Which cardiovascular finding should the nurse assess further in a client who is at 20-weeks gestation?

Which cardiovascular finding should the nurse assess further in a client who is at 20-weeks gestation?

• A. Decrease in pulse rate.
• B. Decrease in blood pressure.
• C. Increase in heart sounds (S1, S2).
• D. Increase in red blood cell production.

Answer: (A)

In midpregnancy the heart and blood vessels are in a state of increased activity to supply the growing fetus. Blood volume expands, the heart pumps more blood (cardiac output rises), and systemic vascular resistance falls, which often lowers diastolic blood pressure. The overall effect is a heart that works harder, so the pulse rate usually increases modestly rather than decreases. A decrease in pulse rate would not fit this pattern and would warrant further assessment to rule out possible issues such as bradycardia or an underlying condition affecting maternal cardiac function. By contrast, a mild drop in blood pressure during the second trimester can be a normal finding, and changes in heart sounds can occur with the hyperdynamic circulatory state. An increase in red blood cell production contributes to the higher blood volume but isn’t itself a direct cardiovascular abnormality to chase. So, the finding that should be explored further is a pulse rate that has declined, since the expected adaptation is a higher, not lower, heart rate during pregnancy.

In midpregnancy the heart and blood vessels are in a state of increased activity to supply the growing fetus. Blood volume expands, the heart pumps more blood (cardiac output rises), and systemic vascular resistance falls, which often lowers diastolic blood pressure. The overall effect is a heart that works harder, so the pulse rate usually increases modestly rather than decreases.

A decrease in pulse rate would not fit this pattern and would warrant further assessment to rule out possible issues such as bradycardia or an underlying condition affecting maternal cardiac function. By contrast, a mild drop in blood pressure during the second trimester can be a normal finding, and changes in heart sounds can occur with the hyperdynamic circulatory state. An increase in red blood cell production contributes to the higher blood volume but isn’t itself a direct cardiovascular abnormality to chase.

So, the finding that should be explored further is a pulse rate that has declined, since the expected adaptation is a higher, not lower, heart rate during pregnancy.