The nurse knows that a normal physiologic alteration of the circulatory system associated with thromboembolic events in pregnancy is:

Choice A rationale

Blood returning to the right atrium from the pulmonary system is consistent with adult circulation, not fetal circulation. In fetal circulation, blood bypasses the lungs via the ductus arteriosus and foramen ovale since the fetus receives oxygenated blood from the placenta, not the lungs.

Choice B rationale

Blood is returning to the placenta via the umbilical arteries. In fetal circulation, deoxygenated blood is carried from the fetus to the placenta through the umbilical arteries. This is consistent with normal fetal circulation as the placenta is responsible for gas exchange.

Choice C rationale

Blood being shunted to the right side from the left side of the heart is incorrect. In fetal circulation, there is a right-to-left shunt through the foramen ovale, allowing blood to bypass the non-functioning fetal lungs and go directly into systemic circulation.

Choice D rationale

A right-to-left shunt is not seen between the umbilical arteries. Instead, the shunts in fetal circulation are the ductus venosus, ductus arteriosus, and foramen ovale, which help reroute blood away from the fetal lungs and liver.

Choice A rationale

Ambivalent feelings are common in early pregnancy due to hormonal changes and the significant life adjustments that accompany pregnancy. It is normal for pregnant women to experience mixed emotions as they adapt to the reality of impending parenthood.

Choice B rationale

Suggesting the client speak to her mother about these feelings may not be appropriate as it could dismiss the client's current feelings and needs. While family support is valuable, the nurse should first address the client's concerns directly.

Choice C rationale

Referring the client to a counselor may be necessary in some cases, but it is essential to first normalize the client's feelings. It helps in providing immediate reassurance and understanding before suggesting further intervention.

Choice D rationale

Telling the client "Don't worry, you will be fine once the baby is born" is dismissive and minimizes her current concerns. It is important to validate her feelings and provide supportive responses to help her cope with her emotions.