Sherpath EAQ CH 11: High Risk Perinatal Care: Preexisting Conditions

Which nursing intervention would the nurse implement when assessing a patient with gestational diabetes? Select all that apply. One, some, or all responses may be correct. a. Tells the patient to follow a diabetic diet b. Explains the importance of exercising daily c. Demonstrates how to monitor blood glucose levels d. Tells the patient to not take any oral hypoglycemics e. Explains the effects of diabetes on the pregnancy and fetus

a, c, e

The nurse is teaching a woman with gestational diabetes the technique to inject insulin. Which will the nurse include in the teaching session? Select all that apply. One, some, or all responses may be correct. a. Inject insulin slowly. b. Aspirate before injecting. c. Clean injection site with alcohol. d. After injection, cover site with sterile gauze. e. Insert the needle at a 45- to 90-degree angle.

a, d, e

Which symptom is associated with systemic lupus erythematosus (SLE)? Select all that apply. One, some, or all responses may be correct. a. Fever b. Hyperactivity c. Hypotension d. Muscle aches e. Weight changes

a, d, e

Which information will the nurse tell a patient with gestational diabetes about the prescribed nonstress test (NST)? a. "The test is used to evaluate the fetus's well-being." b. "The test is used to evaluate the weight of your fetus." c. "The test is used to evaluate fetal cardiac anomalies." d. "The test is used to evaluate defects in the neural tube."

a. "The test is used to evaluate the fetus's well-being."

A patient who recently had a heart transplant with no evidence of rejection asks the nurse about the safety of conceiving a child. Which is the best response by the nurse? a. "You may conceive 1 year after the transplant." b. "A heart transplant does not tolerate pregnancy." c. "The newborn may have congenital heart disease." d. "You may need to terminate pregnancy at any time."

a. "You may conceive 1 year after the transplant."

The nurse is caring for a woman with mitral stenosis who is in the active stage of labor. Which action will the nurse take to promote cardiac function? a. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. b. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling. c. Encourage the woman to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function. d. Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics.

a. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics.

Which action will the nurse take to determine whether the carbohydrate intake is inadequate in a pregnant patient with diabetes? a. Monitor for urine ketones. b. Evaluate the nonstress test results. c. Determine the degree of glycosuria. d. Schedule a baseline fetal sonogram.

a. Monitor for urine ketones.

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 of type 2 diabetes mellitus

a. Previous birth of large infant

The prenatal medical record for a pregnant patient with gestational diabetes states that amniotic fluid phosphatidylglycerol is greater than 3%. Which would this result indicate? a. The fetal lung maturation is normal. b. The mother may develop hydramnios. c. There is a chance of fetal macrosomia. d. The mother is at risk for hypoglycemia.

a. The fetal lung maturation is normal.

Which is a metabolic change associated with pregnancy? Select all that apply. One, some, or all responses may be correct. a. Maternal insulin requirements increase during the first trimester. b. Maternal production of insulin increases during the first trimester. c. There is enough glucose for the fetus during the second trimester. d. Fasting blood glucose levels will decrease during the first trimester. e. The patient's tolerance to glucose increases in the second trimester.

b, c, d

Which intervention would the nurse implement to ease the labor process of a pregnant patient with heart disease? Select all that apply. One, some, or all responses may be correct. a. Use stirrups to facilitate an easy labor. b. Monitor the patient's oxygen saturation. c. Maintain a peaceful, calm environment. d. Place the patient in a side-lying position. e. Provide the patient with a relaxing back rub.

b, c, d ,e

Which test would the nurse evaluate to determine the health status of a patient with diabetes in the first few weeks of pregnancy? Select all that apply. One, some, or all responses may be correct. a. Nonstress fetal test b. Thyroid function test c. Urinalysis and culture d. 24-Hour urine collection e. Glycosylated hemoglobin Alc

b, c, d ,e

A patient with gestational diabetes tells the nurse, "I'm extremely worried that my child will be diabetic, too." Which action would the nurse take to alleviate the patient's anxiety? Select all that apply. One, some, or all responses may be correct. a. Evaluate the test results to assess fetal growth. b. Use therapeutic communication with the patient. c. Listen to the feelings and concerns of the patient. d. Provide factual information of risks to the patient. e. Ask the patient to share any fears with the nurse.

b, c, d, e

A pregnant woman in her first trimester with a history of epilepsy is transported to the hospital via ambulance after suffering a seizure. Which health care provider prescription would the nurse expect to be included in the plan of care? Select all that apply. One, some, or all responses may be correct. a. Valproate b. Abdominal ultrasounds c. Carbamazepine d. Serum laboratory levels of medications e. Prenatal vitamins with vitamin D

b, d, e

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. "Take iron supplements and T4 at different times."

