Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 11 Physical and Psychologic Changes of Pregnancy

1. A client with a normal prepregnancy weight asks why she has been told to gain 25-35 pounds during her pregnancy while her underweight friend was told to gain more weight. What should the nurse tell the client the recommended weight gain is during pregnancy?
2. 25-35 pounds, regardless of a client's prepregnant weight
3. More than 25-35 pounds for an overweight woman
4. Up to 40 pounds for an underweight woman
5. The same for a normal weight woman as for an overweight woman

Page Ref: 212

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Identify the anatomic and physiologic changes that occur during pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse understands that a client's pregnancy is progressing normally when what physiologic changes are documented on the prenatal record of a woman at 36 weeks' gestation?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. The joints of the pelvis have relaxed, causing a waddling gait.
2. The cervix is firm and blue-purple in color.
3. The uterus vasculature contains one sixth of the total maternal blood volume.
4. Gastric emptying time is delayed, and the client complains of constipation and bloating.
5. Supine hypotension occurs when the client lies on her back.

Page Ref: 208, 210, 211, 224

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. A client who is in the second trimester of pregnancy tells the nurse that she has developed a darkening of the line in the midline of her abdomen from the symphysis pubis to the umbilicus. What other expected changes during pregnancy might she also notice?
2. Lightening of the nipples and areolas
3. Reddish streaks called striae on her abdomen
4. A decrease in hair thickness
5. Small purplish dots on her face and arms

Page Ref: 208

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse is listening to the fetal heart tones of a client at 37 weeks' gestation while the client is in a supine position. The client states, "I'm getting lightheaded and dizzy." What is the nurse's best action?
2. Assist the client to sit up.
3. Remind the client that she needs to lie still to hear the baby.
4. Help the client turn onto her left side.
5. Check the client's blood pressure.

Page Ref: 209

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise, and evidence. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. What is the increased vascularization causing the softening of the cervix known as?
2. Hegar sign
3. Chadwick sign
4. Goodell sign
5. McDonald sign

Page Ref: 214

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise, and evidence. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Identify the anatomic and physiologic changes that occur during pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. It is 1 week before a pregnant client's due date. The nurse notes on the chart that the client's pulse rate was 74-80 before pregnancy. Today, the client's pulse rate at rest is 90. What action should the nurse should take?
2. Chart the findings.
3. Notify the physician of tachycardia.
4. Prepare the client for an electrocardiogram (E K G).
5. Prepare the client for transport to the hospital.

Page Ref: 209

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise, and evidence. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. A client at 16 weeks' gestation has a hematocrit of 35%. Her prepregnancy hematocrit was 40%. Which statement by the nurse best explains this change?
2. "Because of your pregnancy, you're not making enough red blood cells."
3. "Because your blood volume has increased, your hematocrit count is lower."
4. "This change could indicate a serious problem that might harm your baby."
5. "You're not eating enough iron-rich foods like meat."

Page Ref: 209

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise, and evidence. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination and his or her own power and self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 1 Identify the anatomic and physiologic changes that occur during pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. During her first months of pregnancy, a client tells the nurse, "It seems like I have to go to the bathroom every 5 minutes." The nurse explains to the client that this is because of which of the following?
2. The client probably has a urinary tract infection.
3. Bladder capacity increases throughout pregnancy.
4. The growing uterus puts pressure on the bladder.
5. Some women are very sensitive to body function changes.

Page Ref: 210

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise, and evidence. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse is assessing a client in the third trimester of pregnancy. What physiologic changes in the client are expected?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. The client's chest circumference has increased by 6 cm during the pregnancy.
2. The client has a narrowed subcostal angle.
3. The client is using thoracic breathing.
4. The client may have epistaxis.
5. The client has a productive cough.

Page Ref: 209

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse has received a phone call from a multigravida who is 21 weeks pregnant and has not felt fetal movement yet. What is the best action for the nurse to take?
2. Reassure the client that this is a normal finding in multigravidas.
3. Suggest that she should feel for movement with her fingertips.
4. Schedule an appointment for her with her physician for that same day.
5. Tell her gently that her fetus is probably dead.

