To reassure and educate pregnant patients about changes in their cardiovascular system, maternity nurses should be aware that:

Correct Answer: D

Rationale: The correct answer is D because all the statements in choices A, B, and C are true regarding changes in the cardiovascular system during pregnancy. A: Pregnant women with disturbed cardiac rhythm, such as sinus arrhythmia, should be closely monitored as it can impact both the mother and the fetus, regardless of the mother's overall health status. B: Changes in heart size, position, and blood volume lead to auditory changes from 20 weeks to term, which is important for nurses to be aware of in order to monitor the cardiovascular health of pregnant patients. C: Palpitations are more likely to occur in twin gestations due to the increased demands on the cardiovascular system. In summary, all the changes mentioned in choices A, B, and C are common occurrences in pregnancy and it is crucial for maternity nurses to be aware of them in order to provide appropriate care and education to pregnant patients.

Correct Answer: C

Rationale: The correct answer is C because hyperthyroidism can indeed develop during pregnancy due to the increase in hormone production, specifically human chorionic gonadotropin (hCG) stimulating the thyroid gland. This can lead to symptoms such as weight loss, anxiety, and palpitations. Other choices are incorrect because A is false - ptyalism is actually linked to progesterone levels, not estrogen. B is incorrect because acid indigestion tends to worsen as pregnancy progresses, not decline. D is incorrect as severe nausea and vomiting, known as hyperemesis gravidarum, can have harmful effects on both the mother and fetus if not properly managed.

Correct Answer: B

Rationale: The correct answer is B: Glycosuria. In pregnant women, glycosuria is considered a variation of normal due to the hormonal changes affecting glucose metabolism. During pregnancy, the renal threshold for glucose is lowered, leading to glucose spillage in urine without significant pathology. Proteinuria (A) can indicate kidney damage. Bacteria in the urine (C) suggest a possible urinary tract infection. Ketones in the urine (D) may indicate a metabolic disorder or inadequate carbohydrate intake. Glycosuria in pregnancy is a physiological adaptation and not necessarily a cause for concern.

Correct Answer: B

Rationale: Physiologic anemia during pregnancy occurs due to the expansion of plasma volume, causing a dilution of hemoglobin concentration. Increased blood volume is necessary to support the growing fetus, leading to a relative decrease in hemoglobin levels. Inadequate iron intake (Choice A) can cause iron-deficiency anemia but is not the primary reason for physiologic anemia in pregnancy. The fetus establishing iron stores (Choice C) is unrelated to the maternal anemia. Decreased production of erythrocytes (Choice D) is not the main cause of anemia in pregnancy; rather, it is the dilution effect from increased plasma volume.

Correct Answer: A

Rationale: Step-by-step rationale for choice A (Identification of fetal heartbeat) being correct: 1. Detection of fetal heartbeat confirms the presence of a developing fetus. 2. It is a definitive sign of pregnancy and indicates fetal viability. 3. Fetal heartbeat can be detected using ultrasound or Doppler. 4. This sign is not subject to interpretation or misinterpretation. Summary of why the other choices are incorrect: - Choice B (Palpation of fetal outline) and D (Verification of fetal movement) are considered probable signs of pregnancy and do not provide definitive confirmation. - Choice C (Visualization of the fetus) is not a reliable sign as it requires advanced imaging techniques and can be subjective.