How will the nurse advise the patient who has given birth to an infant with microcephaly in the past and is now planning for the next child? a. "There is a higher chance of having a preterm birth." b. "You should be screened for phenylketonuria (PKU)." c. "You must go for genetic counseling before conception." d. "There may be a miscarriage in your second pregnancy."

b. "You should be screened for phenylketonuria (PKU)."

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 six 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. Eat six saltine crackers or drink 8 oz of milk.

Which test would the nurse evaluate to understand the cause of fatigue, shortness of breath, and dyspnea in a pregnant patient? a. Nonstress test b. Electrocardiography c. 24-Hour urine collection d. Glycosylated hemoglobin

b. Electrocardiography

A patient is diagnosed with severe cardiac disease in the fourth week of pregnancy. Which would be the nurse's priority? a. Initiate fetal surveillance twice a week. b. Explain the risks of continuing pregnancy. c. Assess the patient for signs of heart failure. d. Tell the patient to end the pregnancy right away.

b. Explain the risks of continuing pregnancy.

Which instruction would the nurse include when teaching a pregnant woman with class lI heart disease? a. Advise her to gain at least 30 pounds. b. Instruct her to avoid strenuous activity. c. Inform her of the need to limit fluid intake. d. Explain the importance of a diet high in calcium.

b. Instruct her to avoid strenuous activity.

Which condition in a pregnant patient includes signs of fatigue, lethargy, glossitis, and rough skin? a. Thalassemia b. Megaloblastic anemia c. Iron-deficiency anemia d. Sickle cell hemoglobinopathy

b. Megaloblastic anemia

Which medication is administered to a pregnant patient to treat hyperthyroidism? a. Isotretinoin b. Methimazole c. Levothyroxine d. Sodium iodide 131

b. Methimazole

Which form of heart disease in women of childbearing years usually has a benign effect on pregnancy: a. Cardiomyopathy b. Mitral valve prolapse c. Rheumatic heart disease d. Congenital heart disease

b. Mitral valve prolapse

Which clinical finding in a pregnant patient will indicate proper fetal brain development? a. Hemoglobin Alc 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. Normal maternal thyroxine (T4) levels

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. Subtotal thyroidectomy

Which instruction would the nurse give to a pregnant patient with hyperthyroidism who often gets fatigued and weak because of nervousness and hyperactivity? a. "Ensure that you wear warm clothes." b. "Perform aerobic exercises every day." c. "Become involved in reading or a craft." d. "Avoid going out in the cold or at night."

c. "Become involved in reading or a craft."

Which would the nurse recommend to a pregnant patient with diabetes who works long, irregular hours? a. "Quit working for a while." b. "Eat a snack hourly when at work." c. "Keep fruits or fruit juice available." d. "Try taking naps when you are free."

c. "Keep fruits or fruit juice available."

The nurse is teaching a pregnant patient with diabetes mellitus about ways to prevent infant morbidity. Which is the most important aspect to include? a. "You must avoid exercise after meals." b. "Fetal growth needs to be checked monthly." c. "Your blood glucose levels must be in control." d. "You need to adhere to a strict ketogenic diet."

c. "Your blood glucose levels must be in control."

Which is the most important intervention that the nurse implements for a pregnant patient with uncorrected tetralogy of Fallot in the late third trimester of pregnancy? a. Monitor respiratory function. b. Monitor heart valve function. c. Apply pressure support hose. d. Assess pedal and radial pulses.

c. Apply pressure support hose.

Which is an important nursing intervention for a patient with pregestational diabetes mellitus during the first trimester? a. Encourage oral fluid intake. b. Increase the insulin dosage. c. Assess blood glucose levels. d. Prevent nausea and vomiting.

c. Assess blood glucose levels.

Which intervention will the nurse include while providing care for a pregnant patient with primary pulmonary hypertension (PPH)? a. Assess the heart valve function. b. Administer parenteral analgesia. c. Assess the patient's blood pressure. d. Place the patient in the supine position.

c. Assess the patient's blood pressure.

