Chapter 11 EAQ EXAM 2

Which information does the nurse include in preconception counseling for a patient with Marfan syndrome who also presents with an aortic root diameter of more than 6 cm? "It should be repaired before you become pregnant." "There is an increased chance of maternal mortality." "The newborn child may develop Marfan syndrome." "You may not be able to deliver the child vaginally." "You should not even try to become pregnant at all."

abcd

Which conditions are common in infants born to mothers with diabetes mellitus? Brachial plexus palsy Cephalhematoma Marfan syndrome Shoulder dystocia Hypoglycemia

abde

Which tests does the nurse evaluate to determine the health status of a patient with diabetes in the first few weeks of pregnancy? Urinalysis and culture 24-Hour urine collection Nonstress fetal test Thyroid function test Glycosylated hemoglobin A1c

abde

A patient who recently had a heart transplant with no evidence of rejection asks the nurse about the safety of conceiving a child. What is the best response by the nurse? "A heart transplant does not tolerate pregnancy." "You may conceive 1 year after the transplant." "The newborn may have congenital heart disease." "You may need to terminate pregnancy at any time."

b

Which instruction should the nurse include when teaching a pregnant woman with class II heart disease? Advise her to gain at least 30 pounds. Instruct her to avoid strenuous activity. Inform her of the need to limit fluid intake. Explain the importance of a diet high in calcium.

b

Which is the ideal treatment for severe unmanageable hyperthyroidism in a patient who is pregnant? Radioactive iodine Subtotal thyroidectomy Methimazole (Tapazole) Propylthiouracil (Propacil)

b

Which medication is administered to a pregnant patient to treat hyperthyroidism? Isotretinoin (Accutane) Methimazole (Tapazole) Levothyroxine (Synthroid) Sodium iodide 131I (Hicon)

b

During pregnancy, alcohol withdrawal may be treated using: disulfiram (Antabuse). corticosteroids. benzodiazepines. aminophylline.

c

Maternal and neonatal risks associated with gestational diabetes mellitus are: maternal premature rupture of membranes and neonatal sepsis. maternal hyperemesis and neonatal low birth weight. maternal preeclampsia and fetal macrosomia. maternal placenta previa and fetal prematurity.

c

The nurse is teaching a pregnant patient with diabetes mellitus about ways to prevent infant morbidity. What is the most important aspect to include? "You must avoid exercise after meals." "Fetal growth needs to be checked monthly." "Your blood glucose levels must be in control." "You need to adhere to a strict ketogenic diet."

c

What does the nurse recommend to a pregnant patient with diabetes who works long, irregular hours? "Eat a snack hourly when at work." "Try taking naps when you are free." "Keep fruits or fruit juice available." "Quit working for a while."

c

Which condition should the nurse be alert for after administering terbutaline (Brethine) to a pregnant patient with diabetes mellitus? Dyspnea Infection Ketoacidosis Hypoglycemia

c

The nurse is teaching a woman with gestational diabetes the technique to inject insulin. What should the nurse include in the teaching session? . Aspirate before injecting Clean injection site with alcohol Insert the needle at a 45- to 90-degree angle Inject insulin slowly After injection, cover site with sterile gauze

cde

Thalassemia is a relatively common anemia in which: an insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). RBCs have a normal life span but are sickled in shape. folate deficiency occurs. there are inadequate levels of vitamin B 12.

a

Which nursing interventions does the nurse implement when assessing a patient with gestational diabetes? Tells the patient to follow a diabetic diet Explains the importance of exercising daily Tells the patient to not take any oral hypoglycemics Demonstrates how to monitor blood glucose levels Explains the effects of diabetes on the pregnancy and fetus

ade

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: with good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. the most important cause of perinatal loss in diabetic pregnancy is congenital malformations. infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. at birth, the neonate of a diabetic mother is no longer at any greater risk.

b

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this woman understands that: oral hypoglycemic agents should not be used if the woman is reluctant to give herself insulin. dietary modifications and insulin are both required for adequate treatment. glucose levels are monitored by testing urine 4 times a day and at bedtime. dietary management involves distributing nutrient requirements over three meals and two or three snacks.

d

The nurse is developing the plan of care for a pregnant patient with an underlying history of cardiovascular disease. Which conditions would this patient be at risk for? Stillbirth Miscarriage Hypoglycemia Atrial septal defect Intrauterine growth restriction

abe

Which conditions does the nurse ask the pregnant patient with a cardiac disorder to report immediately? Urinary tract infection Palpitations and pain Shortness of breath Onset of constipation Orthostatic hypotension

abc

When providing preconception counseling, what instructions does the nurse give to a patient with diabetes mellitus? Inform the patient about the potential risks. Instruct the patient about the expenses involved. Explain the need for frequent obstetrical visits. Advise the patient to use effective contraception. Advise the patient against trying to conceive a child.

abcd

Which obstetric or medical complications should the nurse be alert for while providing care to a pregnant patient with diabetes mellitus? Preeclampsia Hypoglycemia Hydramnios Monilial vaginitis Brachial plexus palsy

abcd

The nurse is informing the pregnant patient with a cardiac disorder about the dietary changes that are needed. What should the nurse include in the teaching? "Take iron and folic acid supplements daily." "Increase your daily intake of dietary fiber." "Take the stool softener daily as prescribed." "Cut intake of dark, green leafy vegetables." "Include potassium-rich foods in the diet."

abce

Which nursing interventions are included in the plan of care of a pregnant patient with mitral stenosis? Restrict dietary sodium. Place the patient on bed rest. Assess the echocardiogram. Teach passive exercises. Assess respiratory status.

abce

What are the metabolic changes associated with pregnancy? Maternal production of insulin increases during the first trimester. Fasting blood glucose levels will decrease during the first trimester. The patient's tolerance to glucose increases in the second trimester. There is enough glucose for the fetus during the second trimester. Maternal insulin requirements increase during the first trimester.

abd

The nurse is caring for a woman with mitral stenosis who is in the active stage. What action should the nurse take to promote cardiac function? Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics. Encourage the woman to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.

a

Which action does the nurse take to determine whether the carbohydrate intake is inadequate in a pregnant patient with diabetes? Monitor for urine ketones. Evaluate the nonstress test results. Determine the degree of glycosuria. Schedule a baseline fetal sonogram.

a

Which condition does the nurse expect to find in the medical record of a pregnant patient with diabetes mellitus? Hypoglycemia Cyanosis of lips Increasing fatigue Generalized edema

a

Which factor is known to increase the risk of gestational diabetes mellitus? Previous birth of large infant Maternal age younger than 25 Underweight before pregnancy Previous diagnosis of type 2 diabetes mellitus

a

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often: orthopnea. decreasing energy levels. moist frequent cough and frothy sputum. crackles (rales) at the bases of the lungs on auscultation.

b

From 4% to 8% of pregnant women have asthma, making it one of the most common preexisting conditions of pregnancy. Severity of symptoms usually peaks: in the first trimester. between 17 to 24 weeks of gestation. during the last 4 weeks of pregnancy. immediately postpartum.

b

How does the nurse advise the patient who has given birth to an infant with microcephaly in the past and is now planning for the next child? "There is a higher chance of having a preterm birth." "You should be screened for phenylketonuria (PKU)." "There may be a miscarriage in your second pregnancy." "You must go for genetic counseling before conception."

b

The nurse notices that a pregnant patient shows signs of fatigue and lethargy and has glossitis and rough skin. Which condition does the nurse likely suspect? Thalassemia Megaloblastic anemia Iron deficiency anemia Sickle cell hemoglobinopathy

b

What instruction does the nurse give to a pregnant patient who takes iron supplements and is also prescribed levothyroxine (Synthroid) (T 4)? "Perform your aerobic exercises after taking levothyroxine (T 4)." "Take iron supplements and levothyroxine (T 4) at different times." "Lower the levothyroxine (T 4) dosage as the pregnancy progresses." "Discontinue the iron supplements in case of nausea or vomiting."

