10 Nursing Care Related To Psychological and Physiologic Changes of Pregnancy

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Chapter: 10
Instruction:
Name: __________________________ Date: _____________
Multiple Choice
1. A woman in a prenatal clinic tells the nurse that her pregnancy was unplanned and unwanted.
At what point in pregnancy does the average woman change her mind about an unwanted
pregnancy?
A) around the third month
B) when quickening occurs
C) after lightening happens
D) after the seventh month
Ans: B
Client Needs: Health Promotion and Maintenance
Cognitive Level: Understand
Page: 206
Feedback: Quickening, or feeling the baby move inside the body, is such a dramatic event that
it can cause a woman's perceptions about the pregnancy to change.
2. A nurse is assessing a pregnant woman who has come to the clinic for a follow up visit.
During the visit the nurse assesses the woman for evidence that she is working through the
developmental tasks and adjusting psychologically. Which statement would the nurse interpret as
indicating that the woman is adjusting positively?
A) ―My mother and I are closer than ever before.‖
B) ―I don't care what sex baby I have as long as it's healthy.‖
C) ―I'm thinking about everything I eat these days.‖
D) ―There are a lot of allergies in my husband's family.‖
Ans: A
Client Needs: Psychosocial Integrity
Cognitive Level: Analyze
Page: 207
Feedback: A developmental task for a woman during pregnancy is to review and restructure her
relationship with her mother.
3. During pregnancy, which situation would interfere with mother–child bonding?

A) A woman's neighbor is planning an extensive vacation.
B) A woman's father has been very ill during the pregnancy.
C) A woman's husband was awarded a large year-end bonus.
D) A woman's sister recently had a baby boy.
Ans: B
Page: 207
Feedback: Any event during pregnancy that has the potential to reduce the time the woman
spends working through the developmental tasks of pregnancy can interfere with bonding.
4. A pregnant woman needs to increase the amount of milk she drinks daily. Early in
pregnancy, which statement would probably be most effective as a health teaching measure?
A) ―Milk will strengthen your fingernails as well as be good for the baby.‖
B) ―The fetus needs milk to build strong bones and teeth.‖
C) ―Milk is a rich source of calcium that is important for fetal growth.‖
D) ―Your future baby will benefit from a high milk intake.‖
Ans: A
Cognitive Level: Apply
Page: 208
Feedback: Early in pregnancy, before the pregnancy seems real, women often respond best to
health teaching that meets their needs rather than those of the coming infant.
5. A pregnant woman's husband does not voice concerns at prenatal visits. Which observation
would lead the nurse to suspect that the husband is emotionally involved in the pregnancy?
A) He states he definitely wants a girl.
B) He walks around furniture as if his abdomen is enlarged.
C) He states he is concerned about the loss of his free time.
D) He has refused to paint the baby's room blue.
Ans: B
Page: 209
Feedback: Many partners experience physical symptoms such as nausea, vomiting, and
backache to the same degree or even more intensely than their partners during a pregnancy; some
begin to gain weight along with their partner. This is known as couvade syndrome. As a woman's
abdomen begins to grow, partners may perceive themselves as growing larger too, as if they
were the ones who were experiencing changing boundaries the same as the pregnant woman.
These symptoms apparently result from stress, anxiety, and empathy for the pregnant woman.
Men who identify with their wife's pregnancy may act as if their abdomen is enlarging, the same
as they may take on nausea of pregnancy.
6. To prepare his 4-year-old son for a new baby, a father should use which statement?
A) ―The new baby will need your bed so we're buying you a new one.‖
B) ―It will be fun to have a sister or brother to give your old toys to.‖
C) ―A new baby will make our family bigger but not change our love for you.‖
D) ―Mother will need to spend a lot of time with the new baby.‖
Ans: C
Page: 210
Feedback: It is important that siblings see a new family member as adding to the family (not
displacing them) to prevent jealousy.
7. What is a positive sign of pregnancy?
A) positive pregnancy test
B) fetal movement felt by examiner
C) Hegar's sign
D) uterine contractions
Ans: B
Client Needs: Physiological Integrity: Physiological Adaptation
Cognitive Level: Remember
Page: 212
Feedback: The positive signs of pregnancy are fetal image on sonogram, hearing a fetal heart
rate, and examiner feeling fetal movement.
8. If a woman is 3 months pregnant, which finding related to breast changes would the nurse
expect to assess?
