Family Focused Exam 2

marijuana is safe to use in pregnancy if used in states that have legalized it and you have a prescription for it - true - false

-false • rationale: marijuana can cause IUGR. some studies suggest that it can cause ADD in the child's life. just like with many other drugs, just because you have a prescription for it does. not make it safe for pregnancy (pg 273)

insulin needs dramatically decrease postpartum - true - false

-true • rationale: insulin needs decrease substantially because the major source of insulin resistance, the placenta, has been removed (pg 252)

arrange the steps in the order in which diabetic ketoacidosis (DKA) develops in a pregnant patient. 4. the hepatic glucose production increases because of some infection 1. the stress hormones that cause impaired insulin action are secreted 6. the fatty acids are mobilized from fat stores & enter the circulation 2. the extra glucose & ketone bodies are released into the circulation 5. the buffering system is unable to compensate, & acidosis develops 3. osmotic diuresis results with volume depletion & cellular dehydration

4, 1, 6, 2, 5, 3 • a stress factor, such as an infection, increases the hepatic glucose production & decreases peripheral glucose use. therefore the stress hormones are released, which act to impair insulin action. fatty acids are mobilized from fat stores to enter the circulation. as they are oxidized, ketone bodies are released into the peripheral circulation. the patient's buffering system is unable to compensate, which causes DKA to develop. the excessive blood glucose & ketone bodies result in osmotic diuresis, which then cause loss of fluid & electrolytes, volume depletion, & cellular dehydration. because the body's buffering system cannot compensate, this results in a diagnosis of diabetes ketoacidosis

which investigation would the nurse suggest for a patient in the 6th month of pregnancy who expresses her wish to see the fetus? A) ultrasonography B) nuchal translucency (NT) C) computed tomography (CT) D) magnetic resonance imaging (MRI)

A) • 3-dimenstional (3D) or 4-dimensional (4D) US is adviseable for women who want to see the fetus. MRI cannot be used in this case because it requires the fetus to be still for a long period of time for a clear image. CT uses ionizing radiation for imaging, which can be harmful to the fetus. therefore CT is contraindicated for fetal imaging. NT is a specific ultrasonography screening procedure used to test for genetic abnormalities in the fetus

The nurse would be aware of which strength and limitation of various biochemical assessments during pregnancy? A) maternal serum alpha-fetoprotein (AFP) is a screening tool only; it identifies candidates for more definitive procedures B) chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis C) percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for down syndrome D) screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects

A) • MSAFP is a screening tool, not a diagnostic tool. further diagnostic testing is indicated after an abnormal MSAFP. CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. MSAFP, not PUBS, is part of the quad-screen tests for down syndrome

which information would the nurse give when preparing a patient for a transvaginal ultrasonography? A) there is no pain felt during TVUS B) there is no pressure felt during TVUS C) the patient needs to be in semi-fowler position for the test D) the patient needs to drink lots of fluids to keep the bladder full before the test

A) • TVUS is a painless procedure in which a transducer probe is inserted into the vagina & the pelvic anatomic features are evaluated. the patient is positioned in lithotomy position, not semi-fowler position. this helps in proper insertion of the probe. intake of large amounts of fluids is generally recommended for transabdominal US but not for TVUS. some pressure is felt on the vaginal walls as the transducer probe is moved to get a complete view of the pelvis

which are indicators for performing a contraction stress test? A) maternal DM & postmaturity B) adolescent pregnancy & poor prenatal care C) increased fetal movement & small for gestational age D) history of preterm labor & intrauterine growth restriction

A) • maternal DM & post maturity are 2 indications for performing a contraction stress test. decreased fetal movement is an indictor for performing a contraction stress test; the size (small for gestational age) is not an indicator. although adolescent pregnancy & poor prenatal care are risk factors for poor fetal outcomes, they are not indicators for performing a contraction stress test. intrauterine growth restriction is an indicator, but history of a previous stillbirth (not preterm labor) is the other indicator

which viral infection can result in neonatal brain complications? A) herpes infection B) rubella infection C) varicella-zoster infection D) cytomegalovirus infection

A) • rationale: herpes infection can cause neonatal encephalitis a rubella infection, varicella zoster infection, and cytomegalovirus infection do not cause neonatal encephalitis

which major concern regarding epilepsy in pregnancy would the nurse recognize? A) many antiseizure medications are known teratogens B) there is an increased risk for miscarriage and preeclampsia C) a woman who has been seizure free for many years may have a severe exacerbation in pregnancy D) epilepsy in pregnancy may lead to Graves disease

A) • rationale: many women who are pregnant and have epilepsy may require specialized medication management to prevent adverse fetal effects while managing their condition there is an increased risk for miscarriage and preeclampsia with SLE, not epilepsy the longer a woman has been seizure free, the less likely she is to have seizures in pregnancy graves disease is a hyperthyroid disorder and is not related to epilepsy

A patient is prescribed lamotrigine for bipolar depression. Which patient teaching statement made by the nurse is accurate regarding lamotrigine and preganncy A) serum levels should be monitored in the second & third trimesters B) this medication is a high alert & not recommended for use in pregnancy C) the dose should be decreased between 24-48 hours prior to delivery D) lamotrigine causes known effects in newborns, including floppy baby syndrome, hypothyroid, poor feeding, & developmental delays

A) • rationale: serum levels monitored in the 2nd & 3rd trimesters due to increased renal clearance lamotrigine is preferred to other medications in pregnancy for the treatment of bipolar depression lithium, not lamotrigine, should be decreased between 24-48 hours prior to delivery lithium, not lamotrigine, causes known effects in newborns, including floppy baby syndrome, hypothyroid, poor feeding, & developmental delays

Which type of anemia is an inherited anemia? A) sickle cell anemia B) aplastic anemia C) iron deficiency anemia D) pernicious anemia

A) • rationale: sickle cell anemia is an autosomal recessive disorder aplastic anemia is acquired iron deficiency anemia is acquired and can be corrected by increasing intake of food high in iron pernicious anemia is acquired and may be corrected with diet and supplementation

a pregnant woman is yawning excessively, is diaphoretic, and is experiencing nausea, vomiting, diaphoreses, and diarrhea. the nurse suspects that the woman may be withdrawing from which substance? A) opioids B) alcohol C) cocaine D) marijuana

A) • rationale: symptoms of opioid withdrawal include yawning, diaphoresis, rhinorrhea, restlessness, tearing of the eyes, nausea, vomiting, and abdominal cramps symptoms of alcohol withdrawal may include irritability, tachycardia, seizures, delirium, and altered LOC symptoms of cocaine withdrawal can include agitation, irritability, cravings, and rarely, paranoia marijuana does not have characteristic symptoms of withdrawal in most patients

which action should the nurse take when a pregnant patient with bulimia nervosa presents to the office with tachycardia & orthostatic hypotension? A) alert the HCP & consider hospitalization B) nothing; these are expected abnormal findings C) advise the patient to rest & retake the VS in 10 minutes D) encourage vitamin B12 & calcium supplementation

A) • rationale: tachycardia & orthostatic hypotension are indicative of severe malnutrition & dehydration requiring hospitalization monitoring the patient is necessary, but immediate action is required supplementation will not treat these symptoms

when would the nurse refer the patient for US to detect maternal abnormalities that could affect the fetus? A) 1st trimester B) 3rd trimester C) 2nd trimester D) 2nd & 3rd trimesters

A) • US is performed in the 1st trimester to detect maternal abnormalities such as bicornuate uterus, ovarian cysts, & fibroids. in the 2nd trimester, US is usually performed to detect congenital abnormalities & conditions such as polyhydramnios & oligohydramnios. in the 3rd trimester, US is used for visualization during amniocentesis & to measure gestational age. in the 2nd & 3rd trimesters, US is used mostly to observe the fetal growth pattern

a primigravida Hispanic patient asks why she needs to be screened for gestational diabetes when she is not a diabetic. which response by the nurse is appropriate? A) many patients with gestational diabetes show no symptoms. it is an important way to help you have a healthy pregnancy B) we test all patients for diabetes because today's diet makes you more likely to get diabetes C) your race makes you more likely to develop gestational diabetes, so we are screening you just in case D) because this is your first pregnancy, we don't know what to expect, so we are going to test you just in case

