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Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and the basis for many tests. A maternity nurse should be aware that:
- A. hCG can be detected 2.5 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.
Correct Answer: D
Rationale: Higher levels also could be a sign of multiple gestation. hCG can be detected 7 to 8 days after conception. The hCG level fluctuates during pregnancy.
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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: The correct answer is D because increased vascularity of the vagina during pregnancy leads to heightened sensitivity and can result in increased arousal, especially in the second trimester. This is due to increased blood flow and hormonal changes affecting the vaginal tissues. This physiological response is a normal part of pregnancy and can enhance sexual experiences for some women.
A is incorrect because changes in the cervix do not impact the evaluation of abnormal Pap tests. B is incorrect as quickening refers to the first perception of fetal movements by the pregnant woman, not palpating the fetus. C is incorrect as Chadwick's sign, the deepening color of the vaginal mucosa and cervix, typically appears in the first trimester, not 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.
The maternity nurse understands that vascular volume increases 40% to 45% during pregnancy to:
- A. compensate for decreased renal plasma flow.
- B. provide adequate perfusion of the placenta.
- C. eliminate metabolic wastes of the mother.
- D. prevent maternal and fetal dehydration.
Correct Answer: B
Rationale: The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta.
To reassure and educate pregnant patients 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 Montgomery's 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.
Correct Answer: A
Rationale: Rationale for Correct Answer A:
1. Montgomery's tubercles are sebaceous glands on the areola.
2. Blood vessels becoming visible indicates increased blood supply due to hormonal changes during pregnancy.
3. The intertwining blue network reflects full function of Montgomery's tubercles.
4. Infection may cause inflammation and increased visibility of blood vessels.
Summary of Incorrect Choices:
B: Incorrect, mammary glands develop during puberty, not right before labor.
C: Incorrect, lactation is primarily influenced by prolactin, not estrogen.
D: Incorrect, colostrum is a thick, yellowish fluid containing antibodies, not an oily substance for lubrication.
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
Correct Answer: B
Rationale: Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term.