A pregnant client complains of nasal stuffiness and occasional nosebleeds. The nurse explains this is a common physiological change due to:
Decreased blood volume
Estrogen-induced hyperemia of mucous membranes
Reduced respiratory rate
Increased clotting factors
The Correct Answer is B
Nasal congestion in pregnancy is primarily caused by estrogen-induced hyperemia of the mucous membranes. Estrogen increases vascular engorgement and capillary permeability, leading to nasal stuffiness, epistaxis, and a sensation of obstruction. Normal blood volume increases by 40–50% during pregnancy, which enhances mucosal vascularity, further worsening nasal congestion. These changes are benign but commonly distressing to clients.
Rationale for correct answer
2. 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.
Rationale for incorrect answers
1. 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.
3. 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.
4. 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.
Take home points
• Estrogen increases nasal mucosal vascularity, causing congestion and nosebleeds in pregnancy.
• Blood volume increases 40–50% and contributes to mucosal engorgement.
• Respiratory rate remains stable, but tidal volume increases due to progesterone.
• Hypercoagulability in pregnancy prevents hemorrhage but does not cause nasal symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Physiological anemia in pregnancyis caused by an increased plasma volumerelative to red blood cell mass. Plasma volume expands by 40–50% while red blood cell mass rises only 20–30%, leading to hemodilution. The normal hemoglobin range in pregnancy is 11–13 g/dL, and hematocrit falls to 32–36%. This adaptation enhances uteroplacental perfusion but predisposes to symptoms like fatigueand paleness.
Rationale for correct answer
3.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.
Rationale for incorrect answers
1.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.
2.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.
4.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.
Take home points
• Physiological anemia in pregnancy results from disproportionate plasma volume expansion.
• Hemoglobin values normally fall to 11–13 g/dL, hematocrit to 32–36% in pregnancy.
• Cardiac output and blood volume increase but oxygen-carrying capacity is maintained.
• Differentiate physiological anemia from iron-deficiency anemia, which lowers hemoglobin below 11 g/dL.
Correct Answer is ["A","C","E"]
Explanation
Cardiovascular changes in pregnancyare adaptive responses to support maternal and fetal needs. Blood volumeincreases by 40–50%, while heart raterises by 10–20 beats/minute, resulting in increased cardiac outputby 30–50%. Systemic vascular resistancedecreases due to progesterone-mediated smooth muscle relaxation. Hematocritdecreases to 32–36% because plasma volume increases more than red blood cell mass, causing physiological anemia.
Rationale for correct answers
1.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.
3.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.
5.Hematocrit decreases to 32–36% because plasma volume expands more than red blood cell mass. This hemodilution results in physiological anemia of pregnancy.
Rationale for incorrect answers
2.Cardiac output does not decrease; it increases by 30–50% due to elevated stroke volume and heart rate. This adaptation ensures optimal uteroplacental perfusion.
4.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.
Take home points
• Pregnancy increases blood volume by 40–50% and cardiac output by 30–50%.
• Heart rate rises by 10–20 beats/minute to maintain uteroplacental circulation.
• Hematocrit decreases to 32–36% due to plasma volume expansion.
• Systemic vascular resistance decreases under progesterone influence, keeping blood pressure stable or slightly reduced.
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