A) slack, soft breast tissue
B) deeply fissured nipples
C) enlarged lymph nodes
D) darkened breast areolae
Ans: D
Page: 216
Feedback: As part of the pigment changes that occur with pregnancy, breast areolae become
darker.
9. A woman tells the nurse that she is going to use a home pregnancy test to determine whether
she is pregnant. Which precautions should the nurse give her?
A) Use a diluted urine specimen.
B) Wait until after two missed menstrual periods.
C) Arrange for prenatal care if the test is positive.
D) Refrain from eating for 4 hours before testing.
Ans: C
Client Needs: Safe, Effective Care Environment: Management of Care
Page: 205
Feedback: Home pregnancy testing can be accurate as soon as a period is missed; it should not
take the place of prenatal care.
10. Early in pregnancy, frequent urination results mainly from which cause?
A) pressure on the bladder from the uterus
B) increased concentration of urine
C) addition of fetal urine to maternal urine
D) decreased glomerular selectivity
Ans: A
Page: 220
Feedback: Early in pregnancy, the expanding uterus presses on the bladder. Later, it rises above
the bladder so pressure is relieved.
11. At her 16-week checkup, a client's blood pressure is slightly decreased from her
prepregnancy level. The nurse evaluates this change based on which statements concerning
blood pressure during pregnancy?
A) Normally, blood pressure increases steadily throughout pregnancy.
B) Blood pressure remains stable until decreasing the day of the birth.
C) A decrease in the second trimester may occur because of placental growth.
D) Blood pressure progressively decreases throughout the entire pregnancy.
Ans: C
Page: 213
Feedback: Because the placenta ―traps‖ a great deal of blood for fetal circulation as it expands
at about 3 months, maternal blood pressure may temporarily be slightly decreased. Otherwise,
blood pressure stays fairly constant throughout pregnancy.
12. A pregnant woman tells the nurse she often has allergic responses to drugs. She is
concerned that she will be allergic to her fetus or her body will reject the pregnancy. The nurse's
reply would be based on which statement?
A) Immunologic activity is decreased during pregnancy.
B) The level of aldosterone during pregnancy reduces production of IgG antibodies.
C) The decreased corticosteroid activity during pregnancy ensures this will not happen.
D) The kidneys release a hormone during pregnancy to prevent this from happening.
Ans: A
Page: 217
Feedback: It is unproven why women do not reject fetal (foreign) tissue, but a substance
secreted by the placenta is thought to decrease the usual immunologic response and prevent this
from happening.
13. The nurse is caring for a woman in a prenatal clinic who thinks she might be pregnant.
Which assessment is a probable sign of pregnancy?
A) fatigue
B) nausea and vomiting
C) a positive pregnancy test
D) amenorrhea
Ans: C
Page: 210
Feedback: Most probable signs of pregnancy are objective signs; laboratory testing is probable,
not positive, because error can occur.
14. A pregnant patient tells the nurse that she is not happy to learn about the pregnancy. At
which point in the pregnancy does the nurse realize that the patient will change her mind about
the pregnancy?
A) Around the third month
B) After the seventh month
C) When quickening occurs
D) After lightening happens
Ans: C
Client Needs 2: Health Promotion and Maintenance
Page: 206
Feedback: Quickening or feeling the baby move inside the body is a dramatic event and causes
the pregnant woman's feelings about the pregnancy to change. Quickening occurs during the
second trimester of the pregnancy, which is after the third but before the seventh month.
Lightening occurs near the end of the pregnancy.
15. The nurse determines that a pregnant patient is working through developmental tasks.
Which statement did the patient make to the nurse?
A) ―My mother and I are closer than ever before.‖
B) ―I'm thinking about everything I eat these days.‖
C) ―There are a lot of allergies in my husband's family.‖
D) ―I don't care what sex baby I have as long as it's healthy.‖
Ans: A
Page: 207
Feedback: For the first time in her life, a woman during pregnancy can begin to empathize with
the way her mother used to worry. This can make her own mother become more important to her
and a new, more equal relationship develops. Thinking about diet, allergies, and the baby's sex
are not developmental tasks for the pregnant patient.
Multiple Selection
16. A newly wed young adult patient tells the nurse that she hopes to become pregnant soon.
What should the nurse recommend to this patient to support the 2020 National Health Goals for
pregnancy? Select all that apply.
A) Stop smoking.
B) Increase exercise.
C) Eat a healthy diet.
