Ch. 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations

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? "The exposure to the cat litter may cause you to need a C-section." "You should wait until after you give birth to obtain the cat for your daughter." "If you don't think caring for a cat is too much work, that would be great." "This will cut down on the jealousy for your two-year-old when the baby comes."

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

A pregnant woman with diabetes is having a glycosylated hemoglobin (HgbA1C) level drawn. Which result would require the nurse to revise the client's plan of care? 5.5% 8.5% 7% 6.0%

8.5%

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? Schedule an appointment for her to return to discuss her asthma management. Note in the chart that the woman was not counseled about her asthma. 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. Remind her to continue taking asthma medications, to monitor peak flow daily, and to monitor the baby's kicks in the second and third trimesters.

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.

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? Inject a bolus of insulin. Add a bolus of long-acting insulin. Eat a high-carbohydrate snack. Eat a sustaining-carbohydrate snack.

Eat a sustaining-carbohydrate snack.

A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? antibiotics antihypertensive drugs diuretic drugs IV fluids

IV fluids

A nurse is documenting a dietary plan for a pregnant client with pregestational diabetes. What instruction should the nurse include in the dietary plan for this client? Include more dairy products in the diet. Eat at least one egg per day. Eat only two meals per day. Include complex carbohydrates in the diet.

Include complex carbohydrates in the diet.

The nurse is assessing a mother who just delivered a 7 lb (3136 g) baby via cesarean delivery. Which assessment finding should the nurse prioritize if the mother has a history of controlled atrial fibrillation? Jugular distention Abdominal cramps Nausea and vomiting Urinary retention

Jugular distention

A pregnant woman diagnosed with diabetes should be instructed to perform which action? Discontinue insulin injections until 15 weeks gestation. Prepare foods with increased carbohydrates to provide needed calories. Ingest a smaller amount of food prior to sleep to prevent nocturnal hyperglycemia. Notify the primary care provider if unable to eat because of nausea and vomiting.

Notify the primary care provider if unable to eat because of nausea and vomiting.

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? Loud systolic murmur Repaired atrial septal defect Pulmonary hypertension Secondary hypertension

Pulmonary hypertension

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 limiting sodium intake inspecting the extremities for edema ensuring that the client consumes a high fiber diet

assessing for cardiac decompensation

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 neonatal laryngeal papillomas chickenpox deafness

blindness

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply. obesity maternal age less than 18 years genitourinary tract abnormalities previous large-for-gestational-age (LGA) infant hypertension

obesity previous large-for-gestational-age (LGA) infant hypertension

A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn? microcephaly clubbed fingers and toes bicuspid valve stenosis hypertension

microcephaly

A pregnant client has developed iron-deficiency anemia and has been prescribed 200 mg of elemental iron per day. The nurse should encourage the client to take this medication with which substance? orange juice a full meal water milk

orange juice

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 consumption of a low-fat diet administration of immunoglobulins constipation prevention

avoidance of infection

Which change in insulin is most likely to occur in a woman during pregnancy? unavailable because it is used by the fetus less effective than normal enhanced secretion from normal not released because of pressure on the pancreas

less effective than normal

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: exercise for 1 to 2 hours each day to keep the blood glucose down. limit weight gain to 15 pounds during the pregnancy. check her blood sugars frequently and adjust insulin accordingly. begin oral hyperglycemic medications along with the insulin she is currently taking.

check her blood sugars frequently and adjust insulin accordingly.

A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement? "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy." "A pregnant woman with a chronic illness can put the fetus at risk." "A pregnant woman does not have to worry about contracting new illnesses during pregnancy." "A pregnant woman with a chronic condition can put herself at risk."

"A pregnant woman does not have to worry about contracting new illnesses during pregnancy."

A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement? "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy."term-28 "A pregnant woman with a chronic illness can put the fetus at risk." "A pregnant woman with a chronic condition can put herself at risk." "A pregnant woman does not have to worry about contracting new illnesses during pregnancy."

"A pregnant woman does not have to worry about contracting new illnesses during pregnancy."

A pregnant client is diagnosed with syphilis. Which response would demonstrate respect for the client and therapeutic communication? "Why didn't you use protection when having intercourse with your partner?" "I noticed that you seem fidgety. Is there something wrong besides your STI?" "I am sure it is frightening to you to be diagnosed with a disease that can affect your baby." "You should have thought about what diseases you could be exposed to. At least you are HIV negative."

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

A nurse is talking to a newly pregnant woman who had a mitral valve replacement in the past. Which statement by the client reveals an understanding about the preexisting condition? "I understand that my fetus and I both are at risk for complications." "I don't have to worry about this because I had the problem fixed before I became pregnant." "I know I will be fine, but I worry about the fetus." "I know my baby will be fine, but I am worried about having a personal complication."

"I understand that my fetus and I both are at risk for complications."

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or during the birth for the infant. Which statement by the mother indicates that further teaching is needed by the nurse? "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born." "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day." "My baby may be very large and I may need a cesarean birth to have him." "If my blood sugars are elevated, my baby's lungs will mature faster, which is good."

"If my blood sugars are elevated, my baby's lungs will mature faster, which is good."

A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer? "HIV antibodies do not cross the placenta; this means the baby will develop AIDS." "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." "HIV is transmitted at birth; having a cesarean birth prevented transmission." "She already has AIDS. That's what being HIV positive means."

"The antibodies may be those transferred across the placenta; the baby may not develop AIDS."

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? 8.5% 8.0% 6.5% 7.5%

6.5%

A 38-year-old client comes into the office for prenatal care, stating that she is about 12 weeks' pregnant with her first child. What action will the nurse take, considering the client's age and potential sensitivity to being labeled an "older" primipara? Ask about chronic illnesses that the health care provider should know about due to the client being older. Offer genetic counseling and an early amniocentesis to determine if termination is needed. Inquire about any family history of chromosomal abnormalities since older women are more likely to have infants with a chromosomal defect. Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore.

Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore.

Between her regularly scheduled visits, a woman in her first trimester of pregnancy who is taking iron supplements for anemia calls the nurse at her obstetrician's office reporting constipation. She reports that she has never had this problem before and asks for some advice about how to get relief. What is the best advice the nurse can give her? Increase the iron supplements, fluid intake, and consumption of high-fiber foods; exercise more. Continue taking iron supplements but increase fluids and high-fiber foods; exercise more. Take the iron supplement every other day, increase fluid intake and consumption of high-fiber foods; exercise more. Stop taking iron supplements for a few days, exercise more, drink more fluids, eat high-fiber, low-iron foods until the constipation is relieved, then resume the iron supplement.

Continue taking iron supplements but increase fluids and high-fiber foods; exercise more.

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? Report any signs of possible urinary tract infection Maintain a daily blood glucose log Plan daily menus with dietitian Long-term therapy goals

Maintain a daily blood glucose log

A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize? Bed rest and bathroom privileges only until birth. Increase fluids and take more vitamins. Decrease activity and rest more often. Discuss induction of labor with the health care provider.

Decrease activity and rest more often.

A nurse caring for a pregnant client suspects substance use during pregnancy. What is the priority nursing intervention for this client? Determine how long the client has been using drugs. Determine if the client has emotional support. Provide education material on cessation of substance use. Obtain a urine specimen for a drug screening.

Obtain a urine specimen for a drug screening.

A woman develops gestational diabetes. Which assessment should she make daily? Measure her uterine height by hand-span distance. Test her urine for protein with a chemical reagent strip. Measure serum for glucose level by a finger prick. Measure her abdominal diameter with a tape measure.

Measure serum for glucose level by a finger prick.

