Concept: Pregnancy
Difficulty: Difficult
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Luteinizing hormone is secreted first, stimulating release of the egg. Next, the
corpus luteum releases progesterone. The ovum is fertilized, and only after
traveling through the fallopian tube can the fertilized egg implant in the
endometrium of the uterus.
PTS: 1
CON: Pregnancy
Chapter 5: 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 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) Feeling short of breath with mild exertion
3) Nasal congestion
4) A dark line appearing on the abdomen
4. The nurse is conducting an assessment on a pregnant patient. Which symptom does the nurse
recognize as abnormal for a pregnant patient?
1) Urinary frequency
2) Urgency
3) Stress incontinence
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4) Burning on urination
5. A pregnant woman complains about backaches. Which of the following should the nurse
recommend?
1) Kegel exercises
2) Increased fluid intake
3) Sleeping on her back
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 should the nurse expect the patient to report?
1) Insomnia
2) Pica
3) Fatigue
4) Leg pain
8. During the physical examination of a pregnant woman the health-care provider notes a bluishpurple coloration of the vaginal mucosa and cervix. The nurse knows that this finding indicates
which probable sign of pregnancy?
1) Ballottement
2) Chadwick’s sign
3) Goodell’s sign
4) Hegar’s sign
9. The nurse is providing teaching to a pregnant patient. Which recommendation will help the
patient avoid vena caval syndrome?
1) Lie on your left side.
2) Walk for 30 minutes per day.
3) Drink 2 L of water per day.
4) Wear low-heeled shoes.
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10. A pregnant woman is being assessed by the nurse and reports pain and swelling in her right calf.
Which action should the nurse take?
1) Call 911.
2) Massage the patient’s calf.
3) Recommend that the patient go for a walk.
4) Notify the health-care provider.
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
Hematocrit
Serum blood urea nitrogen
(BUN)
Serum creatinine
Alanine transaminase (ALT)
Aspartate aminotransferase
(AST)
Alkaline phosphatase (ALP)
Lactate dehydrogenase (LDH)
12.2 g/dL
42.8%
18 mg/dL
0.68 mg/dL
8 units/L
12 units/L
108 units/L
635 units/L
Which conclusion does the nurse draw based on 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. A woman in her third trimester is reporting an itchy rash on her abdomen, arms, and legs. The
nurse realizes that the patient may have what skin condition that is associated with pregnancy?
1) Impetigo
2) Eczema
3) Pruritic urticarial papules and plaques
4) Linea nigra
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14. A pregnant patient is complaining of constipation. The nurse should recommend that the patient
incorporate which food into her diet?
1) Saltine crackers
2) Lean meats
3) Eggs
4) Nuts
15. 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
16. 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
17. The nurse is talking with a pregnant patient at her 36-week appointment about preparations for the
baby’s arrival. The patient says that she has prepared the nursery, gone to childbirth classes, read
several books, and has accumulated all of the care items and clothing she will need. Which Reva
Rubin maternal task is this woman demonstrating?
1)
2)
3)
4)
Seeking safe passage for herself and her fetus
Securing acceptance for herself as a mother and for her fetus
Learning to give of herself and to accept herself as a mother to the infant
Committing herself to the child as she progresses through pregnancy
18. A 16-year-old patient is acting indifferent when the nurse is asking questions about her pregnancy.
This is consistent with what expected behavior of pregnant teens?
1) Inconsistency
2) Acceptance
3) Ambivalence
4) Commitment
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19. A pregnant woman is talking to the nurse about skin abnormalities that she has noticed since she
got pregnant. She points to brown patches on her forehead, cheeks, and nose and asks if they are
permanent. How should the nurse respond?
1) “Those brown patches are called melasma. The severity can be decreased with
sunscreen use. They should disappear after childbirth.”
2) “Those brown patches are called linea nigra. They are the result of dry skin. They
should disappear after childbirth.”
3) “Those brown patches are called melasma. I recommend that you have the doctor
take a look at them.”
