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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.
Correct Answer: C
Rationale: Estrogen levels increase, causing the upper respiratory tract to become more vascular producing swelling and congestion in the nose and ears leading to voice changes and impaired hearing.
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A patient in her first trimester complains of nausea and vomiting. She asks, 'Why does this happen?' The nurse's best response is:
- A. It is due to an increase in gastric motility
- B. It may be due to changes in hormones
- C. It is related to an increase in glucose levels
- D. It is caused by a decrease in gastric secretions
Correct Answer: B
Rationale: Nausea and vomiting are primarily caused by hormonal changes, particularly elevated human chorionic gonadotropin (hCG) and progesterone levels.
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 hCG levels may indicate conditions such as multiple gestation, ectopic pregnancy, or Down syndrome. hCG levels fluctuate during pregnancy and peak around 8-10 weeks.
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.
Correct Answer: A
Rationale: The appendix is displaced high and to the right, beyond McBurney point.
To reassure and educate 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: D
Rationale: Compression of pelvic veins by the enlarging uterus contributes to varicosities, including hemorrhoids. Blood pressure trends vary, but systolic pressure generally remains stable while diastolic pressure decreases initially.
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 vascularity and sensitivity in the vagina are common during pregnancy. Chadwick's sign appears earlier (6-8 weeks), and quickening refers to maternal perception of fetal movement.