NU143- Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations

Type 1 diabetes

absolute insulin deficiency (due to an autoimmune process) usually appears before the age of 30 years approximately 5% of those diagnosed have type 1 diabetes

pregestational diabetes

alteration in carbohydrate metabolism identified before conception

A pregnant client is diagnosed with syphilis. Which response would demonstrate respect for the client and therapeutic communication?

"I am sure it is frightening to you to be diagnosed with a disease that can affect your baby."

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?

Eat a sustaining-carbohydrate snack.

A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize?

IV fluids

The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement?

Orange juice

The maternal health nurse is caring for a group of high-risk pregnant clients. Which client condition will the nurse identify as being the highest risk for pregnancy?

Pulmonary hypertension

A 15-year-old adolescent arrives at the office with a report of flu symptoms, including nausea and vomiting and recent weight loss. A pregnancy test is done and is positive. The client begins crying and tells the nurse her mother will be furious with her. What can the nurse do to assist this adolescent at this point?

Support her by respecting her right to privacy and confidentiality.

Maintenance on methadone or buprenorphine is the most common medical treatment for which of the following drug addictions? a. Alcohol b. Nicotine c. Opiates d. Marijuana

c. Opiates

type 2 diabetes

insulin resistance or deficiency (related to obesity, sedentary lifestyle) diagnosed primarily in adults older than 30 years of age but now being seen in children the most common type of diabetes. It is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as older adults.

alcohol

major public health issue in the United States

human immunodeficiency virus (HIV)

a chronic infection caused by the retrovirus HIV, which infects T cells that causes immunodeficiency

multiple sclerosis (MS)

a chronic inflammatory, demyelinating autoimmune disorder of the central nervous system

A pregnant woman in her 39th week of pregnancy presents to the clinic with a vaginal infection. She tests positive for chlamydia. What would this disease make her infant at risk for?

blindness

The nurse is teaching a pregnant woman with iron-deficiency anemia about her prescribed iron supplement. The nurse determines that the teaching was successful when the client states that she will take the supplement with:

citrus juice.

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?

cytomegalovirus

Gestational diabetes mellitus

glucose intolerance with its onset during pregnancy usually around the 24th week or first detected in pregnancy. The prevalence of gestational diabetes has been increasing in the United States and is as high as up to 10% in the United States.

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?

the viral load

caffeine

widely used and accepted pharmacologically active substance

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?

She is at increased risk for type 2 diabetes mellitus after her baby is born.

fetal alcohol spectrum disorder (FASD)

entirely preventable through alcohol abstinence, but worldwide approximately 30% of pregnant women consume alcohol during pregnancy

A woman who immigrated here from a third world country presents to the clinic to find out if she is pregnant. Which signs and/or symptoms would the nurse assess as possible indicators that she might have an active case of tuberculosis as well? Select all that apply.

fatigue night sweats hemoptysis anorexia

The nurse is preparing a postpartum nursing care plan for a single HIV-positive primigravida client. The nurse should prioritize in the plan how to acquire which resource?

formula

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?

Exercise

neonatal abstinence syndrome

The most common harmful effect of heroin and other narcotics on newborns symptoms may include irritability, hypertonicity, jitteriness, fever, excessive and often high-pitched cry, vomiting, diarrhea, feeding disturbances, respiratory distress, disturbed sleeping, excessive sneezing and yawning, nasal stuffiness, diaphoresis, fever, poor sucking, tremors, and seizures

teratogen

a substance known to be toxic to human development

A nurse is teaching a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority?

avoidance of infection

Which factor would contribute to a high-risk pregnancy?

type 1 diabetes

Nonmedical Use of Prescription Drugs

unintentional poisoning deaths occur frequently

perinatal drug abuse

use of alcohol and other drugs by pregnant women

The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of having a heroin use disorder. The nurse would be alert for which finding when assessing the neonate?

hypertonicity

A pregnant client with iron-deficiency anemia is prescribed an iron supplement. After teaching the woman about using the supplement, the nurse determines that more teaching is needed based on which client statement?

"I will take the iron with milk instead of orange or grapefruit juice."

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?

"You should wait until after you give birth to obtain the cat for your daughter."

A woman at 26 weeks' gestation is undergoing screening for diabetes with a 1-hour oral glucose challenge test. On the client's return visit, the nurse anticipates the need to schedule a 3-hour glucose challenge test based on which result of the previous test?

146 mg/dL (8.10 mmol/L)

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?