A) • most patients with gestational diabetes are asymptomatic. for this reason, universal screening is best practice to promote the best pregnancy outcomes although diets are changing in the US, this is not the best reason to test for gestational diabetes. some women with balanced diets go on to develop gestational diabetes some races and ethnicities are at increased risk for developing gestational diabetes. however, everyone is screened for gestational diabetes, so this is not the best response all patients should be screened for gestational diabetes regardless of the number of times that they have been pregnant

which condition would the nurse suspect in a fetus with oligohydramnios? A) potter syndrome B) down syndrome C) twin-twin syndrome D) fetal alcohol syndrome

A) • oligohydramnios means that there is a low amniotic fluid volume (AFV). oligohydramnios is known to cause Potter syndrome. Potter syndrome is the atypical physical appearance of a fetus or a neonate. excessive alcohol intake during pregnancy may cause fetal alcohol syndrome & is not associated with oligohydramnios. down syndrome is a genetic abnormality of the fetus & can be identified using prenatal screening tests such as triple marker screen & quad screen. down syndrome is not associated with oligohydramnios. twin-twin syndrome is associated mainly with polyhydramnios

which factor is known to increase the risk of gestational diabetes mellitus? A) previous birth of large infant B) maternal age younger than 25 C) underweight before pregnancy D) previous diagnosis for type 2 DM

A) • previous birth of a large infant suggests gestational diabetes mellitus. a woman younger than 25 is not at risk for gestational diabetes mellitus. obesity (greater than 90 kg or 198 lb) creates a higher risk for gestational diabetes. the person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy

Which of the following is true about fetal movements? A) a pregnant client usually perceives about 80-90% of fetal movements B) a client should continue to feel fetal movements during a fetal sleep cycle C) the client should expect the absence of fetal movement around 39 weeks gestation D) a client should start fetal kick count monitoring at 20 weeks gestation

A) • rationale: fetal movements should not slow down

Which supplement would the nurse recommend to prevent fetal neural tube defects as a result of pernicious anemia? A) folic acid B) calcium carbonate C) magnesium hydroxide D) red raspberry leaf tea

A) • rationale: folic acid supplementation has been shown to decrease the incidence of neural tube defects when initiated at least 1 month before conception and continued throughout the pregnancy calcium carbonate may be recommended for dyspepsia by some HCP but does not prevent neural tube defects magnesium hydroxide has not been shown to decrease the incidence of neural tube defects in the fetus red raspberry leaf tea in used in the third trimester by some HCPs because of the belief that it promotes good uterine tone. however, it does not prevent neural tube defects

which nursing intervention would be included in the care of a woman with lupus during her 1st trimester? A) monitor for liver function B) monitor for increased joint pain and fatigue C) provide patient education on remission of lupus D) administer subcutaneous heparin for thrombosis prevention

A) • rationale: renal function, not liver function often worsens with lupus pregnancy can worsen progression of disease, and the disease should be carefully monitored during pregnancy remission of lupus does not usually occur with pregnancy lupus does not increase the risk for thrombosis and heparin is not indicated

which statement by the HCP is an example of coercive behavior? A) your child will be taken away if you continue to use marijuana in your pregnancy B) your child may be born with multiple birth defects and learning disorders if you continue to use alcohol while pregnant C) the staff at the hospital will discuss all possible options for pain management in labor if you have too much pain D) using alcohol and cocaine while pregnant is not a healthy behavior for you or your baby

A) • rationale: stating that the patient's child will be taken away is a threatening statement that suggests legal retaliation for maternal behaviors stating that the child may be born with multiple birth defects and learning disorders if the patient continues to use alcohol while pregnant is an appropriate statement. it is important for the parent to understand how alcohol can affect a growing fetus stating that the hospital staff will discuss all possible options for pain management is an appropriate statement. it is important to provide reassurance to the patient that she will receive the same care as patients who do not suffer from substance misuse disorders stating that using alcohol and cocaine while pregnant is not a healthy behavior for the patient and their baby is an appropriate statement. it is important for the parent to understand how alcohol and cocaine can affect a growing fetus

The laboring patient becomes verbally abusive when denied a cigarette to relax. which response by the nurse is most appropriate? A) I know this is scary and may be causing some anxiety, but I'll help you the best way that I can B) I'm sorry but smoking isn't allowed inside the hospital C) I'm sorry, but smoking is bad for you and the baby D) Please don't talk to me like that--I'm here to help you

A) • rationale: the nurse is providing nonjudgmental therapeutic communication with the patient although it is hospital policy, it may encourage the patient to leave the hospital during labor and is nontherapeutic the nurse needs to provide nonjudgmental therapeutic communication this will only anger the patient and will not help deescalate the situation

A patient who is positive for HIV is about to be discharged from the hospital with her new infant. which patient statement indicates that further patient teaching is required? A) I'm glad I'll still be able to breastfeed my baby B) "It's still possible that I gave my baby HIV, even though I took all my medication C) "I will go to the pharmacy right now to fill my antiretroviral drug D) "Even though I don't feel sick, I should plan on bottle-feeding my baby

A) • rationale: the patient's statement that she will be able to breastfeed her baby is incorrect, so further teaching is required. breast milk is a route of HIV virus transmission and should be avoided the patient's statement that it is possible she gave her baby HIV is correct. even with medication compliance, vertical transmission is a concern, especially for women who deliver vaginally the patient's statement that she should take antiretroviral drugs is correct. antiretroviral drugs can prolong the mother's life and prevent transmission to the infant. the mother should understand the importance of taking the appropriate medication the patient's statement that she should bottle-feed her baby is correct. regardless of how the patient feels, HIV can be passed to the infant through the mother's breast milk, so an alternate feeding method must be chosen

when teaching a patient with a body mass index (BMI) of 20 about recently prescribed subcutaneous insulin, which statement is correct? A) you will need to insert the needle at a 45 degree angle to ensure it is delivered to the subcutaneous tisse B) if you need to deliver more than 0.5mL of insulin, you will need to use 2 injection sites C) if you use the no-pinch method, you should use an 8 mm needle D) gently massage the injection site with sterile gauze after administration to ensure the medication is absorbed

A) • this patient has a very low BMI & likely minimal subcutaneous tissue. entering at a 45 degree angle will ensure the medication is delivered into subcutaneous tissue and not muscle up to 2 mL of insulin can be delivered using a subcutaneous injection because of this patient's BMI, a 5-mm needle is more appropriate than an 8-mm needle the site should not be massaged after administration, but a band aid may be applied

which antihypertensive classifications are contraindicated in pregnancy? - beta blockers - ACE inhibitors - calcium channel blockers - vasodilators - ARBs

ACE, ARBs • rationale: ACE inhibitors have been linked to adverse fetal effects and are contraindicated in pregnancy ARBs have been linked to fetal morbidity and are not approved for use in pregnancy beta blockers are considered relatively safe for blood pressure management in pregnancy calcium channel blockers are used for a variety of reasons in pregnancy vasodilators are frequently used with hypertensive crisis in pregnancy

which statement by the nurse is an appropriate response when the pregnant patient asks about the safety of psychiatric medication during pregnancy? A) "The medications used to treat mental illness will cause birth defects, so you should discontinue your antidepressants" B) "your mental wellness is an important part of pregnancy wellness, & continuing your medication is sometimes necessary" C) "all psychiatric medications have been proven to cross the placenta & cause birth defects in babies" D) "your obstetrician should have enough information to prescribe your antipsychotics without consulting with your psychiatrist"

B • rationale: many patients are encouraged to continue their medications throughout pregnancy under the guidance of a HCP many antidepressants are considered relatively safe to use in pregnancy, & some patients are encouraged to continue them throughout pregnancy it is known that all medications used to treat mental illness can cross the placenta, can be detected in amniotic fluid, & are present in breast milk a standardized, interdisciplinary approach is the optimal way to ensure safe & effective treatment of mental illness in pregnancy

which can the nurse interpret about the development in the fetus after reviewing the amniocentesis reports of a pregnant patient indicating the phosphatidylglycerol (PG) is absent in the amniotic fluid? A) impaired brain development B) impaired lung development C) impaired limb development D) impaired cardiac development

