Nokea
A client in her third trimester reports increased perineal pressure. Which is the clinical cause for this complaint?
- A. Fundal height
- B. Urinary infection
- C. Constipation
- D. Hydramnios
Correct Answer: A
Rationale: The correct answer is A: Fundal height. In the third trimester, the growing uterus causes increased pressure on the pelvic organs, leading to perineal pressure. Fundal height measures the height of the uterus and correlates with gestational age, indicating the position and size of the fetus. As the uterus grows, fundal height increases, causing pressure on the perineal area. Urinary infection (B) can cause discomfort but would present with other symptoms like burning urination. Constipation (C) may cause discomfort but typically does not lead to increased perineal pressure. Hydramnios (D) refers to excess amniotic fluid, which can lead to abdominal distension but is not directly related to perineal pressure.
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What is the physiologic reason for vascular volume increasing by 40% to 60% during pregnancy?
- A. Prevents maternal and fetal dehydration
- B. Eliminates metabolic wastes of the mother
- C. Provides adequate perfusion of the placenta
- D. Compensates for decreased renal plasma flow
Correct Answer: C
Rationale: The correct answer is C: Provides adequate perfusion of the placenta. During pregnancy, the increased vascular volume ensures sufficient blood flow to the placenta, supplying oxygen and nutrients to the developing fetus. This is crucial for fetal growth and development. The other choices are incorrect because:
A: Preventing maternal and fetal dehydration is not the main reason for the significant increase in vascular volume during pregnancy.
B: Eliminating metabolic wastes of the mother does not require such a substantial increase in vascular volume.
D: Compensating for decreased renal plasma flow is not the primary physiologic reason for the vascular volume expansion during pregnancy.
Now in her second trimester of pregnancy, the client, who was a marathon runner before nausea and overwhelming tiredness kept her from exercising regularly, is wondering whether she can run now. What is the nurse's best response?
- A. Certainly, if you feel up to it.
- B. Your level of exercise will be somewhat modified by the changes occurring in your body.
- C. Your primary health care provider will need to give you permission.
- D. Because your body is meeting the needs of two people now, you should avoid too much exercise.
Correct Answer: B
Rationale: The correct answer is B: "Your level of exercise will be somewhat modified by the changes occurring in your body."
Rationale:
1. Pregnancy impacts a woman's body significantly, including changes in hormones, weight distribution, and center of gravity.
2. These changes can affect a woman's ability to engage in high-impact activities like running.
3. The nurse's response acknowledges the need for modification in exercise routine to accommodate these changes.
4. It promotes a balanced approach to exercise during pregnancy, considering both the benefits of physical activity and the safety of the mother and baby.
Summary of Other Choices:
A: "Certainly, if you feel up to it." - This response oversimplifies the situation and does not consider the specific physiological changes during pregnancy that may impact the woman's ability to run safely.
C: "Your primary health care provider will need to give you permission." - While consulting a healthcare provider is important, this response does not address the specific concerns related to exercise during pregnancy.
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 patient's 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.
Correct Answer: C
Rationale: The correct answer is C because during pregnancy, the systolic blood pressure tends to increase slightly as pregnancy progresses due to increased cardiac output and decreased systemic vascular resistance. On the other hand, the diastolic pressure typically remains constant or may even decrease slightly. This physiological change is important for maternity nurses to be aware of in order to differentiate normal pregnancy-related changes from potential complications like preeclampsia.
Choices A, B, and D are incorrect:
A: This choice discusses the effect of cuff size on blood pressure readings, which is important but not directly related to the changes in blood pressure during pregnancy.
B: Shifting positions and changing arms for measurements may affect accuracy but is not specifically related to blood pressure changes during pregnancy.
D: Compression of iliac veins and inferior vena cava by the uterus leading to hemorrhoids is unrelated to changes in blood pressure during pregnancy.
To reassure and educate pregnant patients 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's 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.
Correct Answer: D
Rationale: Increased sensitivity and an increased interest in sex sometimes go together. This frequently occurs during the second trimester.
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 woman's increased urinary frequency in the first trimester is the result of exaggerated uterine anteflexion 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
Correct Answer: B
Rationale: Softening of the lower uterine segment (Hegar's sign) causes increased urinary frequency in the first trimester. Lightening occurs late in pregnancy, Braxton Hicks contractions are not typically painful, and the uterine souffle refers to blood flow sounds.