Review Practice Exercise 1

Physiological Maternal Changes > Maternal Newborn

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Practice Exercise 1

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Total Questions : 5

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Question 1:

Which physiological change in pregnancy contributes to physiological anemia?

A. Increased red blood cell mass B. Decreased plasma volume C. Increased plasma volume relative to red blood cell mass D. Decreased cardiac output

Answer and Explanation

Choice A:

Increased red blood cell mass does occur, but it is not sufficient to match the larger plasma volume expansion. Therefore, while it increases oxygen delivery, it does not cause anemia.

Choice B:

Decreased plasma volume is opposite of what occurs in pregnancy. Plasma volume expands significantly under estrogen and aldosterone influence, ensuring greater blood flow to the placenta.

Choice C:

Plasma volume increases more than red blood cell mass, resulting in hemodilution and relative anemia. This explains the physiological anemia observed during pregnancy, which ensures optimal placental perfusion without true reduction in oxygen-carrying capacity.

Choice D:

Cardiac output increases by 30–50% in pregnancy due to increased stroke volume and heart rate. This enhances systemic and placental circulation but does not directly explain anemia.

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Question 2:

Supine hypotensive syndrome is caused by:

A. Compression of the aorta by the gravid uterus B. Compression of the inferior vena cava by the gravid uterus C. Peripheral vasodilation due to progesterone D. Increased cardiac output in the supine position

Answer and Explanation

Choice A:

Compression of the aorta can occur in late pregnancy, but it does not primarily cause hypotension. Aortic compression mainly reduces uteroplacental perfusion and fetal oxygen delivery, not maternal blood pressure.

Choice B:

The gravid uterus compresses the inferior vena cava in the supine position, reducing venous return and cardiac output. This leads to hypotension and symptoms such as dizziness and pallor, defining supine hypotensive syndrome.

Choice C:

Peripheral vasodilation due to progesterone contributes to systemic vascular resistance reduction in pregnancy. However, it is a generalized adaptation of pregnancy, not the mechanism of acute hypotension in the supine position.

Choice D:

Cardiac output increases by 30–50% in pregnancy due to elevated stroke volume and heart rate. Supine position does not increase cardiac output but instead decreases it by restricting venous return.

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Question 3:

What is the primary reason for increased tidal volume during pregnancy?

A. Decreased oxygen demand B. Progesterone’s effect on the respiratory center C. Increased functional residual capacity D. Reduced chest wall compliance

Answer and Explanation

Choice A:

Oxygen demand does not decrease in pregnancy; instead, it increases by about 20–30% due to fetal and maternal metabolic requirements. Therefore, decreased oxygen demand is not a cause of increased tidal volume.

Choice B:

Progesterone stimulates the central respiratory center, increasing sensitivity to carbon dioxide. This leads to deeper breaths, thereby increasing tidal volume and maternal minute ventilation, which supports enhanced oxygen transfer to the fetus.

Choice C:

Functional residual capacity decreases by about 20% during pregnancy because the enlarged uterus elevates the diaphragm. A reduced FRC does not cause increased tidal volume; rather, it reflects decreased lung volumes.

Choice D:

Chest wall compliance is not reduced in pregnancy. Rib cage expansion actually increases chest wall dimensions to accommodate the growing uterus, and this adaptation does not explain the rise in tidal volume.

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Question 4:

A pregnant client complains of nasal stuffiness and occasional nosebleeds. The nurse explains this is a common physiological change due to:

A. Decreased blood volume B. Estrogen-induced hyperemia of mucous membranes C. Reduced respiratory rate D. Increased clotting factors

Answer and Explanation

Choice A:

Blood volume does not decrease in pregnancy; instead, it increases by 40–50%. A decrease in blood volume would cause hypotension and poor perfusion, not nasal congestion or epistaxis.

Choice B:

Estrogen increases vascular engorgement and hyperemia of the nasal mucosa. This leads to increased swelling and fragility of capillaries, causing stuffiness and frequent nosebleeds as a normal physiological change in pregnancy.

Choice C:

Respiratory rate does not significantly decrease in pregnancy. It usually remains stable, while tidal volume increases. A reduced rate would impair gas exchange but does not cause nasal congestion or bleeding.

Choice D:

Increased clotting factors are a hematological change of pregnancy to reduce postpartum hemorrhage risk. While this creates a hypercoagulable state, it does not cause nasal stuffiness or epistaxis.

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Question 5:

Which of the following are normal cardiovascular changes in pregnancy? Select all that apply.

A. Increased blood volume B. Decreased cardiac output C. Increased heart rate D. Increased systemic vascular resistance E. Decreased hematocrit

Answer and Explanation

Choice A:

Blood volume increases by 40–50% in pregnancy to meet the metabolic demands of the fetus and placenta. This expansion enhances perfusion and prepares for blood loss at delivery.

Choice B:

Cardiac output does not decrease; it increases by 30–50% due to elevated stroke volume and heart rate. This adaptation ensures optimal uteroplacental perfusion.

Choice C:

Heart rate increases by 10–20 beats/minute, which contributes to elevated cardiac output. This change helps maintain adequate circulation to the uterus and other maternal organs.

Choice D:

Systemic vascular resistance does not increase; it decreases under the vasodilatory influence of progesterone, prostaglandins, and nitric oxide. This maintains normal to slightly lower blood pressure despite expanded blood volume.

Choice E:

Hematocrit decreases to 32–36% because plasma volume expands more than red blood cell mass. This hemodilution results in physiological anemia of pregnancy.

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Practice Exercise 1

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