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? Dried beans Dried apples Fortified grains Orange juice

Orange juice

The nurse is leading a discussion with a group of pregnant women who have diabetes. The nurse should point out which situation can potentially occur during their pregnancy? Postterm birth Polyhydramnios Hypotension of pregnancy Small-for-gestational-age (SGA) infant

Polyhydramnios

A pregnant client with diabetes in the hospital reports waking up with shakiness and diaphoresis. Which action should the nurse prioritize after discovering the client's fasting blood sugar is 60 mg/dl (3.33 mmol/L)? Recheck her blood sugar for accuracy. Stay with her, and ask another nurse to bring her insulin. Withhold her insulin, and notify the health care provider. Provide the client some milk to drink.

Provide the client some milk to drink.

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. Tell the adolescent that this is too big of a problem for her to make decisions about and she needs to listen to her mother. Recommend some adoption agencies for her to talk to in the near future. Contact the mother of the adolescent to be sure the child gets prenatal care.

Support her by respecting her right to privacy and confidentiality.

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? adhering to standard precautions preparing the woman for cesarean birth educating her about family planning helping her choose a newborn feeding method

adhering to standard precautions

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? ensuring that the client consumes a high fiber diet inspecting the extremities for edema limiting sodium intake assessing for cardiac decompensation

assessing for cardiac decompensation

The nurse is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize? dyspnea, crackles, and irregular weak pulse shortness of breath, bradycardia, and hypertension increased urinary output, tachycardia, and dry cough regular heart rate and hypertension

dyspnea, crackles, and irregular weak pulse

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? fetal alcohol spectrum disorder genetic anomalies pregnancy category X medications maternal drug addiction

fetal alcohol spectrum disorder

A nurse is caring for a 33-year-old primigravida client who is obese and near the end of their second trimester. The client has a history of prepregnancy obesity, hypertension, and smoking. Complete the following sentence(s) by choosing from the lists of options. The client is at highest risk for developing __________. The nurse provides discharge teaching to reduce the risks of developing this condition. Teaching should include __________.

gestational diabetes; change in lifestyle

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? hypoglycemia macrosomia birth trauma hyperglycemia

hyperglycemia

A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client? options for birth control in the future sexual development of the client whether sex was consensual knowledge of child development

knowledge of child development

A woman with an artificial mitral valve develops heart failure at the 20th week of pregnancy. Which measure would the nurse stress with her during the remainder of the pregnancy? obtaining enough rest beginning a low-impact aerobics program maintaining a high fluid intake discontinuing her prepregnancy anticoagulant

obtaining enough rest

During the assessment of a laboring client, the nurse learns that the client has cardiovascular disease (CVD). Which assessment would be priority for the newborn? urine output temperature respiratory function heart rate

respiratory function

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? hypertensive crisis stage 2 elevated stage 1

stage 1

What is the role of the nurse during the preconception counseling of a pregnant client with chronic hypertension? stressing the avoidance of dairy products stressing the increased use of Vitamin D supplements stressing regular walks and exercise stressing the positive benefits of a healthy lifestyle

stressing the positive benefits of a healthy lifestyle

The nurse is caring for a pregnant client who is in her 30th week of gestation and has congenital heart disease. Which finding should the nurse recognize as a symptom of cardiac decompensation with this client? swelling of the face dry, rasping cough elevated temperature slow, labored respiration

swelling of the face

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 mother's age the viral load amniocentesis results at 34 weeks' gestation prophylactic antiretroviral therapy (ART) to the infant at birth

the viral load

A nurse is performing an assessment on a new client. The woman estimates that she is approximately 16 weeks pregnant. While assessing her, the nurse asks her about apparent scratch marks on her hands, and she tells the nurse that she has three cats at home. What screening would be prescribed for this woman? herpes simplex virus hepatitis C toxoplasmosis cytomegalovirus

toxoplasmosis

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? parvovirus B19 toxoplasmosis herpes simplex virus cytomegalovirus

toxoplasmosis