A nurse is describing cardiovascular system changes that occur during pregnancy to a client and understands that which finding would be normal for a client in the second trimester?

1. A

   Increase in pulse rate

2. B

   Increase in blood pressure

3. C

   Frequent bowel elimination

4. D

   Decrease in red blood cell production

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

• During pregnancy, the heart rate increases by 10-15 beats per minute to support a higher cardiac output.
• This increase in heart rate is a normal physiological adaptation to meet the increased metabolic demands of the mother and the growing fetus.
• The rise in heart rate, combined with an increase in stroke volume, ensures adequate blood flow and oxygen delivery to the uteroplacental unit.

Why Other Options Were Wrong

• Option B: Blood pressure typically decreases during the second trimester due to hormonal vasodilation.
• Option C: Progesterone, a hormone elevated in pregnancy, relaxes smooth muscle, which slows gastrointestinal motility and commonly leads to constipation.
• Option D: Red blood cell (RBC) production and mass increase by 20-30% during pregnancy to enhance oxygen-carrying capacity.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Physiological adaptations of the cardiovascular system during pregnancy to guide bedside assessment, documentation, and the next nursing action.
• Nurses must educate pregnant clients about these normal physiological changes to reduce anxiety and help them distinguish between normal symptoms and potential warning signs.
• Monitoring vital signs is crucial. A stable or slightly decreased blood pressure is expected in the second trimester. A significant increase requires immediate evaluation for pre-eclampsia.
• Advising clients on managing common discomforts like constipation (through increased fiber and fluid intake) and fatigue is a key nursing role.

How to Approach the Question

• First, identify the core of the question: it asks for a 'normal' physiological change in the 'second trimester' related to the 'cardiovascular system'.
• Recall the major adaptations the body makes during pregnancy for each system mentioned in the options.
• Evaluate Option A (Pulse Rate): Remember that cardiac output must increase, and an increased heart rate is a primary way the body achieves this. This is a likely correct answer.
• Evaluate Option B (Blood Pressure): Recall that progesterone causes vasodilation, which leads to a decrease, not an increase, in blood pressure during the first and second trimesters. Eliminate this option.
• Evaluate Option C (Bowel Elimination): Recall that progesterone relaxes smooth muscle, slowing GI motility and causing constipation. Eliminate this option.
• Evaluate Option D (RBC Production): Remember that the body needs more oxygen, so it increases RBC production. The term 'physiologic anemia' refers to hemodilution, not decreased production. Eliminate this option.

Concept Tested & Keywords

• Concept Tested: Physiological adaptations of the cardiovascular system during pregnancy.
• Stem keywords: cardiovascular system, pregnancy, second trimester, normal finding
• Lead-in keywords: which finding would be normal
• Negative lead-in flag: false

Question ID

QAD18BzTU_O_W3hA3SrCfE

Copy ID

Reference Book

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 2-7

E6 Medicine Davidson Principles Practice 24e p. 1292-1294