Physiologic Adaptation To Pregnancy

Front 1

A pregnant woman has a blood glucose screening at 26 weeks' gestation. The result is 128mg/dl. The nurse should expect that
a. no additional glucose testing will be neded
b. insulin injections will be needed by 30 weeks' gestation
c. oral drugs may be prescribed to lower her glucose level
d. more testing is needed to determine additional therapy

Back 1

a

Front 2

What two factors contribute to a woman's sense of dyspnea?

Back 2

The growing uterus eventually lifts the diaphragm and reduces lung expansion. Because the respiratory center becomes more sensitive to carbon dioxide, the minute volume increases and the partial pressure of carbon dioxide falls.

Front 3

What prenancy-induced changes in pigmentation may occur in the face? What hormone is responsible?

Back 3

Chloasma, or mask of pregnancy, a highly pigmented aref of the forehead, cheeks, and bridge of the nose

Front 4

What is "supine hypotensive syndrome"?

Back 4

Lying in the supine position places the heavy uterus over the aorta and inverior vena cave, which temporarily occludes these vessels.

Front 5

What pregnancy-induced changes in pigmentation may occur in the abdomen? What hormone is responsible?

Back 5

Linea nigra extends from the umbilicus to the symphysis. Estrogen is responsible for increased pigmentation, which is more prominent in dark skinned women.

Front 6

When during pregnancy is the Fundus at the xiphoid process?

Back 6

36 weeks

Front 7

Why is pregnancy risk assessment not a one-time evaluation?

Back 7

Later in the pregnancy risk factors may appear that were not apparent at previous assessments.

Front 8

What should the nurse do to prevent or relieve supine hypotensive syndrome?

Back 8

Prevention/treatment is to position woman on her side or with a pillow under one hip.

Front 9

Use Nagele's rule to calculate estimated dates of delivery (EDD) for each of these dates representing last menstual period dates.
a. February 4
b. August 2

Back 9

a. November 11
b. May 9

Front 10

What is the cause of Goodell's sign during pregnancy?

Back 10

Cervical, uterine, and vaginal softening with increased vascularity and softening of the connective tissue.

Front 11

Describe the edema that is expected during pregnancy and why it occurs. When should it be reported?

Back 11

Edema of the legs and feet is not uncommon. Edema above the waist (face and fingers) may be an indication of pregnancy-induced hypertension and should be reported.

Front 12

Why does the pregnant woman's bone mass stay stable even though the fetus requires calcium for skeleton development?

Back 12

Although parathyroid hormone usually acts to increase absorption of calcium from the intestine, reduce renal losses, and mobilize bone, estrogen and calcitonin interfere with its effects on bone mobilization during pregnancy.

Front 13

When during pregnancy is the Fundus at the level of umbilicus?

Back 13

20 weeks

Front 14

Define uterine souffle and specify the heart rate to which it corresponds.

Back 14

Placental blood flow sounds, corresponding to maternal heart rate and rhythm.

Front 15

lightening

Back 15

descent of fetus into pelvis, reducing pressure on diaphragm

Front 16

physiologic anemia of pregnancy

Back 16

fall in hematocrit that occurs because plasma volume expands more than red blood cell volume

Front 17

What breast changes occur during pregnancy?

Back 17

Darkening of the areolae, increased nipple and areolae size, areolae become more erect, Montgomery's tubercles become prominent.

Front 18

What is the difference among the three classifications (presumptive, probable, and positive indications of pregnancy)

Back 18

Presumptive indicators are the least reliable because they are often caused by other conditions; probable indicators are stronger evidence but still may have other causes; positive indicators are those caused only by pregnancy.

Front 19

What routine urine testing is done during prenatal visits?

Back 19

Protein, glucose, ketones

Front 20

How does Uterine size differ when a woman has a multifetal pregnancy?

Back 20

Uterine size is larger than expected for the length of gestation.

