CH 04

Chapter 4: Physical and Psychological Changes of Pregnancy
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. While assisting the physician with a physical examination, the nurse notes which sign or symptom as
most definitive of a diagnosis of pregnancy?
1) Positive Goodell’s sign
2) Quickening felt by mother
3) Auscultation of fetal heart sounds
4) Breast enlargement and tenderness
____ 2. Which nursing assessment finding indicates the need for further testing before a diagnosis of
pregnancy can be confirmed?
1) Audible fetal heart tones
2) Fetal movement felt by the nurse
3) Fetal ultrasound showing a growing fetus
4) Amenorrhea
____ 3. The nurse caring for a woman who is beginning the second trimester of pregnancy recognizes the
need for further assessment when the woman reports which change in her body?
1) Constipation
2) Feels short of breath with mild exertion
3) Nasal congestion
4) A dark line appearing on the abdomen
____ 4. The nurse caring for a woman who is in the third trimester of pregnancy suspects a urinary tract
infection on the basis of which reported symptom?
1) Urinary frequency
2) Urgency
3) Stress incontinence
4) Burning on urination
____ 5. A pregnant woman tells the nurse how clumsy she feels. Which teaching will the nurse provide?
1) Kegel exercises
2) Increased fluid intake
3) Avoidance of standing or sitting for prolonged periods
4) Wearing low-heeled shoes and using good body mechanics
____ 6. When talking with the nurse, a pregnant patient points out her darkened areolas, the linea nigra on
her abdomen, and the brown patches on her forehead and nose and says, “I’m never going to be able
to wear a bikini again.” Which is the nurse’s best response?
1) “Makeup will help you hide these after you have the baby.”
2) “Be sure to point these out to the doctor. You may need to see a dermatologist.”
3) “These changes normally go away after you have the baby.”
4) “Applying vitamin E oil or cocoa butter will reverse these discolorations.”
____ 7. The nurse reviews a pregnant patient’s laboratory values and notes a reduced red blood cell count
and hemoglobin level. Which symptom reported by the patient results from these findings?
1) Insomnia
2) Pica
3) Fatigue
4) Leg pain
____ 8. After assessing the cardiovascular system of a pregnant woman, the nurse recognizes the need to
report which finding to the provider?
1) Asymptomatic systolic murmur
2) Heart rate of 96 bpm
3) Blood pressure of 152/94 mm Hg
4) Nasal congestion
____ 9. Which symptom reported to the nurse by the patient needs to be brought to the attention of the
health-care provider?
1) Vaginal itching
2) Leakage of fluid from the nipples
3) Increase in vaginal discharge
4) Breast tenderness and enlargement
____ 10. The nurse reviews the patient’s laboratory findings and suspects anemia when noting which result?
1) Hemoglobin 12.4 g/dL
2) Red blood cell count 4.1
3) White blood cell count 24.3
4) Hematocrit 53.5%
____ 11. Which finding does the nurse recognize as a normal result of pregnancy?
1) Reduction in red blood cell count
2) Reduced platelet count
3) Increased urine glucose level
4) Elevated hematocrit value
____ 12. The nurse reviews the patient’s laboratory values and sees the following:
Hemoglobin 12.2 g/dL

