Chapter 20 Prep-U OB

A pregnant woman with diabetes is having her glycosylated hemoglobin level evaluated. The nurse determines that the woman's glucose is under control and continues the woman's plan of care based on which result? A. 6.5% B. 8.0% C. 7.5% D. 8.5%

A R: A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. A glycosylated hemoglobin level of more than 8.0% indicates poor blood glucose control and the need for intervention, necessitating a revision in the woman's plan of care.

A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse? A. "I'll let the doctor know so you can discuss your medications.In the meantime, I'll give you a list of folate-rich foods you can add to your diet." B. "Do you want to talk to a counselor who can help you weigh the pros and cons of having your own child rather than adopting?" C. "You should talk to the doctor about that; the medications you're on can damage the fetus." D. "That's great. I've got a 4-year-old and a 2-year-old myself."

A R: Any woman with epilepsy needs to discuss the medication management with her provider. The current research indicates the medications used for epileptic management are the major cause of birth defects for these patients. The nurse should be careful about mentioning that some epileptics are teratogenic; some women may stop taking their medications in order to get pregnant. Suggesting adoption is inappropriate as the mother has given no indication she is interested in adoption; also, the mother needs to discuss this with the physician so that she can get accurate information about being on anti-seizure medications and being pregnant. The nurse should not share personal information as it does not assist this client in making a serious decision. The client should be referred to the health care provider to help the client make the best decision.

A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client? A. diet B. long-acting insulin C. oral hypoglycemic D. drugs glucagon

A R: Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are contraindicated in pregnancy. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.

A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum? A. assessing for cardiac decompensation B. limiting sodium intake C. inspecting the extremities for edema D. ensuring that the client consumes a high fiber diet

A R: The nurse should assess the client with heart disease for cardiac decompensation, which is most common from 28 to 32 weeks of gestation and in the first 48 hours postpartum. Limiting sodium intake, inspecting the extremities for edema, and ensuring that the client consumes a high-fiber diet are interventions during pregnancy not in the first 48 hours postpartum.

A pregnant woman with diabetes is having a glycosylated hemoglobin (HbA1C) level drawn. Which result would require the nurse to revise the client's plan of care? A. 8.5% B. 5.5% C. 6.0% D. 7%

A R: An HbA1C level of more than 8% indicates poor control and the need for intervention, necessitating a revision in the woman's plan of care.

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? A. mild hypertensive B. normotensive C. prehypertensive D. severe hypertensive

A R: Chronic hypertension exists when the woman has high blood pressure before pregnancy or before the 20th week of gestation, or when hypertension persists for more than 12 weeks. It has been classified as normotensive (systolic less than 120 mm Hg, diastolic less than 80 mm Hg); prehypertension (systolic 120 to 139 mm Hg, diastolic 80 to 89 mm Hg); mild hypertension (systolic 140 to 159 mm Hg, diastolic 90 to 99 mm Hg); and severe hypertension (systolic 160 mm Hg or higher, diastolic 100 mm Hg or higher).

The nursing instructor is pointing out the various complcations which can occur during pregnancy in women with diabetes mellitus. The instructor determines the session is successful after the students correctly choose which complication that can occur if the diabetes is not kept under control? A. hydramnios B. hypotension C. placenta previa D. cerebral vascular accident

A R: Out-of-control diabetes can result in hyperglycemia which tends to lead to excessive amniotic fluid (hydramnios or polyhydramnios) because of osmotic pressure fluid shifts. A small placenta is more common than placenta previa. The woman may experience hypertension versus hypotension if the diabetes is not controlled. Cerebral vascular accidents are usually not related to diabetes but to circulatory issues.

A nurse is teaching a woman diagnosed with gestational diabetes about meal planning and nutrition. The nurse determines that additional teaching is needed based on which client statement? A. "I need to avoid any fat with my meals." B. "It's okay to eat small meals or snacks throughout the day." C. "Having a bedtime snack is good for me." D. "I should get most of my calories from good complex carbs."

A R: Recommendations for nutrition and diet with gestational diabetes include: eating three meals a day plus three snacks to promote glycemic control with 40% of calories from good-quality complex carbohydrates, 35% of calories from protein sources, and 25% of calories from unsaturated fats; eating small frequent feedings throughout the day; having bedtime snacks; and including protein and fat at each meal.

