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Chapter 07: Anatomy and Physiology of
Pregnancy Perry
- A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? a. 3- 1 - 1 - 1 - 3 b. 4- 1 - 2 - 0 - 4 c. 3- 0 - 3 - 0 - 3 d. 4- 2 - 1 - 0 - 3 - ✔✔ANS: B The correct calculation of this woman's gravidity and parity is 4- 1 - 2 - 0 - 4. The numbers reflect the woman's gravidity and parity information. Using the GPTAL system, her information is calculated as: G: The first number reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term. P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L: This number signifies the number of children born who are currently living; the woman has four children.
- A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have: a. amenorrhea. b. positive pregnancy test. c. Chadwick's sign. d. Hegar's sign. - ✔✔ANS: A Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are felt by the woman. A positive pregnancy test, the presence of Chadwick's sign, and the presence of Hegar's sign are all probable signs of pregnancy.
- The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is: a. a positive pregnancy test. b. fetal movement palpated by the nurse-midwife. c. Braxton Hicks contractions. d. quickening. - ✔✔ANS: B Positive signs of pregnancy are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. A positive pregnancy test and Braxton Hicks contractions are probable signs of pregnancy. Quickening is a presumptive sign of pregnancy.
- A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level?
- 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 - ✔✔ANS: B Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. In the first trimester, blood pressure usually remains the same as at the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and the diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.
- Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth? a. Epulis b. Chloasma c. Telangiectasia d. Striae gravidarum - ✔✔ANS: D Striae gravidarum, or stretch marks, reflect separation within the underlying connective tissue of the skin. They usually fade after birth, although they never disappear completely. An epulis is a red, raised nodule on the gums that bleeds easily. Chloasma, or mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in dark-complexioned pregnant women. Chloasma usually fades after the birth. Telangiectasia, or vascular spiders, are tiny, star-shaped or
branch-like, slightly raised, pulsating end-arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen. These usually disappear after birth.
- The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change? a. Her center of gravity will shift backward. b. She will have increased lordosis. c. She will have increased abdominal muscle tone. d. She will notice decreased mobility of her pelvic joints. - ✔✔ANS: B An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help the woman maintain her balance. The center of gravity shifts forward. She will have decreased muscle tone. She will notice increased mobility of her pelvic joints.
- A 31-year-old woman believes that she may be pregnant. She took an OTC pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse enquires about the woman's last menstrual period and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan that reveals she is not pregnant. What is the most likely cause of the false-positive pregnancy test result? a. She took the pregnancy test too early.
extremities. Determining that the woman is a victim of domestic violence and was hit in the face cannot be made on the basis of the sparse facts provided. If the woman had been hit in the face, she most likely would have additional physical findings. Determination of the use of cocaine by the woman cannot be made on the basis of the sparse facts provided.
- The nurse caring for the pregnant patient must understand that the hormone essential for maintaining pregnancy is: a. estrogen. b. human chorionic gonadotropin (hCG). c. oxytocin. d. progesterone. - ✔✔ANS: D Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles. This reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. hCG levels increase at implantation but decline after 60 to 70 days. Oxytocin stimulates uterine contractions.
- A patient at 24 weeks of gestation contacts the nurse at her obstetric provider's office to complain that she has cravings for dirt and gravel. The nurse is aware that this condition is known as ________ and may indicate anemia. a. ptyalism b. pyrosis c. pica d. decreased peristalsis - ✔✔ANS: C
Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. Ptyalism (excessive salivation), pyrosis (heartburn), and decreased peristalsis are normal findings of gastrointestinal change during pregnancy. Food cravings during pregnancy are normal.
- 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. - ✔✔ANS: A The appendix is displaced high and to the right, beyond McBurney point.
- A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: a. primipara. b. primigravida. c. multipara. d. nulligravida. - ✔✔ANS: A A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind: gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more
d. a higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome. - ✔✔ANS: D 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: peaking, declining, stabilizing, and increasing again. Abnormally slow increases may indicate impending miscarriage.
- 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. - ✔✔ANS: B The softening of the lower uterine segment is called Hegar's sign. Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.
- 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. - ✔✔ANS: D Increased sensitivity and an increased interest in sex sometimes go together. This frequently occurs during the second trimester. Cervical changes make evaluation of abnormal Pap tests more difficult. Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus. Chadwick's sign appears from the sixth to eighth weeks.
- The mucous plug that forms in the endocervical canal is called the: a. operculum. b. leukorrhea. c. funic souffle. d. ballottement. - ✔✔ANS: A The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the umbilical vessels. Ballottement is a technique for palpating the fetus.
- To reassure and educate pregnant patients about changes in their breasts, nurses should be aware that:
- 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. - ✔✔ANS: D Compression of the iliac veins and inferior vena cava also leads to varicose veins in the legs and vulva. The tightness of a cuff that is too small produces a reading that is too high; similarly the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first decreases and then gradually increases.
- 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. - ✔✔ANS: C 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. The diaphragm is displaced, and the volume of blood is increased. However, the main concern is increased estrogen levels.
- To reassure and educate pregnant patients about the functioning of their kidneys in eliminating waste products, maternity nurses should be aware that: a. increased urinary output makes pregnant women less susceptible to urinary infection. b. increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty. c. renal (kidney) function is more efficient when the woman assumes a supine position. d. using diuretics during pregnancy can help keep kidney function regular. - ✔✔ANS: B First bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often. Numerous anatomic changes make a pregnant woman more susceptible to urinary tract infection. Renal function is more efficient when the woman lies in the lateral recumbent position and less efficient when she is supine. Diuretic use during pregnancy can overstress the system and cause problems.
painless and continue throughout the pregnancy. Although they are not painful, some women complain that they are annoying. Braxton Hicks contractions usually cease with walking or exercise. They can be mistaken for true labor; however, they do not increase in intensity or frequency or cause cervical dilation. In addition, they facilitate uterine blood flow through the intervillous spaces of the placenta and promote oxygen delivery to the fetus.
- Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a. Proteinuria b. Glycosuria c. Bacteria in the urine d. Ketones in the urine - ✔✔ANS: B Small amounts of glucose may indicate "physiologic spilling." The presence of protein could indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.
- 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. - ✔✔ANS: B
The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Renal plasma flow increases during pregnancy. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume.
- Physiologic anemia often occurs during pregnancy as a result of: a. inadequate intake of iron. b. dilution of hemoglobin concentration. c. the fetus establishing iron stores. d. decreased production of erythrocytes. - ✔✔ANS: B When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman has physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may lead to true anemia. There is an increased production of erythrocytes during pregnancy.
- 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." - ✔✔ANS: B Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester.
Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Quickening is the first recognition of fetal movements or "feeling life." Quickening is often described as a flutter and is felt earlier in multiparous women than in primiparas. Lightening occurs when the fetus begins to descend into the pelvis. This occurs 2 weeks before labor in the nullipara and at the start of labor in the multipara. Mucus fills the cervical canal creating a plug otherwise known as the operculum. The operculum acts as a barrier against bacterial invasion during the pregnancy. Passive movement of the unengaged fetus is referred to as ballottement.