B) • PG is a glycerophospholipid found in the lungs as a pulmonary surfactant. the presence of PG in amniotic fluid is an early indicator of fetal lung maturity. the PG test is used mostly to assess fetal lung maturity in late pregnancy; therefore absence of PG indicates impaired lung development. the PG test is not used to assess the heart, brain, or limb growth of the fetus. fetal heart activity can be assessed by using transvaginal ultrasound. MRI is used to observe the growth & development of the fetal brain. limb development of the fetus can be observed on ultrasound

which is the ideal treatment for severe unmanageable hyperthyroidism in a patient who is pregnant? A) radioactive iodine B) subtotal thyroidectomy C) methimazole D) propylthiouracil

B) • a subtotal thyroidectomy is prescribed for a pregnant patient with severe hyperthyroidism if the drug therapy proves toxic. oral methimazole & propylthiouracils are prescribed for hyperthyroidism but may be ineffective in severe cases. radioactive idodine is not used to treat hyperthyroidism in pregnant patients, because it may destroy the fetus's thyroid gland

when a pregnant woman with diabetes experiences hypoglycemia while hospitalized, which would the nurse have the woman do? A) eat a candy bar B) eat 6 saltine crackers or drink 8 oz of milk C) drink 4 oz of orange juice followed by 8 oz of milk D) drink 8 oz of orange juice with 2 teaspoons of sugar added

B) • crackers provide carbohydrates in the form of polysaccharides. a candy bar provides only monosaccharides. milk is a disaccharide, & orange juice is a monosaccharide. this will provide an increase in blood sugar but will not sustain it to normal levels. orange juice & sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar

when reviewing the amniocentesis reports of a patient who has completed 20 weeks of pregnancy, the nurse finds the presence of high alpha-fetoprotein (AFP) levels. which can the nurse infer from this information related to the clinical condition of the fetus? A) cardiac disorder B) neurologic disorder C) circulatory disorder D) pulmonary disorder

B) • high AFP levels after 15 weeks of gestation indicate an open neural tube or other disorder relating to the CNS. AFP levels in amniotic fluid cannot test cardiac disorders. doppler blood flow analysis can be used to assess circulatory disorders in the fetus. the lecithin-to-sphingomyelin (L/S) ratio of the amniotic fluid is a useful predictor of pulmonary disorders in the fetus

which is the most likely reason for referring a pregnant patient in the third trimester for transvaginal and transabdominal ultrasound scanning? A) to determine genetic abnormalities B) to determine the risk of preterm labor C) to assess development of the embryo D) to determine the risk of ectopic pregnancy

B) • premature labor occurs when the mother's body starts preparing for childbirth too early in her pregnancy. in some instances, during the 2nd & 3rd trimesters, transvaginal US scan may be used along with transabdominal scanning to evaluate the preterm labor. to detect genetic abnormalities in the fetus, chorionic villus sampling (CVS) is used in the 1st trimester and amniocentesis is used in the 2nd & 3rd trimesters. US scan is usually not used to detect genetic abnormalities in the fetus. transvaginal US scan is used in the 1st trimester of pregnancy to detect ectopic pregnancies & monitor development of the embryo

which clinical finding in a pregnant patient will indicate proper fetal brain development? A) hemoglobin A1c levels greater than 6 B) normal maternal thyroxine (T4) levels C) 3% amniotic fluid phosphatidylglycerol D) fasting glucose levels less than 95 mg/dL

B) • proper fetal brain development depends on normal maternal T4 levels early in pregnancy. mild maternal hypothyroidism during the 1st trimester can cause neuropsychological damage in the infant. hemoglobin A1c levels greater than 6 indicate long-term elevated glucose levels in the patient. A 3% amniotic fluid phosphatidylglycerol indicates proper lung maturation in the fetus. fasting glucose levels less than 95 mg/dL indicate proper glycemic control in the pregnant patient

which description is true of congenital cytomegalovirus (CMV)? A) can lead to severe maternal anemia B) can lead to neonatal hearing loss C) often causes severe flulike symptoms in the mother D) causes weeping skin lesions on the neonate

B) • rationale: CMV is a leading cause of neonatal hearing loss CMV is not known to cause maternal anemia cytomegalovirus is most often asymptomatic herpes simplex virus, not CMV, lead to skin lesions

a pregnant woman presents with clumpy, white vaginal discharge, vulvar pruritus, and burning. which treatment would the nurse expect for this patient? A) clindamycin B) miconazole C) metronidazole D) imiquimod

B) • rationale: clumpy, white vaginal discharge with vulvar pruritus and burning is associated with candidiasis and should be treated with the appropriate anti fungal, such as miconazole clindamycin and metronidazole are antibacterials imiquimod is an antiparasitic drug. an antiparasitic would be prescribed to a patient with a parasitic infection, not to a patient presenting with signs of candidiasis

which action would the nurse take if a pregnant patient opts out of prenatal human immunodeficiency virus (HIV) testing? A) report the mother to child protective services B) inform the mother that the baby will likely be screened for HIV after birth C) collect the sample anyway D) requesting the patient's sexual partners come in for screening

B) • rationale: it is recommended that the neonate be screened after birth even if the mother has opted out of prenatal testing opting out of prenatal testing is not a reportable occurrence. however, it is essential that the nurse document her decision performing testing without patient consent is illegal and could result in legal action against the nurse requesting that the patient's sexual partners come in for screening is not a part of most office routines and may violate patient privacy laws

which of the following is the most widely applied technique for antepartum evaluation of the fetus? A) the contraction stress test B) the nonstress test C) vibroacoustic stimulation (VAS) D) amniocentesis

B) • rationale: this is done during an NST to stimulate the fetus

which condition in a pregnant patient includes signs of fatigue, lethargy, glossitis, & rough skin? A) thalassemia B) megaloblastic anemia C) iron-deficiency anemia D) sickle cell hemoglobinopathy

B) • signs of fatigue, lethargy, glossitis, & skin roughness indicate megaloblastic anemia. this is caused by a folic acid deficiency. thalassemia is indicated by severe anemia & congestive heart failure in a pregnant patient. fatigue indicates iron-deficiency anemia, but glossitis & skin roughness are not present. anemia, repeated infections, SOB, fatigue, & jaundice are seen in a patient with sickle cell hemoglobinopathy

the nurse reviews the US reports of a pregnant patient & finds that the images of fetal anatomic details are not clear. which would the nurse administer to the patient before performing the MRI? A) a diuretic B) a sedative C) an analgesic D) an antipyretic

B) • the MRI scan may take 20-60 minutes. during the scan, the patient must be perfectly still. moreover, fetal movement during the scan will obscure the anatomic details. to avoid this problem, the patient would be administered to increase the rate of urine formation. if a diuretic is given before the MRI, frequent urination may occur. because the patient does not complain of pain, analgesics need not be administered. antipyretics would not helpful in decreasing the patient's activity level. they would be administered only if the patient has a fever

the amniotic fluid index (AFI) of a pregnant patient is 3 cm. which clinical information related to the fetus does the nurse infer from this? A) fetal hydrops B) renal defects C) low activity level D) neural tube defect

B) • the normal value of AFI is 10 cm or greater, with the upper limit of normal around 25 cm. an AFI less than 5 cm indicates oligohydramnios. this condition is associated with renal genesis in the fetus. a high AFI indicates neural tube defects & fetal hydrops. the AFI is not directly related to fetal movement. fetal activity can be assessed using ultrasonography

which instruction would the nurse give to a pregnant patient who takes iron supplements and is also prescribed levothyroxine (T4)? A) perform your aerobic exercises after taking T4 B) take iron supplements and T4 at different times C) discontinue the iron supplements in case of nausea or vomiting D) lower the T4 dosage as the pregnancy progresses

