A woman who gave birth 2 months ago calls the perinatal clinic crying because her hair is falling out in large amounts. What action by the nurse is most appropriate?
A. Advise the woman to make an appointment with a dermatologist.
B. Explain that this symptom will end once she stops breastfeeding.
C. Reassure the woman that her hair will grow back within a year.
D. Tell the woman its really extra hair that grew in pregnancy.
ANS: C
New hair growth may be stimulated during pregnancy, but after birth, this process reverses and hair shedding occurs for 14 months. Virtually all hair will be replaced within 612 months. The nurse should educate the woman about this natural process. Although telling the woman that she had extra hair in pregnancy is accurate, simply stating this fact does nothing to ease her distress. The woman does not need to see a dermatologist. The process is not related to breastfeeding.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

8. A pregnant woman in the perinatal clinic complains of a diffuse, reddish discoloration of her palms. What action by the nurse is most appropriate?
A. Ask if she has been exposed to measles.
B. Assess her for Reynauds phenomenon.
C. Explain that this is a normal finding.
D. Take the womans vital signs.
ANS: C
Palmar erythema is a reddish discoloration of the palms and occurs in about 60% of Caucasian women and in about 35% of African American women during pregnancy. Although the nurse should assess the patients vital signs during the visit, there is no need to do so specifically tied to this condition. Palmar erythema is not related to measles or Reynauds phenomenon, which is a vascular condition.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

9. A woman in her third trimester of pregnancy complains of a painful burning sensation in her hands and lower arms. Which action by the nurse is best?
A. Advise the woman to elevate her hands at night.
B. Document the finding and alert the provider.
C. Encourage the woman to see a neurologist.
D. Request a prescription for pregabalin (Lyrica).
ANS: A
Edema that occurs during pregnancy can lead to fluid collection in the wrist and puts pressure on the median nerve. This leads to carpal tunnel syndrome, characterized by burning pain and paresthesia in the (usually dominant) hand or hands up to the elbow. The nurse should advise the woman to elevate her hands at night. Carpal tunnel syndrome usually resolves after pregnancy, but if it persists, the woman may require surgical treatment. The nurse should always document abnormal findings and alert the provider, but further action is needed. Lyrica is used for nerve pain and would not be suggested here.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

10. A pregnant woman in the perinatal clinic complains of occasional fainting. Which action by the nurse is best?
A. Educate her that this is a frequent occurrence in pregnancy.
B. Encourage her to carry small snacks with her at all times.
C. Instruct her to lie down when the warning signs occur.
D. Tell her to lie down on her left side if she has warning signs.
ANS: D
Syncope, or fainting, is occasionally seen in pregnancy and is often preceded by warning signs such as lightheadedness, sweating, nausea, yawning, or sensations of warmth. The nurse should instruct the woman to sit or lie down when these warning signs occur. Lying on the left side is preferred to avoid compressing the vena cava. Simply saying that this occurs frequently does not help the woman take care of herself. This symptom is not related to food intake.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

11. A woman in the emergency department is in her third trimester and is bleeding heavily from a laceration on her thigh from a car crash. She is pale and diaphoretic. Her blood pressure is 138/82 mm Hg. What can the nurse conclude from this information?
A. Blood loss from the laceration has not been that great.
B. She is in shock from the trauma of the injury and blood loss.
C. Her increased blood volume is maintaining the blood pressure.
D. Her vital signs and physical assessment do not match.
ANS: C
Maternal blood volume increases by 40 to 50% near term. The nurse would expect the blood pressure to be low due to the blood loss, but the pregnancy-related extra volume is maintaining the blood pressure at normal levels. The vital signs and physical assessment do not match, but that is vague and does not explain the inconsistency. The patient is not in shock.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Nursing Process: Analysis
Integrated Process: Physiological Integrity: Physiological Adaptation
Difficulty: Difficult

