# Chapter 06: Anatomy and Physiology of Pregnancy My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 06: Anatomy and Physiology of Pregnancy

Test Bank

MULTIPLE CHOICE

1. A womans obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One child was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?

 a. 3-1-1-1-3 b. 4-1-2-0-4 c. 3-0-3-0-3 d. 4-2-1-0-3

ANS: B

 Feedback A The numbers do not accurately reflect the womans gravidity and parity information. Using the GTPAL system, her information would be calculated as: G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term. P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L: This number signifies the number of children born that currently are living; the woman has four children. B This is the correct calculation of this womans gravidity and parity. C The numbers do not accurately reflect the womans gravidity and parity information. Using the GTPAL system, her information would be calculated as: G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term. P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L: This number signifies the number of children born that currently are living; the woman has four children. D The numbers do not accurately reflect the womans gravidity and parity information. Using the GTPAL system, her information would be calculated as: G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term. P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L: This number signifies the number of children born that currently are living; the woman has four children.

DIF:Cognitive Level: ComprehensionREF:169, 170

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

2. A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system?

 a. 2-0-0-1-1 b. 2-1-0-1-0 c. 3-1-0-1-0 d. 3-0-1-1-0

ANS: C

 Feedback A Using the GTPAL system explained in question 1, this patients gravidity and parity information would be calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time). T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term). P: Number of pregnancies that resulted in a preterm birth (none). A: Abortions or miscarriages before the period of viability (she has had one). L: Number of children born who are currently living (she has no living children). B Using the GTPAL system explained in question 1, this patients gravidity and parity information would be calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time). T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term). P: Number of pregnancies that resulted in a preterm birth (none). A: Abortions or miscarriages before the period of viability (she has had one). L: Number of children born who are currently living (she has no living children). C This is the correct calculation of this womans gravidity and parity. D Using the GTPAL system explained in question 1, this patients gravidity and parity information would be calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time). T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term). P: Number of pregnancies that resulted in a preterm birth (none). A: Abortions or miscarriages before the period of viability (she has had one). L: Number of children born who are currently living (she has no living children).

DIF:Cognitive Level: ComprehensionREF:169, 170

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

3. Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)?

 a. Radioimmunoassay b. Radioreceptor assay c. Latex agglutination test d. Enzyme-linked immunosorbent assay (ELISA)

ANS: D

 Feedback A The radioimmunoassay test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results. B The radioreceptor assay test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results. C The latex agglutination test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results. D ELISA technology is used in OTC pregnancy tests.

DIF:Cognitive Level: KnowledgeREF:171

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

4. A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have:

 a. Amenorrhea. b. Positive pregnancy test. c. Chadwicks sign. d. Hegars sign.

ANS: A

 Feedback A Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman. B A positive pregnancy test would be a probable sign of pregnancy. C The presence of Chadwicks sign would be a probable sign of pregnancy. D The presence of Hegars sign would be a probable sign of pregnancy.

DIF:Cognitive Level: ComprehensionREF:172

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

5. The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurses instructions if she states that a positive sign of pregnancy is:

 a. A positive pregnancy test. b. Fetal movement palpated by the nurse-midwife. c. Braxton Hicks contractions. d. Quickening.

ANS: B

 Feedback A A positive pregnancy test would be a probable sign of pregnancy. B Positive signs of pregnancy are those that are attributed to the presence of a fetus such as hearing the fetal heartbeat or palpating fetal movement. C Braxton Hicks contractions would be a probable sign of pregnancy. D Quickening would be a presumptive sign of pregnancy.

DIF:Cognitive Level: ComprehensionREF:172

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

6. A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level?

 a. Not palpable above the symphysis at this time b. Slightly above the symphysis pubis c. At the level of the umbilicus d. Slightly above the umbilicus

ANS: B

 Feedback A As the uterus grows, it may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy. B In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy. C The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation. D The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation.

DIF:Cognitive Level: ComprehensionREF:173

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

7. Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?

 a. Less audible heart sounds (S1, S2) b. Increased pulse rate c. Increased blood pressure d. Decreased red blood cell (RBC) production

ANS: B

 Feedback A Splitting of S1 and S2 is more audible. B Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. C In the first trimester, blood pressure usually remains the same as at the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. D Production of RBCs accelerates during pregnancy.

DIF:Cognitive Level: ComprehensionREF:177

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

8. The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change?

 a. Her center of gravity will shift backward. b. She will have increased lordosis. c. She will have increased abdominal muscle tone. d. She will notice decreased mobility of her pelvic joints.

ANS: B

 Feedback A The center of gravity shifts forward. B An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain her balance. C She will have decreased muscle tone. D She will notice increased mobility of her pelvic joints.