Hematocrit 42.8%
Serum blood urea nitrogen 18 mg/dL
(BUN)
Serum creatinine 0.68 mg/dL
Alanine transaminase (ALT) 8 units/L
Aspartate aminotransferase 12 units/L
(AST)
Alkaline phosphatase (ALP) 108
ImU/mL
Lactate dehydrogenase (LDH) 635 units/L
Which conclusion does the nurse draw on the basis of these findings?
1)The patient is anemic.
2)The patient has liver damage.
3)The patient has kidney damage.
4)The patient is dehydrated.
____ 13. During the woman’s first prenatal visit, she makes many statements about the recommendations she
has received from her friends about maintaining her health and the health of the growing fetus.
According to Reva Rubin, which maternal task is this woman demonstrating?
1) Seeking safe passage for herself and her fetus
2) Securing acceptance for herself as a mother and for her fetus
3) Learning to give of herself and to accept herself as a mother to the infant
4) Committing herself to the child as she progresses through pregnancy
____ 14. The nurse learns that a pregnant patient lost her mother when she was a teenager and recognizes that
the absence of a mother figure will cause this patient to have difficulty with which of Reva Rubin’s
four maternal tasks?
1) Seeking safe passage for herself and her fetus
2) Securing acceptance for herself as a mother and for her fetus
3) Learning to give of herself and to accept herself as a mother to the infant
4) Committing herself to the child as she progresses through pregnancy
____ 15. Upon examining a woman in the late second trimester of pregnancy, the nurse notes circular bruises
around each wrist and circular bruises above the umbilicus. What should the nurse suspect?
1) Physical abuse from the father of the baby
2) Clumsiness resulting from changes in the woman’s body
3) The woman’s attempt to induce a miscarriage
4) A motor vehicle accident
____ 16. A pregnant woman is telling the nurse about her other children’s reaction to news of the pregnancy
but says she is waiting to tell her toddler until she’s further along. Which is the nurse’s best
response?
1) “If you’ve told the other children, you should also tell your toddler.”
2) “That’s a wise decision because toddlers have no concept of time.”
3) “It would’ve been better if you hadn’t told any of the children yet.”
4) “The younger the child, the sooner you should tell him to give him time to
prepare.”
____ 17. When the nurse cares for a pregnant adolescent, which psychosocial assessment takes priority before
teaching self-care?
1) Gestational age
2) Developmental level
3) Support system
4) School progression
____ 18. The emergency department nurse admits an adolescent who is complaining of abdominal pain and
denies pregnancy. Assessment findings include a distended, pregnant-appearing abdomen and fetal
heart tones. How does the nurse interpret these contradictory findings?
1) Denial of pregnancy until late in gestation is not uncommon in adolescence.
2) The adolescent is mentally ill and incapable of recognizing pregnancy.
3) The adolescent is developmentally delayed and does not recognize pregnancy.
4) Further testing is needed to determine the cause of the assessment findings.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 19. The nurses is caring for a pregnant Indian woman. Which observations does the nurse attribute to the
woman’s cultural beliefs? (Select all that apply.)
1) The woman may play the sick role.
2) The woman may report eating a great deal of chicken broth.
3) The woman believes it is her husband’s responsibility to satisfy her food cravings.
4) The woman continues to carry heavy loads.
5) The woman does not believe doctors are necessary during pregnancy.
____ 20. The nurse working with a culturally diverse obstetric patient population recognizes which common
cultural practices? (Select all that apply.)
1) Hispanic and Indian women tend to remain physically active.
2) Japanese women do not freely discuss problems with morning sickness.
3) Chinese and Japanese women avoid physical activity.
4) Hispanic women rely on older women in the family for advice.
5) Indian women expect others to satisfy food cravings.
Chapter 4: Physical and Psychological Changes of Pregnancy
Answer Section
MULTIPLE CHOICE
1. ANS: 3
Chapter number and title: 4: Physical and Psychological Changes of Pregnancy
Chapter learning objective: Differentiate presumptive, probable, and positive signs of pregnancy.
Chapter page reference: 39
Heading: Diagnosis of Pregnancy
Integrated processes: Clinical Problem-Solving Process
Client need: Health Promotion and Maintenance
Cognitive level: Application [Applying]
Concept: Pregnancy
Difficulty: Easy
Feedback
1 Although a positive Goodell’s sign is a probable sign of pregnancy, it is not a
definitive sign.
2 Reported quickening, or fetal movement, felt by the mother is considered a
subjective presumptive sign, but it is not a definitive diagnosis of pregnancy.
3 When the health-care provider auscultates fetal heart sounds, it is considered a
positive and definitive indication of pregnancy.
4 Breast enlargement and tenderness are considered a subjective presumptive sign
of pregnancy, but they are not a definitive or positive sign of pregnancy.
PTS: 1 CON: Pregnancy

2. ANS: 4
Chapter learning objective: Differentiate presumptive, probable, and positive signs of pregnancy.
Heading: Diagnosis of Pregnancy
Concept: Pregnancy
Difficulty: Easy
Feedback
1 Audible fetal heart tones are considered a positive sign of pregnancy and do not
require further testing.
2 Fetal movement felt by the nurse is considered a positive sign of pregnancy and
does not require further testing.
3 A fetal ultrasound demonstrating a growing fetus is considered a positive sign of
pregnancy, eliminating the need for further testing.
4 Although amenorrhea is considered a presumptive sign of pregnancy, it can be
caused by other factors; thus, further testing is needed before making a diagnosis
of pregnancy.