PTS: 1

12. A woman in the third trimester of her first pregnancy complains of excessive fatigue. Her hemoglobin is 11.2 g/dL. What action by the nurse is best?
A. Arrange hospital admission for blood transfusions.
B. Assess the womans diet for adequate iron and protein.
C. Inform the woman that this is a normal finding in pregnancy.
D. Tell the woman to get more sleep at night and to take naps.
ANS: B
Anemia of pregnancy occurs mainly due to hemodilution. The mean acceptable hemoglobin level in pregnancy is 1112 g/dL. Some women experience fatigue due to this change. Sleep disturbances can contribute to the fatigue, but the nurse should ensure that the woman is adequately hydrated and is eating a diet high in protein and iron. She does not need transfusions. Informing the woman that this is normal does not give her the information she needs to care for herself. If sleep disturbances are a contributing factor, extra sleep can help.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

13. A woman in her second trimester of pregnancy is in the clinic for a checkup. She complains of feeling short of breath at times. Her lungs are clear and her oxygen saturation is 98%. Her vital signs are all normal. What action by the nurse is best?
A. Alert the provider to the symptoms.
B. Encourage slow, deep breathing.
C. Document the findings.
D. Facilitate a chest x-ray.
ANS: B
Many pregnant women verbalize an increased awareness of the need to breathe and can perceive this as dyspnea. Because there are no other abnormalities, the nurse should reassure the woman that this is normal and encourage slow, deep breathing while resting with the head elevated.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

14. The perinatal nurse reads the diagnosis of ptyalism in a patients chart. What teaching does the nurse plan for this patient?
A. Chew food thoroughly before swallowing.
B. Drink plenty of decaffeinated beverages.
C. Eat something before getting up in the morning.
D. Lozenges and chewing gum can help.
ANS: D
Ptyalism is excessive production of saliva. The etiology is uncertain, but chewing gum and using lozenges can offer limited relief. The other measures are not helpful for this condition.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

15. A pregnant woman is complaining of frequent heartburn. What statement by the patient indicates to the nurse that teaching has been effective?
A. Drinking less alcohol should prevent this.
B. Eating larger, less frequent meals will help.
C. I should take antacids before each meal.
D. I will not lie down for 1 hour after eating.
ANS: D
Heartburn, or pyrosis, occurs due to changes in the function of the cardiac sphincter, which allows reflux of stomach contents into the esophagus. Self-care measures for this condition include eating small meals and remaining upright for at least an hour after meals. Antacid use should be limited. Pregnant women should not drink alcohol at all.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

16. A student asks the nurse why so many pregnant women get cholecystitis. Which response by the nurse is best?
A. Inefficient emptying leads to stasis of bile and inflammation, or cholecystitis.
B. Pregnant women crave high-fat foods that cause gallbladder irritation.
C. Some pregnant women have a genetic predisposition to gallbladder problems.
D. Vascular changes to the liver capsule cause bile to back up into the gallbladder.
ANS: A
The gallbladder muscle becomes more relaxed during pregnancy, resulting in inefficient emptying. Stasis of the bile occurs, which then leads to infection or inflammation (cholecystitis). High-fat meals can worsen the symptoms, which include epigastric pain. However, this is not the primary etiology. This condition is not related to genetic predisposition and liver vascular changes.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

17. What information should the nurse plan to teach a pregnant woman regarding safety in the third trimester?
A. Dont drive after dark.
B. Exercise to maintain good posture.
C. Use handrails when using the stairs.
D. Wear supportive shoes.
ANS: C
Pregnant women experience laxity of the ligaments, separation of the pubis symphysis, and changes in their center of gravity, which places them at risk for falling. The most immediate action the woman can take is to use caution when negotiating stairs. Exercise can help with toning abdominal muscles and can reduce some of the symptoms of these changes, but results take time. Wearing supportive shoes and avoiding driving after dark are not related.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

