OB chapter 20

When dealing with a pregnant adolescent, the nurse assists the client to integrate the tasks of pregnancy while at the same time fostering development of which trait? dependence trust self-identity autonomy

self-identity The nurse assists the pregnant adolescent to integrate the tasks of pregnancy, bonding, and preparing to care for another with the tasks of developing self-identity and independence. Trust is a developmental task of infancy. Autonomy is a developmental task of toddlerhood. Independence, not dependence, is fostered.

A pregnant client with type 1 diabetes is in labor. The client's blood glucose levels are being monitored every hour and she has a prescription for an infusion of regular insulin as needed based on the client's blood glucose levels. Her levels are as follows: 1300: 105 mg/dL (5.83 mmol/L) 1400: 100 mg/dL (5.55 mmol/L) 1500: 120 mg/dL (6.66 mmol/L) 1600: 106 mg/dl (5.88 mmol/L) Based on the recorded blood glucose levels, at which time would the nurse likely administer the regular insulin infusion? 1400 1300 1500 1600

1500 For the laboring woman with diabetes, intravenous (IV) saline or lactated Ringer's is given, and blood glucose levels are monitored every 1 to 2 hours. Glucose levels are maintained below 110 mg/dL (6.11 mmol/L) throughout labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level. The insulin infusion would be given at 1500, based on the blood glucose level being higher than 110 mg/dL (6.11 mmol/L).

A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant? 12 months 6 months 9 months 3 months

6 months If the woman is considering pregnancy, it is recommended that she postpone conception until the disease has been stable or in remission for six months. Active disease at the time of conception and history of renal disease increase the likelihood of a poor pregnancy outcome.

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

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

A pregnant woman with diabetes is having her glycosylated hemoglobin level evaluated. The nurse determines that the woman's glucose is under control and continues the woman's plan of care based on which result? 6.50% 8.00% 8.50% 7.50%

6.50% A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. A glycosylated hemoglobin level less than 7% indicates that the plan is working and should be continued.

A pregnant woman at 36 weeks' gestation comes to the care center for a follow-up visit. The woman is to be screened for group B streptococcus (GBS) infection. When describing this screening to the woman, the nurse would explain that a specimen will be taken from which area(s)? Select all that apply. Nasal cavity Rectum Conjunctiva Vagina Throat

Rectum Vagina According to Centers for Disease Control and Prevention guidelines, all pregnant women should be screened for GBS at 35 to 37 weeks' gestation and treated. Vaginal and rectal specimens are cultured for the presence of the bacterium. Specimens from the throat, nasal cavity, or conjunctiva are not used.

Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 130/86 mm Hg; week 20 - 138/88 mm Hg; week 24 - 136/82 mm Hg; and week 28 - 138/88 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure? Stage 1 Elevated Stage 2 Hypertensive crisis

Stage 1 Chronic hypertension exists when the woman has high blood pressure before pregnancy or before the 20th week of gestation, or when hypertension persists for more than 12 weeks. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (Joint National Committee [JNC 8], 2018) blood pressure guidelines classify hypertension as follows: elevated: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg; Stage 1: Systolic between 130 and 139 mm Hg or diastolic between 80-89 mm Hg; Stage 2: Systolic at least 140 mm Hg or diastolic at least 90 mm Hg; Hypertensive crisis: Systolic over 180 mm Hg and/or diastolic over 120 mm Hg (Alexander, 2019; Bakris, 2019). The client has stage 1 hypertension.

A pregnant woman who is HIV-positive comes to the labor and birth unit in labor. When developing the plan of care for this client, which intervention would be most important for the nurse to include? preparing the woman for cesarean birth educating her about family planning adhering to standard precautions helping her choose a newborn feeding method

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

A nurse is conducting a presentation about prenatal care and preexisting maternal conditions. When discussing the various risks to the mother and infant, the nurse would include information about which condition as the leading cause of intellectual disability in the United States? pregnancy category X medications genetic anomalies maternal drug addiction fetal alcohol spectrum disorder

fetal alcohol spectrum disorder Fetal alcohol spectrum disorder is a lifelong yet completely preventable set of physical, mental, and neurobehavioral birth defects. It is the leading cause of intellectual disability in the United States.

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. hemoptysis anorexia fatigue weight gain night sweats

hemoptysis anorexia fatigue night sweats Women emigrating from developing countries are at high risk for tuberculosis. Clinical manifestations include fatigue, fever or night sweats, nonproductive cough, weakness, slow weight loss, anemia, hemoptysis, and anorexia.

The nurse is teaching a pregnant woman with iron deficiency anemia about foods high in iron. Which foods if selected by the woman indicate a successful teaching program? Select all that apply. potatoes peanut butter yogurt corn broccoli raisins

peanut butter broccoli raisins Foods high in iron include dried fruits such as raisins, whole grains, green leafy vegetables such as broccoli and spinach, peanut butter, and iron-fortified cereals. Potatoes and corn are high in carbohydrates. Yogurt is a good source of calcium.