B) • the nurse advises the patient to take the iron supplements and T4 at different times, because the supplements decrease the absorption of T4. the T4 dosage is increased as the pregnancy progresses because of increased estrogen levels. iron supplements are not discontinued, because discontinuing the supplements may increase chances of anemia. instead, iron is administered parenterally if the patient is unable to take iron supplements orally. aerobic exercises do not affect the drug action of T4. aerobic exercises are prescribed for patients with diabetes

which would the nurse advise for a patient diagnosed as having a fetus with hemolytic anemia? A) begin an iron-rich diet B) count fetal movements C) undergo US D) undergo blood transfusion

B) • the patient would be instructed to count the fetal movements, because fetal hypoxia may decrease fetal activity. fetal hemolytic anemia is a disorder in which the fetal blood cells act as antigens & the maternal immune system develops antibodies. this results in hemolysis in the fetus, which may lead to low oxygen levels & low activity in the fetus. in hemolytic anemia, maternal antibodies are constantly killing the fetal cells, so an iron-rich diet may not be helpful. blood transfusion may not be helpful in treating fetal hemolytic anemia. plasma exchange may be useful. US is not used to detect hemolytic anemia in the fetus

which action would the nurse take after calculating a score of 5 on the Edinburgh Postpartum Depression scale for a pregnant patient with a history of depression? A) initiate a referral to psychiatry B) nothing; this is a normal score C) advice the patient to discontinue her selective serotonin reuptake inhibitor D) rescore the patient before she leaves the office

B) • a score of less than 8 is not suggestive of current depressive symptoms or exacerbation a psychiatric referral is not indicated at this time the nurse does not discontinue medications without a HCP's prescription. this discussion should occur between the HCP and the patient obtaining a normal score on the Edinburgh Postpartum Depression scale does not indicate rescoring during the same visit

An Rh-negative woman needs an amniocentesis. The nurse understands which statement to be true based upon the information provided? A) the amniocentesis will determine if the mother needs a blood transfusion B) a shot of Rho(D) immune globulin will be required for this procedure C) a Coombs test should be performed immediately after the procedure D) the fetus is likely Rh-positive, so delivery should be expedited

B) • rationale: as a result of the potential for maternal fetal hemorrhage, Rho(D) immune globulin should be given after an amniocentesis when a woman is Rh-negative The amniocentesis can detect fetal hemorrhage and isoimmunization, but the need for a maternal blood transfusion would be determined by using maternal serum A Coombs test is only performed when fetal hemolytic anemia caused by isoimmunization is suspected. amniocentesis generally follows a positive Coombs test in pregnancy There is no information provided that allows the nurse to determine fetal Rh or whether delivery should be expedited

Which method would the nurse recognize as a low-tech assessment of fetal well-being? A) fetal aneuploidy screening B) fetal kick counts C) ultrasonography D) biophysical profile assessment

B) • rationale: fetal kick counts are an inexpensive, noninvasive method of fetal assessment Fetal aneuploidy screening requires complex maternal serum analysis sometimes combined with ultrasound of amniocentesis. this is a high-tech assessment of the fetus Ultrasonography involves expensive machinery and provides detailed information regarding fetal well-being The biophysical profile includes ultrasound and a nonstress test and is not considered low tech

The client with gestational diabetes has risks for which of the following A) liver failure, cesarean delivery, the development of type 2 DM during the current pregnancy B) preeclampsia, cesarean birth, the development of type 2 DM later in life C) thyroid disorder, forceps-assisted vaginal birth, the development of type 1 DM later D) cholestasis, vacuum-assisted vaginal birth, the development of type 2 DM later in life

B) • rationale: in those with gestational diabetes, preeclampsia risk increases by 9.8% if well controlled & 18% if not well controlled, cesarean section delivery by 17-23%, and the development of type 2 DM later in life by up to 70% (pg253-54)

which of the below is the most common type of anemia during pregnancy? A) sickle cell anemia B) iron deficiency anemia C) thalasemia D) folic acid deficiency anemia

B) • rationale: iron deficiency anemia is by far the most common anemia of pregnancy, accounting for approximately 75% of cases (pg 266)

which technique is used to assess genetic abnormalities in a 12-week old fetus? A) amniocentesis B) standard ultrasonography C) chorionic villus sampling (CVS) D) magnetic resonance imaging (MRI)

C) • CVS is a popular technique used for genetically studying the fetus in the 1st trimester (11-14 weeks) of pregnancy. the advantage of CVS over other techniques is that it reveals the presence of genetic abnormalities at an early stage of pregnancy very accurately. amniocentesis can be used for diagnostic genetic abnormalities only after 14 weeks of pregnancy; before 14 weeks, the amount of amniotic fluid available is insufficient for testing. standard US is not used to detect genetic abnormalities in the fetus. this diagnostic technique is used only for visualizing the fetus. MRI is used mostly to evaluate the fetal structure & overall growth, the placenta, & the quantity of amniotic fluid. this technique is not useful for genetic studies

the nurse understands that which concurrent condition during pregnancy is the leading cause of maternal mortality in the united states today? A) cytomegalovirus (CMV) B) human immunodeficiency virus (HIV) C) cardiovascular disease D) anemia secondary to blood loss

C) • rationale: CVD is now the leading cause of maternal mortality in the US today CMV is not a known cause of maternal mortality. most infected adults have mild to no symptoms HIV is not a significant cause of maternal mortality in the US acute blood loss is a significant cause of maternal mortality, but it is not the leading cause

how many ounces of alcohol are considered safe in the first trimester of pregnancy? A) 18-22 B) 12-16 C) 0 D) 4-8

C) • rationale: no amount of alcohol is considered safe at any point in pregnancy

which condition is related to the increased risk for respiratory distress in neonates born to mothers with gestational diabetes? A) hyperinsulinemia after birth B) recurrent fetal hypoxia and subsequent increased production of erythrocytes C) decreased fetal cortisol levels and therefore insufficient surfactant D) decreased maternal magnesium levels

C) • rationale: surfactant helps the alveoli function properly after birth and promote adequate ventilation in the newborn. when surfactant is insufficient, ventilation may be impaired hyperinsulinemia in utero is responsible for decreased cortisol, which leads to an increased risk for respiratory distress as a result of decreased surfactant. hyperinsulinemia after birth leads to hypoglycemia recurrent fetal hypoxia leads to hyperbilirubinemia after birth, not respiratory distress syndrome decreased maternal magnesium may lead to hypocalcemia in the neonate, not respiratory distress

A patient reports a fishy, greenish, malodorous vaginal discharge after intercourse. the nurse understands these findings to be classic symptoms of which condition? A) genital warts (condyloma) B) chlamydia C) bacterial vaginosis (Gardnerella) D) vaginal yeast infections (Candidiasis)

C) • rationale: the number one complaint for women with bacterial vaginosis is a fishy, greenish, thin discharge that is worse after intercourse genital warts appear as bumps on the skin although chlamydia may have discharge, the majority of patients are asymptomatic yeast infections present as copious, thick, white discharge that may accompany dysuria

During pregnancy, alcohol withdrawal may be treated using which medication? A) aminophylline B) corticosteroids C) benzodiazepines D) disulfiram

C) • symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. disulfiram is contraindicated in pregnancy because it is teratogenic. corticosteroids are not used to treat alcohol withdrawal. aminophylline is not used to treat alcohol withdrawal

which test would the nurse recommend for the patient to help assess fetal genetic abnormalities? A) fetal heart activity B) fetal body movements C) nuchal translucency (NT) D) amniotic fluid volume (AFV)

C) • the NT ultrasound screening technique is used to measure fluid in the nape of the fetal neck between 10 & 14 weeks of gestation. fluid volume greater than 3 mm is considered abnormal. NT is used mostly to identify possible fetal genetic abnormalities. AFV, fetal body movements, & fetal heart activity are measured to assess fetal well-being

which factor during a nonstress test of a pregnant patient indicates it is nonreactive? A) no qualifying accelerations in a 20 min period B) 2 qualifying accelerations in a 20 minute period C) less than 2 qualifying accelerations in a 20 minute period D) more than 2 qualifying accelerations in a 20 minute period