Page Ref: 214

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The client in the prenatal clinic tells the nurse that she is sure she is pregnant because she has not had a menstrual cycle for 3 months, and her breasts are getting bigger. What response by the nurse is best?
2. "Lack of menses and breast enlargement are presumptive signs of pregnancy."
3. "The changes you are describing are definitely indicators that you are pregnant."
4. "Lack of menses can be caused by many things. We need to do a pregnancy test."
5. "You're probably not pregnant, but we can check it out if you like."

Page Ref: 214

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse has completed a community presentation about the changes of pregnancy, and knows that the lesson was successful when a community member states that which of the following is one probable or objective change of pregnancy?
2. "Enlargement of the uterus"
3. "Hearing the baby's heart rate"
4. "Increased urinary frequency"
5. "Nausea and vomiting"

Page Ref: 215

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 3 Compare subjective (presumptive), objective (probable), and diagnostic (positive) changes of pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. A client who is experiencing her first pregnancy has just completed the initial prenatal examination with a certified nurse-midwife. Which statement indicates that the client needs additional information?
2. "Because we heard the baby's heartbeat, I am undoubtedly pregnant."
3. "Because I have had a positive pregnancy test, I am undoubtedly pregnant."
4. "My last period was 2 months ago, which means I'm 2 months along."
5. "The increased size of my uterus means that I am finally pregnant."

Page Ref: 214

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations that foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 3 Compare subjective (presumptive), objective (probable), and diagnostic (positive) changes of pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The adolescent client reports to the clinic nurse that her period is late, but her home pregnancy test is negative. What should the nurse explain that these findings most likely indicate?
2. "This means you are not pregnant."
3. "You might be pregnant, but it might be too early for your home test to be accurate."
4. "We don't trust home tests. Come to the clinic for a blood test."
5. "Most people don't use the tests correctly. Did you read the instructions?"

Page Ref: 214

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Contrast the various types of pregnancy tests.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The client is at 6 weeks' gestation, and is spotting. The client had an ectopic pregnancy 1 year ago, so the nurse anticipates that the physician will order which intervention?
2. A urine pregnancy test
3. The client to be seen next week for a full examination
4. An antiserum pregnancy test
5. An ultrasound

Page Ref: 216

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Contrast the various types of pregnancy tests.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. A woman calls the clinic and tells a nurse that she thinks she might be pregnant. She wants to use a home pregnancy test before going to the clinic, and asks the nurse how to use it correctly. What information should the nurse give?
2. The false-positive rate of these tests is quite high.
3. If the results are negative, the woman should repeat the test in 2 weeks if she has not started her menstrual period.
4. A negative result merely indicates growing trophoblastic tissue and not necessarily a uterine pregnancy.
5. The client should follow up with a healthcare provider after taking the home pregnancy test.

Page Ref: 216—217

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on patient values, clinical expertise, and evidence. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and effectively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 4 Contrast the various types of pregnancy tests.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. A prenatal educator is asking a partner about normal psychologic adjustment of an expectant mother during the second trimester of pregnancy. Which answer by the partner would indicate a typical expectant mother's response to pregnancy?
2. "She is very body-conscious, and hates every little change."
3. "She daydreams about what kind of parent she is going to be."
4. "I haven't noticed anything. I just found out she was pregnant."
5. "She has been having dreams at night about misplacing the baby."

Page Ref: 218

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preference and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 5 Discuss the emotional and psychologic changes that commonly occur in a woman, her partner, and her family during pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The partner of a client at 16 weeks' gestation accompanies her to the clinic. The partner tells the nurse that the baby just doesn't seem real to him, and he is having a hard time relating to his partner's fatigue and food aversions. Which statement would be best for the nurse to make?
2. "If you would concentrate harder, you'd be aware of the reality of this pregnancy."
3. "My husband had no problem with this. What was your childhood like?"
4. "You might need professional psychological counseling. Ask your physician."
5. "Many men feel this way. Feeling the baby move in a few weeks will help make it real to you."