A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn? A. microcephaly B. hypertension C. clubbed fingers and toes D. bicuspid valve stenosis

A R: Signs that are likely to be present in the 10 percent of newborns who are symptomatic at birth include microcephaly, seizures, IUGR, hepatosplenomegaly, jaundice, and rash.

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client? A. restricted sodium intake B. ginger therapy C. methadone therapy D. monoamine oxidase inhibitors

A R: The client with peripartum cardiomyopathy should be prescribed restricted sodium intake to control the blood pressure. Monoamine oxidase inhibitors are given to treat depression in pregnancy not peripartum cardiomyopathy. Methadone is a drug given for the treatment of substance abuse during pregnancy. Complimentary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum not peripartum cardiomyopathy.

Which changes in pregnancy would the nurse identify as a contributing factor for arterial thrombosis, especially for the woman with atrial fibrillation? A. hypercoagulable state B. increase in blood volume C. increased cardiac output D. elevation of diaphragm

A R: The nurse should identify that the increased risk of arterial thrombosis in atrial fibrillation is due to hypercoagulable state of pregnancy. During pregnancy there is a state of hypercoagulation. This increases the risk of arterial thrombosis in clients having atrial fibrillation and artificial valves. Increased cardiac output and blood volume do not cause arterial thrombosis. Elevation of the diaphragm is due to the uterine distension, and it causes a shift in the QRS axis and is not a associated with arterial thrombosis.

Which change in insulin is most likely to occur in a woman during pregnancy? A. less effective than normal B. not released because of pressure on the pancreas C. unavailable because it is used by the fetus D. enhanced secretion from normal

A R: Somatotropin released by the placenta makes insulin less effective. This is a safeguard against hypoglycemia.

The nurse is caring for a pregnant client who is in her 30th week of gestation and has congenital heart disease. Which finding should the nurse recognize as a symptom of cardiac decompensation with this client? A. swelling of the face B. elevated temperature C. slow, labored respiration D. dry, rasping cough

A R: Swelling of the face is a symptom of cardiac decompensation, along with moist, frequent cough and rapid respirations. Dry, rasping cough; slow, labored respiration; and an elevated temperature are not symptoms of cardiac decompensation.

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? A. "Your primary care provider will order safe doses of your medication." B. "I'll let your primary care provider know how you feel about it." C. "It's OK to not use them if you would feel more comfortable." D. "They won't cause any major defects."

A R: Women should take no medication during pregnancy except that prescribed by their primary care provider. The PCP will work with the mother to ensure the safest amount is given to adequately handle the mother's health issues and not injure the fetus. The PCP must weigh the risks against the benefits for both the mother and her fetus. The nurse should not encourage the client to stop her asthma medication as that may result in the client having an asthma attack, which could result in injury to the fetus or even miscarriage. The nurse should not tell the client a drug will not cause any defects, especially if it is known that it can. That could make the nurse liable for damages. The nurse should inform the PCP of the client's concerns; however, it is more important for the nurse to calm the client's anxiety and offer positive reinforcement that the PCP is working hard to protect the mother and infant from harm.

A pregnant woman with chronic hypertension comes to the clinic for evaluation. The last several blood pressure readings were gradually increasing. On today's visit her blood pressure is 166/100 mm Hg. The health care provider prescribes an antihypertensive agent. The nurse anticipates which agent as being most commonly prescribed? A. atenolol B. methyldopa C. labetalol D. nifedipine

B R: Although labetalol, atenolol, and nifedipine may be ordered, methyldopa is the most commonly prescribed agent because of its safety record during pregnancy. It is a slow-acting antihypertensive agent that also helps to improve uterine perfusion.

The nurse encourages a woman with gestational diabetes to maintain an active exercise period during pregnancy. Prior to this exercise period, the nurse would advise her to take which action? A. Eat a high-carbohydrate snack. B. Eat a sustaining-carbohydrate snack. C. Add a bolus of long-acting insulin. D. Inject a bolus of insulin.

B R: Because exercise uses up glucose, women with diabetes should take a sustaining-carbohydrate snack before hard exercise to prevent hypoglycemia.

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? A. Bed rest and bathroom privileges only until birth. B. Decrease activity and rest more often. C. Increase fluids and take more vitamins. D. Discuss induction of labor with the primary care provider.

B R: If the client is developing symptoms associated with her heart condition, the first intervention is to monitor activity levels, decrease activity, and treat the symptoms. At 32 weeks' gestation, the suggestion to induce labor is not appropriate, and without knowledge of the type of heart condition one would not recommend increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity.