DIF:Cognitive Level: ComprehensionREF:185

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

9. A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that:

 a. This is a normal respiratory change in pregnancy caused by elevated levels of estrogen. b. This is an abnormal cardiovascular change, and the nosebleeds are an ominous sign. c. The woman is a victim of domestic violence and is being hit in the face by her partner. d. The woman has been using cocaine intranasally.

ANS: A

 Feedback A Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract. This may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. B Cardiovascular changes in pregnancy may cause edema in lower extremities. C This determination cannot be made on the basis of the sparse facts provided. If the woman had been hit in the face, she most likely would have additional physical findings. D This determination cannot be made on the basis of the sparse facts provided.

DIF:Cognitive Level: ApplicationREF:181

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

10. The nurse caring for the pregnant patient must understand that the hormone essential for maintaining pregnancy is:

 a. Estrogen. b. Human chorionic gonadotropin (hCG). c. Oxytocin. d. Progesterone.

ANS: D

 Feedback A Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. B hCG levels rise at implantation but decline after 60 to 70 days. C Oxytocin stimulates uterine contractions. D Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles. This reduces uterine activity and prevents miscarriage.

DIF:Cognitive Level: ComprehensionREF:187

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

11. The nurse providing care to the pregnant woman should know that all are normal gastrointestinal changes in pregnancy except:

 a. Ptyalism. b. Pyrosis. c. Pica. d. Decreased peristalsis.

ANS: C

 Feedback A Ptyalism (excessive salivation) is a normal finding. B Pyrosis (heartburn) is a normal finding. C Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. D Decreased peristalsis is a normal finding.

DIF:Cognitive Level: AnalysisREF:186

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

12. Appendicitis may be difficult to diagnose in pregnancy because the appendix is:

 a. Displaced upward and laterally, high and to the right. b. Displaced upward and laterally, high and to the left. c. Deep at McBurney point. d. Displaced downward and laterally, low and to the right.

ANS: A

 Feedback A The appendix is displaced high and to the right. B The appendix is displaced high and to the right. C The appendix is displaced beyond McBurney point. D The appendix is displaced high and to the right.

DIF:Cognitive Level: ComprehensionREF:187

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

13. Which time-based description of a stage of development in pregnancy is accurate?

 a. Viability22 to 37 weeks since the last menstrual period (LMP) (assuming a fetal weight greater than 500 g) b. Termpregnancy from the beginning of week 38 of gestation to the end of week 42 c. Pretermpregnancy from 20 to 28 weeks d. Postdatepregnancy that extends beyond 38 weeks

ANS: B

 Feedback A Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since LMP. B Term is 38 to 42 weeks of gestation. C Preterm is 20 to 37 weeks of gestation. D Postdate or postterm is a pregnancy that extends beyond 42 weeks or what is considered the limit of full term.

DIF:Cognitive Level: KnowledgeREF:170

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

14. Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and therefore the basis for many tests. A maternity nurse should be aware that:

 a. hCG can be detected as early as 2 weeks after conception. b. The hCG level increases gradually and uniformly throughout pregnancy. c. Much lower than normal increases in the level of hCG may indicate a postdate pregnancy. d. A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

ANS: D

 Feedback A hCG can be detected as early as 7 to 10 days after conception. B The hCG level fluctuates during pregnancy: peaking, declining, stabilizing, and increasing again. C Abnormally slow increases may indicate impending miscarriage. D Higher levels also could be a sign of multiple gestation.

DIF:Cognitive Level: KnowledgeREF:171

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

15. To reassure and educate pregnant patients about changes in the uterus, nurses should be aware that:

 a. Lightening occurs near the end of the second trimester as the uterus rises into a different position. b. The womans increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening. c. Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise. d. The uterine souffle is the movement of the fetus.

ANS: B

 Feedback A Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. B The softening of the lower uterine segment is called Hegars sign. C Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. D The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

DIF:Cognitive Level: ComprehensionREF:173

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

16. When the nurse is providing education to the pregnant patient regarding changes in the cervix, vagina, and the position of the fetus, it is important to be aware that:

 a. Because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are much easier to evaluate. b. Quickening is a technique of palpating the fetus to engage it in passive movement. c. The deepening color of the vaginal mucosa and cervix (Chadwicks sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor. d. Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

ANS: D

 Feedback A These cervical changes make evaluation of abnormal Pap tests more difficult. B Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus. C Chadwicks sign appears from the sixth to eighth weeks. D Increased sensitivity and an increased interest in sex sometimes go together. This frequently occurs during the second trimester.

DIF:Cognitive Level: ComprehensionREF:176

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

17. The mucous plug that forms in the endocervical canal is called:

 a. The operculum. b. Leucorrhea. c. The funic souffle. d. Ballottement.