D) Reduce work hours.
E) Limit alcohol intake.
Ans: A, C, E
Page: 210
Feedback: Nurses can help the nation achieve the 2020 National Health Goals for pregnancy by
being certain women receive counseling in nutrition and low uses of alcohol and tobacco before
pregnancy so they can enter intended pregnancies in the best health possible. Increasing exercise
and reducing work hours are not interventions that would support the 2020 National Health
Goals for pregnancy.
Multiple Choice
17. The nurse is planning to instruct a patient who is 6 weeks pregnant about increasing the
intake of milk each day. Which statement should the nurse make as the most effective health
teaching measure?
A) ―The fetus needs milk to build strong bones and teeth.‖
B) ―Your future baby will benefit from a high milk intake.‖
C) ―Milk is a rich source of calcium that is important for fetal growth.‖
D) ―Milk will strengthen your fingernails as well as be good for the baby.‖
Ans: D
Client Needs 2: Physiological Integrity: Basic Care and Comfort
Page: 208
Feedback: There is a tendency to organize health instructions during pregnancy around the
baby; however, this approach may be inappropriate early in pregnancy, before the fetus stirs, and
before a woman is convinced not only she is pregnant but also there is a baby inside her. At early
stages, a woman may be much more interested in doing things for herself because it is her body,
her tiredness, and her well-being that will be directly affected. The nurse should instruct the
patient to drink more milk to improve fingernail strength. The statements that address fetal
development are inappropriate for the nurse to use for health teaching at this time.
18. The spouse of a pregnant patient is quiet during prenatal visits but is demonstrating
emotional involvement in the pregnancy. What action did the spouse perform?
A) States he definitely wants a girl
B) Refuses to paint the baby's room blue
C) States he is concerned about the loss of his free time
D) Walks around furniture as if his abdomen is enlarged
Ans: D
Client Needs 2: Safe, Effective Care Environment: Management of Care
Page: 205
Feedback: Many men experience physical symptoms and may begin to gain weight along with
their partner. As a woman's abdomen begins to grow, the partner may perceive himself as
growing larger too, as if he were the one who was experiencing changing boundaries the same as
his partner. This is known as couvade syndrome. This indicates emotional involvement in the
pregnancy. Stating a specific sex for the baby, losing free time, and refusing to paint the baby's
room blue are not indications that the spouse is emotionally involved in the pregnancy.
19. A father is preparing a 4-year-old son for the arrival of a new baby. Which statement should
the nurse suggest the father use to explain this to the child?
A) ―Mother will need to spend a lot of time with the new baby.‖
B) ―It will be fun to have a sister or brother to give your old toys to.‖
C) ―The new baby will need your bed so we're buying you a new one.‖
D) ―A new baby will make our family bigger but not change our love for you.‖
Ans: D
Page: 210
Feedback: Preschool-age children may need to be assured periodically during pregnancy that a
new baby will be an addition to the family and will not replace them in their parents' affection.
Explaining that the mother will have less time for the child, equating the new baby as ―fun,‖ and
taking away a bed for the baby will not help the child accept the new baby into the family.
20. A patient makes an appointment at the prenatal clinic because she thinks she might be
pregnant. Which assessment is a probable sign of pregnancy?
A) Amenorrhea
B) Enlargement and darkening of areola
C) Nausea and vomiting
D) A positive pregnancy test
Ans: D
Page: 210
Feedback: A probable sign of pregnancy is one that is objective and can be measured by an
observer. A positive pregnancy test is a probable sign of pregnancy. Amenorrhea, enlargement
and darkening of areola, and nausea and vomiting are presumptive signs because they could
indicate another health condition.
Multiple Selection
21. After an examination, an advanced practice nurse confirms that a patient is pregnant. What
did the nurse assess in this patient? Select all that apply.
A) Painful breast tissue
B) Positive pregnancy test
C) Fetal movements felt by the nurse
D) Visualization of the fetus by ultrasound
E) Fetal heart rate separate from the patient's
Ans: C, D, E
Page: 212
Feedback: There are only three documented or positive signs of pregnancy—demonstration of a
fetal heart separate from the mother's, fetal movements felt by an examiner, and visualization of
the fetus by ultrasound. Painful breast tissue is a presumptive sign of pregnancy. A positive
pregnancy test is a probably sign of pregnancy.
Multiple Choice
22. The nurse is assessing a patient who is 3 months pregnant. Which breast changes would the
nurse expect to assess in this patient?
