Chapter 16
Nursing care for women diagnosed with gestational diabetes includes which of the following? A) Encourage blood glucose control B) Counseling the patient on the need for cesarean birth C) Education for the women on life-long diabetic needs D) Referral for the infant to diabetic care after delivery
A
A woman with a positive history of genital herpes is in active labor. She has small pin-point vesicles in the perineum area. Her membranes are ruptured, she is dilated 5cm, effaced 70%. The nurse should anticipate what type of delivery? A) Spontaneous vaginal. C) Cesarean. B) Vacuum assisted. D) Forceps assisted.
C
A woman with a long history of controlled asthma has just had her first antenatal visit for her fourth child. She is late for a meeting and says she knows what to do. What is the best action the nurse can take? A) Remind her to continue taking her asthma medications, to monitor her peak flow daily, and to monitor the baby's kicks in the second and third trimesters. B) Acknowledge her need to leave but ask her to demonstrate the use of her inhaler and her peak flow meter before she goes; make any necessary corrections to her technique. Remind her to take her regular medications. C) Schedule an appointment for her to return to discuss her asthma management. D) Note in the chart that the woman was not counseled about her asthma.
b
A woman with Class II heart disease is in the third trimester of her pregnancy. She's been taking good care of herself and has had little difficulty, but to be on the safe side the obstetrician has ordered bed rest for her for the final month. For her own and the baby's safety, in what position should the nurse advise the patient to sleep? A) Lie flat on her back. B) Stay in high Fowler's position. C) Lie in a semirecumbent position. D) Use pillows and wedges to stay in a fully recumbent position.
c
A 32-year-old woman with epilepsy is having an annual checkup at her primary care physician's office. While the nurse is taking her blood pressure prior to the doctor's examination, the patient tells the nurse that she is thinking about getting pregnant and asks the nurse's advice. What is an appropriate answer for the nurse to give? A) "You should talk to the doctor about that; the medications you're on can damage the fetus." B) "Do you want to talk to a counselor who can help you weigh the pros and cons of having your own child rather than adopting?" C) "I'll let the doctor know so you can discuss your medications with her. In the meantime, I'll give you a list of folate-rich foods you can add to your diet. D) "That's great. I've got a 4-year-old and a 2-year-old myself."
c
A woman is pregnant and has asthma. Her physician has told her to continue taking prednisone during pregnancy, but she is concerned the drug may be teratogenic. What advice would be best to give her regarding this? A) Prednisone is considered safe in the doses prescribed by her physician. B) She should half her dose during the first 3 months of pregnancy. C) You would recommend she omit the drug during pregnancy. D) Prednisone is a teratogenic drug, but she may need it to control her asthma symptoms.
A
A woman who has sickle cell anemia asks you if her infant will develop sickle cell disease. The nurse would base the answer on which of the following? A) Sickle cell anemia is recessively inherited. B) Sickle cell anemia has more than one polygenic inheritance pattern. C) Sickle cell anemia is dominantly inherited. D) Sickle cell anemia is not inherited; it occurs following a malaria infection.
A
A woman with cardiac disease is 32 weeks gestation and alerts the nurse she has been having spells of light-headedness and dizziness every few days. The nurse provides which of the following interventions as an option to the patient? A) Decrease activity and rest more often. B) Increase fluids and take more vitamins. C) Bed rest and bathroom privileges only until delivery. D) The patient needs to discuss induction of labor with the physician.
A
Which of the following scenarios should the nurse follow up on as a potential indication of intimate partner violence? A) The partner of a pregnant woman attends each of her appointments. The partner is friendly and outgoing. Each time the nurse asks the patient a question, the partner answers. While the partner speaks, the patient looks at her lap. B) The partner of a pregnant woman attends each of her appointments. The partner is friendly and outgoing. Each time the nurse asks the patient a question the partner tries to answer. When the partner speaks, the patient interrupts and answers the question herself. The partner listens to the answer. C) The partner of a pregnant woman attends an ultrasound appointment. The partner is friendly and outgoing. When the technician reveals the patient's belly to apply the electrodes, the partner comments that the patient is really fat. The patient pulls at the partner's shirt and says the partner is fat too. They both laugh. D) The partner of a pregnant woman attends an ultrasound appointment. The partner is friendly and outgoing. The nurse notices bruises on the patient's upper arms and says they look sore. The patient says she's getting so big she keeps bumping into things. She maintains good eye contact with the nurse as she explains.