Front 21

Describe maternal cardiac workload changes that occur in a multifetal pregnancy.

Back 21

Cardiac workload is higher due to increased blood volume.

Front 22

What is the cause of Chadwick's sign during pregnancy?

Back 22

Bluish color that often extends to the vagina and labia; cause is hyperemia

Front 23

A pregnant woman expects to give birth to her fisrt baby in about a week. She asks the nurse if she has a bladder infection since she urinates so much, even though urination causes no discomfort. The nurse should explain to her that:
a. urinary tract infections are most common just before birth, so she should have a urine specimen tested
b. her fetus is probably lower in her pelvis, putting more pressure on her bladder
c. limiting her fluid can reduce the number of times she must interrupt her activity to urinate
d. the fetal growth has probably stopped and she should expect to start labor in a few days

Back 23

b

Front 24

Describe maternal bowel changes that occur in multifetal pregnancy.

Back 24

Pressure on bowels increases constipation.

Front 25

How do fetal movements differ when a woman has a multifetal pregnancy?

Back 25

Fetal movements are more numerous, which the woman who has had a previous pregnancy is more likely to notice.

Front 26

A woman having physiologic anemia of pregnany has a hemoglobin and hematocrit level of at least
a. 10 gm and 30%
b. 10.5 gm and 33%
c. 11 gm and 35%
d. 12 gm and 38%

Back 26

b

Front 27

hyperplasia

Back 27

growth that occurs because of an increase in the number of normal cells

Front 28

A pregnant woman complains that both of her thumbs hurt at times. Nither thumb is inflamed or discolored. The nurse should explain to the woman that
a. she probably injured her hand and does not recall doing so
b. an undiagnosed fracture may have healed improperly
c. osteoarthritis often has its onset during pregnancy
d. increased tissue fluid is causing compression of a nerve

Back 28

d

Front 29

A pregnant woman is prone to urinary tract infection primarily because
a. a large volume of fetal wastes must be excreted by her kidneys
b. nutrients that enhance bacterial growth are excreted by her kidneys
c. the volume of urine excreted is reduced and its specific gravity is high
d. reduced blood flow to the urinary tract allows wastes to accumulate

Back 29

b

Front 30

Slight respiratory alkalosis during pregnancy enhances
a. growth of fetal arteries within the placenta
b. the fall in systolic and diastolic blood pressures
c. maternal metabolism of food and nutrients
d. transfer of fetal carbon dioxide to maternal blood

Back 30

d

Front 31

What is the cause of a Bloody Show during pregnancy?

Back 31

Mixture of cervical mucus and a small amount of blood; disruption of mucous plug and small capillaries of cervix.

Front 32

ballottement

Back 32

fetal rebound in the amniotic fluid when the cervix is touched

Front 33

hypertrophy

Back 33

growth that occurs because of increased size of existing cells

Front 34

Describe the maternal blood volume changes that occur in a multifetal pregnancy.

Back 34

There is a 500-ml increase in blood volume over the singleton pregnancy.

Front 35

What signs and symptoms might a woman with supine hypostensive syndrome display?

Back 35

faintness, lightheadedness, dizziness, agitation, and sometimes brief unconsciousness. This position can reduce placental blood flow.

Front 36

List the presumptive, probable, and positive indications of pregnancy.

Back 36

table 13-1, p 273

Front 37

At what point in gestation is it possible to hear fetal heart sounds with the Doppler?

Back 37

10 to 12 weeks

Front 38

What is the cause of McDonald's sign during pregnancy?

Back 38

Easy flexion of the uterine body against the cervix; cause same as Goodell's sign

Front 39

What changes in carbohydrate metabolism and the production, utilization, and breakdown of insulin occur during pregnancy? Why do the changes occur? How does the woman's body normally respond to these changes?