A) Enlarged lymph nodes
B) Slack, soft breast tissue
C) Deeply fissured nipples
D) Darkened breast areolae
Ans: D
Page: 216
Feedback: As the pregnancy progresses, the areola of the nipples darkens, and its diameter
increases. Enlarged lymph nodes; slack, soft breast tissue; and deeply fissured nipples are not
expected breast changes in a pregnant patient.
23. After a routine examination, a patient tells the nurse that she plans to use a home pregnancy
test to determine if she is pregnant. What should the nurse's response be to this patient's plan?
A) Use a diluted urine specimen.
B) Arrange for prenatal care if the test is positive.
C) Wait until after two missed menstrual periods.
D) Refrain from eating for 4 hours before testing.
Ans: B
Page: 211-212
Feedback: After a positive pregnancy test, the first step should be to arrange for prenatal care.
This is the response that the nurse should make to the patient. The urine is not usually diluted for
a home pregnancy test. The patient should not wait for 2 months before determining if she is
pregnant. Eating does not impact the results of the home pregnancy test.
24. A patient who is 2 months pregnant is concerned about frequent urination. What should the
nurse instruct the patient about this occurrence?
A) This means urine is more concentrated.
B) The fetus is adding urine to the patient's bladder.
C) It is caused by pressure on the bladder from the uterus.
D) There is a decrease in the glomerular cells of the kidney.
Ans: C
Page: 214-220
Feedback: A pregnant woman may notice an increase in urinary frequency during the first 3
months of pregnancy, until the uterus rises out of the pelvis and relieves pressure on the bladder.
An increase in urination early in pregnancy is not caused by concentrated urine or a decrease in
the glomerular cells of the kidney. The fetus is not adding urine to the patient's bladder.
25. A patient who is 16 weeks pregnant has a lower blood pressure than that of prepregnancy
levels. What should the nurse realize as being the cause for this lower blood pressure?
A) Prepregnancy blood pressure measurements were inaccurate.
B) Blood pressure progressively decreases throughout the entire pregnancy.
C) A decrease in the second trimester may occur because of placental growth.
D) Dehydration because blood pressure increases steadily throughout pregnancy.
Ans: C
Client Needs 2: Physiological Integrity: Reduction of Risk Potential
Page: 209
Feedback: In some women, blood pressure actually decreases slightly during the second
trimester because the expanding placenta causes peripheral resistance to circulation to lower. The
lower blood pressure is not because prepregnancy blood pressure measurements were inaccurate.
Blood pressure does not normally decrease throughout the entire pregnancy. There is no enough
information to determine if the patient is dehydrated; however, this is not the reason for the
blood pressure to be lower in the second trimester of pregnancy.
26. A pregnant patient who has frequent allergic responses to drugs is concerned about an
allergic reaction to the fetus. What information will the nurse use when responding to this
patient's concern?
A) Immunologic activity is decreased during pregnancy.
B) The level of aldosterone during pregnancy reduces production of IgG antibodies.
C) The kidneys release a hormone during pregnancy to prevent this from happening.
D) The decreased corticosteroid activity during pregnancy ensures this will not happen.
Ans: A
Page: 217
Feedback: Immunologic competency during pregnancy decreases, probably to prevent a
woman's body from rejecting the fetus as if it were a transplanted organ. Aldosterone does not
impact the production of IgG antibodies. The kidneys do not influence an allergic response.
Adrenal gland activity increases during pregnancy.
27. During a routine prenatal examination, a pregnant patient's urine is found to have a trace
amount of glucose. What does this finding indicate to the nurse?
A) The patient has gestational diabetes.
B) Lactose may be spilling into the urine.
C) The patient is eating excessive calories.
D) It is because of a decrease in glomerular filtration rate.
Ans: B
Page: 217
Feedback: Because reabsorption of glucose by the tubule cells occurs at a fixed rate, this causes
some accidental spilling of glucose into the urine during pregnancy. Lactose, which is being
produced by the mammary glands but is not used during pregnancy, will also be spilled into the
urine. If more than a trace amount of glucose is found in the pregnant patient's urine, this could
indicate gestational diabetes. The increase of glucose in the urine is not because of eating
excessive calories. The glomerular filtration rate increases in pregnancy.
28. During an assessment, a patient who is 5 months pregnant tells the nurse that she has to
change her diet because she is just becoming too fat. Which nursing diagnosis should the nurse
use to guide interventions for the patient at this time?