Page Ref: 220—221

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preference, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Discuss the emotional and psychologic changes that commonly occur in a woman, her partner, and her family during pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The client at 30 weeks' gestation with her first child is upset. She tells the prenatal clinic nurse that she is excited to become a mother, and has been thinking about what kind of parent she will be. But her mother has told her that she doesn't want to be a grandmother because she doesn't feel old enough, while her husband has said that the pregnancy doesn't feel real to him yet, and he will become excited when the baby is actually here. What is the most likely explanation for what is happening within this family?
2. Her husband will not attach with this child and will not be a good father.
3. Her mother is rejecting the role of grandparent, and will not help out.
4. The client is not progressing through the developmental tasks of pregnancy.
5. The family members are adjusting to the role change at their own paces.

Page Ref: 217

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. C. 10. Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Discuss the emotional and psychologic changes that commonly occur in a woman, her partner, and her family during pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The pregnant client at 14 weeks' gestation is in the clinic for a regular prenatal visit. Her mother also is present. The grandmother-to-be states that she is quite uncertain about how she can be a good grandmother to this baby because she works full time. Her own grandmother was retired, and was always available when needed by a grandchild. What is the nurse's best response to this concern?
2. "Don't worry. You'll be a wonderful grandmother. It will all work out fine."
3. "What are your thoughts on what your role as grandmother will include?"
4. "As long as there is another grandmother available, you don't have to worry."
5. "Grandmothers are supposed to be available. You should retire from your job."

Page Ref: 223

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. C. 10. Value active partnership with patients or designated surrogates in planning, implementation and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Discuss the emotional and psychologic changes that commonly occur in a woman, her partner, and her family during pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. Nurses who are interacting with expectant families from a different culture or ethnic group can provide more effective, culturally sensitive nursing care by doing what?
2. Recognizing that ultimately it is the family's right to make a woman's healthcare choices.
3. Obtaining a medical interpreter of the language the client speaks.
4. Evaluating whether the client's healthcare beliefs have any positive consequences for her health.
5. Accepting personal biases, attitudes, stereotypes, and prejudices.

Page Ref: 223

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Affirm and value diversity. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Summarize cultural factors that may influence a family's response to pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. Which of the following is common in many non-Western cultures and is on the increase in the United States?
2. Ceremonial rituals and rites
3. Cultural assessment
4. Cultural values
5. Co-sleeping

Page Ref: 222

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Relationship-Centered Care: Affirm and value diversity. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Summarize cultural factors that may influence a family's response to pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The introduction of a new baby into the family is often the beginning of which of the following?
2. Sibling rivalry
3. Inconsistent childrearing
4. Toilet training
5. Weaning

Page Ref: 222

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Relationship-Centered Care: Affirm and value diversity. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Discuss the emotional and psychologic changes that commonly occur in a woman, her partner, and her family during pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. A pregnant patient is observed lying in bed in the following position. Which health problem is this patient prone to developing?

1. Vena caval syndrome
2. Physiologic anemia of pregnancy
3. Physiologic leukocytosis
4. Low iron level

Page Ref: 209

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment; Nursing Process.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. During a routine assessment of a pregnant patient the nurse observes the following on the patient's abdomen. How should the nurse document this finding?

1. Striae
2. Chloasma
3. Linea nigra
4. Vascular spider nevi

Page Ref: 210

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Communication and Documentation.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. A patient weighing 80 k g with a body mass index of 29.8 is 6 weeks pregnant. What should be this patient's maximum weight at the time of delivery?

Page Ref: 212

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Nursing Process.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. During a pelvic examination of a pregnant patient the following area is identified as being softened. How should the nurse document this finding?

1. Ladin sign
2. Braun von Fernwald sign
3. Piskacek's sign
4. Goodell sign

Page Ref: 216

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Communication and Documentation.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse is evaluating the fundal height of a patient who is 20 weeks pregnant. Which height should the nurse expect to assess in this patient?

1. A
2. B
3. C
4. D

Page Ref: 216

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. A patient at 28 weeks' gestation asks the nurse why she has backaches. To help explain the changes, the nurse shows her a picture of the shape of her back. Which picture should the nurse use?

1. A
2. B
3. C
4. D

Page Ref: 211

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse is providing prenatal care to an obese client who asks, "How much weight should I gain during my pregnancy?" Which response by the nurse is appropriate?
2. "You should gain 15 to 25 pounds."
3. "You should gain 25 to 35 pounds."
4. "You should gain 11 to 20 pounds."
5. "You should gain 28 to 40 pounds."

Page Ref: 212

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. A. 1. Demonstrate knowledge of basic scientific methods and processes. | A A C N Essentials Competencies: Ⅸ.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Teaching and Learning.

Learning Outcome: 1 Identify the anatomic and physiologic changes that occur during pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse is conducting an initial prenatal appointment for a client who believes she is pregnant. Which is considered a positive sign of pregnancy?
2. Linea nigra
3. Fetal heartbeat
4. Breast tenderness
5. Urinary frequency

Page Ref: 217

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. A. 1. Demonstrate knowledge of basic scientific methods and processes. | A A C N Essentials Competencies: Ⅸ.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Compare subjective (presumptive), objective (probable), and diagnostic (positive) changes of pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse is providing care to a client who is entering the second trimester of pregnancy. Which client statement does the nurse anticipate when assessing this client?
2. "We picked out a name for a boy and for a girl."
3. "We bought the baby's crib and car seat this past weekend."
4. "I am so uncomfortable all the time and I can't seem to sleep at night."
5. "I am angry with my husband for not showing more interest in my pregnancy."

Page Ref: 218

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice: apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Discuss the emotional and psychologic changes that commonly occur in a woman, her partner, and her family during pregnancy.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse is providing care to a pregnant client who is experiencing an increase in white, thick, and "cottage-cheese-like" vaginal discharge. Based on this data, which diagnosis does the nurse anticipate for this client?
2. Syphilis
3. Gonorrhea
4. Moniliasis
5. Chlamydia

Page Ref: 208

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. A. 1. Demonstrate knowledge of basic scientific methods and processes. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of

health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse notes purplish stretch marks on the pregnant client's breasts during the physical assessment. Which term will the nurse use when documenting this finding in the medical record?
2. Striae
3. Colostrum
4. Linea nigra
5. Chadwick's sign

Page Ref: 208

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. A. 1. Demonstrate knowledge of basic scientific methods and processes. | A A C N Essentials Competencies: Ⅸ.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Communication and Documentation.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse is assessing a pregnant client who reports nasal stuffiness and congestion. Which term will the nurse use to document this data in the medical record?
2. Rales
3. Epistaxis
4. Rhinitis of pregnancy
5. Pregnancy-induced asthma

Page Ref: 209

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. A. 1. Demonstrate knowledge of basic scientific methods and processes. | A A C N Essentials Competencies: Ⅸ.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Communication and Documentation.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse is assessing a pregnant client during a scheduled prenatal visit who reports dizziness and clamminess when lying in bed each morning. Which statement by the nurse is appropriate based on this data?
2. "The doctor may order an amniocentesis to determine if the fetus is healthy."
3. "This information indicates that you are developing gestational hypertension."
4. "Be sure to sit up slowly and stay sitting for several minutes prior to getting up."
5. "Try lying on your left side to enhance blood flow, which will help your symptoms."

Page Ref: 209

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. A. 1. Demonstrate knowledge of basic scientific methods and processes. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.

1. The nurse is assessing a pregnant client in the second trimester of pregnancy during a scheduled prenatal visit. Which questions are appropriate during the assessment process?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "Do you feel bloated?"
2. "Do you have hemorrhoids?"
3. "Are you experiencing heartburn?"
4. "Are you experiencing constipation?"
5. "Are you experiencing nausea and vomiting?"

Page Ref: 210

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. A. 1. Demonstrate knowledge of basic scientific methods and processes. | A A C N Essentials Competencies: Ⅸ.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Knowledge and Science: Knowledge: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

M N L L O: Demonstrate understanding of the physical and physiological changes that occur during pregnancy.