18. A pregnant woman calls the clinic to complain of sharp, right-sided lower abdominal pain. Which question by the nurse would elicit the most relevant information?
A. Do you have a fever, constipation, or any diarrhea?
B. Have you fallen down or experienced any kind of injury in the last few days?
C. Have you tried placing either a heating pad or an ice pack on your abdomen?
D. Is the pain worse between your navel and hip bone or closer to the hip?
ANS: A
Sharp pain in the lower abdomen is frequently due to round ligament pain. However, more serious conditions need to be ruled out first. Appendicitis must be considered. Because the appendix is pushed up and posterior by the uterus, the typical location of pain on the right side between the umbilicus and anterior iliac crest (McBurneys point) is not accurate. The nurse should ask about fever or changes in bowel habits. Trauma is not as likely a cause of this pain. After ruling out a serious medical condition, the nurse can advise the patient to use heat to help relieve the pain.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

19. According to Rubin (1975), completion of what task is paramount for a pregnant woman to master in order to have successful integration of the maternal role?
A. Incorporating the pregnancy into her total identity
B. Learning to adapt to all the physiological changes
C. Recognizing a before pregnant and after pregnant self
D. Reorienting all relationships to put the pregnancy first
ANS: A
According to Rubin (1975), there are specific tasks a pregnant woman must accomplish to integrate the maternal role into her identity. In order to accomplish these tasks, the pregnant woman has to incorporate the pregnancy into her total identity. The other tasks are not part of Rubins theory.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Easy

PTS: 1

20. A father accompanies his partner to her OB clinic visit. The woman is near term. The father confides to the nurse that the patient is cranky, irritable, and yells at him for no reason. Which action by the nurse is best?
A. Explain why the woman needs emotional support.
B. Instruct the mother to get more rest during the day.
C. Reassure the father that this behavior is normal in pregnancy.
D. Teach the father assertive communication skills.
ANS: A
As they near term, women are tired and looking forward to the end of the discomforts of pregnancy. Women at this stage need considerable emotional support from family and friends as they await childbirth. The nurse should explain these psychological changes in the woman and encourage the father to be as supportive as possible. Simply reassuring the father of the normalcy of this situation does not help him or help the woman. More rest might be helpful to some women. Assertive communication skills are not as important as knowing how best to support the woman at this time.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

21. The nurse is explaining to a student that a pregnant woman needs to complete a process called binding in. Which is the best explanation of this phenomenon?
A. Becoming excited about the impending childbirth
B. Incorporating the pregnancy into the womans reality
C. Learning to not focus on ones own discomforts
D. Renegotiating roles within the womans family
ANS: B
Binding in is the process in which the woman accepts the pregnancy and incorporates it into her total reality and self-concept. The other options are all small parts of this process.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Easy

PTS: 1

22. A woman is in her second trimester of pregnancy. Which behaviors by the womans family or friends would best indicate to the nurse that they are accepting the unborn child?
A. An older sibling is talking about my baby brother or sister.
B. Close friends throw a baby shower for the expectant mother.
C. Immediate family members express delight over the pregnancy.
D. The parents state that no matter what the gender, they will love the baby.
ANS: A
Accepting the unborn child is critical to adjusting successfully to the pregnancy. For this woman in her second trimester, having immediate family members begin relating to the unborn child is consistent with their place in the family. A sibling talking about being a big sister or big brother to the new baby is an example. In the first trimester friends and family need to accept the pregnancy and unborn child. In the third trimester, the woman must develop unconditional acceptance of the child.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Evaluation
Difficulty: Difficult

PTS: 1

23. A woman is in the first trimester of her first pregnancy and confides to the nurse that she is not really sure if she is happy because so many things in her life will change. She is not sure she is willing to alter her current lifestyle. What action by the nurse is most appropriate?
A. Ask the woman if she would like to see a counselor.
B. Reassure the woman that ambivalence is normal now.
C. Refer the woman to an expectant-mother support group.
D. Tell the woman she needs to think of her unborn child.
ANS: B
An expectant mother must learn to give to her unborn child in the process of successfully negotiating the tasks of pregnancy. It is normal for a first-time mother to grieve for the impending loss of her lifestyle. The nurse should reassure the woman. A referral to a support group may be helpful for some women. The woman probably does not need a counselor. Telling the woman to think of the unborn child is disrespectful and dismissive.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