4) “Those brown patches are called linea nigra. They are common in pregnancy.”
20. A pregnant patient is crying and says to the nurse, “I am so fat! I don’t even recognize myself
anymore.” Which is the best therapeutic response by the nurse?
1) “A gluten-free diet will help you lose some weight.”
2) “Why do you think you’re fat?”
3) “Weight gain is expected during pregnancy.”
4) “You need to exercise more to avoid excessive weight gain.”
21. The nurse caring for a woman who is 40 weeks pregnant reports having thick vaginal discharge
that appeared to be a mixture of blood and mucus. The nurse interprets this finding as a sign of:
1) Yeast infection
2) Early labor
3) Preterm labor
4) Miscarriage
22. A woman in her second trimester of pregnancy tells the nurse that she has noticed an increase in
her libido recently but is concerned that sexual intercourse will harm the baby. What is the best
response by the nurse?
1) “Sexual intercourse will only harm the baby in the third trimester.”
2) “Sexual intercourse can sometimes cause preterm labor.”
3) “Sexual intercourse is safe if your partner is on top.”
4) “Sexual intercourse will not harm your baby.”
23. 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
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Identify one or more choices that best complete the statement or answer the question.
24. The nurse is educating a patient about preventing yeast infections. What teaching points should be
included? (Select all that apply.)
1) Wear cotton underwear.
2) Clean the vagina by douching.
3) Clean the vulva with unscented soap and water.
4) Avoid petroleum-based lubricants.
5) Avoid douching.
25. Sibling response to a new baby is influenced by the child’s age and other factors. Which of the
following are correctly paired responses for each age group? (Select all that apply.)
1) Toddlers: become clingy and irritable; baby is only a story
2) Toddlers: sense of loss; being replaced; jealous
3) Preschool child: sense of loss; being replaced; jealous
4) Preschool child: interested and ask questions about conception, pregnancy, and
childbirth
5) Older children: interested and ask questions about conception, pregnancy, and
childbirth
26. Couvade syndrome is a sympathetic response to pregnancy experienced by spouses or partners of
pregnant women. What symptoms would likely be reported? (Select all that apply.)
1) Anxiety
2) Feet swelling
3) Nausea
4) Weight gain
5) Hair loss
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Chapter 5: Physical and Psychological Changes of Pregnancy
Answer Section
MULTIPLE CHOICE
1. ANS: 3
Chapter number and title: 5: Physical and Psychological Changes of Pregnancy
Chapter learning objective: Differentiate presumptive, probable, and positive signs of pregnancy.
Chapter page reference: 69
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
2
3
4
Although a positive Goodell’s sign is a probable sign of pregnancy, it is not a
definitive sign.
Reported quickening, or fetal movement, felt by the mother is considered a
subjective presumptive sign, but it is not a definitive diagnosis of pregnancy.
When the health-care provider auscultates fetal heart sounds, it is considered a
positive and definitive indication of pregnancy.
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 number and title: 5: Physical and Psychological Changes of Pregnancy
Chapter learning objective: Differentiate presumptive, probable, and positive signs of pregnancy.
Chapter page reference: 69
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
2
3
Audible fetal heart tones are considered a positive sign of pregnancy and do not
require further testing.
Fetal movement felt by the nurse is considered a positive sign of pregnancy and
does not require further testing.
A fetal ultrasound demonstrating a growing fetus is considered a positive sign of
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4
pregnancy, eliminating the need for further testing.
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.
PTS: 1
CON: Pregnancy
3. ANS: 2
Chapter number and title: 5: Physical and Psychological Changes of Pregnancy
Chapter learning objective: Describe the physiological changes in each body system occurring
during pregnancy.
Chapter page reference: 72-73
Heading: Table 5.2 Respiratory System Changes in Pregnancy and Table 5.3 Cardiovascular
System Changes in Pregnancy
Integrated processes: Clinical Problem-Solving Process
Client need: Health Promotion and Maintenance
Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Difficult
Feedback
1
2
3
4
Constipation is not uncommon in pregnancy and requires patient teaching, not
further assessment.