ANS: A

 Feedback A The operculum protects against bacterial invasion. B Leucorrhea is the mucus that forms the endocervical plug (the operculum). C The funic souffle is the sound of blood flowing through the umbilical vessels. D Ballottement is a technique for palpating the fetus.

DIF:Cognitive Level: KnowledgeREF:176

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

18. To reassure and educate pregnant patients about changes in their cardiovascular system, maternity nurses should be aware that:

 a. A pregnant woman experiencing disturbed cardiac rhythm such as sinus arrhythmia requires close medical and obstetric observation, no matter how healthy she otherwise may appear. b. Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks to term. c. Palpitations are twice as likely to occur in twin gestations. d. All of the above changes likely will occur.

ANS: B

 Feedback A A healthy woman with no underlying heart disease does not need any therapy. B These auscultatory changes should be discernible after 20 weeks of gestation. C The maternal heart rate increases in the third trimester, but palpitations may not necessarily occur, let alone double. D Auditory changes are discernible at 20 weeks.

DIF:Cognitive Level: ComprehensionREF:177

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

19. To reassure and educate their pregnant patients about changes in their blood pressure, maternity nurses should be aware that:

 a. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. b. Shifting the patients position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. c. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.

ANS: D

 Feedback A The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. B Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. C The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases. D This compression also leads to varicose veins in the legs and vulva.

DIF:Cognitive Level: ComprehensionREF:178

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Planning, Implementation

20. Some pregnant patients may complain of changes in their voice and impaired hearing. The nurse can tell these patients that these are common reactions to:

 a. A decreased estrogen level. b. Displacement of the diaphragm, resulting in thoracic breathing. c. Congestion and swelling, which occur because the upper respiratory tract has become more vascular. d. Increased blood volume.

ANS: C

 Feedback A Estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing. B The diaphragm is displaced. However, the key is that estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing. C Estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing. D The volume of blood is increased. However, the key is that estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing.

DIF:Cognitive Level: ComprehensionREF:181

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

21. To reassure and educate pregnant patients about the functioning of their kidneys in eliminating waste products, maternity nurses should be aware that:

 a. Increased urinary output makes pregnant women less susceptible to urinary infection. b. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty. c. Renal (kidney) function is more efficient when the woman assumes a supine position. d. Using diuretics during pregnancy can help keep kidney function regular.

ANS: B

 Feedback A A number of anatomic changes make a pregnant woman more susceptible to urinary tract infection. B First bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often. C Renal function is more efficient when the woman lies in the lateral recumbent position and less efficient when she is supine. D Diuretic use during pregnancy can overstress the system and cause problems.

DIF:Cognitive Level: ComprehensionREF:182

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

22. Which statement about a condition of pregnancy is accurate?

 a. Insufficient salivation (ptyalism) is caused by increases in estrogen. b. Acid indigestion (pyrosis) begins early but declines throughout pregnancy. c. Hyperthyroidism often develops (temporarily) because hormone production increases. d. Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

ANS: D

 Feedback A Ptyalism is excessive salivation, which may be caused by a decrease in unconscious swallowing or stimulation of the salivary glands. B Pyrosis begins as early as the first trimester and intensifies through the third trimester. C Increased hormone production does not lead to hyperthyroidism in pregnant women. D Normal nausea and vomiting rarely produce harmful effects, and nausea and vomiting periods may be less likely to result in miscarriage or preterm labor.

DIF:Cognitive Level: ApplicationREF:186

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

MULTIPLE RESPONSE

1. The diagnosis of pregnancy is based on which positive signs of pregnancy? Choose all that apply.

 a. Identification of fetal heartbeat b. Palpation of fetal outline c. Visualization of the fetus d. Verification of fetal movement e. Positive hCG test

ANS: A, C, D

 Feedback Correct These are all positive, objective signs of pregnancy. Incorrect These are probable signs of pregnancy. A tumor also can be palpated. Medication and tumors may lead to false-positive results on pregnancy tests.

DIF:Cognitive Level: AnalysisREF:172

OBJ:Client Needs: Health Promotion and Maintenance

TOP:Nursing Process: Assessment, Diagnosis

2. A woman is in for a routine prenatal checkup. You are assessing her urine for proteinuria. You know that which findings are considered normal? Choose all that apply.

 a. Dipstick assessment of trace to +1 b. <300 mg/24 hours c. Dipstick assessment of +2 d. >300 mg/24 hours

ANS: A, B

 Feedback Correct Small amounts of protein in the urine are acceptable during pregnancy. The presence of protein in greater amounts may indicate renal problems. Incorrect These are excessive amounts of protein in the urine and should be evaluated further.

DIF:Cognitive Level: ApplicationREF:181

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment