Chapter 19: Conditions Existing Before Conception: PREPU

A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response? 1 "Your primary care provider will order safe doses of your medication." 2 "It's OK to not use them if you would feel more comfortable." 3 "They won't cause any major defects." 4 "I'll let your primary care provider know how you feel about it."

1

A pregnant woman with a history of mitral stenosis is to be prescribed medication as treatment. Which of the following medication classes would the nurse expect the patient to begin taking? 1 anticoagulant 2 diuretic 3 antihypertensive 4 antineoplastic

1

During the assessment of a laboring client, the nurse learns that the client has cardiovascular disease (CVD). Which assessment would be priority for the newborn? 1 respiratory function 2 heart rate 3 temperature 4 urine output

1

Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 124/86 mm Hg; week 20 - 138/90 mm Hg; week 24 - 140/92 mm Hg; and week 28 - 142/94 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure? 1 mild hypertensive 2 normotensive 3 prehypertensive 4 severe hypertensive

1

The nurse is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize? 1 regular heart rate and hypertension 2 increased urinary output, tachycardia, and dry cough 3 shortness of breath, bradycardia, and hypertension 4 dyspnea, crackles, and irregular weak pulse

4

The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement? 1 Dried apples 2 Fortified grains 3 Dried beans 4 Orange juice

4

Which factor would contribute to a high-risk pregnancy? 1 blood type O positive 2 first pregnancy at age 3 history of allergy to honey bee pollen 4 type 1 diabetes

4

Which response is most appropriate for a client with diabetes who wants to breast-feed but is concerned about the effects of breastfeeding on her health? 1 Diabetic clients who breast-feed have a hard time controlling their insulin needs 2 Diabetic clients shouldn't breast-feed because of potential complications 3 Diabetic clients shouldn't breast-feed; insulin requirements are doubled 4 Diabetic clients may breast-feed; insulin requirements may decrease from breast-feeding

4

A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize? 1 Decrease activity and rest more often. 2 Increase fluids and take more vitamins. 3 Bed rest and bathroom privileges only until birth. 4 Discuss induction of labor with the primary care provider.

1

A pregnant woman of Jewish descent comes to the clinic for counseling and tells the nurse that she is worried her baby may be born with a genetic disorder. Which disease does the nurse identify to be a risk for this client's baby based on the family's ancestry? 1 sickle cell anemia 2 b-thalassemia 3 Tay-Sachs 4 Down syndrome

3

The nurse is assessing a mother who just delivered a 7 lb (3136 g) baby via cesarean delivery. Which assessment finding should the nurse prioritize if the mother has a history of controlled atrial fibrillation? 1 Nausea and vomiting 2 Jugular distention 3 Abdominal cramps 4 Urinary retention

2

A nurse is conducting a class for a group of couples about subfertility. When describing the causes of subfertility, which cause would the nurse include as being most common? 1 pelvic inflammatory disease 2 anovulation 3 excessive exercise 4 excess body weightf

2 anovulation= absence of ovulation

A couple is seeking guidance for their inability to conceive a child after trying for 15 months. They are morbidly obese but state they have friends with the same weight problem who have had no difficulty conceiving. What education can the nurse provide this couple to increase their chances of success? 1 "If you have been trying for this long without success, something must be wrong. So we will need to run a series of tests to see what that is." 2 "Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering." 3 "Being this overweight is unhealthy for you and for any child that you may bring into the world. Before you consider conceiving, you should lose weight." 4 "Weight has no bearing on the ability to conceive. Something else must be going on with your reproductive organs."

2

A pregnant client with type I diabetes asks the nurse about how to best control her blood sugar while she is pregnant. The best reply would be for the woman to: 1 limit weight gain to 15 pounds during the pregnancy. 2 check her blood sugars frequently and adjust insulin accordingly. 3 exercise for 1 to 2 hours each day to keep the blood glucose down. 4 begin oral hyperglycemic medications along with the insulin she is currently taking.

2

A woman with a history of systemic lupus erythematosus comes to the clinic for evaluation. The woman tells the nurse that she and her partner would like to have a baby but that they are afraid her lupus will be a problem. Which response would be most appropriate for the nurse to make? 1 "It's probably not a good idea for you to get pregnant since you have lupus." 2 "Be sure that your lupus is stable or in remission for 6 months before getting pregnant." 3 "Your lupus will not have any effect on your pregnancy whatsoever." 4 "If you get pregnant, we'll have to add quite a few medications to your normal treatment plan.

2

A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse? 1 Both parents have to carry the trait. 2 There is a good chance the infant will inherit the disease from the mother. 3 The infant inherits the disease from the father. 4 If the mother goes into a crisis while pregnant, the baby will develop sickle cell anemia.

1

A nursing instructor is teaching students about high-risk pregnancies. Some circumstances that may cause a pregnancy to be labeled as high-risk include which of the following? (Select all that apply.) 1 poverty 2 lack of support people 3 genetic inheritance 4 good coping mechanisms 5 past history of pregnancy complications 6 high socioeconomic status

1, 2, 3, 5

A client is 33 weeks pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled? 1 45 mg/dL 2 85 mg/dL 3 120 mg/dL 4 136 mg/dL

2

A woman's obstetrician prescribes vitamin K supplements for a client who is on antiepileptic medications beginning at 36 weeks' gestation. The mother asks the nurse why she is taking this medication. The nurse's best response would be: 1 vitamin K helps in keeping the placenta healthy. 2 antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn. 3 administration of vitamin K aids in lung maturity of the fetus. 4 The antiepileptic medications can cause the mother's platelets to drop.

2

In women with cardiac failure, the maternal blood pressure becomes insufficient to provide an adequate supply of blood to the placenta. The infant will likely experience some undesired effects, including which of the following? 1 hypoglycemia 2 low birth weight 3 hyperglycemia 4 high birth weight

2

A nurse informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night's sleep. The nurse further instructs the client that which position for this rest is best? 1 right lateral recumbent 2 left lateral recumbent 3 on her back 4 prone

2 recumbent- means laying on the side.

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which schedule would be most appropriate? 1 monthly visits until 32 weeks, then bi-monthly visits 2 bi-monthly visits until 28 weeks, then weekly visits 3 monthly visits until 20 weeks, then bi-monthly visits 4 bi-monthly visits until 36 weeks, then weekly visits

2

Which of the following statements regarding weight and pregnancy is correct? 1 An underweight woman should increase her caloric intake by 500 to 1000 calories a day. 2 Obesity usually occurs from hypothyroidism. 3 Dieting during pregnancy to reduce weight is recommended only for morbidly obese women. 4 Women who are underweight coming into pregnancy should gain the same amount of weight as women with a normal BMI.

1

A pregnant client in her 20th week of gestation, having systemic lupus erythematosus (SLE), is admitted to the healthcare unit for management of the exacerbation of SLE. Which of the following would be most appropriate to treat the client's condition? 1 Hydroxyurea 2 Corticosteriods 3 Beta2 agonists 4 Prostaglandin E

2

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction? 1 "I need to be aware of my triggers and avoid them as much as possible." 2 "It is fine for me to use my albuterol inhaler if I begin to feel tight." 3 "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." 4 "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on."

3

A nurse is talking to a newly pregnant woman who had a mitral valve replacement in the past. Which statement by the client reveals an understanding about the preexisting condition? 1 "I don't have to worry about this because I had the problem fixed before I became pregnant." 2 "I know I will be fine, but I worry about the fetus." 3 "I understand that my fetus and I both are at risk for complications." 4 "I know my baby will be fine, but I am worried about having a personal complication."

3

A nursing instructor is teaching about causes of infertility and identifies a need for further instruction when a student states which of the following? 1 "A genetic abnormality may cause infertility." 2 "An absence of ovulation may cause infertility." 3 "Diet does not play a role in infertility." 4 "Exercise can influence infertility."

3

A pregnant client with a history of heart disease has been admitted to a health care center reporting breathlessness. The client also reports shortness of breath and easy fatigue when doing ordinary activity. The client's condition is markedly compromised. The nurse would document the client's condition using the New York Heart Association (NYHA) classification system as which class? 1 class I 2 class II 3 class III 4 class IV

3

The nurse is caring for a client who is at 37 weeks' gestation and has a biophysical profile of 9. Which nursing action is best? 1 Notify the health care provider immediately. 2 schedule a health care provider appointment for one week. 3 Tell the client to report to the hospital for a nonstress test. 4 Prepare all records as the client will be admitted for a cesarean section.

2

A 17-year-old primigravida with type 1 diabetes is at 37 weeks gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next? 1 Scheduling the woman for induction of labor today. 3 Allowing her to continue without plans for delivery. 3 Scheduling a cesarean delivery at 39 weeks. 4 Preparing for amniocentesis and fetal lung maturity assessment

4

The client is 32 weeks pregnant and has been referred for biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective? 1 The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. 2 The BPP is a blood test to detect placental problems. 3 The BPP is a screening for neural tube defects. 4 The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

4

Your patient is very conscious of the weight she gained during her pregnancy. She has decided to breastfeed her baby and asks you how many calories a day extra she should be eating so that she and her baby are healthy. She states she does not want to gain any extra weight from over-eating. What would be your best response? 1 "You are eating for two now. Besides, you are breastfeeding and you will lose your pregnancy weight very quickly." 2 "You need to keep eating just like when you were pregnant. That gives you about 300 kcal extra every day." 3 "You have a nice slender body type. Just eat what you want and you will do fine." 4 "You should be eating an extra 200 kcal over what you were eating while you were pregnant."

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