Medical Conditions in Pregnancy Part 2 (Week 10)

Which nursing diagnosis would be most appropriate for a woman diagnosed with gestational hypertension?

Deficient fluid volume related to vasospasm of arteries Explanation: Gestational hypertension is caused by vascular spasm. This leads to increased blood pressure and edema. Extensive edema leads to a deficiency of fluid volume.

A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which finding would the lead the nurse to suspect that the client is having an adverse effect associated with this drug?

tachycardia Explanation: Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision, or sweating. Magnesium sulfate may cause sweating

A nurse is caring for a pregnant client with eclamptic seizure. Which is a characteristic of eclampsia?

Coma occurs after seizure. Explanation: The nurse should know that coma usually follows an eclamptic seizure. Muscle rigidity occurs after facial twitching. Respirations do not become rapid during the seizure; they cease. Coma usually follows the seizure activity, with respiration resuming.

As a rule, women can receive chemotherapy in the second and third trimesters without adverse fetal effects.

True

A pregnant client with severe preeclampsia has developed HELLP syndrome. In addition to the observations necessary for preeclampsia, what other nursing intervention is critical for this client?

observation for bleeding Explanation: Because of the low platelet count associated with this condition, women with HELLP syndrome need extremely close observation for bleeding, in addition to the observations necessary for preeclampsia. Maintaining a patent airway is a critical intervention needed for a client with eclampsia while she is having a seizure. Administration of a tocolytic would be appropriate for halting labor. Monitoring for infection is not a priority intervention in this situation

A nurse is assessing a client diagnosed with mild preeclampsia. The nurse suspects that the client has developed severe preeclampsia based on which finding?

urine output of less than 400 mL/24 hours Explanation: Severe preeclampsia may develop suddenly and bring with it high blood pressure of more than 160/110 mm Hg, proteinuria of more than 5 g in 24 hours, oliguria of less than 400 mL in 24 hours, cerebral and visual symptoms, and rapid weight gain. Mild facial edema or hand edema occurs with mild preeclampsia. Proteinuria in severe preeclampsia is greater than 500 mg/24 hours

The nurse is required to assess a client for HELLP syndrome. Which are the signs and symptoms of this condition? Select all that apply.

• epigastric pain • upper right quadrant pain • hyperbilirubinemia Explanation: The signs and symptoms of HELLP syndrome are nausea, malaise, epigastric pain, upper right quadrant pain, demonstrable edema, and hyperbilirubinemia. Blood pressure higher than 160/110 mm Hg and oliguria are the symptoms of severe preeclampsia rather than HELLP syndrome

During a routine prenatal check up, the nurse interviews a pregnant client to identify possible risk factors for developing gestational diabetes. Which factors would alert the nurse to an increased risk? Select all that apply.

• previous history of spontaneous abortion • maternal obesity with body mass index more than 35 • client of African-American lineage Explanation: The risk factors for gestational diabetes include previous history of spontaneous abortion, maternal obesity with body mass index (BMI) more than 35, and client of African-American lineage. The other risk factors for gestational diabetes are previous history of stillbirth, birth of large for gestational age infant, and advancing maternal age. High-risk ethnic groups include African American, Hispanic, and Native North American

Which change in insulin is most likely to occur in a woman during pregnancy?

less effective than normal Explanation: Somatotropin released by the placenta makes insulin less effective. This is a safeguard against hypoglycemia.

A woman in week 40 of her pregnancy has developed a urinary tract infection (UTI). The nurse recognizes that which of the following treatments would be safe and appropriate to use with this client? (Select all that apply.)

• Amoxicillin • Ampicillin • Cephalosporins Explanation: Amoxicillin, ampicillin, and cephalosporins are effective against most organisms causing UTIs and are safe antibiotics during pregnancy. The sulfonamides can be used early in pregnancy but not near term because they can interfere with protein binding of bilirubin, which then leads to hyperbilirubinemia in the newborn. Tetracyclines are contraindicated during pregnancy as they cause retardation of bone growth and staining of the fetal teeth. Heparin is an anticoagulant and is used to prevent clot formation; it would not be prescribed for a UTI.

A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware that client is at risk for which perinatal complication?

congenital anomalies Explanation: Multiple gestation involves two or more fetuses. The perinatal complications associated with multiple pregnancy include preterm birth, maternal hypertension and congenital anomalies. Fetal nonimmune hydrops occurs in the infection of pregnant clients with parvovirus. Postterm birth, maternal hypotension, and fetal nonimmune hydrops are not seen as complications of multiple pregnancy

For which problem would the nurse be alert in a pregnant woman with gestational diabetes?

hydramnios related to glucose/insulin imbalance Explanation: Hyperglycemia tends to lead to excessive amniotic fluid (hydramnios) because of osmotic pressure fluid shifts.

A nurse is explaining to a group of nursing students that eclampsia or seizures in pregnant women are preceded by an acute increase in maternal blood pressure. What are features of an acute increase in blood pressure? Select all that apply.

hypereflexia • proteinuria • blurring of vision Explanation: Eclampsia is usually preceded by an acute increase in blood pressure as well as worsening signs of multi-organ system failure seen as increasing liver enzymes, proteinuria, and symptoms such as blurred vision and hyperreflexia. Hyperglycemia and auditory hallucinations are not seen with an acute increase in maternal blood pressure.

A nurse is caring for a pregnant client with sickle cell anemia. What should the nursing care for the client include? Select all that apply.

• Teach the client meticulous handwashing. • Assess hydration status of the client at each visit. • Urge the client to drink 8 to 10 glasses of fluid daily Explanation: The nurse caring for a pregnant client with sickle cell anemia should teach the client meticulous hand-washing to prevent the risk of infection, assess the hydration status of the client at each visit, and urge the client to drink 8 to 10 glasses of fluid daily. The nurse need not assess serum electrolyte levels of the client at each visit or instruct the client to consume protein-rich food

A pregnant woman at 4 weeks' gestation who has preexisting diabetes mellitus visits her primary care provider for a check up. Which fetal complications might occur because of this maternal condition? Select all that apply.

• congenital malformations • macrosomia (oversized fetus) • respiratory disorder Explanation: Potential problems during pregnancy involving maternal diabetes mellitus include fetal death, macrosomia (oversized fetus), a fetus with a respiratory disorder, difficult labor, preeclampsia or eclampsia, polyhydramnios, and congenital malformations