C) • the nonstress test is the most widely used technique for prenatal evaluation of the fetus. the results are either nonreactive or reactive. in a nonreactive test, there are less than 2 qualifying accelerations of the fetal HR in a 20 minute period. absence of fetal HR accelerations during the nonstress test indicates that the fetus is sleeping. in a reactive test, there are at least 2 qualifying accelerations in a 20 minute time period. more than 2 fetal HR accelerations within a 20 minute time period also would be considered a reactive test

when do the severity of symptoms in a pregnant asthmatic patient usually peak? A) in the first trimester B) immediately postpartum C) between 17-24 weeks gestation D) during the last 4 weeks of pregnancy

C) • the period between 17 & 24 weeks of pregnancy is associated with the greatest severity of symptoms. women often have few symptoms of asthma during the 1st trimester. during the last 4 weeks of pregnancy symptoms often subside. often issues have resolved by the time the woman gives birth

which test would the nurse recommend for an obese pregnant patient to assess the risk for intrauterine growth restriction? A) daily fetal movement count B) abdominal US C) computed tomography (CT) D) transvaginal ultrasonography

D) • IUGR is poor growth of the fetus during pregnancy. transvaginal US allows early diagnosis of IUGR & detailed examination of the pelvic anatomic features. thick abdominal layers in obese women may not allow adequate penetration during abdominal US; therefore TVUS is preferred in obese women. daily fetal movement count is used to monitor the complications related to poor fetal oxygenation. CT is contraindicated in pregnant women because the ionizing radiation may cause adverse effects in the fetus

which medication is preferred in the treatment of SLE in a pregnant patient? A) aspirin B) corticosteroids C) prednisone D) hydroxychloroquine

D) • Plaquenil reduces SLE disease activity in a pregnant patient without any adverse effects of the fetus. aspirin is not recommended during pregnancy, because it has an increased risk for premature closure of the fetal ductus arterioles. corticosteroids are used to treat multiple sclerosis. prednisone is prescribed to treat SLE during pregnancy, but it increases the risk for bone demineralization, gestational diabetes, preeclampsia, premature rupture of membranes (PROM), & IUGR

which finding in the Doppler umbilical flow reports of a pregnant patient would cause the nurse to advise the patient to quit smoking immediately? A) high amniotic fluid volume (AFV) B) low amniotic fluid volume (AFV) C) low systolic-to-diastolic (S/D) ratio D) high systolic-to-diastolic (S/D) ratio

D) • exposure to nicotine from maternal smoking has been reported to increase the fetal S/D ratio. an elevated S/D ratio indicates a poorly perfused placenta. to improve the blood supply to the placenta, the patient would quit smoking as soon as possible. the AFV cannot be assessed through Doppler umbilical blood flow study. moreover, smoking does not affect amniotic fluid volume. smoking increases the S/D ratio; it does not decrease it

which test would the nurse recommend to a pregnant patient who has undergone a cesarean section in her previous pregnancy and needs to be checked for the fetal heart rate pattern? A)biophysical profile B) nipple-stimulated test C) oxytocin-stimulated test D) fetal acoustic stimulation

D) • fetal acoustic stimulation is a nonstress test for monitoring the fetal HR pattern. it can be used in cases of previous cesarean birth becasue there is no stress to the fetus. a BPP is done to determine the physical profile of the fetus; it cannot be used to monitor the HR of the fetus. an oxytocin-stimulated test is a type of stress testing that is contraindicated in cases of previous cesarean birth because of the stress caused by the injected oxytocin. a nipple-stimulated test is a contraction stress test that is contraindicated in patients with previous cesarean birth. in this test, the released oxytocin may cause distress to the fetus

which advice would the nurse provide to a pregnant patient with late decelerations in fetal heart rate occurring with 60% of contractions during a contraction stress test? A) continue with the weekly testing schedule B) take the test again tomorrow at the same time C) you should take the test again today after resting D) you should be hospitalized and monitored continuously

D) • if late decelerations occur with more than 50% of the contractions in the contraction stress testing, this is a positive test result. in this situation, the patient must be hospitalized & evaluated further. if the fetus has no significant variable HR decelerations with at least 3 uterine contractions for a period of 10 minutes, the patient can continue with the weekly testing schedule. if late deceleration in the HR occurs with less than 50% of the contractions, the patient would be advised to repeat the test the next day. repeating the test on the same day can cause fetal distress and would be avoided

A patient with gestational diabetes experiences rupture of membranes at 36 weeks gestation. which patient teaching statement regarding this condition is accurate? A) rupture of membranes is more common in women with gestational diabetes because of the excess amounts of glucose in your urine B) rupture of membranes at this time in your pregnancy is normal and sometimes happens before labor begins C) your membranes likely ruptured because of excess ketones in your blood D) preterm rupture of membranes is more common in women with gestational diabetes, and it might be related to overdistention of your uterus

D) • it is thought that the cause of increased incidence of preterm rupture of membranes in gestational diabetics is overdistention of the uterus UTI, not rupture of membranes, is a common result of excess amounts of glucose in the urine 36 weeks is considered preterm, and therefore rupture of membranes is not normal ketones in the blood have not been directly linked to preterm rupture of membranes

Which of the following is an assessment finding that should alert the nurse to the possibility of cardiac decompensation? A) a decrease in perceived edema B) brisk capillary refill C) a slow, deep respiratory rate D) moist, frequent cough

D) • rationale: a nurse might see an irregular weak pulse, generalized edema, crackles at the lung bases, orthopnea, rapid respirations, moist frequent cough, and cyanosis of the lips and nail beds (pg 263)

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 which condition? A) euglycemia B) pneumonia C) rheumatic fever D) cardiac decompensation

D) • symptoms of cardiac decompensation may appear abruptly or gradually. euglycemia is a condition of normal glucose levels. these symptoms indicate cardiac decompensation. rheumatic fever can cause heart problems, but it does not present with these symptoms, which indicate cardiac decompensation. pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation

which parameter would the nurse check in the amniocentesis report of a pregnant patient to assess fetal lung growth? A) antibody titer in the blood B) alfa-fetoprotein (AFP) levels C) creatinine levels in the blood D) lecithin-to-sphingomyelin (L/S) ratio

D) • the L/S ratio indicates fetal lung maturity. AFP is assessed to check for the presence of neural defects. presence of creatinine in the amniotic fluid indicates that the patient's gestational age is more than 36 weeks. the antibody titer is used to determine Rh incompatibility in the fetus

for which clinical condition in the fetus would the primary HCP advise a pregnant woman to undergo a Doppler blood flow analysis after reviewing the amniocentesis reports that indicate the presence of bilirubin? A) fetal hydrops B) down syndrome C) potter syndrome D) hemolytic anemia

D) • the presence of bilirubin in the amniotic fluid indicates the possibility of hemolytic anemia in the fetus. the degree of hemolytic anemia can be determined by using Doppler blood flow analysis. the presence of the placental hormone inhibit-A in the quad screen indicates down syndrome. the AFI values are used to detect Potter syndrome. fetal hydrops is caused by polyhydramnios, which can be assessed by US scanning

the nurse advise would the pregnant patient to repeat the test on a weekly basis for which biophysical profile (BPP) score? A) 1 B) 4 C) 6 D) 9

D) • if the BPP score is 8-10, then the test would be repeated weekly or twice weekly. if the BPP score is 0-2, then chronic asphyxia may be suspected. in this case the testing time would be extended to 120 minutes. if the BPP score is 4 after 36 week's gestation, then clinical conditions exist that may lead to an imminent delivery. if the BPP score is 4 before 32 weeks, the test would be repeated. if the BPP score is 6 at 36-37 weeks with positive fetal pulmonary testing, then delivery can be performed. if the BPP score is 6 before 36 weeks of gestation with negative pulmonary testing, then BPP can be repeated in 4-6 hours; if oligohydramnios is present, then delivery can be done. the BPP provides an insight into fetal maturity & well-being & as such would be used as a diagnostic tool to plan & evaluate management of care. findings are related to several factors involving both maternal & fetal characteristics

Insulin needs through a pregnancy overall: A) stay the same B) level off after 20 weeks gestation C) decrease D) increase