3. ANS: 2
Chapter learning objective: Describe the physiological changes in each body system occurring
during pregnancy.
Chapter page reference: 39-46
Heading: Tables 4-1 to 4-7
Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Difficult
Feedback
1 Constipation is not uncommon in pregnancy and requires patient teaching, not
further assessment.
2 Shortness of breath with mild exertion during the early part of the second
trimester indicates a problem requiring further assessment.
3 Nasal congestion at this stage of pregnancy is common, and the nurse should
provide teaching to help the woman cope with this symptom.
4 A dark line appearing on the abdomen is known as the linea nigra; it is not
uncommon and does not require further assessment.

4. ANS: 4
Chapter learning objective: Describe the physiological changes in each body system occurring
during pregnancy.
Heading: Table 4-5 Urinary System Changes in Pregnancy
Client need: Physiological Adaptation
Concept: Pregnancy
Difficulty: Moderate
Feedback
1 Urinary frequency is not uncommon in the third trimester of pregnancy because
of the pressure of the fetus on the bladder and does not indicate a urinary tract
infection.
2 Urgency is common in late-stage pregnancy and does not indicate a urinary tract
infection.
3 Stress incontinence due to the pressure of the fetus on the bladder is not
uncommon in the third trimester of pregnancy.
4 Burning on urination is not an anticipated urinary symptom of pregnancy and
indicates the potential for a urinary tract infection, requiring further testing.

5. ANS: 4
Chapter learning objective: Plan safe and effective nursing interventions addressing the common
physiological discomforts of pregnancy.
Heading: Tables 4-3 to 4-7
Integrated processes: Teaching and Learning
Concept: Pregnancy
Feedback
1 Kegel exercises are performed to reduce urinary incontinence, not to reduce
clumsiness.
2 Increased fluid intake prevents dehydration that may be due to wanting to reduce
frequency of urination.
3 Teaching to avoid sitting or standing for long periods is done to prevent
thrombophlebitis.
4 Wearing low-heeled shoes and using good body mechanics will help avoid injury
from the clumsiness that occurs as the result of relaxin secretion.

6. ANS: 3
Heading: Table 4-6
Integrated processes: Teaching and Learning
Concept: Pregnancy
Feedback
1 This is an incorrect statement because makeup will not be needed.
2 Hyperpigmentation is not unusual in pregnancy and does not require a referral to
a dermatologist.
3 This statement is accurate and will help to reassure the woman.
4 Vitamin E oil or cocoa butter may be helpful with striae, but they will not help
with the hyperpigmentation the woman is demonstrating.

7. ANS: 3
Heading: Table 4-3 Cardiovascular System Changes in Pregnancy
Client need: Reduction of Risk Potential
Concept: Pregnancy
Feedback
1 The patient’s laboratory values reflect anemia, which does not result in
insomnia.
2 Pica is an abnormal craving for nonfood substances and is not reflected by the
laboratory values.
3 Fatigue is a common symptom associated with anemia, which is what the
laboratory values reflect.
4 Leg pain is associated with a venous thrombosis and is not reflected in these
laboratory values.

8. ANS: 3
Chapter learning objective: Identify physiological discomfort symptoms that should be reported to
the health-care provider.
Heading: Table 4-3 Cardiovascular System Changes in Pregnancy
Concept: Pregnancy
Feedback
1 It is not unusual for a pregnant woman to develop an asymptomatic systolic
murmur.
2 It is not unusual for her heart rate to increase 10 to 20 beats above prepregnancy
levels.
3 Blood pressure is expected to remain stable, perhaps with a slight decrease in
systolic pressure and an increase in diastolic pressure, so this unexpected
elevation in blood pressure should be reported to the provider.
4 Nasal blood flow is often increased in pregnancy, resulting in nasal congestion,
and does not need to be reported to the provider.

