The backache commonly experienced in pregnancy is related to:
Decreased lumbar lordosis
Relaxation of pelvic ligaments and joints by relaxin
Reduced maternal weight gain
Increased abdominal muscle strength
The Correct Answer is B
Backache in pregnancy is mainly due to relaxin-induced ligament laxity, lumbar lordosis, and increased mechanical strain from 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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
Heartburn in pregnancy(pyrosis) results from progesterone-induced relaxationof the lower esophageal sphincter, delayed gastric emptying, and mechanical pressurefrom the enlarging uterus. Gastric acid normally has a pH of 1.5–3.5, and disruption of esophageal sphincter tone allows reflux of this acidic content into the esophagus, producing burning retrosternal pain. Risk factors include large meals, lying supine after eating, fatty/spicy foods, and abdominal compression. Management emphasizes lifestyle and positional modifications.
Rationale for correct answers
1.Eating small, frequent meals prevents gastric overdistension, lowering reflux risk.
2.Avoiding spicy and fatty foods reduces gastric acid stimulation and delays gastric emptying, helping relieve symptoms.
4.Elevating the head of the bed during sleep decreases nocturnal reflux by using gravity to limit acid regurgitation.
5.Avoiding tight clothing around the abdomen reduces intra-abdominal pressure, lowering the chance of reflux.
Rationale for incorrect answers
3.Lying down immediately after eating worsens reflux because gravity no longer prevents acid regurgitation. Patients should wait at least 2–3 hours before lying down.
Take home points
- Heartburn in pregnancy is due to progesterone relaxation of the LES and uterine pressure.
- Small, frequent meals and avoidance of spicy/fatty foods help reduce reflux.
- Elevating the head of the bed prevents nocturnal symptoms.
- Tight abdominal clothing increases reflux risk and should be avoided.
Correct Answer is ["A","B","D"]
Explanation
Constipation in pregnancyis due to progesterone-induced smooth muscle relaxation, reduced gastrointestinal motility, and increased water absorptionin the colon. Normal bowel frequency is 3 times per day to 3 times per week, with stool water content 70–75%. Constipation is worsened by iron supplements, low fiber intake (normal recommended 25–30 g/day), and dehydration (recommended fluid intake 2–3 L/day). Nursing assessment should focus on bowel habits, diet, and hydration status.
Rationale for correct answers
1.Evaluating bowel frequency and consistency identifies deviations from normal patterns and confirms constipation. Hard, infrequent stools suggest delayed colonic transit.
2.Assessing dietary fiber intake is essential since insufficient fiber reduces stool bulk and increases constipation risk. Recommended intake is 25–30 g/day.
4.Checking hydration status is important because inadequate fluid intake leads to excessive colonic water reabsorption, hardening stools. Adequate hydration softens stool and improves motility.
Rationale for incorrect answers
3.Monitoring respiratory rate is not relevant to constipation assessment. Respiratory changes in pregnancy are related to diaphragm elevation, not bowel habits.
5.Measuring blood glucose levels is related to screening for gestational diabetes, not constipation. Constipation is unrelated to glycemic status.
Take home points
- Constipation in pregnancy is due to progesterone, iron supplements, low fiber, and dehydration.
- Assessment should focus on stool frequency/consistency, fiber intake, and hydration status.
- Adequate hydration (2–3 L/day) and fiber (25–30 g/day) prevent constipation.
- Must differentiate constipation from bowel obstruction, which presents with pain, distension, and vomiting.
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