A woman calls the obstetrician's office to inquire how long she needs to wait to get pregnant following a seizure she had last week. The nurse would tell her to wait how long? A. Most doctors recommend that a woman wait 1 year following a seizure to get pregnant. B. It is recommended that she wait 6 months after seizures are under control before getting pregnant. C. She needs to wait 2 months after seizures are controlled before conceiving. D. There is no set time to wait before conceiving following a seizure.

B R: Most physicians recommend that a woman wait 6 months after seizures are under control before getting pregnant to ensure that her fetus will be safe.

A nurse is providing education to a woman at 28 weeks' gestation who has tested positive for gestational diabetes mellitus (GDM). What would be important for the nurse to include in the client teaching? A. Her baby is at increased risk for neonatal diabetes mellitus. B. She is at increased risk for type 2 diabetes mellitus after her baby is born. C. She is at increased risk for type 1 diabetes mellitus after her baby is born. D. Her baby is at increased risk for type 1 diabetes mellitus.

B R: The woman who develops GDM is at increased risk for developing type 2 diabetes mellitus after pregnancy.

Which medication would you expect to see prescribed for a pregnant woman with an artificial heart valve shortly before or during labor? A. Coumadin B. Penicillin C. A hypotensive D. Digoxin

B R: Women with artificial heart valves have an increased risk of subacute bacterial endocarditis following delivery because some bacteria enter the bloodstream from the denuded placental surface. Such bacteria settle in the eddying blood surrounding cardiac shunts or valves.

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? A. Abdominal cramps B. Jugular distention C. Urinary retention D. Nausea and vomiting

B R: A woman who has a cardiac condition is at increased risk in the postpartum period. The most important nursing action is to monitor for signs of cardiac decompensation. The nurse should monitor for and report jugular distention, clubbing, and slow capillary refill time. If an irregular pulse is noted, compare it to the apical pulse. The abdominal cramps may be related to the uterus involution. The nausea and vomiting and urinary retention may be related to the surgical procedure and not necessarily the cardiac issue.

A nurse is caring for a 45-year-old pregnant client with a cardiac disorder who has been instructed by her primary care provider to follow class I functional activity recommendations. The nurse correctly instructs the client to follow which limitations? A. "It is important for you to rest after any physical activity in order to prevent any cardiac complications." B. "You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or shortness of breath." C. "You will need to be on bedrest for the remainder of your pregnancy." D. "It will be beneficial if you plan rest periods throughout your day."

B R: Class I recommendations (no physical activity limitations) are suggested for client's who are asymptomatic and exhibit no objective evidence of cardiac disease. The functional classifications system consists of classes I to IV, based on past and present disability and physical signs resulting from cardiac disease.

After conducting a refresher class on possible congenital infections with a group of perinatal nurses, the nurse recognizes the class was successful when the group identifies which congenital viral infection as the most common? A. RSV B. CMV C. HIV D. HPV

B R: Cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. Human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus (HSV) are other potential viruses.

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or at delivery for her baby. Which statement by the mother indicates that further teaching is needed by the nurse? A. "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day." B. "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." C. "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born." D. "My baby may be very large and I may need a cesarean section to have him."

B R: Elevated blood sugars delay the maturation of fetal lungs, not increase maturation time, resulting in potential respiratory distress in newborns born to diabetic mothers. Doing "kick counts", as the fetal movement monitoring is often called, is standard practice, as is the possibility of an amniocentesis to determine lung maturity during the third trimester. Health care personnel should also prepare the mother for the potential of a cesarean section delivery if the infant is too large.

The nurse is leading a discussion with a group of pregnant women who have diabetes. The nurse should point out which situation can potentially occur during their pregnancy? A. Post-term birth B. Polyhydramnios C. Small for gestation age infant D. Hypotension of pregnancy

B R: Polyhydramnios is an increase, or excess, in amniotic fluid and is a pregnancy-related complication associated with diabetes. An infant who is small for gestational age is not associated with a mother who had diabetes prior to pregnancy. Other pregnancy-related complications associated with pregestational DM include hypertensive disorders, preterm birth, and shoulder dystocia.

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? A. temperature B. respiratory function C. heart rate D. urine output

B R: The nurse should identify respiratory distress syndrome as a major risk that can be faced by the offspring of a client with cardiovascular disease. While the other assessments are important, they are not priority.