A) Powerlessness
B) Imbalanced nutrition
C) Deficient knowledge
D) Disturbed body image
Ans: D
Page: 208
Feedback: The diagnosis of disturbed body image is the most appropriate because the patient is
equating the weight gain of pregnancy as being fat. The patient may or may not have a
knowledge deficit. There is no evidence to support the diagnosis of imbalanced nutrition. There
is also no evidence to support that the patient is experiencing powerlessness.
29. The nurse is concerned that a pregnant patient is not adjusting emotionally to being
pregnant. Which statement indicates that the patient may need additional counseling?
A) ―I cannot wait to lose all of this excess weight.‖
B) ―I need to get right back to work after delivery.‖
C) ―My mother has been so helpful during this time.‖
D) ―My dad has already purchased toys for the baby!‖
Ans: B
Page: 208
Feedback: The statement that the patient needs to get back to work after delivery could indicate
that the patient feels the pregnancy is robbing her of financial stability or ruin chances of a
promotion. Desiring to lose weight after pregnancy does not indicate that the patient is not
adjusting emotionally to being pregnant. The statements about parental support do not indicate
that the patient is not adjusting emotionally to being pregnant.
30. The nurse instructs a pregnant patient on the need to increase foods containing folic acid.
Which patient statement indicates that teaching has been effective?
A) ―Eating an extra orange a day is important.‖
B) ―I need to drink two glasses of milk each day.‖
C) ―I will add spinach to my salad every evening.‖
D) ―Cabbage and cauliflower are important for me to eat.‖
Ans: C
Page: 202
Feedback: The patient should be instructed to eat foods that are high in folic acid such as
spinach, asparagus, and legumes. Adding spinach every day to the evening salad indicates that
teaching about folic acid nutrition has been effective. Oranges, milk, cabbage, and cauliflower
are not food items that will specifically influence the folic acid level.
Multiple Selection
31. A patient who is 6 months pregnant is complaining of a lumbar backache. What actions
should the nurse suggest to help this patient? Select all that apply.
A) Do pelvic rocking.
B) Walk with head high.
C) Rest and elevate the feet.
D) Wear higher heeled shoes.
E) Twist the spine at the hips.
Ans: A, B, C
Page: 223
Feedback: Interventions to reduce lower lumbar backache associated with pregnancy include
pelvic rocking exercises, walking with the head high, and resting and elevating the feet. The
patient should be instructed to limit the use of high heels. Twisting the spine is not recommended
to help with a lumbar backache.
Multiple Choice
32. A pregnant patient is observed talking with another patient holding an infant in the clinic
waiting room. What does this observation indicate to the nurse?
A) The patient is role-playing.
B) The patient is being narcissistic.
C) The patient is reworking developmental tasks.
D) The patient is ambivalent about being pregnant.
Ans: A
Page: 207
Feedback: A step in preparing for parenthood is role-playing or fantasizing about what it will
be like to be a parent. This is done by a pregnant woman spending time with other pregnant
women or mothers of young children to learn how to be a mother. The pregnant patient's
behavior does not indicate narcissism. Spending time with a mother of a small child is not
reworking developmental tasks. This behavior does not demonstrate ambivalence about being
pregnant.
33. A nurse is assessing a pregnant women in her second trimester and obtains a urine sample
for analysis. When reviewing the results, which finding would cause the nurse to be concerned?
A) serum creatinine: 1.2 mg/100 mL (106 mol/L)
B) BUN: 10 mg/100 mL (3.57 mmol/L)
C) reduced glomerular filtration rate
D) creatinine clearance: 100 mL/minute (1.67 mL/s/m2)
Ans: A
Client Needs: Physiological Integrity: Reduction of Risk Potential
Page: 222
Feedback: During pregnancy, the urinary system undergoes many physiologic changes,
including alterations in fluid retention and renal, ureter, and bladder function. Glomerular
filtration rate increases by 50%, BUN decreases by 25%, and creatinine decreases. A serum
creatinine greater than 1 mg/100 mL (88.40 mol/L) is abnormal and would be a cause for
concern. A BUN of 15 mg/100 mL (5.35 mmol/L) or higher is abnormal. A creatinine clearance
should be 90 to 180 mL/min (1.50 to 3.01 mL/s/m2) in a 24-hour urine sample.

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3. During pregnancy, which situation would interfere with mother–child bonding?

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