Chapter 13: Anatomy and Physiology of Pregnancy My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 13: 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 her children from previous pregnancies are living. One 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

4-1-2-0-4 is the correct calculation of this womans gravidity and parity.

The numbers reflect the womans gravidity and parity information. Using the GPTAL system, her information is calculated as:

G reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.

T 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 is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm.

A signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not.

L signifies the number of children born that currently are living; the woman has four children.

3-1-1-1-3 is an incorrect calculation of this womans gravidity and parity.

3-0-3-0-3 is an incorrect calculation of this womans gravidity and parity.

4-2-1-0-3 is an incorrect calculation of this womans gravidity and parity.

DIF: Cognitive Level: Comprehension REF: 290

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

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

a.

Amenorrhea

b.

Positive pregnancy test

c.

Chadwick sign

d.

Hegar sign

ANS: A

Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman.

A positive pregnancy test is a probable sign of pregnancy.

The presence of the Chadwick sign is a probable sign of pregnancy.

The presence of the Hegar sign is a probable sign of pregnancy.

DIF: Cognitive Level: Comprehension REF: 292

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

3. A woman is at 14 weeks of gestation. The nurse expects 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

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.

As the uterus grows it may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy.

At 14 weeks the uterus is not yet at the level of the umbilicus.

The fundus is not palpable above the umbilicus until 22 to 24 weeks of gestation.

DIF: Cognitive Level: Comprehension REF: 292

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

4. 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

An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain her balance.

The center of gravity shifts forward.

She will have decreased muscle tone.

She will notice increased mobility of her pelvic joints.

DIF: Cognitive Level: Comprehension REF: 302

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

5. A 31-year-old woman believes that she may be pregnant. She took an over-the-counter (OTC) pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the womans last menstrual period (LMP) and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which reveals that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?

a.

She took the pregnancy test too early.

b.

She takes anticonvulsants.

c.

She has a fibroid tumor.

d.

She has been under considerable stress and has a hormone imbalance.

ANS: B

Anticonvulsants may cause false-positive pregnancy test results.

OTC pregnancy tests use enzyme-linked immunosorbent assay (ELISA) technology, which can yield positive results as soon as 4 days after implantation. Implantation occurs 6 to 10 days after conception. If the woman were pregnant, she would be into her third week at this point (having missed her period 1 week ago).

Fibroid tumors do not produce hormones and have no bearing on human chorionic gonadotropin (hCG) pregnancy tests.

Although stress may interrupt normal hormone cycles (menstrual cycles), it does not affect hCG levels or produce positive pregnancy test results.

DIF: Cognitive Level: Application REF: 291

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

6. 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

Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract, which may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis.

Cardiovascular changes in pregnancy may cause edema in lower extremities.

Domestic violence cannot be determined based on the sparse facts provided. If the woman had been hit in the face, she most likely would have additional physical findings.

Cocaine use cannot be determined based on the sparse facts provided.

DIF: Cognitive Level: Application REF: 298

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

7. In order to reassure and educate pregnant clients about changes in their breasts, nurses should be aware that:

a.

The visibility of blood vessels that form an intertwining blue network indicates full function of Montgomerys tubercles and possibly infection of the tubercles

b.

The mammary glands do not develop until 2 weeks before labor

c.

Lactation is inhibited until the estrogen level declines after birth

d.

Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding

ANS: C

Lactation is inhibited until after birth.

The visible blue network of blood vessels is a normal outgrowth of a richer blood supply.

The mammary glands are functionally complete by midpregnancy.

Colostrum is a creamy white-to-yellow premilk fluid that can be expressed from the nipples before birth.

DIF: Cognitive Level: Knowledge REF: 296

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

8. A nurse caring for a pregnant client must understand that the hormone essential for maintaining pregnancy is:

a.

Estrogen

b.

Human chorionic gonadotropin (hCG)

c.

Oxytocin

d.

Progesterone

ANS: D

Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles. This reduces uterine activity and prevents miscarriage.

Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy.

hCG levels rise at implantation but decline after 60 to 70 days.

Oxytocin stimulates uterine contractions.

DIF: Cognitive Level: Comprehension REF: 304

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

9. A nurse providing care to a pregnant woman should know that all are normal gastrointestinal changes in pregnancy except:

a.

Ptyalism

b.

Pyrosis

c.

Pica

d.

Decreased peristalsis

ANS: C

Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated.

Ptyalism (excessive salivation) is a normal finding.

Pyrosis (heartburn) is a normal finding.

Decreased peristalsis is a normal finding.

DIF: Cognitive Level: Analysis REF: 303, 304

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

10. 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 McBurneys point

d.

Displaced downward and laterally, low and to the right

ANS: A

The appendix is displaced high and to the right.

The appendix is displaced high and to the right, rather than to the left.

The appendix is displaced beyond McBurneys point.

The appendix is not displaced in a downward direction; it will be high and to the right.

DIF: Cognitive Level: Comprehension REF: 304

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

11. In order to reassure and educate pregnant clients 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

These auscultatory changes should be discernible after 20 weeks of gestation.

A healthy woman with no underlying heart disease does not need any therapy.

The maternal heart rate increases in the third trimester, but palpitations may not necessarily occur, let alone double.

Auditory changes are discernible at 20 weeks.

DIF: Cognitive Level: Comprehension REF: 297

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

12. Probable signs of pregnancy are:

a.

Determined by ultrasound

b.

Observed by the health care provider

c.

Reported by the client

d.

Diagnostic tests

ANS: B

Probable signs are those detected through trained examination.

Fetal visualization is a positive sign of pregnancy.