9. ANS: 1
Chapter learning objective: Identify physiological discomfort symptoms that should be reported to
the health-care provider.
Heading: Table 4-1 Reproductive System Changes in Pregnancy
Concept: Pregnancy
Feedback
1 Vaginal itching is a symptom of a vaginal yeast infection and should be reported
to the provider.
2 Leakage of fluid from the nipples is most likely colostrum, which indicates the
breasts are preparing to lactate, and is an expected finding.
3 An increase in vaginal discharge is expected because of the increased vascularity
in the area.
4 Breast tenderness and enlargement are expected findings and do not need to be
reported to the health-care provider.

10. ANS: 2
Chapter learning objective: Identify normal laboratory values for the pregnant woman.
Heading: Lab and Diagnostics
Concept: Pregnancy
Feedback
1 A hemoglobin value of 12.4 g/dL is within normal limits and does not indicate
anemia.
2 A red blood cell count of 4.1 indicates mild anemia because it is lower than the
expected finding.
3 The white blood cell count is elevated and indicates a potential infection, not
anemia.
4 The hematocrit value is elevated, which indicates dehydration rather than
anemia.

11. ANS: 2
Cognitive level: Comprehension [Understanding]
Concept: Pregnancy
Difficulty: Easy
Feedback
1 The normal range for red blood cell count does not change with pregnancy.
2 The normal range for platelets drops from 140,000 to 300,000 mm3 to less than
100,000 per mm3.
3 Urine glucose values are expected to be elevated in the pregnant female.
4 The normal range for hematocrit values decreases in pregnancy; it does not
increase.

12. ANS: 4
Concept: Pregnancy
Feedback
1 The hemoglobin level is within the normal range, and the hematocrit value is
elevated, so there is no reason to suspect anemia.
2 The ALT, AST, ALP, and LDH values are within normal limits for a pregnant
woman, so there is no indication of liver damage.
3 Although the BUN value is elevated, the creatinine level is normal, so there is no
indication of kidney damage.
4 An elevated BUN level accompanied by an elevated hematocrit value is an
indication of dehydration, possibly caused by frequent vomiting if the pregnant
woman is in the first trimester.

13. ANS: 1
Chapter learning objective: Discuss Reva Rubin’s four maternal tasks the woman accomplishes
during pregnancy.
Heading: The Mother
Client need: Psychosocial Integrity
Concept: Pregnancy
Feedback
1 During the first trimester, a woman expresses concerns for her own health and
her pregnancy symptoms, demonstrating her attempt to seek safe passage for
herself and her fetus (as demonstrated by this woman).
2 Securing acceptance of herself as a mother is demonstrated by a desire for
acceptance of the pregnancy by others in the family, which is not what this
woman is demonstrating during her first prenatal visit.
3 Learning to give of herself and accept herself as a mother to the infant occurs
when the woman begins to bond and feel love for the infant, which is not what
this woman is demonstrating.
4 Committing herself to the child is demonstrated by preparing for the birth, which
is not what this woman is demonstrating.

14. ANS: 2
Chapter learning objective: Discuss Reva Rubin’s four maternal tasks the woman accomplishes
during pregnancy.
Heading: The Mother
Client need: Health Psychosocial Integrity
Concept: Pregnancy
Feedback
1 The absence of a mother will not impact the patient’s ability to seek safe
passage, which involves concern for her health and that of her fetus.
2 The absence of a mother will be noted during this stage because a mother’s
reaction to the pregnancy and reminiscence about her own pregnancy help the
daughter anticipate and prepare for the pregnancy.
3 This phase of maternal tasks involves the mother recognizing the presence of the
fetus and will not be impacted by the absence of the patient’s mother.
4 The fourth maternal task involves preparing for the baby’s birth; although the
patient may miss her mother, the absence of the mother will not impact this stage
as heavily as it impacts another stage.