24. To provide anticipatory psychosocial guidance to a woman entering her third trimester, what topic should the nurse plan to include?
A. Extreme fatigue may make the woman very vulnerable at the end.
B. She may feel overwhelmed with the physical discomforts of pregnancy.
C. Initial feelings of uncertainty will go away at childbirth.
D. She may worry about impending childbirth but see it as a relief.
ANS: D
Around the seventh month of pregnancy, the woman begins to feel extremely vulnerable and worries about the impending labor and birth. At the same time, she is exhausted and sees this event as delivering her from the pregnancy. This contradiction can be disconcerting for some women who have not been educated about the normalcy of its occurrence. Fatigue is not the driving force for the vulnerability, although it can contribute to it. Uncertainty about ones ability to be a parent can continue past childbirth. Concern with physical discomforts is more acute in the first trimester for most women.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

25. A nurse works with pregnant adolescents during pregnancy and for the first 2 years afterward. Which teen demonstrates the most successful resolution of the conflict between normal growth and development tasks and tasks associated with being a new mother?
A. Attends alternative school with an on-site day care
B. Lives at home with parents who care for the infant
C. Needs strong encouragement to keep appointments
D. Plans activities around the baby one day at a time
ANS: A
The teen mother has conflicting developmental tasks to negotiate. Adolescents must develop a personal value system; choose a vocation/career; develop body image, sexuality, and a stable identity; and attain independence from their parents. The teen who continues to go to school with an on-site day care is providing child care for her baby and finishing her education, both of which are role-appropriate. The teen whose parents care for the infant is not fully involved as a mother. The teen who needs strong encouragement to keep appointments and the teen who only plans activities one day at a time are not future oriented.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Evaluation
Difficulty: Difficult

PTS: 1

26. A woman is in her fourth month of pregnancy and is in the clinic for a scheduled visit. She confides to the nurse that her husband seems detached and is no longer interested in hearing about the pregnancy. Which action by the nurse is best?
A. Explain that paternal reactions vary widely.
B. Offer a referral to a marriage counselor.
C. Reassure the woman that this behavior changes after the birth.
D. Tell her that men are usually jealous of the baby.
ANS: A
Mens reactions to pregnancy and impending childbirth vary widely, from alienation to nurturing to dominance. The nurse should provide guidance by explaining the different paternal responses. A referral to a marriage counselor may or may not be needed. Simply reassuring the woman that this behavior will go away is not accurate or helpful. Stating that men are usually jealous is stereotypical and inaccurate.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

27. A nurse is working with a woman in her second trimester and her partner. The partner comes to clinic appointments but spends his time texting on his cell phone in the waiting room. The woman states that this behavior makes her sad. Which action by the nurse is best?
A. Ask the father to turn off his cell phone in the clinic.
B. Assess the woman for ongoing relationship problems.
C. Invite the father into the exam room to listen to the babys heartbeat.
D. Refer the couple to counseling for depression.
ANS: C
Fathers have developmental tasks to accomplish during a womans pregnancy. During the second trimester, a father may seem disconnected and binding in may take longer than it did for the mother. This may be due to the remoteness of the fetus and father. Actions that can make the baby seem more real to the father will be helpful. A warm invitation to come into the exam room and listen to fetal heart tones is the best option. Asking the father to turn off his cell phone is likely to be perceived as disrespectful and will not be helpful. Assessing for relationship problems and referring the couple for counseling may be indicated in some situations, but is not the best choice here.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Moderate

PTS: 1

28. A nurse manager on the high-risk OB unit wants to improve the experience of women admitted for lengthy stays. What action by the manager is best?
A. Designate a specific chaplain to visit women every day.
B. Develop a program to help women attain developmental tasks.
C. Initiate primary nursing to provide consistency in caregiving.
D. Provide open visitation and special events for siblings.
ANS: B
Although all options can be very beneficial, the biggest challenge women in the high-tech environment of this unit face is stress that hinders development of their maternal role. One solution may be a program specifically designed to help women negotiate their roles and prepare for parenting. Of course, spiritual care should be respectful of individual beliefs.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

29. A woman has given birth to a child with a cleft lip. What action by the patient would best indicate that goals for the diagnosis of dysfunctional grieving have been at least partially met?
A. Birth announcements include photo and wording to explain cleft lip.
B. Father accepts information about a cleft lip/cleft palate support group.
C. Mother watches demonstration of holding baby appropriately for feeding.
D. Parents express concern about their abilities to care for the baby.
ANS: A
Dysfunctional grieving (or other types of grieving) can occur with perinatal loss, including birth of a less-than-perfect child. When the parents demonstrate acceptance of the child as he or she is, they are meeting a goal for this diagnosis. Sending birth announcements with photos and wording to explain the anomaly demonstrate that they accept the child and expect others to do so as well. Passively accepting information about a support group or watching a feeding demonstration do not show real parental involvement. Most parents have concerns about their abilities to care for a baby, perfect or not.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate

PTS: 1

30. A pregnant woman has the nursing diagnosis of risk for ineffective role performance. What statement by the patient indicates that she is meeting a maternal task associated with the second trimester?
A. All of this morning sickness and fatigue are distressing.
B. I dont understand why I feel drawn to pregnant women.
C. I really will miss my girls nights out at the local bars.
D. This baby seems so real to me since I feel him move.
ANS: D
In the second trimester, a woman begins to feel the babys movement, and this makes her truly aware of the fetus as a separate being. Being concerned with ones own well-being rather than that of the fetus is common in the first trimester. Being drawn to other pregnant women is a general principle and is not tied to a specific trimester. Giving up favorite activities, or accepting other trade-offs for the baby, generally occurs in the first trimester.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Evaluation
Difficulty: Difficult

PTS: 1

31. A woman in the first trimester of her first pregnancy is upset and worried about physical changes, the labor and birth process, and being able to care for a newborn. Which action by the nurse is best?
A. Ask the woman about her exposure to newborns.
B. Assess the woman for access to a knowledgeable support person.
C. Provide information about childbirth preparation classes.
D. Reassure the woman that these fears are natural.
ANS: C
The importance of childbirth education classes cannot be overemphasized by the nurse. The other options may be helpful, but they are not nearly as beneficial as getting the woman involved in childbirth education classes. Simple reassurance that fears are normal does not help the woman care for herself. Asking about exposure to newborns is likely to be of little help. The woman should be assessed for a support system, but this is not as important as attending classes.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

MULTIPLE RESPONSE

1. The nursing instructor explains to a class of students that the pituitary gland has many functions related to pregnancy. Which of the following functions are performed by hormones secreted by this gland? (Select all that apply.)
A. Cause the corpus luteum to produce progesterone
B. Influence ovarian follicular development
C. Maintain the pregnancy
D. Prompt ovulation
E. Stimulate the uterine lining
ANS: B, C, D, E
The pituitary gland secretes hormones that influence ovarian follicular development, prompt ovulation, and stimulate the uterine lining to prepare for pregnancy. After implantation, the trophoblast secretes human chorionic gonadotropin, which prompts the corpus luteum to continue progesterone production until the placenta takes over this action.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

2. The nurse is explaining to a student that several physiological factors cause a pregnant woman to be prone to venous thrombosis and embolic phenomena. What factors are included? (Select all that apply.)
A. Dehydration
B. Increased blood factors
C. Sedentary lifestyle
D. Venous stasis
E. Volume overload
ANS: B, D
Blood factors VII, VIII, IX, and X increase during pregnancy, which leads to a hypercoagulable state in pregnancy. Poor blood return from the lower extremities (venous stasis) combine with this hypercoagulable state to make the pregnant woman more prone to thrombosis and embolic events. Sedentary lifestyle is not a physiological factor, and most pregnant women are not sedentary. Volume status is not directly related.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