Presumptive signs are those reported by the client.

The term diagnostic tests is open for interpretation. To actually diagnose pregnancy, one would have to see positive signs of pregnancy.

DIF: Cognitive Level: Comprehension REF: 292

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

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

a.

Viability22 to 37 weeks since the last menstrual period (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

Term is 38 to 42 weeks of gestation.

Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since the last menstrual period.

Preterm is 20 to 37 weeks of gestation.

Postdate or postterm is a pregnancy that extends beyond 42 weeks or what is considered the limit of full term.

DIF: Cognitive Level: Knowledge REF: 289

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

Higher levels also could be a sign of multiple gestation.

hCG can be detected as early as 7 to 10 days after conception.

The hCG level fluctuates during pregnancy, peaking, declining, stabilizing, and then increasing again.

Abnormally slow increases may indicate impending miscarriage.

DIF: Cognitive Level: Knowledge REF: 290

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

15. In order to reassure and educate pregnant clients 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

The softening of the lower uterine segment is called the Hegar sign.

Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends.

Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop.

The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

DIF: Cognitive Level: Comprehension REF: 293

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

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

a.

Operculum

b.

Leukorrhea

c.

Funic souffle

d.

Ballottement

ANS: A

The operculum protects against bacterial invasion.

Leukorrhea is the mucus that forms the endocervical plug (the operculum).

The funic souffle is the sound of blood flowing through the umbilical vessels.

Ballottement is a technique for palpating the fetus.

DIF: Cognitive Level: Knowledge REF: 295

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

17. Some pregnant clients may complain of changes in their voice and impaired hearing. The nurse can tell these clients 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

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.

Estrogen levels increase, not decrease.

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.

The volume of blood is increased. However, the key here 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: Comprehension REF: 298

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

18. In order to reassure and educate pregnant clients 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 result 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

First bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often.

A number of anatomic changes make a pregnant woman more susceptible to urinary tract infection.

Renal function is more efficient when the woman lies in the lateral recumbent position and less efficient when she is supine.

Diuretic use during pregnancy can overstress the system and cause problems.

DIF: Cognitive Level: Comprehension REF: 300

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

19. A pregnant woman tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal change, commonly called the mask of pregnancy or, scientifically:

a.

Chloasma

b.

Linea nigra

c.

Striae gravidarum

d.

Palmar erythema

ANS: A

Chloasma, the mask of pregnancy, usually fades after birth.

Linea nigra is a pigmented line that runs vertically up the abdomen.

Striae gravidarum are also known as stretch marks.

Palmar erythema is signified by pinkish red blotches on the hands.

DIF: Cognitive Level: Knowledge REF: 301

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

20. 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

Normal nausea and vomiting rarely produce harmful effects and may be less likely to result in miscarriage or preterm labor.

Ptyalism is excessive salivation that may be caused by a decrease in unconscious swallowing or by stimulation of the salivary glands.

Pyrosis begins as early as the first trimester and intensifies through the third trimester.

Increased hormone production does not lead to hyperthyroidism in pregnant women.

DIF: Cognitive Level: Application REF: 303

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

21. A first-time mother at 18 weeks of gestation is in for her regularly scheduled prenatal visit. The client tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that this is the Braxton Hicks sign and teaches the client that this type of contraction:

a.

Is painless

b.

Increases with walking

c.

Causes cervical dilation

d.

Impedes oxygen flow to the fetus

ANS: A

Soon after the fourth month of gestation, uterine contractions can be felt through the abdominal wall. Braxton Hicks contractions are regular and painless and continue throughout the pregnancy. Although they are not painful, some women complain that they are annoying.

This type of contraction usually ceases with walking or exercise.

Braxton Hicks contractions can be mistaken for true labor; however, they do not increase in intensity, frequency, or cause cervical dilation.

These contractions facilitate uterine blood flow through the intervillous spaces of the placenta and thereby promote oxygen delivery to the fetus.

DIF: Cognitive Level: Comprehension REF: 293

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

22. In order to reassure and educate pregnant clients about changes in the cervix, vagina, and position of the fetus, nurses should 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 (Chadwick 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

Increased sensitivity and an increased interest in sex sometimes go together. This frequently occurs during the second trimester.

These cervical changes make evaluation of abnormal Pap tests more difficult.

Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus.

The Chadwick sign appears from the sixth to eighth weeks.

DIF: Cognitive Level: Comprehension REF: 295

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

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 human chorionic gonadotropin (hCG) test

ANS: A, C, D

Identification of fetal heartbeat, visualization of the fetus, and verification of fetal movement are all positive, objective signs of pregnancy.

Palpation of fetal outline and positive hCG test 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: Analysis REF: 292

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment, Diagnosis

COMPLETION

1. ____________________ is when the fetus begins to descend and drop into the pelvis.

ANS:

Lightening

Between weeks 38 and 40, fundal height drops as the fetus begins to descend and engage in the pelvis. Generally, lightening occurs in the nullipara about 2 weeks before the onset of labor and at the start of labor in the multipara.

DIF: Cognitive Level: Comprehension REF: 292

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

TRUE/FALSE

1. In nonpregnant women, blood glucose levels must be 160 to 180 mg/dl before glucose is spilled into the urine. During pregnancy glucosuria occurs when maternal glucose levels are lower than 160 mg/dl. Is this statement true or false?

ANS: T

This statement is true. Why glucose, as well as other nutrients such as amino acids, is wasted during pregnancy is not understood, nor has the exact mechanism been discovered. Although glucosuria may be found in normal pregnancies, the possibility of gestational diabetes must be kept in mind.

DIF: Cognitive Level: Application REF: 301

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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