A pregnant woman in her second trimester comes to the prenatal clinic for a routine visit. She reports that she has a new kitten. The nurse would have the woman evaluated for which infection? A. cytomegalovirus B. toxoplasmosis C. parvovirus B19 D. herpes simplex virus

B R: Toxoplasmosis is transferred by hand to mouth after touching cat feces while changing the litter box or through gardening in contaminated soil. Cytomegalovirus is transmitted via sexual contract, blood transfusions, kissing, and contact with children in daycare centers. Parvovirus B19 is a common self-limiting benign childhood virus that causes fifth disease. A pregnant woman may transmit the virus transplacentally to her fetus if she is exposed to an infected child. Herpesvirus infection occurs by direct contact of the skin or mucous membranes with an active lesion through kissing, sexual contact, or routine skin-to-skin contact.

A pregnant woman is diagnosed with hyperthyroidism and is prescribed propylthiouracil as part of the treatment plan. When teaching the woman about this medication and its effect on the fetus, which information would the nurse include? A. "The drug could lead to problems with blood clotting in your baby." B. "Your baby might be born with an enlarged thyroid gland." C. "This drug is relatively safe and shouldn't cause your baby any problems." D. "Your baby has an increased risk for developing diabetes."

B R: Treatment for hyperthyroidism is with thioamides (methimazole or propylthiouracil), which reduce thyroid activity. These drugs, unfortunately, cross the placenta and can lead to congenital hypothyroidism and, consequently, an enlarged thyroid gland (i.e., a goiter) in the fetus. Women should be regulated on the lowest possible dose of the drug and cautioned to keep a careful record of doses taken so they do not forget or unintentionally duplicate a dose; doing so could be dangerous, because if a goiter in the fetus enlarges enough, it can obstruct the airway and make resuscitation difficult at birth. The drug does increase the risk for diabetes or blood clotting problems.

A pregnant client with a history of asthma since childhood presents for a prenatal visit. What statement by the client would the nurse prioritize? A. "Certain substances make me sneeze." B. "I sometimes get a bit wheezy." C. "I sometimes get a feeling of euphoria." D. "I have trouble getting comfortable in bed."

B R: Wheezing is a classic symptom of asthma. This statement should alert the nurse to the possibility that the woman's asthma is not being well-controlled and needs further evaluation and possible intervention. The other statements do not relate to the typical presentation of this disease in pregnancy.

An infant is born to a mother with gestational diabetes. Which long-term maternal complication is associated with this diagnosis? A. Weight gain that is not lost after the pregnancy B. Increased risk of development of type 2 diabetes C. Development of long-term hypertension D. Heart disease

B R:A mother who had gestational diabetes is at a 30% to 50% higher risk of developing type 2 diabetes mellitus than the general population. Long-term hypertension and heart disease are not associated with gestational diabetes, nor is weight gain following pregnancy. There is no data that validates long-term weight gain as a complication of gestational diabetes.

The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of abusing heroin. The nurse would be alert for which finding when assessing the neonate? A. low, feeble cry B. hypertonicity C. easy consolability D. vigorous sucking

B R:Newborns of mothers who abuse heroin or other narcotics display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth? A. The mother's age B. The viral load C. Amniocentesis results at 34 weeks D. Prophylactic ART to infant at birth

B R: A woman who has HIV during pregnancy is at risk for transmitting the infection to the fetus during pregnancy or childbirth and to the newborn while breastfeeding. The type of birth, vaginal or cesarean, depends on several factors, including the woman's viral load, use of ART during pregnancy (not waiting until the birth), length of time membranes have been ruptured, and gestational age (not mother's age). With prenatal ART and prophylactic treatment of the newborn, there is a reduced risk of perinatal HIV transmission. The amniocentesis results would not be a factor in preventing the spread of HIV to the infant and may actually lead to the fetus being infected through the puncture site and bleeding into the amniotic sac.