3. A nurse is providing anticipatory guidance to a pregnant woman regarding normal changes in the nose and nasal passages. What information should the nurse provide? (Select all that apply.)
A. Blow your nose gently.
B. Dry mucous membranes cause bleeding.
C. Increase your fluid intake.
D. Stuffiness is common.
E. Use decongestant spray.
ANS: A, C, D
Nasal stuffiness and congestion are common complaints in pregnancy. Increased fluid intake can help thin the mucus and mobilize it. Decongestant sprays should be avoided due to the rebound effect. Blowing the nose gently can help prevent nosebleeds that are common due to nasal edema.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

4. A patient is complaining of constipation. What teaching should the nurse plan to provide? (Select all that apply.)
A. Avoid vigorous exercise.
B. Drink 8 to 10 glasses of water each day.
C. Dont strain to move your bowels.
D. Eat small, frequent meals.
E. Increase your fiber intake.
ANS: B, C, E
Constipation is a common problem in pregnant women. Nurses should advise women to drink 8 to 10 glasses of water a day, avoid straining to have a bowel movement, and increase their fiber intake. Exercise is important to prevent constipation. Small, frequent meals are not related.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

5. A pregnant woman had several urinary tract infections (UTIs) in her last pregnancy and wants to avoid them during this pregnancy. What advice by the nurse is best? (Select all that apply.)
A. Drink 8 to 10 glasses of water daily.
B. Drink a glass of apple juice daily.
C. Empty the bladder before intercourse.
D. Void every 1 to 2 hours while awake.
E. Void every 2 to 3 hours while awake.
ANS: A, E
To avoid UTIs, women should be encouraged to drink 8 to 10 glasses of water a day, to void every 2 to 3 hours while awake, and to void immediately after intercourse. Drinking apple juice and voiding every 1 to 2 hours are not recommended.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

6. In providing anticipatory guidance to a couple expecting their first child, which tasks and activities does the nurse discuss with the parents? (Select all that apply.)
A. Honing communication and listening skills
B. Learning to cope with a lack of sexual activity
C. Negotiating household roles and daily tasks
D. Reorganizing the house for a new member
E. Reviewing patterns of money management
ANS: A, C, D, E
According to Duvall, members of the expectant family have many tasks to do as they set about preparing for the birth of their child. Some of these include negotiating household roles, reorganizing the home, reviewing (and possibly changing) patterns of money management, adapting the sexual relationship to the physical changes of pregnancy, and reorienting roles with family and friends. As emotional responses can be unpredictable, good communication skills are vital.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

7. A nurse is providing anticipatory guidance to a pregnant woman who has another child. Which information should the nurse plan to include? (Select all that apply.)
A. School-age: can fully grasp the reality of the pregnancy
B. School-age: too young to attend sibling classes
C. Teen: may feel resentment and embarrassment
D. Toddler: may be excited to play with the new baby
E. Toddler: may regress in behavior
ANS: C, E
Toddlers typically inhabit their own little world in which they are the center. They may react with indifference and also may regress in their behavior. School-age children may be interested, but they are unable to fully grasp the situation. Sibling preparation classes are a good way to involve and educate them. The teenager may feel resentment or be embarrassed that his or her parents are sexual beings.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

8. A nurse is providing anticipatory guidance regarding psychosocial adaptations to pregnancy to a group of women. Which topics are consistent with their associated trimesters? (Select all that apply.)
A. First trimester: ambivalence about the pregnancy
B. First trimester: separation from the fetus
C. Second trimester: active dreams and fantasy life
D. Second trimester: becoming more introspective
E. Third trimester: realignment of roles and tasks
ANS: A, C
During the first trimester, the woman may feel ambivalent about the pregnancy. In the second trimester, active dreams and fantasy life are common. Separation from the fetus is a task of the third trimester, as is becoming more introspective. Realignment of roles and tasks typically occurs in the second trimester.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

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