A nurse is educating a pregnant patient about heartburn prevention. Which recommendation is most effective?
Lying down immediately after eating
Elevating the head of the bed during sleep
Consuming large meals
Eating spicy foods
The Correct Answer is B
Heartburn in pregnancy is due to lower esophageal sphincter relaxation, progesterone effect, and gastric compression by the enlarging uterus. Normal lower esophageal sphincter pressure is about 10–30 mmHg, but in pregnancy it decreases significantly, predisposing to gastroesophageal reflux. Gastric emptying time remains normal, but increased intra-abdominal pressure worsens reflux. Symptoms include burning retrosternal pain, regurgitation, and discomfort after meals or when lying down. Management includes postural modifications, dietary adjustments, and safe antacids if needed.
Rationale for correct answers
2. Elevating the head of the bed during sleep prevents reflux by using gravity to reduce upward flow of gastric contents into the esophagus. This is the most effective conservative strategy for heartburn prevention in pregnancy.
Rationale for incorrect answers
1. Lying down immediately after eating promotes reflux because gastric contents move more easily into the esophagus when supine. It worsens symptoms instead of preventing them.
3. Consuming large meals increases gastric distension and raises intra-abdominal pressure, predisposing to reflux. Smaller, more frequent meals are recommended instead.
4. Eating spicy foods stimulates gastric acid secretion and can irritate the esophagus, worsening heartburn. Avoiding spicy, fatty, and acidic foods helps reduce symptoms.
Take home points
- Heartburn in pregnancy is caused by progesterone-induced sphincter relaxation and uterine compression.
- Elevating the head of the bed is the most effective preventive strategy.
- Avoid lying down after meals, eating large meals, and irritating foods.
- Differentiate from peptic ulcer disease, which presents with localized epigastric pain related to meals.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Edema in pregnancycan be physiologicaldue to increased plasma volume, decreased colloid osmotic pressure, and uterine compressionof venous return, or pathological, as in preeclampsia. Plasma volume expands 40–50% and colloid osmotic pressure decreases from ~25 mmHg to ~22 mmHg, favoring dependent edema in legs and ankles. Physiological edema is gradual, dependent, and improves with rest or leg elevation. Pathological edema in preeclampsia is sudden, generalized (including face and hands), and associated with hypertension (≥140/90 mmHg after 20 weeks) and proteinuria (>300 mg/24h).
Rationale for correct answers
3.Physiological edema is dependent and improves with rest/elevation, while pathological edema in preeclampsia is sudden, generalized, and often resistant to postural changes. Its association with hypertension and proteinuria makes it clinically significant.
Rationale for incorrect answers
1.Physiological edema typically affects ankles and feet, not the face. Facial swelling is more concerning for preeclampsia.
2.Pathological edema is not localized to the ankles; it is usually generalized, involving face, hands, and sometimes entire body.
4.Pathological edema of preeclampsia occurs after 20 weeks, not in the first trimester. Early pregnancy edema is usually benign and physiologic.
Take home points
- Physiological edema is dependent, gradual, and resolves with rest and elevation.
- Pathological edema in preeclampsia is sudden, generalized, and associated with hypertension and proteinuria.
- Facial and hand swelling are red flags for preeclampsia.
- Differentiation is critical, as preeclampsia increases risk of maternal and fetal complications.
Correct Answer is B
Explanation
Backache in pregnancyis mainly due to relaxin-induced ligament laxity, lumbar lordosis, and increased mechanical strainfrom fetal growth. Relaxin peaks in the first trimester and remains elevated, softening the pubic symphysis and sacroiliac joints to prepare for childbirth. This increased joint mobility reduces pelvic and spinal stability, predisposing to lumbosacral pain. Additionally, weight gain (11.5–16 kg normal for BMI 18.5–24.9) and shift of the center of gravity increase lordotic curvature, straining paraspinal muscles.
Rationale for correct answers
2.Relaxation of pelvic ligaments and joints due to relaxin decreases pelvic stability, contributing to lumbosacral and back pain in pregnancy. This hormonal effect, combined with postural changes, explains the musculoskeletal discomfort commonly reported.
Rationale for incorrect answers
1.Lumbar lordosis actually increases, not decreases, in pregnancy due to the anterior shift in center of gravity. This worsens back strain but is not decreased as stated.
3.Reduced maternal weight gain would lessen, not worsen, back strain. It is excessive weight gain that increases musculoskeletal discomfort.
4.Abdominal muscle strength decreases as the uterus enlarges, further reducing core support. Increased strength would help prevent backache, not cause it.
Take home points
- Pregnancy backache results from relaxin-induced ligamentous laxity and increased lumbar lordosis.
- Mechanical load from fetal growth and maternal weight gain exacerbates pain.
- Reduced abdominal muscle tone worsens postural instability.
- Important differentials include urinary tract infection and preterm labor, which can also present with back pain.
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