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

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

A pregnant woman tests positive for tuberculosis (TB). The nurse explains to the woman that additional tests are needed to confirm the diagnosis. When describing these tests, which one(s) would the nurse likely include? Select all that apply. Whole-body CT scan Sputum culture Spirometry Chest x-ray Abdominal ultrasound

Sputum culture Chest x-ray If a TB screening test is positive, the woman will need a follow-up chest x-ray with lead shielding over the abdomen, as well as sputum cultures to confirm the diagnosis. A whole-body CT scan, spirometry, or abdominal ultrasound are not used to confirm the diagnosis.

A pregnant woman with chronic hypertension comes to the clinic for evaluation. The last several blood pressure readings have been gradually increasing. On today's visit her blood pressure is 166/100 mm Hg. The health care provider prescribes an antihypertensive agent. The nurse anticipates which agent as likely to be prescribed? ipratropium albuterol hydroxychloroquine labetalol

labetalol Medications used to treat chronic hypertension with pregnancy include labetalol hydrochloride (Trandate), hydralazine hydrochloride (Apresoline), and nifedipine (Procardia). Hydroxychloroquine would be used to treat rheumatoid arthritis. Albuterol and ipratropium would be used to treat asthma.

The nurse is providing care to a neonate whose mother has heroin use disorder. The nurse suspects that the neonate is experiencing neonatal abstinence syndrome based on which finding? sneezing hypotonicity vigorous sucking easy consolability

sneezing Newborns of mothers with heroin or other narcotic use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

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? vigorous sucking easy consolability low, feeble cry hypertonicity

hypertonicity Newborns of mothers with heroin or other narcotic use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

Cytomegalovirus infection can result in different congenital anomalies. It can also be transmitted via different routes. When discussing this infection with a pregnant woman, the nurse integrates understanding that permanent fetal disability can occur with which type of transmission of CMV? during birth transmission in utero transmission after birth transmission with any transmission

in utero transmission There are three time periods during which mother-to-child transmission can occur; however, permanent disability occurs only in association with in utero infection. Such disability can result from maternal infection during any point in the pregnancy, but more severe disabilities are usually associated with maternal infection during the first trimester.

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

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

A woman comes to the clinic for her first prenatal visitation. As part of the assessment, the woman is screened for rubella antibodies. The nurse determines that a client has immunity against rubella based on which rubella titer? 01:00:00 01:04:00 01:06:00 01:08:00

01:08:00 A rubella antibody titer of 1:8 or greater proves evidence of immunity. Women with titers of less than 1:8 should be immunized.

A pregnant client has tested positive for HIV using an enzyme-linked immunoassay (ELISA) test. When talking with the client about the results, she asks, "So what happens next?" Which response by the nurse would be appropriate as the next step? "You will need to have an amniocentesis to check on the baby." "You will need to have another test to confirm the diagnosis." "First you will get treated with antibiotics and then antiviral medicines." "You will need testing for other infections like gonorrhea or syphilis."

"You will need to have another test to confirm the diagnosis." The client with a reactive screening test, such as the ELISA test, needs to be prepared for an additional test, such as the Western blot or an immunofluorescence assay. The Western blot is the confirmatory diagnostic test. A positive antibody test confirmed by a supplemental test indicates that the client has been infected with HIV and can pass it on to others. Antiviral therapy and testing for other sexually transmitted infections will be done, but the diagnosis must be confirmed first. Antibiotics are not used for HIV. Also amniocentesis is to be avoided to prevent contamination of the amniotic fluid with maternal blood.

A woman with diabetes is in labor. To promote optimal outcomes for the mother and neonate, the nurse monitors the client's blood glucose level closely ensuring that it is maintained below which level? 120 mg/dL 110 mg/dL 130 mg/dL 150 mg/dL

110 mg/dL For the laboring woman with diabetes, the blood glucose levels are monitored every 1 to 2 hours with the goal to maintain the levels below 110 mg/dL throughout the labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level.

A pregnant woman with diabetes is having a glycosylated hemoglobin (HbA1C) level drawn. Which result would require the nurse to revise the client's plan of care? 8.50% 6.00% 7% 5.50%

8.50% A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. Therefore, the nurse would need to revise the plan of care.

A new young mother has tested positive for HIV. When discussing the situation with the client, the nurse should advise the mother that she should avoid which activity? cesarean birth breastfeeding handling the infant with open sores future pregnancies

breastfeeding Breastfeeding is a major contributing factor for mother-to-child transmission of HIV. Cesarean birth before the onset of labor and/or rupture of membranes can greatly reduce the chance of transmitting the infection to the infant. Future pregnancies should be discussed and decided on an individual basis. Proper treatment of any open wounds and education should be provided to the mother to ensure she reduces the chance of transmitting HIV to her infant.

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: fiber-rich foods. tea. citrus juice. coffee.

citrus juice. Iron absorption is enhanced when taken with foods high in vitamin C, such as citrus juice. The nurse should advise patients to avoid consuming milk, antacids, high-fiber foods, and caffeine for 2 hours after taking iron for superior absorption.