D) • rationale: after 20 weeks is when they really start to increase considerably

which finding in the US reports of a pregnant woman would indicate a normal fetus? A) amniotic fluid index of 6 cm B) amniotic fluid index of 2 cm C) amniotic fluid index of 30 cm D) amniotic fluid index of 13 cm

D) • rationale: an AFI of 10 cm or more is considered normal. an amniotic fluid index of 25 cm is considered above the normal range & indicates polyhydramnios. an AFI less than 10 cm is considered below the normal range. an AFI before 5 cm is considered oligohydramnios

why is it so important that diabetic clients seek early preconception care? A) because uncontrolled diabetes can lead to several major birth defects of the musculoskeletal system and reproductive system B) because uncontrolled diabetes can lead to several major birth defects of the integumentary system and gastrointestinal system C) because uncontrolled diabetes can lead to several major birth defects of the genitourinary system and biliary system D) because uncontrolled diabetes can lead to several major birth defects of the cardiovascular system and central nervous system

D) • rationale: hyperglycemia during the first trimester of pregnancy, when organs and organ systems are forming, is the main cause of diabetes-associated birth defects (pg 245)

Which adverse maternal effect can be caused when a patient experiences anxiety disorders in pregnancy? A) increased incidence of 1st trimester bleeding B) increased risk for cord prolapse in labor C) increased risk for maternal mortality D) increased risk for forceps delivery

D) • rationale: women with anxiety disorders have an increased risk for operative delivery (forceps/vacuum/episiotomy) 1st trimester bleeding, cord prolapse, and maternal mortality have not been statistically proven in pregnant women with anxiety disorders

thalassemia is a relatively common anemia in which what occurs? A) folate deficiency occurs B) there are inadequate levels of vitamin B12 C) RBCs have a normal life span but are sickled in shape D) an insufficient amount of hemoglobin is produced to fill the RBCs

D) • thalassemia is a hereditary disorder that involves the abnormal synthesis of the alpha or beta chains of hemoglobin. an insufficient amount of hemoglobin is produced to fill the RBCs. this is the underlying description for sickle cell anemia. folate deficiency is the most common cause of megaloblastic anemias during pregnancy. B12 deficiency must also be considered if the pregnant woman presents with anemia

which statement by the woman at 36 weeks of gestation indicates a correct understanding of a nonstress test? A) i will need to have a full bladder for the test to be done accurately B) i should have my spouse drive me home after the test because i may be nauseous C) this test will help determine if the baby has Down syndrome or a neural tube defect D) this test will observe for fetal activity & an acceleration of the fetal HR to determine the well-being of the baby

D) • the nonstress test is one of the most widely used techniques to determine fetal well-being & is accomplished by monitoring fetal HR in conjunction with fetal activity & movements. an US is the test that requires a full bladder. an amniocentesis is the test that a pregnant woman should be driven home afterward. a maternal alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, & human chorionic gonadotropin (hCG) helps to determine down syndrome

Which methods can all women use to reduce risk in the preconception period? - increasing saturated fats in their diet - abstaining from alcohol - taking a folic acid supplement - learning about inherited conditions that can affect pregnancy - achieving a healthy weight - waiting to update vaccines until after pregnancy to prevent exposure to teratogens

abstaining from alcohol, taking a folic acid supplement, learning about inherited conditions that can affect pregnancy, achieving a healthy weight • rationale: abstaining from alcohol for at least 1 month before conceiving and throughout pregnancy can prevent complications from fetal alcohol exposure folic acid deficiencies are linked to open neural tube defects. all women of childbearing age who may become pregnant should take a supplement certain conditions can be passed on to offspring or can adversely affect a pregnancy being severely overweight or underweight has serious health consequences for the mother and fetus eating a healthy, balanced diet is important for overall pregnancy health. saturated fats should be limited, not increased although certain vaccines should not be administered to a pregnant individual, obtaining recommended vaccines before pregnancy (the preconception period) is a good way to promote health and well-being

a woman tests positive for group B streptococcus (GBS) at 36 weeks gestation before a vaginal birth. which interventions would the nurse include in the plan of care? - retest for GBS upon admission to labor and delivery - instruct the patient to use condoms until the infection clears - administer antibiotics during labor until delivery as prescribed - monitor the neonate for signs and symptoms of respiratory illness - inspect the perineum carefully for lesions upon admission for labor and delivery

administer antibiotics during labor until delivery as prescribed, monitor the neonate for signs and symptoms of respiratory distress • rationale: antibiotics are administered in labor to help prevent transmission to the neonate during delivery monitor the neonate for signs and symptoms of respiratory distress retesting is not recommended. treatment is based upon initial testing results between 35 and 37 weeks gestation GBS is a bacterium that is present on the skin. it is not a STI, so condoms are not necessary inspecting the perineum for lesions is necessary for genital herpes. GBS bacteria, however, do not cause lesions

A patient with bipolar depression & bulimia nervosa who is homeless enters care at 30 weeks' gestation. Which HCPs should be a part of the interdisciplinary team when developing a plan of care for this patient? - dentist - obstetrician - nurse - psychiatrist - social worker - legal aid

all of the above • all pregnant patients are at risk for adverse pregnancy outcomes related to tooth decay. patients with bulimia are at increased risk due to frequent vomiting the obstetrician will coordinate care for a safe passage & delivery of the baby the nurse will conduct targeted assessments, administer necessary treatments, conduct home health visits, & act as an advocate for the patient the psychiatrist, together with the obstetrician, will choose medications that are safer for the mother & fetus the social worker can help connect the patient with services such as counseling, nutrition, obtaining health insurance, & other community resources most HCPs in most states are mandated reporters when child abuse or neglect is suspected. this patient is homeless & will not be able to take her baby from the hospital without securing a safe place to live. a legal case worker can help her navigate the legal process & act as an advocate for the mother who loses custody of her child

when cardiovascular disease is severe during pregnancy, which health care providers may be a part of the interdisciplinary care team? -anesthesiologists - nurses - dermatologists - neonatologists - obstetricians - maternal fetal medicine specialists

anesthesiologists, nurses, neonatologists, obstetricians, maternal-fetal medicine specialists • rationale: Anesthesiologists are important team members who help manage patient conditions, administer analgesia in labor, and manage the airway and hemodynamic stability in the operating room. they should be involved in care long before delivery nurses help monitor, care for, and implement interventions dermatologists are not typically involved in the care of a pregnant patient with CVD neonatologists must be involved in the care of the pregnant patient, as the neonate may have been exposed to dangerous medications, may have growth restrictions, and may have many other complications obstetricians lead the team in the care for the pregnant patient and work closely with specialists to develop a plan of care maternal-fetal medicine specialists focus on high-risk pregnancy and implement advanced monitoring and interventions specific to the high-risk pregnancy

which considerations would the nurse recognize for a pregnant patient with HIV? - a 2nd test toward the end of the 3rd trimester is not recommended - vaginal delivery is always contraindicated - antiretroviral therapy for the mother and neonate helps reduce transmission at birth - testing all pregnant women for HIV at the beginning of pregnancy is a best practice - breastfeeding should be avoided - an elective cesarean birth at 38 weeks helps prevent transmission to the neonate

antiretroviral therapy for the mother and neonate helps reduce transmission at birth, testing all pregnant women for HIV at the beginning of pregnancy is a best practice, breastfeeding should be avoided, an elective cesarean birth at 38 weeks helps prevent transmission to the neonate • rationale: the risk of transmission decreases from 30% to less than 2% with antiretroviral therapy all women, regardless of history, should be tested for HIV in the beginning of pregnancy breastfeeding is contraindicated with maternal HIV infection elective cesarean birth has been shown to reduce the rate of neonatal HIV transmission as a result of the risk of infection in pregnancy, a second test is recommended after a discussion of risks and benefits, a health care provider may decide to continue with vaginal delivery if the mother's viral count is low

which characteristics are associated with sickle cell anemia? - causes frequent hospitalization throughout the life span - characterized by distorted and decreased erythrocytes - can lead to preterm birth - causes severe pain - commonly leads to fetal neural tube defects - may be cured with diet and supplementation

causes frequent hospitalization throughout the life span, characterized by distorted and decreased erythrocytes, can lead to preterm birth, causes severe pain • rationale: crises may cause frequent hospitalizations from childhood and beyond erythrocytes appear sickled under microscopy pregnant women with sickle cell anemia are at increased risk for preterm birth sickle-cell patients have extreme pain when experiencing a flare-up fetal neural tube defects are common in pernicious anemia, not sickle cell anemia sickle cell anemia is an inherited disorder and cannot be cured

polymorphic eruption of pregnancy (PEP) also known as pruritic urticarial papules and plaques of pregnancy (PUPPs) usually occurs in the 3rd trimester and rarely resolves after delivery - true - false

false • rationale: PEP or PUPPs usually resolves before birth or within several weeks after birth (pg 269)

the nurse understands that which physiologic changes in the thyroid are considered abnormal in pregnancy? - fatigue, edema, and muscle aches may be the result of thyroid activity in pregnancy - the thyroid gland enlarges and becomes palpable - thyroid-stimulating hormone (TSH) decreases in the 1st trimester - free thyroxine (T4) levels increase - increased free thyroxine (T4) levels lead to weight loss and goiter

fatigue, edema, and muscle aches may be the result of thyroid activity in pregnancy, the thyroid gland enlarge and becomes palpable, increased free thyroxine (T4) levels lead to weight loss and goiter • rationale: fatigue, edema, and muscle aches may be the result of thyroid activity in pregnancy the thyroid gland enlarging and becoming palpable is not an expected finding in pregnancy weight loss and goiter would be abnormal and indicative of hyperthyroidism TSH decreasing in the first trimester is an expected change during pregnancy. TSH decreases as a result of the influence of human chorionic gonadotropin in early pregnancy T4 levels increasing is an expected change during pregnancy. the TSH decrease causes an increase in T4

Which assessments may be performed using ultrasonography? - fetal anatomy - fetal Rh status - gestational age - chromosomal disorders - fetal heart activity - amniotic fluid index

fetal anatomy, gestational age, chromosomal disorders, fetal heart activity, amniotic fluid index • rationale: ultrasounds are frequently used to assess fetal amniotic structures for abnormality gestational age can be estimated with ultrasound by collecting specific measurements in different trimesters certain chromosomal abnormalities may be initially detected using ultrasound soft markers. these findings are not diagnostic, however, and require further workup fetal heart activity is easily detected using ultrasonography amniotic fluid amount may be measured using ultrasound fetal Rh status cannot be determined with an ultrasound. this requires biochemical assessment and analysis

which symptom is associated with systemic lupus erythematosus (SLE)? SATA - fever - hyperactivity - hypotension - muscle aches - weight changes

fever, muscle aches, weight changes • common symptoms, including myalgias, fatigue, weight change, & fevers, occur in nearly all women with SLE at some time during the disease. fatigue, rather than hyperactivity, is a common sign of SLE. hypotension is not a characteristic sign of SLE. although a diagnosis of SLE is suspected based on clinical signs & symptoms, it is confirmed by laboratory testing that demonstrates the presence of circulating autoantibodies. as with other autoimmune diseases, SLE is characterized by a series of exacerbations (flares) and remissions

which statements are true regarding hyperglycemia? - glucose levels in the blood may be elevated, but at the cellular level glucose may be low with some forms of diabetes - in gestational diabetes, hyperglycemia always leads to polydipsia - the body attempts to dilute the glucose load, resulting in polyuria - glycosuria can occur - glucose is stored in the pancreas when hyperglycemia occurs

glucose levels in the blood may be elevated, but at the cellular level glucose may be low with some forms of diabetes; the body attempts to dilute the glucose load, resulting in polyuria; glycosuria can occur • rationale: glucose may be low at the cellular level with hyperglycemia when there is insulin resistance or decreased insulin production with hyperglycemia, the body will try to compensate for the high glucose level using the renal system as the body compensates for hyperglycemia, more glucose may be spilled into the urine for excretion the classic signs of polydipsia, polyphagia, and polyuria may not occur with gestational diabetes the pancreas excretes insulin so that glucose can be absorbed by the body

The nurse is responsible for intake history at an obstetrics and gynecology (OB/GYN) office. Which medical conditions would the nurse recognize as high-risk conditions that could have adverse outcomes on a pregnancy? - hemophilia - type 1 DM - HIV - chronic hypertension - xeroderma

hemophilia, type 1 DM, HIV, chronic hypertension • rationale: hemophilia is a coagulopathy that increases a woman's risk in pregnancy type 1 DM is a medical condition that exists before pregnancy and can have serious adverse health outcomes for the pregnant mother and fetus HIV is a medical diagnosis that can have adverse outcomes on a pregnancy chronic HTN can cause adverse outcomes for a mother and fetus during pregnancy having dry skin alone does not increase a woman's pregnancy risk

which obstetric or medical complication is the pregnant patient with diabetes mellitus at risk? SATA - hydramnios - preeclampsia - hypoglycemia - monilial vaginitis - brachial plexus palsy

hydramnios, preeclampsia, hypoglycemia, monilial vaginitis • a pregnant patient with diabetes mellitus is at risk for hypertension, which may result in preeclampsia. hypoglycemia may occur because of an increase in insulin levels in the 1st trimester of pregnancy. hydramnios may occur in the 3rd trimester of pregnancy because of hyperglycemia. monilial vaginitis is a vaginal infection that is seen in women with diabetes during pregnancy. this results from an alteration in the normal resistance of the body to infection. brachial plexus palsy may be seen in the child born to a woman with diabetes because of a difficult vaginal birth

which condition is common in infants born to mothers with diabetes mellitus? - hypoglycemia - marfan syndrome - cephalhematoma - shoulder dystocia - brachial plexus palsy

hypoglycemia, cephalhematoma, shoulder dystocia, brachial plexus palsy • brachial plexus palsy & cephalhematoma may occur in the child because of a difficult vaginal birth. the brachial plexus is a group of nerves that originate from the spinal cord. they can be damaged because of a difficult birth. a cephalhematoma is a hemorrhage of blood between the skull & the periosteum. shoulder dystocia is a risk associated with diabetic pregnancy becasue the infants born to women with diabetes tend to have a disproportionate increase in the shoulder, trunk, & chest size. hypoglycemia is a risk if the patient does not control her blood glucose during the last half of pregnancy. marfan syndrome is a cardiac disease & is not seen in infants with diabetic mothers

Match the type of diabetes with its characterization - lack of insulin secretion: - insulin resistance: - gestational diabetes mellitus: • type 2 DM, type 1 DM, gestational diabetes mellitus

lack of insulin secretion: type 1 diabetes mellitus insulin resistance: type 2 diabetes mellitus early gluconeogenesis: gestational diabetes mellitus

Which is a metabolic change associated with pregnancy? SATA - maternal insulin requirements increase during the 1st trimester - maternal production of insulin increases during the first trimester - there is enough glucose for the fetus during the 2nd trimester - fasting blood glucose levels will decrease during the 1st trimester - the patient's tolerance to glucose increases in the 2nd trimester

maternal production of insulin increases during the 1st trimester, there is enough glucose for the fetus in the 2nd trimester, fasting blood glucose levels will decrease in the 1st trimester • in the first trimester, an increase in estrogen & progesterone production stimulates the beta cells in the pancreas to increase insulin production. the beta cells also increase peripheral use of glucose & in turn, decrease the overall blood glucose levels. this reduces fasting glucose levels by approximately 10%. during the 2nd & 3rd trimesters, hormonal changes increase insulin resistance & ensure an abundant supply of glucose for the fetus. the body develops insulin resistance as a glucose-sparing mechanism. in the 2nd trimester, hormonal changes decrease tolerance to glucose. maternal insulin requirements increase from 18-24 weeks of gestation, not in the 1st trimester

Which clinical test evaluates the health status of a pregnant patient who abuses substances? - meconium testing - complete blood count - tuberculosis screening - urine toxicologic testing - glycosylated hemoglobin A1c

meconium testing, CBC, tuberculosis screening, urine toxicologic testing • urine toxicologic testing helps assess for illicit drug use in a pregnant patient. meconium from the neonate helps determine past drug use over a longer period. a CBC helps assess any deficiency in the patient. tuberculosis screening is important so that the infection, if present, can be prevented from progressing. glycosylated hemoglobin A1c levels are assessed in a patient with diabetes to assess recent glycemic control