Shortness of breath with mild exertion during the early part of the second
trimester indicates a problem requiring further assessment.
Nasal congestion at this stage of pregnancy is common, and the nurse should
provide teaching to help the woman cope with this symptom.
A dark line appearing on the abdomen is known as the linea nigra; it is not
uncommon and does not require further assessment.
PTS: 1
CON: Pregnancy
4. ANS: 4
Chapter number and title: 5: Physical and Psychological Changes of Pregnancy
Chapter learning objective: Describe the physiological changes in each body system occurring
during pregnancy.
Chapter page reference:76
Heading: Table 5.5 Urinary System Changes in Pregnancy
Integrated processes: Clinical Problem-Solving Process
Client need: Physiological Adaptation
Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Moderate
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Feedback
1
2
3
4
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.
Urgency is common in late-stage pregnancy and does not indicate a urinary tract
infection.
Stress incontinence due to the pressure of the fetus on the bladder is not
uncommon in the third trimester of pregnancy.
Burning on urination is not an anticipated urinary symptom of pregnancy and
indicates the potential for a urinary tract infection, requiring further testing.
PTS: 1
CON: Pregnancy
5. ANS: 4
Chapter number and title: 5: Physical and Psychological Changes of Pregnancy
Chapter learning objective: Plan safe and effective nursing interventions that address the
common physiological discomforts of pregnancy.
Chapter page reference: 78
Heading: Table 5.7 Musculoskeletal System Changes in Pregnancy
Integrated processes: Teaching and Learning
Client need: Health Promotion and Maintenance
Cognitive level: Application [Applying]
Concept: Pregnancy
Difficulty: Moderate
Feedback
1
2
3
4
Kegel exercises are performed to reduce urinary incontinence, not to prevent
backaches.
Increased fluid intake prevents dehydration but does not prevent backaches.
Sleeping on the back is not recommended for pregnant patients because it puts
them at risk for vena caval syndrome.
Wearing low-heeled shoes and using good body mechanics will help avoid
backaches.
PTS: 1
CON: Pregnancy
6. ANS: 3
Chapter number and title: 5: Physical and Psychological Changes of Pregnancy
Chapter learning objective: Plan safe and effective nursing interventions that address the
common physiological discomforts of pregnancy.
Chapter page reference: 77
Heading: Table 5.6 Integumentary System Changes in Pregnancy
Integrated processes: Teaching and Learning
Client need: Health Promotion and Maintenance
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Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Moderate
Feedback
1
2
3
4
This is an incorrect statement because makeup will not be needed.
Hyperpigmentation is not unusual in pregnancy and does not require a referral to
a dermatologist.
This statement is accurate and will help to reassure the woman.
Vitamin E oil or cocoa butter may be helpful with striae, but they will not help
with the hyperpigmentation that the woman is demonstrating.
PTS: 1
CON: Pregnancy
7. ANS: 3
Chapter number and title: 5: Physical and Psychological Changes of Pregnancy
Chapter learning objective: Plan safe and effective nursing interventions that address the
common physiological discomforts of pregnancy.
Chapter page reference: 73
Heading: Table 5.3 Cardiovascular System Changes in Pregnancy
Integrated processes: Clinical Problem-Solving Process
Client need: Reduction of Risk Potential
Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Difficult
Feedback
1
2
3
4
The patient’s laboratory values reflect anemia, which does not result in
insomnia.
Pica is an abnormal craving for non-food substances and is not reflected by the
laboratory values.
Fatigue is a common symptom associated with anemia, which is what the
laboratory values reflect.
Leg pain is associated with venous thrombosis and is not reflected in these
laboratory values.
PTS: 1
CON: Pregnancy
8. ANS: 2
Chapter number and title: 5: Physical and Psychological Changes of Pregnancy
Chapter learning objective: Differentiate presumptive, probable, and positive signs of pregnancy.
Chapter page reference: 69
Heading: Diagnosis of Pregnancy
Integrated processes: Clinical Problem-Solving Process
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