During pregnancy, alcohol withdrawal may be treated using which medication? a. Aminophylline b. Corticosteroids c. Benzodiazepines d. Disulfiram

c. Benzodiazepines

When do the severity of symptoms in a pregnant asthmatic patient usually peak? a. In the first trimester b. Immediately postpartum c. Between 17 to 24 weeks of gestation d. During the last 4 weeks of pregnancy

c. Between 17 to 24 weeks of gestation

Which information would the nurse teach a patient with phenylketonuria (PKU) about breastfeeding? a. "You should breastfeed your child every 3 to 4 hours." b. "Eat a phenylalanine-restricted diet for breastfeeding. " c. "Eat wheat products immediately after breastfeeding." d. "You should bottle-feed, because it is not safe to breastfeed."

d. "You should bottle-feed, because it is not safe to breastfeed."

Thalassemia is a relatively common anemia in which what occurs? a. Folate deficiency occurs. b. There are inadequate levels of vitamin B12. c. Red blood cells have a normal life span but are sickled in shape. d. An insufficient amount of hemoglobin is produced to fill the red blood cells.

d. An insufficient amount of hemoglobin is produced to fill the red blood cells.

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. Cardiac decompensation

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes mellitus (GDM). Which education is important for this woman understand? a. Glucose levels are monitored by testing urine four times a day and at bedtime. b. Dietary modifications and insulin are both required for adequate treatment. c. Oral hypoglycemic agents should not be used if the woman is reluctant to give herself insulin. d. Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

d. Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

Which medication will the primary health care provider ask the nurse to administer in a vaginal delivery to a patient who has a history of a myocardial infarction (MI)? a. Oxytocin b. Diuretics c. Anticoagulant d. Epidural analgesia

d. Epidural analgesia

Which medication is preferred in the treatment of systemic lupus erythematosus (SLE) in a pregnant patient? a. Aspirin b. Corticosteroids c. Prednisone d. Hydroxychloroquine

d. Hydroxychloroquine

Arrange the steps in the order in which diabetic ketoacidosis (DA) develops in a pregnant patient. a. The stress hormones that cause impaired insulin action are secreted b. Osmotic diuresis results with volume depletion and cellular dehydration. c. The hepatic glucose production increases because of some infection. d. The buffering system is unable to compensate, and acidosis develops. e. The extra glucose and ketone bodies are released into the circulation. f. The fatty acids are mobilized from fat stores and enter the circulation.

1. c 2. a 3. f 4. e 5. d 6. b

Which intervention would the nurse implement while providing care for a pregnant patient with cystic fibrosis? Select all that apply. One, some, or all responses may be correct. a. Monitor the fetal movements. b. Assess for pulmonary infection. c. Encourage exposure to sunlight. d. Assess the patient's weight daily. e. Assess for vitamin A, D, E, or K deficiency.

a, b, d, e

Which will the nurse include in the plan of care of a patient with a cardiac disorder during the postpartum period? Select all that apply. One, some, or all responses may be correct. a. Monitor oxygen saturation levels. b. Place the newborn at the bedside. c. Put the patient on a full liquid diet. d. Teach the patient how to breastfeed. e. Have the patient talk to the newborn.

a, b, d, e

Which will the nurse inform a breastfeeding patient who is taking propylthiouracil for hyperthyroidism? a. "The medication is likely to decrease milk production." b. "Stop breastfeeding the child and start infant formula." c. "It can adversely affect the neonate's thyroid function." d. "Take the medication immediately after breastfeeding."

d. "Take the medication immediately after breastfeeding."

A pregnant patient with diabetes is prescribed aerobic exercise with resistance training, arm exercises, and a recumbent exercise bicycle. Which would the nurse instruct the patient to ensure optimal benefit from the exercise? Select all that apply. One, some, or all responses may be correct. a. "Do the prescribed exercises after meals." b. "Stop the exercises if you have uterine contractions." c. "Perform aerobic exercises for 10 minutes every day." d. "Increase exercise if there are signs of hypoglycemia." e. "Check glucose levels before, during, and after exercise."

a, b, e

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? Select all that apply. One, some, or all responses may be correct. a. Stillbirth b. Miscarriage c. Hypoglycemia d. Atrial septal defect e. Intrauterine growth restriction

a, b, e

Which would the nurse tell a pregnant patient with diabetes who asks about dietary management during pregnancy? Select all that apply. One, some, or all responses may be correct. a. "Eat meals at the same time every day." b. "You need a large carbohydrate snack at bedtime." c. "If you skip a meal, you should have a large snack." d. "You need to stay away from any aerobic exercise." e. "Remember to have more whole grains in your diet."

a, b, e

Which dietary supplement would the primary health care provider prescribe for a pregnant patient who takes anticonvulsant medications? Select all that apply. One, some, or all responses may be correct. a. Iron b. Vitamin K c. Folic acid d. Vitamin D e. Vitamin B12

a, c, d

Which condition is common in infants born to mothers with diabetes mellitus? Select all that apply. One, some, or all responses may be correct. a. Hypoglycemia b. Marfan syndrome c. Cephalhematoma d. Shoulder dystocia e. Brachial plexus palsy

a, c, d, e

Which nursing intervention is included in the plan of care of a pregnant patient with mitral stenosis? Select all that apply. One, some, or all responses may be correct. a. Restrict dietary sodium. b. Teach passive exercises. c. Assess respiratory status. d. Assess the echocardiogram. e. Place the patient on bed rest.

a, c, d, e

Which information would the nurse include in preconception counseling for a patient with Marfan syndrome who also presents with an aortic root diameter of more than 6 cm? Select all that apply. One, some, or all responses may be correct. a. "You may not be able to deliver the child vaginally." b. "It should be repaired before you become pregnant." c. "There is an increased chance of maternal mortality." d. "The newborn child may develop Marfan syndrome." e. "You should not even try to become pregnant at all.

a, b, c, d

Which would the nurse include in the plan of care of a pregnant patient with Eisenmenger syndrome? Select all that apply. One, some, or all responses may be correct. a. Assess for signs of fluid overload. b. Put on compression support hose. c. Use the prescribed oxygen therapy. d. Have the patient change positions slowly. e. Advise the patient to perform light physical exercises.

a, b, c, d

Which condition would the nurse ask the pregnant patient with a cardiac disorder to report immediately? Select all that apply. One, some, or all responses may be correct. a. Shortness of breath b. Palpitations and pain c. Hypoglycemia d. Onset of constipation e. Orthostatic hypotension

a, b, d

Which obstetric or medical complication is the pregnant patient with diabetes mellitus at risk? Select all that apply. One, some, or all responses may be correct. a. Hydramnios b. Preeclampsia c. Hypoglycemia d. Monilial vaginitis e. Brachial plexus palsy

a, b, c ,d

The nurse is informing the pregnant patient with a cardiac disorder about the dietary changes that are needed. Which will the nurse include in the teaching? Select all that apply. One, some, or all responses may be correct. a. "Include potassium-rich foods in the diet." b. "Increase your daily intake of dietary fiber." c. "Take iron and folic acid supplements daily." d. "Take the stool softener daily as prescribed." e. "Cut intake of dark-green leafy vegetables."

a, b, c, d

When providing preconception counseling, which instruction will the nurse give to a patient with diabetes mellitus? Select all that apply. One, some, or all responses may be correct. a. Inform the patient about the potential risks. b. Explain the need for frequent obstetrical visits. c. Instruct the patient about the expenses involved. d. Advise the patient to use effective contraception. e. Advise the patient against trying to conceive a child.

a, b, c, d

Which clinical test evaluates the health status of a pregnant patient who abuses substances? Select all that apply. One, some, or all responses may be correct. a. Meconium testing b. Complete blood count c. Tuberculosis screening d. Urine toxicologic testing e. Glycosylated hemoglobin Alc

a, b, c, d

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for which condition? Select all that apply. One, some, or all responses may be correct. a. Stillbirth b. Miscarriage c. Macrosomia d. Placental abruption e. Gestational hypertension

a, b, d, e

In planning for the care of a 30-year-old woman with pregestational diabetes, which does the nurse recognize as the most important factor affecting pregnancy outcome? a. The mother's age b. The amount of insulin required prenatally. c. The degree of glycemic control during pregnancy d. The number of years since diabetes was diagnosed

c. The degree of glycemic control during pregnancy

Which is the rationale for the nurse asking a pregnant patient with heart disease to document her daily weight? a. To monitor for heart failure b. To monitor nutritional intake c. To assess for fluid retention d. To assess for any weight loss

c. To assess for fluid retention