A G4P3 client with a history of controlled asthma is upset her initial prenatal appointment is taking too long, making her late for another appointment. What is the nurse's best response when the client insists she knows how to handle her asthma and needs to leave? A. Remind her to continue taking asthma medications, to monitor peak flow daily, and to monitor the baby's kicks in the second and third trimesters. B. Acknowledge her need to leave but ask her to demonstrate the use of inhaler and peak flow meter before she goes; remind her to take regular medications. C. Note in the chart that the woman was not counseled about her asthma. D. Schedule an appointment for her to return to discuss her asthma management

B R:Management of asthma during pregnancy is very important; the nurse must document that the client has the proper ability to manage her asthma for her health and the health of the fetus. Reminding the client to continue taking her prescribed medication and to monitor her peak flow daily is not enough. It is the nurse's responsibility to know that the client knows how to take her medications. Monitoring the baby's kicks in the second and third trimester is an appropriate action. Scheduling a return appointment to discuss asthma management is not appropriate. She could have an asthma attack between the time the nurse sees her and the time of the return appointment. Noting in the chart that the woman was not counseled does not relieve the nurse of their obligation to ensure that the woman knows how to use her inhaler and her peak flow meter.

A nurse is caring for a pregnant client who is human immunodeficiency virus (HIV) positive. What is a priority issue that the nurse should discuss with the client? A. the amount of physical contact that should occur with the infant B. the need for the client to avoid breastfeeding C. the client's relationship with the spouse D. the client's plan for future pregnancies

B R: The nurse should stress the avoidance of breastfeeding when counseling a pregnant client who is HIV positive. The client's relationship with the spouse, contact with the infant, and the plan for future pregnancies is not the highest priority at this time.

A patient with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The patient explains that she has been "eating for two" so the baby is healthy. How should the nurse respond to the patient? A. "Elevated blood glucose levels ensure the baby has mature lungs at birth." B. "Elevated blood glucose levels hasten the development of the fetus in utero." C. "Elevated blood glucose levels in the first trimester have been linked to congenital anomalies." D. "Elevated blood glucose levels cause low birth weights in infants."

C R:The first trimester of pregnancy is the most important time for fetal development. If the patient can control hyperglycemia during this time, the chances of a congenital anomaly are greatly reduced. Infants of patients with poorly controlled diabetes tend to be large. At birth, babies born to patients with uncontrolled diabetes are prone to respiratory distress syndrome. Elevated blood glucose levels do not hasten the development of the fetus in utero and can lead to hydramnios.

A pregnant woman determined to be at high risk for gestational diabetes is undergoing a 1-hour glucose challenge test. The nurse schedules the client for a 3-hour glucose tolerance test based on which result? A. 126 mg/dL B. 134 mg/dL C. 146 mg/dL D. 118 mg/dL

C R: Any blood glucose level over 140 mg/dL with a 1-hour glucose challenge test is considered abnormal and warrants follow up testing with a 3-hour glucose tolerance test.

A 38-year-old woman comes into the obstetrician's office for prenatal care, stating that she is about 12 weeks pregnant with her first child. What questions would the nurse ask this client, considering her age and potential sensitivity to being labeled an "older" primipara? A. Ask the mother if she has any chronic illnesses that the doctor needs to know about due to her being older. B. Offer genetic counseling and an early amniocentesis to determine if termination is needed. C. Be non-judgmental in your history gathering and offer her pregnancy resources to read and explore. D. Inquire about any family history of chromosomal abnormalities since older women are more likely to have infants with a chromosomal defect.

C R: Women are having babies later in life and nurses must be supportive of their choices to postpone pregnancy. Most women realize the increased risks for having a baby after 35 years of age and don't need constant reminding of all the potentially bad outcomes that can occur. The majority of pregnancies to women over 35 years of age end up with healthy babies and mothers.

The nurse is preparing information for a client who has just been diagnosed with gestational diabetes. Which instruction should the nurse prioritize in this information? A. Report any signs of possible urinary tract infection B. Plan daily menus with dietitian C. Maintain a daily blood glucose log D. Long term therapy goals

C R:Control of the blood glucose throughout the pregnancy is the primary goal to help decrease potential complications to both the mother and fetus. The mother should keep a daily log of her blood glucose levels and bring this log to each visit for the nurse to evaluate. The other choices of reporting possible signs of a UTI and working with a dietitian to plan menus would also be important but would follow stressing the blood glucose control. It would be inappropriate to discuss long-term goals at this time. This would be handled at a later time and would depend on the mother's situation.

The nurse explains to a pregnant client that she will need to take iron during her pregnancy after being diagnosed with iron-deficiency anemia. The nurse suggests that absorption of the supplemental iron can be increased by taking it with which substance? A. milk B. meals high in iron C. orange juice D. legumes

C R: Anemia is a condition in which the blood is deficient in red blood cells, from an underlying cause. The woman needs to take iron to manufacture enough red blood cells. Taking an iron supplement will help improve her iron levels, and taking iron with foods containing ascorbic acid, such as orange juice, improves the absorption of iron.