Which pregnancy related condition is realted to both maternal and fetal influences? A) amniotic banding B) polyhydramnios C) nuchal cord D) preeclampsia

polyhydramnios • rationale: polyhydramnios can happen without a known cause. however, maternal diabetes can also lead to polyhydramnios. because the fetus creates amniotic fluid, the condition is considered both maternal and fetal amniotic banding is a fetal condition that happens within the amniotic sac nuchal cord is a fetal condition preeclampsia is a maternal condition

the nurse assessing for hypoglycemia in a neonate would monitor for which symptoms - poor feeding - flexion of the arms and legs - hypothermia - tremors - bluish hands and feet - rooting

poor feeding, hypothermia, tremors • rationale: poor feeding and lack of interest in feeding are signs of hypoglycemia in the neonate and are usually related to lethargy caused by lack of glucose hypothermia is a symptom of hypoglycemia tremors may be observed in a newborn that has low glucose level flexion of the arms and legs is a normal, healthy finding of a neonate; bluish hands and feet, known as acrocyanosis, are not related to hypoglycemia rooting is a normal infant feeding reflex and is indicative of a newborn interested in feeding

Which would the nurse assess at a routine prenatal visit for a patient that has gestational diabetes? - presence of bacteria, ketones, protein, and glucose in urine - fetal movement by palpation and patient report - serum calcium levels - blood pressure - fundal height

presence of bacteria, ketones, protein, & glucose in urine, fetal movement by palpation and patient report, blood pressure, fundal height • rationale: women with diabetes are at increased risk for UTI. additionally, the presence of ketones, glucose, and protein may indicate worsening diabetes or preeclampsia fetal movement is a reliable indicator of well-being. a patient that reports decreased fetal movement requires further evaluation a patient with diabetes is at increased risk for preeclampsia, so the blood pressure should be assessed at each visit an elevated fundal height may indicate macrosomia or hydramnios and requires further diagnostic evaluation low magnesium levels in the mother can cause low calcium levels in the neonate. serum calcium is not a routine assessment for this patient

the nurse caring for a pregnant patient with gestational diabetes at 33 weeks gestation assesses the fundal height at 36 cm. which actions by the nurse are correct regarding this finding? - assure the patient that the fetus is growing appropriately for its age - recommend that the HCP order an US - educate the patient on the importance of limiting weight gain for the remainder of the pregnancy - perform a fetal nonstress test and report the findings to the HCP - assist the patient with scheduling a cesarean delivery at 37 weeks

recommend that the HCP order an US, perform a fetal nonstress test and report the findings to the HCP, • rationale: recommending that the HCP order an US is an appropriate action. amniotic fluid volume & fetal size should be monitored for this patient gestational diabetics require additional fetal surveillance as a result of the high-risk nature of the pregnancy. when assessment findings are abnormal, fetal well-being should be assessed. a nonstress test is part of a biophysical profile and gives the HCP an insight into fetal well-being this fundal height is much higher than expected. gestational diabetics are at risk for polyhydramnios, which can cause higher-than-expected fundal heights. macrosomia is also an issue that can lead to higher-than-expected fundal heights excessive weight gain is likely not the cause of higher-than-expected fundal heights for this patient. hydramnios and macrosomia may be the causes and should be evaluated a cesarean delivery is not indicated based upon these findings alone

the nurse is developing the plan of care for a pregnant patient with an underlying history of cardiovascular disease. this patient would be at risk for which condition? SATA - stillbirth - miscarriage - hypoglycemia - atrial septal defect - intrauterine growth restriction

stillbirth, miscarriage, IUGR • stillbirth & miscarriage may occur because of CV disease in pregnancy. IUGR results in a pregnant patient with CV disease because of low oxygen pressure. hypoglycemia is seen in a pregnant patient with diabetes because of a decrease in glucose levels. an atrial septal defect is a congenital birth defect that is not related to underlying maternal cardiac disease

Hypothyroidism occurs in 2-3 pregnancies per 1000. pregnant women with untreated hypothyroidism are at risk for which condition? SATA - stillbirth - miscarriage - macrosomia - placental abruption - gestational hypertension

stillbirth, miscarriage, placental abruption, gestational hypertension • hypothyroidism is often associated with both infertility & an increased risk for miscarriage. these outcomes can be improved with early diagnosis & treatment. pregnant women with hypothyroidism are more likely to experience both preeclampsia & gestational hypertension. placental abruption & stillbirth are risks associated with hypothyroidism. infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm rather than have macrosomia

which statements are true regarding rubella in pregnancy? - women develop a "slapped-cheek rash" - titers less than 1:8 demonstrate immunity - the virus can cross the placental barrier - most women of childbearing age in the US have received this vaccine already - if a woman is not immune, she can be offered the vaccine during pregnancy

the virus can cross the placental barrier, most women of childbearing age in the US have received this vaccine already • rationale: crossing of the placental barrier is a serious concern with rubella infection the measles-mumps-rubella (MMR) vaccine contains the rubella vaccine development of a "slapped-cheek rash" is characteristic of fifth disease, not rubella titers greater than 1:8 demonstrate immunity rubella is a live vaccine and is offered after pregnancy in the postpartum period

which signs would the nurse assess in a newborn exposed to tobacco while in utero? - flat nasal bridge - tremors - signs of prematurity - open spinal cord defect - colic/fussy behavior - a lower-than-expected weight

tremors, signs of prematurity, colic/fussy behavior, a lower-than-expected weight • rationale: neurodevelopmental delays are often seen in newborns exposed to tobacco in utero signs of prematurity are often seen in newborns exposed to tobacco in utero colic/fussy behavior is often seen in newborns exposed to tobacco in utero lower-than-expected weight is often seen in newborns exposed to tobacco in utero flat nasal bridge is associated with alcohol misuse, not tobacco use open spinal cord defect is associated with decreased folic acid intake, not tobacco use

Which signs & symptoms would a patient with pica demonstrate? - uncontrollable urge to eat toothpaste - increased levels of blood toxins - intestinal parasites - epistaxis - diplopia - large-for-gestational age babies

uncontrollable urge to eat toothpaste, increased levels of blood toxins, intestinal parasites • rationale: pica is defined as a strong urge to eat a nonnutritive or harmful substance. women may crave potting soil, lip balm, coffee grounds, charcoal, toothpaste, baking soda, or any substance that is not considered culturally or developmentally appropriate for the individual pica can cause ingestion of substances that can contain substances that are harmful to the mother and baby such as toxins or parasites epistaxis are not associated with pica directly double vision is not directly related to pica women with eating disorders have babies that are small for gestational age or growth restricted

which complications of pregnancy are associated with substance misuse? - vaginal bleeding - gestational diabetes - preterm labor - intrauterine growth restriction (IUGR) - umbilical cord prolapse - congenital anomalies

vaginal bleeding, preterm labor, intrauterine growth restriction, congenital anomalies • rationale: vaginal bleeding, preterm labor, IUGR, and congenital abnormalities are associated with substance misuse gestational diabetes is not associated with substance misuse umbilical cord prolapse is not associated with substance misuse

Which methods of screening for substance abuse in a pregnant woman are considered acceptable? - verbally screening only at the first prenatal visit - collecting a urine sample and sending without consent - verbally using a validated screening tool - asking the pregnant woman's significant other - obtaining patient consent and collecting laboratory samples

verbally using a validated screening tool, obtaining patient consent and collecting laboratory samples • rationale: using a validated screening tool improves accuracy obtaining laboratory samples helps the nurse determine which substances a patient may have used recently and determine care for the neonate and mother. it is always important to obtain consent for toxicology by following hospital protocol screening for substance misuse is ongoing throughout pregnancy it is important to obtain consent verbally or in writing when collecting laboratory samples from the patient. this helps to build patient trust information obtained from significant others may be important. however, this is not an acceptable screen for substance misuse in pregnancy