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 macrosomia hypoglycemia birth trauma

hyperglycemia Gestational diabetes is associated with either neonatal complications such as macrosomia, hypoglycemia, and birth trauma or maternal complications such as preeclampsia and cesarean birth.

A pregnant client has a history of asthma. After reviewing the possible medications that may be prescribed during her pregnancy to control her asthma, the nurse determines additional teaching is needed when the client identifies which drug as being used? ipratropium albuterol salmeterol misoprostol

misoprostol Pharmacologic agents used to treat asthma in pregnancy fall into two categories: rescue agents and maintenance agents. Rescue agents provide immediate symptomatic relief by reducing acute bronchospasm. Agents used in this category include albuterol and ipratropium. Maintenance agents, by contrast, reduce the inflammation that leads to bronchospasm. Agents used in this category are inhaled steroids. Common ones prescribed include beclomethasone and salmeterol. Misoprostol is a prostaglandin that is used for treating postpartum hemorrhage but is contraindicated with asthma clients due to the risk of bronchial spasm and bronchoconstriction.

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

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

A nurse is conducting a class for a group of pregnant women about ways to minimize the risk of infection during pregnancy. One of the infections that the nurse is discussing is toxoplasmosis. The nurse determines that the class was successful when the group identifies which action(s) as helpful in preventing this infection. Select all that apply. "It is important to cook any meat that we will eat to at least a temperature of 145°F (62.8°C)." "It is important to wear gardening gloves when digging in the soil." "A house cat should be kept outside to prevent bringing things inside the house." "Any cutting surface used for raw meats should be washed afterwards with hot, soapy water." "Peeling any raw vegetables is a good idea before eating them."

"It is important to wear gardening gloves when digging in the soil." "Any cutting surface used for raw meats should be washed afterwards with hot, soapy water." "Peeling any raw vegetables is a good idea before eating them." Pregnant women should do the following to prevent toxoplasmosis: avoid eating raw or undercooked meat, especially lamb or pork. Cook all meat to an internal temperature of 160°F (71°C) throughout; clean cutting boards, work surfaces, and utensils with hot, soapy water after contact with raw meat or unwashed fruits and vegetables, peel or thoroughly wash all raw fruits and vegetables before eating them; keep the cat indoors to prevent it from hunting and eating birds or rodents; and wear gardening gloves when in contact with outdoor soil.

A pregnant woman with gestational diabetes is prescribed 10 units of an intermediate-acting insulin and 5 units of a short-acting insulin each day. The total dose is to be divided into two injections, a morning and an evening dose. To provide the most effective control of the woman's blood glucose levels, the nurse anticipates that the client is likely to be prescribed how many total units for the morning dose? 10 12.5 5 7.5

10 The American College of Obstetricians and Gynecologists affirms the use of insulin as the first-line pharmacotherapy for gestational diabetes when medication is necessary to control blood glucose levels. Insulin, which does not cross the placenta, has historically been the medication of choice for treating hyperglycemia in pregnancy. Combining intermediate- and short-acting insulin yields the best result for most women. Two insulin doses are given daily with two-thirds of the total insulin in the morning to cover energy needs of the active day and one third at night. For this client, it would be a total of 10 units in the morning and 5 units at night.

A nurse is conducting a class for a local community clinic that has a large adolescent and young adult pregnant women population. The nurse is focusing on the effects of various substances on the fetus. The nurse determines that the class was successful when the group identifies which condition(s) as associated with cigarette smoking? Select all that apply. Cerebral palsy Macrosomia Cleft lip Sudden infant death syndrome (SIDS) Attention-deficit/hyperactivity disorder (ADHD)

Cerebral palsy Cleft lip Sudden infant death syndrome (SIDS) Attention-deficit/hyperactivity disorder (ADHD) Smoking increases the risk of spontaneous abortion, preterm labor and birth, fetal growth restriction, stillbirth, low fetal iron stores, and SIDS. Perinatal and childhood risks associated with mothers smoking during their pregnancies include increased risk of cleft lip and palate, clubfoot, asthma, middle ear infections, reduced head circumference, altered brain stem development, and cerebral palsy. Smoking is considered an important risk factor for low birth weight, SIDS, and cognitive deficits, especially in language, reading, and vocabulary, as well as poorer performances on tests of reasoning and memory. Researchers have also reported behavior problems, such as increased activity, attention-deficit/hyperactivity disorder (ADHD), impulsivity, opposition, and aggression.

A woman with cardiac disease has come to the office for prenatal counseling. Assessment supports the decision to caution the woman against pregnancy. The woman most likely fits the criteria for which functional risk classification? class I class III class IV class II

class IV A woman with class IV disease should avoid pregnancy because she has an extremely high risk of maternal mortality or severe morbidity. The pregnancy may put too much stress on the woman's body increasing her risk of serious complications or even death. For risk Class I, there is no detectable increased risk of maternal mortality and no increase or a mild increase in morbidity. For risk class II, there is a small increased risk of maternal mortality or moderate increase in morbidity; for class III, there is a significantly increased risk of maternal mortality or severe morbidity,