Back 39

The fetus draws on maternal glucose and amino acids, which reduces the mother's glucose levels and her ability to synthesize glucose. During the first trimester, the lower maternal blood glucose causes the pancrease to secret less insulin. During the second trimester, hormones (human placental lactgen, prolactin, progesterone, and cortisol) reduce the maternal tissue sensitivity to insulin. Thus the mother's blood glucose levels rise to make more available for the fetus. The woman normally responds by increasing insulin.

Front 40

Describe maternal respiratory workload changes that occur in multifetal pregnancy.

Back 40

Greater diaphragm elevation increases dyspnea

Front 41

striae gravidarum

Back 41

irregular reddish streaks caused by tears in connective tissue; "stretch marks"

Front 42

Define Funic souffle and specify the heart rate to which it corresponds.

Back 42

Umbilical cord blood flow sounds, corresponding to fetal heart rate and rhythm.

Front 43

When during pregnancy can the uterus first be palpated above the symphysis pubis?

Back 43

a. 12 weeks

Front 44

When during pregnancy can the fundus be palpated about halfway between symphysis pubis and umbilicus?

Back 44

16 weeks

Front 45

What is the possible result of an increase in vascularity in the vagina during pregnancy?

Back 45

Bluish color (as in Chadwick's sign), thickening of vaginal mucosa, prominence of rugae, heightened sexual interest

Front 46

What is the cause of Hegar's sign during pregnancy?

Back 46

Softening of the isthmus of the cervix; cause is same as Goodell's sign

Front 47

What is the possible result of Growth of connective tissue in the vagina during pregnancy?

Back 47

Greater pliability and distensibility of the vagina

Front 48

Describe maternal blood vessel compression changes that occur in a multifetal pregnancy.

Back 48

Greater compression of aorta and inferior vena cava causes earlier and more pronounced supine hypotension.

Front 49

Why are pregnant women morelikely to develop gallstones?

Back 49

Hypotonia prolongs emptying time and allows bile to become thicker.

Front 50

At what point in gestation is it possible to hear fetal heart sounds with the Fetoscope?

Back 50

18 to 20 weeks

Front 51

Why does the pregnancy-induced change in fibrinogen levels have a protective effect, yet also increase risk?

Back 51

Increased fibrinogen levels offer protection from excess blood loss but also predispose the woman to thrombus formation.

Front 52

What is the cause of Mucous Plug during pregnancy?

Back 52

Plug caused by increased secretion of mucus from cervical glands that blocks ascent of bacteria from the vagina

Front 53

What is the possible result of Secretion of increased amounts of glycogan in the vagina during pregnancy?

Back 53

Increased acidic vaginal discharge that retards growth of bacteria, but favors growth of Candida albicans (yeast)

Front 54

What nasal changes are common during pregnancy? What causes them?

Back 54

Vasocongestion from estrogen's effects causes increased vascularity and edema, leading to nasal stuffiness, nosebleeds, and voice changes. It may also result in ear fullness or earaches.

Front 55

Progesterone is produced first by the _______ and then by the ______.

Back 55

corpus luteum, placenta

Front 56

Describe maternal ureter compression changes that occur in multifetal pregnancy.

Back 56

Greater ureter compression increases edema and proteinuria.

Front 57

What pregnancy-induced changes in pigmentation may occur in the breasts? What hormone is responsible?

Back 57

Areolae darken

Front 58

How does weight gain differ in a multifetal pregnency?

Back 58

Greater weight gain occurs because of greater uterine growth, increased blood volume and amniotic fluid, and presence of two or more fetuses

Front 59

Describe the changes in maternal heart sounds that may occur during pregnancy. When do the heart sound changes occur? Describe common changes in heart sounds.

Back 59

Changes in heart sounds begin between 12 and 20 weeks and end 2 to 4 weeks after birth. They may include splitting of the first heart sound, a systolic murmur, and in about 20% of women, a diastolic murmur also.

Front 60

Why is progesterone essential during pregnancy?

Back 60

Pregnancy cannot be maintained without progesterone