In a client's seventh month of pregnancy, she reports feeling "dizzy, like I'm going to pass out, when I lie down ﬂat on my back". The nurse explains that this is due to:
Select one:

Physiologic anemia due to maternal increased plasma volume.

Pressure of the gravid uterus on the maternal inferior vena cava and aorta.

Pressure of the presenting fetal part on the maternal diaphragm.

A 50% increase in maternal blood volume during pregnancy.

Answer and Explanation

The Correct Answer is B

Choice A Reason: Physiologic anemia due to maternal increased plasma volume. This is an incorrect answer that refers to a diﬀerent condition that aﬀects hemoglobin levels, not blood pressure. Physiologic anemia is a condition where the maternal plasma volume increases more than the red blood cell mass during pregnancy, which dilutes the hemoglobin concentration and lowers the hematocrit value. Physiologic anemia does not cause significant symptoms or complications in pregnant women, as it is an adaptive mechanism that enhances oxygen delivery and prevents ﬂuid overload.

Choice B Reason: Pressure of the gravid uterus on the maternal inferior vena cava and aorta. This is because this statement explains the cause of supine hypotensive syndrome, which is a condition where lying ﬂat on the back causes compression of the major blood vessels by the gravid uterus, which reduces venous return and cardiac output, which lowers blood pressure and perfusion to vital organs. Supine hypotensive syndrome can cause symptoms such as dizziness, lightheadedness, nausea, pallor, or syncope in pregnant women, especially in the third trimester.

Choice C Reason: Pressure of the presenting fetal part on the maternal diaphragm. This is an incorrect answer that indicates a diﬀerent condition that aﬀects respiratory function, not blood pressure. Pressure of the presenting fetal part on the maternal diaphragm is a result of cephalic engagement or lightening, which occurs when the fetal head descends into the pelvis and occupies more space in the abdominal cavity. Pressure of the presenting fetal part on the maternal diaphragm can cause symptoms such as dyspnea, heartburn, or rib pain in pregnant women.

Choice D Reason: A 50% increase in maternal blood volume during pregnancy. This is an incorrect answer that describes a normal physiological change that occurs during pregnancy, not a cause of supine hypotensive syndrome. A 50% increase in maternal blood volume during pregnancy is due to increased production of plasma and red blood cells, which helps meet the increased oxygen and nutrient demands of the fetus and placenta, and prepares the mother for blood loss during delivery. A 50% increase in maternal blood volume during pregnancy does not cause hypotension or dizziness in pregnant women.

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Correct Answer is A

Explanation

Choice A Reason: Insulin needs decrease in the first trimester, but increase in the second trimester as the woman's body becomes more insulin-resistant. This is because this statement describes the typical patern of insulin requirements during pregnancy for women with pre-existing diabetes. Insulin needs decrease in the first trimester due to increased insulin production by the pancreas, increased insulin sensitivity by the tissues, and increased risk of hypoglycemia due to nausea and vomiting. Insulin needs increase in the second trimester due to increased levels of placental hormones such as human placental lactogen (hPL), which antagonize insulin action and cause insulin resistance.

Choice B Reason: Vascular disease that always accompanies diabetes slows fetal growth. This is an incorrect answer that makes a false and exaggerated claim about diabetes and fetal growth. Vascular disease does not always accompany diabetes, but it can be a complication of long-term or poorly controlled diabetes that aﬀects blood vessels and circulation. Vascular disease can aﬀect fetal growth by reducing placental perfusion and oxygen delivery, but it is not the only factor that inﬂuences fetal growth. Other factors include maternal nutrition, genetics, infections, or anomalies.

Choice C Reason: The risk of ketoacidosis decreases during the length of the pregnancy. This is an incorrect answer that contradicts the evidence and guidelines on diabetes and ketoacidosis during pregnancy. Ketoacidosis is a metabolic emergency where high levels of ketones accumulate in the blood due to insufficient insulin or excessive glucose utilization, which causes acidosis, dehydration, electrolyte imbalance, and coma. Ketoacidosis can occur in women with diabetes during pregnancy due to infection, stress, starvation, or inadequate insulin therapy. The risk of ketoacidosis does not decrease during the length of the pregnancy, but rather increases in the second and third trimesters due to increased insulin resistance and glucose production.

Choice D Reason: The baby is likely to have a congenital abnormality because of the uncontrolled diabetes. This is an incorrect answer that implies a negative and deterministic outcome for the baby. Congenital abnormalities are structural or functional defects that are present at birth, which can aﬀect various organs or systems in the baby.

Congenital abnormalities can be caused by genetic or environmental factors, or a combination of both. Diabetes can increase the risk of congenital abnormalities, especially if the blood glucose levels are high during the first trimester, when organogenesis occurs. However, the risk of congenital abnormalities is not inevitable or predictable, and it can be reduced by maintaining good glycemic control before and during pregnancy.

A. Milia. B. Dermal melanosis. C. Stork bites. D. Birth trauma.

Correct Answer is B

Explanation

Choice A Reason: Milia. This is an incorrect answer that describes a diﬀerent skin condition. Milia are tiny white or yellow cysts that appear on the nose, chin, or cheeks of newborns. They are caused by the retention of keratin in the sebaceous glands or hair follicles. They usually disappear within a few weeks without treatment.

Choice B Reason: Dermal melanosis. This is a correct answer that explains the finding of bluish markings across the newborn's lower back. Dermal melanosis. This is because dermal melanosis, also known as Mongolian spots, is a common benign skin condition that aﬀects newborns of Asian, African, or Hispanic descent. It is characterized by bluish-gray or brown patches of pigmentation on the lower back, butocks, or extremities. It is caused by the migration of melanocytes from the neural crest to the dermis during embryonic development. It usually fades by 2 to 4 years of age.

Choice C Reason: Stork bites. This is an incorrect answer that refers to another skin condition. Stork bites, also known as salmon patches or nevus simplex, are ﬂat pink or red marks that appear on the forehead, eyelids, nose, upper lip, or nape of the neck of newborns. They are caused by dilated capillaries in the superficial dermis. They usually fade by 18 months of age.

Choice D Reason: Birth trauma. This is an incorrect answer that implies an injury or damage to the newborn's skin or tissues during labor and delivery. Birth trauma can cause bruises, abrasions, lacerations, fractures, or nerve injuries. It is not related to bluish markings on the lower back.

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In a client's seventh month of pregnancy, she reports feeling "dizzy, like I'm going to pass out, when I lie down ﬂat on my back". The nurse explains that this is due to: Select one:

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Naxlex Comprehensive Predictor Exams

A client with insulin-dependent type 2 diabetes and an HbA1c of 6.0% is planning to become pregnant soon. What anticipatory teaching should the nurse provide this client? Select one:

Correct Answer is A

Explanation

During a physical assessment of a newborn, the nurse observes bluish markings across the newborn's lower back. The nurse interprets this finding as: Select one:

Correct Answer is B

Explanation

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In a client's seventh month of pregnancy, she reports feeling "dizzy, like I'm going to pass out, when I lie down ﬂat on my back". The nurse explains that this is due to:
Select one: