NCLEX Question for 20th week of pregnancy Assessment

A woman is entering the 20th week of pregnancy. Which normal change would the nurse expect to find on assessment?

a. Fundus just below diaphragm

b. Pigment changes in skin

c. Complaints of frequent urinatio

d. Blood pressure returning to prepregnancy level

Correct Answer: b . From 20-24 weeks gestation, pigment changes in skin may occur from actions of hormones. These include the linea nigra, melasma on the face, and striae gravidarum (stretch marks).

Uterine growth in pregnancy follows a pattern; by the 20th week the fundus should reach the umbilicus, at about the 38th week it is just below the diaphragm until lightening (uterus drops into true pelvis) occurs before labor.

Frequency of urination occurs in the first trimester (weeks 0-12) and again in the last trimester (weeks 28-40) from pressure of the gravid uterus on the bladder. Blood pressure in the first 24 weeks usually decreases 5-10 mmHg systolic and 10-15 mmHg diastolic due to relaxation of the vascular smooth muscle and the formation of new peripheral vascular beds.  The blood pressure usually rises to prepregnancy levels by the time labor begins. 

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