6%

A pregnant woman with diabetes is having her hemoglobin (glycosylated) 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?

6.5%

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?

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.

A nurse is caring for a client with cardiovascular disease who has just given birth. What nursing interventions should the nurse perform when caring for this client? Select all that apply.

Assess for shortness of breath. Assess for a moist cough. Assess for edema and note any pitting. Auscultate heart sounds for abnormalities.

An infant is born to a mother with gestational diabetes. Which long-term maternal complication is associated with this diagnosis?

Increased risk of development of type 2 diabetes

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?

Maintain a daily blood glucose log

Which of the following conditions would most likely cause a pregnant woman with type 1 diabetes the greatest difficulty during her pregnancy? a. Placenta previa b. Hyperemesis gravidarum c. Abruptio placentae d. Rh incompatibility

b. Hyperemesis gravidarum

Which of the following would the nurse include when teaching a pregnant woman about the pathophysiologic mechanisms associated with gestational diabetes? a. Pregnancy fosters the development of carbohydrate cravings. b. There is progressive resistance to the effects of insulin. c. Hypoinsulinemia develops early in the first trimester. d. Glucose levels decrease to accommodate fetal growth.

b. There is progressive resistance to the effects of insulin.

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?

assessing for cardiac decompensation

When explaining to a pregnant woman about HIV infection and transmission, which of the following would the nurse include? a. It primarily occurs when there is a large viral load in the blood. b. HIV is most commonly transmitted via sexual contact. c. It affects the majority of infants of mothers with HIV infection. d. Nurses are most frequently affected due to needlesticks.

b. HIV is most commonly transmitted via sexual contact

Women who drink alcohol during pregnancy: a. Often produce more alcohol dehydrogenase b. Usually become intoxicated faster than before c. Can give birth to an infant with fetal alcohol spectrum disorder d. Gain fewer pounds throughout the gestation

c. Can give birth to an infant with fetal alcohol spectrum disorder

opiates and narcotics

central nervous system depressants that soothe and lull. They may be used medically for pain, but all have a high potential for abuse. Most cause an intense addiction in both the mother and newborn

Impaired fasting glucose and impaired glucose tolerance

characterized by hyperglycemia at a level lower than what qualifies as a diagnosis of diabetes (fasting blood glucose level between 100 and 125 mg/dL blood glucose level between 140 and 199 mg/dL after a 2-hour glucose tolerance test, respectively) symptoms of diabetes are absent newborns are at risk for being large for gestational age (LGA).

rheumatoid arthritis (RA)

characterized by joint inflammation and progressive disability and is one of the most common chronic autoimmune disorders

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:

check her blood sugars frequently and adjust insulin accordingly.

pica

consuming nonfood substances

Women who are obese have a greater risk of developing which of the following during pregnancy? a. Type 1 diabetes b. Hypotension c. Low birth weight infant d. Gestational hypertension

d. Hypotension

When providing prenatal education to a pregnant woman with asthma, which of the following would be important for the nurse to do? a. Explain that she should avoid steroids during her pregnancy. b. Demonstrate how to assess her blood glucose levels. c. Teach correct administration of subcutaneous bronchodilators. d. Ensure she seeks treatment for any acute exacerbation.

d. Teach correct administration of subcutaneous bronchodilators.

A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn?

microcephaly

methamphetamines

more common than cocaine use in pregnancy, and its use by women of childbearing age is increasing in the United States increased risk for preterm births, low birth weight, placental abruption, fetal growth restriction, and congenital anomalies

marijuana

most commonly used illicit drug in America, with over 90 million people having tried it at least once

acquired immunodeficiency syndrome (AIDS)

progressive, debilitating disease that suppresses cellular immunity, predisposing the infected person to opportunistic infections and malignancies

sedatives

relax the central nervous system and are used medically for inducing relaxation and sleep, relieving tension, and treating seizures easily cross the placenta and can cause birth defects and behavioral problems

nicotine

the biggest preventable cause of death and illness in women and infants and is associated with numerous obstetric, fetal, and developmental complications, as well as an increased risk of adverse health consequences in the adult offspring

systemic lupus erythematosus (SLE)

the immune system can target the lungs, hearts, joints, kidneys, brain, and red blood cells chronic, relapsing autoimmune disease of the connective tissues that can affect various organs

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?

persistent rales in the bases of the lungs

A nurse is conducting a class on gestational diabetes for a group of pregnant women who are at risk for the condition. The nurse determines that additional teaching is needed when the class identifies which complication as affecting the neonate?

hyperglycemia