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? A. Scheduling the woman for induction of labor today. B. Scheduling a cesarean delivery at 39 weeks. C. Preparing for amniocentesis and fetal lung maturity assessment D. Allowing her to continue without plans for delivery.

C R: If the infant has macrosomia, is large for gestation age, and the mother has had poor blood-sugar control, the provider will want further information on the fetus and readiness for delivery before making any decisions on delivery. After determining the readiness of the fetus, then plans for delivery can be determined and scheduled.

A nurse caring for a pregnant client suspected substance use during pregnancy. What is the priority nursing intervention for this client? A. Provide education material on cessation of substance use. B. Determine how long the client has been using drugs. C. Obtain a urine specimen for a drug screening. D. Determine if the client has emotional support.

C R: Substance use during pregnancy is associated with preterm labor, abortion, low birth weight, central nervous system and fetal anomalies, and long-term childhood developmental consequences. It is most important to know what the client is taking in order to provide the best care for the client and newborn.

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: A. limit weight gain to 15 pounds during the pregnancy. B. exercise for 1 to 2 hours each day to keep the blood glucose down. C. check her blood sugars frequently and adjust insulin accordingly. D. begin oral hyperglycemic medications along with the insulin she is currently taking.

C R: The goal for a mother who has type I diabetes mellitus is to keep tight control over her blood sugars throughout the pregnancy. Therefore, she needs to test her blood sugar frequently during the day and make adjustments in the insulin doses she is receiving.

A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client? A. options for birth control in the future B. whether sex was consensual C. knowledge of child development D. sexual development of the client

C R: The nurse should address the client's knowledge of child development during assessment of the pregnant adolescent client. The nurse need not address the sexual development of the client or whether sex was consensual. This would not be an opportune time to discuss birth control methods to be used after the pregnancy.

When developing a plan of care for a pregnant woman who is HIV-positive and in labor, the nurse recognizes that which measure is essential? A. helping her choose a newborn feeding method B. preparing the woman for cesarean birth C. using standard precautions D. educating her about family planning

C R:For the pregnant woman who is HIV-positive, nurses must always use standard precautions to reduce the risk of HIV transmission. Educating the woman about family planning methods is not as important as adhering to standard precautions. The decision about the mode of birth is based on the woman's viral load, duration of ruptured membranes, progress of labor, and other clinical factors. Breastfeeding is contraindicated, so helping her choose a feeding method would be inappropriate.

A 43-year-old, physically fit, healthy woman who is newly married tells the nurse that she and her husband would like to have a child. What is an appropriate first response? A. "You're in great shape now, but are you sure that at your age you'll have enough energy to care for a child?" B. "You must know that's pretty risky. Have you thought about adopting instead?" C. "Well, I'm sure you know there are some risks involved so it's helpful that you've been taking such good care of yourself." D. "If you got pregnant now you'd be at risk for multiple fetal pregnancies, chromosomal abnormalities, spontaneous abortion, and hypertension among other things. Are you ready to take that risk?"

C R:The nurse needs to be positive and supportive in patient response and relationship, but honest about the risk involved with advanced maternal age. Option A is incorrect; the nurse should not suggest to the mother that she adopt instead of having her own child. Option C is incorrect as it is not supportive of the mother and it suggests that she could not care for a child if she had one. Option D is incorrect as it challenges the mother's thinking and indicates that the risks outweigh the desire for a child.

A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? A. antibiotics B. antihypertensive drugs C. diuretic drugs D. I.V. fluids

D R: A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and I.V. fluids. Antihypertensive drugs usually aren't necessary. Diuretics would not be used unless fluid overload resulted. The client would be given antibiotics only if there were evidence of an infection.

Between her regularly scheduled visits, a woman in her first trimester of pregnancy who is taking iron supplements for anemia calls the nurse at her obstetrician's office reporting constipation. She reports that she has never had this problem before and asks for some advice about how to get relief. What is the best advice the nurse can give her? A. Stop taking iron supplements for a few days, exercise more, drink more fluids, eat high-fiber, low-iron foods until the constipation is relieved, then resume the iron supplement. B. Take the iron supplement every other day, increase fluid intake and consumption of high-fiber foods; exercise more. C. Increase the iron supplements, fluid intake, and consumption of high-fiber foods; exercise more. D. Continue taking iron supplements but increase fluids and high-fiber foods; exercise more.