b

When a pregnant woman with diabetes experiences hypoglycemia while hospitalized, what should the nurse have the woman do? Eat a candy bar. Eat six saltine crackers or drink 8 oz of milk. Drink 4 oz of orange juice followed by 8 oz of milk. Drink 8 oz of orange juice with 2 teaspoons of sugar added.

b

When planning intrapartum care for a woman with heart disease, the nurse should include: Taking vital signs according to standard protocols. Continuously monitoring cardiac rhythm with telemetry. Massaging the uterus to hasten delivery of the placenta. Maintaining infusion of intravenous fluids to avoid dehydration.

b

Which clinical finding in a pregnant patient will indicate proper fetal brain development? Hemoglobin A1c levels greater than 6 Normal maternal thyroxine (T 4) levels 3% amniotic fluid phosphatidylglycerol Fasting glucose levels less than 95 mg/dL

b

Which test does the nurse evaluate to understand the cause of fatigue, shortness of breath, and dyspnea in a pregnant patient? Nonstress test Electrocardiography 24-Hour urine collection Glycosylated hemoglobin

b

A pregnant patient with diabetes is prescribed aerobic exercise with resistance training, arm exercises, and a recumbent exercise bicycle. What does the nurse instruct the patient to ensure optimal benefit from the exercise? "Perform aerobic exercises for 10 minutes every day." "Do the prescribed exercises after meals." "Stop the exercises if you have uterine contractions." "Check glucose levels before, during, and after exercise." "Increase exercise if there are signs of hypoglycemia."

bcd

A pregnant woman with type 1 diabetes is on rapid-acting, short-acting, and intermediate-acting insulin injections. Which are rapid and short-acting insulins? . NPH (Novolin N) Regular (Humalin) Lispro (Humalog) Aspart (NovoLog) Glargine (Lantus)

bcd

A patient with gestational diabetes tells the nurse, "I'm extremely worried that my child will be diabetic, too." Which actions does the nurse take to alleviate the patient's anxiety? Evaluate the test results to assess fetal growth. Listen to the feelings and concerns of the patient. Provide factual information of risks to the patient. Use therapeutic communication with the patient. Ask the patient to share any fears with the nurse.

bcde

The most important instruction to include in a teaching plan for a woman in early pregnancy who has class I heart disease is: She must report any nausea or vomiting. She may experience mild fatigue in early pregnancy. She must report any chest discomfort or productive cough. She should plan to increase her daily exercise gradually throughout pregnancy.

c

During a physical assessment of an at-risk patient, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of: euglycemia. rheumatic fever. pneumonia. cardiac decompensation.

d

The fasting plasma glucose levels are greater than 95 mg/dL in a patient with gestational diabetes mellitus. The patient is unwilling to take the prescribed insulin therapy. Which medication can be used in this case? Isotretinoin (Accutane) Enoxaparin (Lovenox) Terbutaline (Brethine) Glyburide (Micronase)

d

What does the nurse teach a patient with phenylketonuria (PKU) about breastfeeding? "You should breastfeed your child every 3 to 4 hours." "Eat a phenylalanine-restricted diet for breastfeeding." "Eat wheat products immediately after breastfeeding." "You should bottle-feed, because it is not safe to breastfeed."

d

What intervention does the nurse include while providing care for a pregnant patient with primary pulmonary hypertension (PPH)? Assess the heart valve function. Administer parenteral analgesia. Place the patient in the supine position. Assess the patient's blood pressure.

d

Which condition does the nurse suspect in a pregnant patient if there is weight loss and the patient's pulse rate is greater than 100 beats/min? Atrial septal defect Macrosomia Phenylketonuria Hyperthyroidism

d

Which medication does the primary health care provider ask the nurse to administer to a patient during labor in a vaginal delivery, who has a history of a myocardial infarction (MI)? Oxytocin Diuretics Anticoagulant Epidural analgesia

d

Which medication is ideal for the treatment of systemic lupus erythematosus (SLE) in a pregnant patient? Aspirin (Ecotrin) Azathioprine (Imuran) Prednisone (Deltasone) Hydroxychloroquine (Plaquenil)

d