A
A 21-year old patient arrives at the prenatal clinical at 12 weeks gestation and has a positive STI. Which of the following should the nurse be aware of that would indicate the patient is at high-risk for non-compliance with treatment for the STI? A) Has a job and health insurance B) Noted to have history of substance abuse C) Lives with parents who are supportive of pregnancy D) Monogamous relationship with father of baby
B
A 43-year-old, physically fit, healthy woman who is newly married tells the nurse that she and her husband would like to have a child. What is an appropriate first response? A) "You must know that's pretty risky. Have you thought about adopting instead?" B) "Well, I'm sure you know there are some risks involved so it's helpful that you've been taking such good care of yourself." C) "You're in great shape now, but are you sure that at your age you'll have enough energy to care for a child?" D) "If you got pregnant now you'd be at risk for multiple fetal pregnancies, chromosomal abnormalities, spontaneous abortion, and hypertension among other things. Are you ready to take that risk?"
B
A postpartum mother has the following lab data recorded: a negative rubella titer. What is the appropriate nursing intervention? A) No action needed. B) Administer rubella vaccine before discharge. C) Assess the rubella of the baby D) Notify the health care provider.
B
A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which of the following statements would be the nurse's best answer? A) "She already has AIDS. That's what being HIV positive means." B) "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." C) "HIV is transmitted at birth; having a cesarean birth prevented transmission." D) "HIV antibodies do not cross the placenta; this means the baby will develop AIDS."
B
During prenatal care for the pregnant woman with class II heart disease, the nurse should be aware the most at risk time for this patient is during which of the following times of her pregnancy? A) First trimester C) Third trimester B) Second trimester D) All are at equal risk
B
Fourteen-year-old Ann and her parents have presented at the obstetrician's office in the second trimester, the teen had been hiding the pregnancy. The nurse is helping them develop a plan of care. What is the best thing she can say to the clearly angry parents? A) "Ann needs to make decisions about this pregnancy for herself." B) "I know you must be very upset and angry about Ann's pregnancy but because she's still an adolescent herself, she'll need your guidance in making nutritional and health choices that will be good for the baby and for herself." C) "Anger won't help this situation at all. You'll only push Ann away and she'll be less likely to make good choices." D) "I understand your anger but if you had encouraged Ann to use condoms she would probably not be in this situation."
B
The nurse is providing education to women who had diabetes prior to pregnancy. The nurse is discussing pregnancy-related complications from diabetes. Which of the following is a potential complication? A) Small for gestation age infant C) Post-term delivery B) Polyhydramnios D) Hypotension of pregnancy
B
With advanced maternal age there are increased risks for a fetus to have chromosomal or genetic defects. There is an increased risk of a fetus with trisomy 21, trisomy 18 and trisomy 13 and therefore the mother might be offered fetal genetic screening. Which of the following might be offered during the first trimester to the mother to determine if the fetus has a chromosomal abnormality? A) Amniocentesis C) Maternal Serum Alpha-fetoprotein B) Chorionic villus sampling D) Triple screening
B
Working with pregnant teenagers as a special population requires the nurse to have knowledge of adolescent development. Which of the following is crucial for a positive pregnancy and outcome for the mother and fetus? A) Cultural sensitivity C) Involvement of the father B) Support network D) Acceptance by peers
B
When educating a pregestational patient on how to control her blood sugar, the nurse knows there are three main facets to glycemic control: diet, exercise and _______. Which of the following is the third facet? A) Folic acid B) Niacin C) Insulin D) Glucose tablets
C
When providing education to a teenage prenatal class, the nurse states that infants born to teenage mothers are more likely to have which of the following? A) Genetic problems C) Low-birth weight B) Post-date delivery D) Lower mortality rates
C
A patient is 8 weeks gestation and is a type 1 diabetic. The health care provider has classified this patient as a high-risk pregnancy. To which of the following providers will the health provider send this patient? A) Nurse midwife C) Neonatologist B) Obstetrician/gynecologist D) Perinatologist
D
A pregnant single mom living alone tells the nurse she is considering getting a cat for her two year old daughter. Which is the best response by the nurse? A) The exposure to the cat litter may cause you to need a C-section B) This will cut down on the jealousy for your two year old when the baby comes C) If you don't think caring for a cat is too much work, that would be great D) You should wait until after you deliver to obtain the cat for your daughter
D
A woman develops gestational diabetes. Which of the following self-assessments should the woman be instructed to make daily? A) Test her urine for protein with a chemical reagent strip. B) Measure her abdominal diameter with a tape measure. C) Measure her uterine height by hand span distance. D) Measure serum for glucose level by a finger prick.