D R: Constipation is a common side effect of iron supplementation. The diagnosis of anemia indicates a true need for the iron supplementation; she needs to increase fluid and fiber to relieve the constipation associated with the iron preparations. The nurse should not advise this client to stop taking her iron supplements, even for a few days. The nurse should not advise the client to increase her iron supplementation, nor take the supplements on an every other day basis. These supplements are ordered by the primary care provider based on the client's hematologic status.

A pregnant single mom living alone tells the nurse she is considering getting a cat for her 2-year-old daughter. Which is the best response by the nurse? A. "The exposure to the cat litter may cause you to need a C-section." B. "This will cut down on the jealousy for your two-year-old when the baby comes." C. "If you don't think caring for a cat is too much work, that would be great." D. "You should wait until after you give birth to obtain the cat for your daughter."

D R: Toxoplasma gondii is a protozoan that can be transmitted via undercooked meat and through cat litter. Having a cat is not an issue, but cleaning the litter box may expose the mother to the infection and result in fetal anomalies. Exposure to the cat litter will not necessitate a cesarean section, and having a cat will not cut down on any jealousy the 2-year-old might feel when the new baby is born. The nurse would not encourage the mother to get her child a cat until after the new baby is born.

A nurse is interviewing a pregnant woman who has come to the clinic for her first prenatal visit. During the interview, the client tells the nurse that she works in a day care center with 2- and 3-year olds. Based on the client's history, the nurse would be alert for the development of which condition? A. chlamydia B. gonorrhea C. toxoplasmosis D. cytomegalovirus

D R:The nurse would be alert for the development of cytomegalovirus infection. Pregnant women acquire active disease primarily from sexual contact, blood transfusions, kissing, and contact with children in daycare centers. It can also be spread through vertical transmission from mother to child in utero (causing congenital CMV), during birth, or through breast-feeding. Chlamydia, gonorrhea, and toxoplasmosis are not spread through contact with children in day care centers.

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? A. "It is fine for me to use my albuterol inhaler if I begin to feel tight." B. "I need to be aware of my triggers and avoid them as much as possible." C. "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on." D. "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring."

D R: A pregnant woman with a history of asthma needs to be proactive, taking her inhalers and other asthma medications to prevent an acute asthma attack. She needs to understand that it is far more dangerous to not take the medications and have an asthma attack. She also needs to monitor her peak flow for decreases, be aware of triggers, and avoid them if possible. However, a pregnant woman should never begin allergy shots if she has not been taking them previously, due to the potential of an adverse reaction.

The clinic nurse teaches a pregestational type 1 diabetic client that constant insulin levels are very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use: A. an insulin drip. B. regular insulin twice a day. C. an insulin pen. D. an insulin pump.

D R: Because a pregnant client will have some periods of relative hyperglycemia and hypoglycemia no matter how carefully she maintains her diet and balances her exercise levels, an effective method to keep serum glucose levels constant is to administer insulin with a continuous pump during pregnancy.

A 38-year-old client, G4P3, at 10 weeks' gestation with an unplanned pregnancy, has concerns the fetus may have a genetic defect. The nurse should point out which test would be the best current choice to investigate the possibility of a chromosomal abnormality? A. Triple screening B. Amniocentesis C. Maternal Serum Alpha-fetoprotein D. Chorionic villus sampling

D R: Chorionic villus sampling is the earliest method (8 to 10 weeks gestation) to test the fetal genetics for anomalies. This testing might be offered if the mother wants specific information on the genetics of the fetus as early as possible in pregnancy. Amniocentesis is generally done between 14 and 18 weeks' gestation, but can be done as early as 10 weeks' gestation. Maternal serum alpha-fetoprotein are usually done at 16 to 20 weeks' gestation, and triple screening is performed between 15 and 20 weeks' gestation.

A pregnant client has tested positive for hepatitis B virus. When discussing the situation with the client, the nurse explains that her infant should be vaccinated with an initial HBV vaccine dose at which time? A. within 36 hours of birth B. within 24 hours of birth C. within 48 hours of birth D. within 12 hours of birth

D R: If a woman tests positive for HBV, the newborn will receive HBV vaccine within 12 hours of birth. The second dose will be given at 1 month and the third dose at 6 months.