15. ANS: 1
Chapter learning objective: Discuss the psychosocial changes occurring during pregnancy for the
woman, her partner, and family.
Heading: The Father
Integrated processes: Nursing Process: Assessment
Client need: Safety and Infection Control
Concept: Pregnancy
Feedback
1 When a pregnancy is unplanned or unwanted, it is not unusual for the father to
demonstrate disappointment and frustration through violence; so the potential for
abuse should be considered, especially with the type of bruising described.
2 Although it is not unusual for a woman to become clumsier as her pregnancy
progresses, clumsiness cannot explain the circular bruises around the wrists.
3 These bruises, especially the circular bruises around the wrists, do not indicate
an attempt to induce a miscarriage.
4 The types of bruises described are not consistent with a motor vehicle accident.

16. ANS: 2
Chapter learning objective: Discuss the psychosocial changes occurring during pregnancy for the
woman, her partner, and family.
Heading: Siblings
Integrated processes: Communication and Documentation
Concept: Pregnancy
Feedback
1 This is not an accurate statement because older children are often told before
younger children.
2 This is an accurate statement; because toddlers have no concept of time, they
will think the new baby is only a story, not a reality, if informed too early.
3 It is not the nurse’s place to judge the mother and her decisions about telling her
children, so this is an inappropriate statement.
4 This statement is backward because the younger the child, the longer you should
wait to tell her.

17. ANS: 2
Chapter learning objective: Identify psychosocial issues of the pregnant adolescent.
Heading: The Pregnant Adolescent
Concept: Pregnancy
Feedback
1 Although determining how far along the adolescent is in pregnancy is important,
it is not a psychosocial assessment.
2 It is important to prioritize assessment of the adolescent’s developmental level to
determine how best to teach her.
3 Assessing the support system should be a part of caring for this patient, but it is
not a priority before beginning teaching.
4 School progression (i.e., what grade the adolescent is in) should be assessed, but
it is not the priority.
18. ANS: 1
Chapter learning objective: Identify psychosocial issues of the pregnant adolescent.
Heading: The Pregnant Adolescent
Concept: Pregnancy
Feedback
1 This is a true statement; adolescents often deny pregnancy out of fear.
2 There is no indication of mental illness.
3 There is no indication of a developmental delay.
4 The presence of fetal heart tones is a positive sign of pregnancy; although further
testing may be done to determine the health of the adolescent and fetus, it is not
needed to explain the findings.
MULTIPLE RESPONSE
19. ANS: 3, 4, 5
Chapter learning objective: Discuss possible cultural differences in viewing a normal pregnancy.
Heading: Cultural Considerations Box
Integrated processes: Caring
Concept: Diversity
Feedback
1. Chinese women, not Indian women, may assume a sick role, depending on
others for assistance.
2. Chinese women, not Indian women, may eat special soups and chicken broth to
manage the disruption in the balance of hot and cold foods.
3. Indian women may believe that it is the responsibility of others to satisfy their
cravings.
4. Indian women do not believe in restricting physical activity and may continue
their daily activities, including carrying heavy loads, until labor begins.
5. Indian women view pregnancy as a normal process that does not require any
intervention by health-care professionals.
PTS: 1 CON: Diversity

20. ANS: 1, 2, 4, 5
Chapter learning objective: Discuss possible cultural differences in viewing a normal pregnancy.
Heading: Cultural Considerations Box
Integrated processes: Caring
Concept: Diversity
Feedback
1. Both Hispanic and Indian women tend to see pregnancy as a normal process that
does not require a reduction in physical activity.
2. Japanese women will not discuss morning sickness, even with family members,
and need to be specifically questioned about this issue.
3. Although Chinese women avoid physical activity, often playing the sick role,
this is not true of Japanese women.
4. The Hispanic culture is very respectful of elders, and it is not uncommon for a
woman to rely on mothers, aunts, and grandmothers for advice about pregnancy.
5. Some Indian women believe that it is the responsibility of others to satisfy a
woman’s cravings; and if the newborn baby drools excessively, it is interpreted
as the mother’s cravings not being met during pregnancy.
PTS: 1 CON: Diversity

CH 04

Uploaded by

Copyright:

Available Formats

CH 04

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

CH 04

Uploaded by

Copyright:

Available Formats

Chapter 4: Physical and Psychological Changes of Pregnancy

Hemoglobin 12.2 g/dL

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Pregnancy

PTS: 1 CON: Diversity

PTS: 1 CON: Diversity

You might also like