D
Ms. Wells is a 17-year-old primigravida at 37 weeks gestation, her blood sugar has not been well controlled. She is discussing her delivery options for the infant. The provider suspects the infant has macrosomia. Which of the following should the nurse anticipate? A) Schedule induction of labor today. B) Allowing her to continue without plans for delivery. C) Schedule cesarean delivery at 39 weeks. D) Prepare for amniocentesis and assessment of fetal lung maturity.
D
The nurse explains to a pregnant client that she will need to take iron during her pregnancy after being diagnosed with iron-deficiency anemia. The nurse suggests that absorption of the supplemental iron can be increased by taking it with which of the following? A) Meals high in iron B) Milk C) Legumes D) Orange juice
D
The nurse is helping an indigent HIV-positive pregnant patient set up a postdelivery care plan for her baby. What is an appropriate question/statement during that discussion? A) "You understand that you can't breast-feed, right? Even though formula's expensive, you'll need to figure out a way to get it." B) "You're not planning to breast-feed are you? That would be dangerous for the baby." C) "HIV can be passed to the baby from breast-feeding so it's important that you give the baby formula. You probably can't afford formula can you?" D) "HIV can be passed to the baby from breast-feeding so it's important that you give the baby formula. Formula's pretty expensive so I'll give you some information for places you can contact if you ever need some help getting it."
D
Which of the following is recommended to prevent transmission of HIV to a newborn if the mother has AIDS? A) Avoid scalp electrodes for internal fetal monitoring. B) Admit infant to NICU after delivery. C) Perform amniotomy. D) Prepare for cesarean delivery.
D
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 complaining of 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? A) 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 her iron supplement. B) Continue taking iron supplements but increase fluids and high-fiber foods; exercise more. C) Increase her iron supplements, fluid intake, and consumption of high-fiber foods; exercise more. D) Take her iron supplement every other day, increase fluid intake and consumption of high-fiber foods; exercise more.
b
In working with a pregnant woman who now weighs 55 kg and has developed gestational diabetes mellitus, how much should the nurse recommend that the patient eat? Approximately A) 900 kcals of carbohydrates, 330 kcals of protein, and 415 kcals of fat each day in three meals B) 900 kcals of carbohydrates, 330 kcals of protein, and 415 kcals of fat each day in three meals and three snacks C) 700 kcals of carbohydrates, 165 kcals of protein, and 210 kcals of fat each day in three meals D) 700 kcals of carbohydrates, 165 kcals of protein, and 210 kcals of fat each day in three meals and three snacks
b
While the nurse is weighing a pregnant woman at a regularly scheduled OB visit, the patient complains of vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. She says this is her first pregnancy and she didn't know this was what happened. What can the nurse tell her? A) This is not normal for pregnancy but the doctor might test her for a simple yeast infection. If it is a yeast infection, it can be treated with a single-dose suppository that will not harm the fetus. Remind the patient that she should call immediately if she has any symptoms that don't seem normal to her. B) This is not normal for pregnancy; the doctor might test her for chlamydia. If it is chlamydia, she and her partner can be treated with a 7-day course of antibiotics. Remind the patient that she should call immediately if she has any symptoms that don't seem normal to her. C) This is not normal for pregnancy; the doctor might test her for trichomoniasis. If it is trichomoniasis, she can be treated with an oral dose of metronidazole. Remind the patient that she should call immediately if she has any symptoms that don't seem normal to her. D) This is not normal for pregnancy; the doctor might test her for gonorrhea. If it is gonorrhea, she and her partner will be treated with antibiotics; they might be treated with different medications because some antibiotics normally used to treat gonorrhea are damaging to the fetus. Remind the patient that she should call immediately if she has any symptoms that don't seem normal to her.
c