The nurse is assessing a woman with Class III heart disease who is in for a prenatal visit. What would be the first recognizable sign that this client is in heart failure? A. Low blood pressure B. Audible wheezes C. Elevated blood pressure D. Persistent rales in the bases of the lungs

D R: The earliest warning sign of cardiac decompensation is persistent rales in the bases of the lungs.

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? A. regular heart rate and hypertension B. increased urinary output, tachycardia, and dry cough C. shortness of breath, bradycardia, and hypertension D. dyspnea, crackles, and irregular weak pulse

D R: The nurse should be alert for signs of cardiac decompensation due to congestive heart failure which include crackles in the lungs from fluid, difficulty breathing, and weak pulse from heart exhaustion. The heart rate would not be regular, and a cough would not be dry. The heart rate would increase rather than decrease.

What important instruction should the nurse give a pregnant client with tuberculosis? A. Avoid red meat. B. Wear light, cotton clothes. C. Avoid direct sunlight. D. Maintain adequate hydration.

D R: The nurse should instruct the pregnant client with tuberculosis to maintain adequate hydration as a health-promoting activity. The client need not avoid direct sunlight or red meat, or wear light clothes; these have no impact on the client's condition.

What is the role of the nurse during the preconception counseling of a pregnant client with chronic hypertension? A. stressing the avoidance of dairy products B. stressing the increased use of Vitamin D supplements C. stressing regular walks and exercise D. stressing the positive benefits of a healthy lifestyle

D R: The nurse should stress the positive benefits of a healthy lifestyle during the preconception counseling of a client with chronic hypertension. The client need not avoid dairy products or increase intake of vitamin D supplements. It may not be advisable for a client with chronic hypertension to exercise without consultation.

When providing nutritional counseling to a pregnant woman with diabetes, the nurse would urge the client to obtain most of her calories from which source? A. saturated fats B. protein C. unsaturated fats D. complex carbohydrates

D R: The pregnant woman with diabetes is encouraged to eat three meals a day plus three snacks, with 40% of calories derived from good-quality complex carbohydrates, 35% of calories from protein sources, and 35% of calories from unsaturated fats. The intake of saturated fats should be limited during pregnancy, just as they should be for any person to reduce the risk of heart disease.

A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control? A. Plenty of rest B. Oral hypoglycemic agents C. Vitamin supplements D. Exercise

D R: The three main facets to glycemic control for the woman with pregestational diabetes are diet, exercise, and insulin. An individual with type 1 diabetes uses insulin and not oral hypoglycemic agents. Vitamin supplements may assist with helping to keep the woman healthy but not necessarily through glycemic control. It will be important for the woman to get enough rest throughout the pregnancy but this will not assist with glycemic control.

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? A. 8% B. 14% C. 12% D. 6%

D R: The upper normal level of HbA1C is 6% of total hemoglobin.

A pregnant woman is determined to be at high risk for gestational diabetes. At which time would the nurse expect the client to undergo rescreening? A. 28 to 32 weeks B. 16 to 20 weeks C. 20 to 24 weeks D. 24 to 28 weeks

D R: A woman identified as high risk would undergo rescreening between 24 and 28 weeks.

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: A. The antiepileptic medications can cause the mother's platelets to drop. B. administration of vitamin K aids in lung maturity of the fetus. C. vitamin K helps in keeping the placenta healthy. D. antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn.

D R: Antiepileptic therapy may cause vitamin K-deficient hemorrhage of the newborn that the vitamin K injection the newborn receives following birth cannot fully correct. Therefore, some physicians recommend a Vitamin K supplement for their pregnant patients beginning at 36 weeks' gestation. If the mother should go into preterm labor, the newborn will have received the vitamin K prior to delivery. However, many physicians now question the usefulness of the prophylaxis.

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? A. right lateral recumbent B. prone C. on her back D. left lateral recumbent

D R: The pregnant woman should rest in the left lateral recumbent position to prevent supine hypotension syndrome and increased heart effort.

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? A. "I know I will be fine, but I worry about the fetus." B. "I don't have to worry about this because I had the problem fixed before I became pregnant." C. "I know my baby will be fine, but I am worried about having a personal complication." D. "I understand that my fetus and I both are at risk for complications."

D. R: When a woman enters pregnancy with a preexisting condition, both she and her fetus can be at risk of developing complications.