Review Practice Exercise 3

Discomforts of Pregnancy > Maternal Newborn

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Practice Exercise 3

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Total Questions : 5

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Question 1:

Leg cramps, particularly at night, are a common discomfort of pregnancy. What immediate action should the client take when experiencing a cramp?

A. Massage the calf vigorously B. Apply a hot pack to the area C. Dorsiflex the foot (point toes toward the head) D. Elevate the leg without movement

Answer and Explanation

Choice A:

Vigorous massage may worsen the spasm by stimulating further contraction of muscle fibers. While gentle massage can aid recovery after stretching, it does not provide immediate relief of the acute cramp. It is not considered first-line action.

Choice B:

Applying a hot pack increases blood flow but does not rapidly relax the contracted muscle. Heat may help prevent recurrence but is too slow for immediate relief. Additionally, excessive heat use in pregnancy may cause thermal discomfort or risk of burns.

Choice C:

Dorsiflexing the foot stretches the gastrocnemius muscle, immediately relieving muscle spasm by lengthening contracted fibers. It restores balance between calf muscles and relieves pain faster than massage or heat. Clinical guidelines recommend dorsiflexion as first-line management of acute cramp.

Choice D:

Elevating the leg without movement does not relieve the cramp because the muscle remains shortened and contracted. Elevation is useful for edema and venous return but ineffective for releasing an acute painful spasm.

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Question 2:

To prevent or alleviate varicose veins during pregnancy, a nurse would recommend:

A. Prolonged standing B. Avoiding elevating the legs C. Wearing graduated compression stockings D. Crossing the legs frequently

Answer and Explanation

Choice A:

Prolonged standing worsens venous stasis and increases hydrostatic pressure in the lower limbs. This promotes vein dilation and valve incompetence, aggravating varicosities instead of preventing them.

Choice B:

Avoiding leg elevation prevents blood from draining back toward the heart. Elevation above the level of the heart reduces venous pressure and edema, and thus is a recommended preventive measure. Not elevating the legs increases risk of symptom progression.

Choice C:

Wearing graduated compression stockings supports venous return by applying the greatest pressure at the ankle, gradually decreasing proximally. This reduces venous pooling, alleviates symptoms, and prevents progression of varicosities. Clinical guidelines recommend compression stockings as the most effective conservative measure.

Choice D:

Crossing the legs frequently compresses venous return and obstructs circulation. This further increases venous pressure in the distal extremities, promoting pooling of blood and worsening of varicosities rather than alleviation.

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Question 3:

Which of the following interventions helps manage hemorrhoids during pregnancy?

A. Straining during defecation B. Avoiding fluid intake C. Warm sitz baths D. Prolonged sitting

Answer and Explanation

Choice A:

Straining during defecation increases intra-abdominal and rectal venous pressure, worsening hemorrhoidal congestion and pain. It also increases the risk of hemorrhoidal prolapse and bleeding.

Choice B:

Avoiding fluid intake leads to harder stools and constipation, aggravating hemorrhoids. Adequate hydration of 2–3 L/day is essential to soften stool and reduce straining.

Choice C:

Warm sitz baths promote relaxation of the anal sphincter, improve circulation, and provide symptomatic relief of pain and swelling. They are safe in pregnancy and recommended as a conservative, first-line measure for hemorrhoid management.

Choice D:

Prolonged sitting increases perianal venous pressure and pooling, worsening hemorrhoid symptoms. It can also cause further irritation and swelling.

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Question 4:

Shortness of breath (dyspnea) in the third trimester is primarily caused by:

A. Decreased oxygen consumption by the mother B. Significant lung damage C. Elevation of the diaphragm by the enlarging uterus D. Reduced red blood cell count

Answer and Explanation

Choice A:

Oxygen consumption does not decrease in pregnancy; it actually increases by about 20% to meet maternal and fetal metabolic demands. A decrease in oxygen consumption would not explain dyspnea.

Choice B:

Significant lung damage is not a normal feature of pregnancy. Pathological lung damage may cause dyspnea, but in healthy pregnant women, respiratory mechanics, not disease, explain the symptom.

Choice C:

Elevation of the diaphragm by the enlarging uterus reduces lung volumes, especially functional residual capacity, making the woman feel short of breath. Despite this, tidal volume increases to compensate, maintaining normal oxygenation. This explains why dyspnea is common in late pregnancy but usually not pathological.

Choice D:

Reduced red blood cell count is not the main cause. Although physiologic anemia occurs due to hemodilution (plasma volume increases 40–50% vs. red blood cell mass 20–30%), it causes fatigue rather than the mechanical dyspnea seen in the third trimester.

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Question 5:

Which of the following are common management strategies for dependent edema in pregnancy? Select all that apply.

A. Elevate legs and feet frequently B. Avoid prolonged standing or sitting C. Limit fluid intake significantly D. Wear support stockings E. Lie on the left side to promote venous return

Answer and Explanation

Choice A:

Elevating legs and feet frequently decreases venous hydrostatic pressure, facilitates return of blood to the heart, and reduces pooling in the lower extremities, making it an effective measure.

Choice B:

Avoiding prolonged standing or sitting prevents venous stasis, which otherwise increases capillary hydrostatic pressure and promotes edema formation. Regular position changes are recommended.

Choice C:

Limiting fluid intake significantly is inappropriate. Pregnant women require adequate hydration (2–3 L/day) to maintain plasma volume and amniotic fluid. Restricting fluids may worsen hemoconcentration, impair placental perfusion, and does not effectively treat dependent edema.

Choice D:

Wearing support stockings provides external graduated compression, reducing venous pooling and edema formation, especially when used in the morning before edema develops.

Choice E:

Lying on the left side relieves pressure on the inferior vena cava, improving venous return and renal perfusion, thereby reducing fluid retention and lower extremity edema.

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Practice Exercise 3

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