Chapter 20: Nursing Management of the Pregnancy at Risk

A woman comes to the clinic for her first prenatal visit. 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?

1:8 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 woman tests positive for HBV. Which of the following would the nurse expect to administer? A) HBV immune globulin B) HBV vaccine C) Acylcovir D) Valacyclovir

A

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?

CMV 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?

A nurse is providing care to several pregnant women at the clinic. The nurse would screen for group B streptococcus infection in a client at: A) 16 weeks' gestation B) 28 week' gestation C) 32 weeks' gestation D) 36 weeks' gestation

D) 36 weeks' gestation

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

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?

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.

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

microcephaly Signs that are likely to be present in the 10% of newborns who are symptomatic at birth include microcephaly, seizures, IUGR, hepatosplenomegaly, jaundice, and rash.

The nurse is caring for a 2-day-old newborn whose mother was diagnosed with cytomegalovirus during the first trimester. On which health care provider prescription should the nurse place the priority?

perform a hearing screen test Symptoms of CMV in the fetus and newborn, known as CMV inclusion disease, include hepatomegaly, thrombocytopenia, IUGR, jaundice, microcephaly, hearing loss, chorioretinitis, and intellectual disability. A hearing screen would be priority over monitoring growth and development because that will have to be done over an extended period of time. Urine and pulse are not important with this diagnosis.

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 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 group of nursing students are preparing a presentation for their class about measures to prevent toxoplasmosis. Which of the following would the students be least likely to include? Select all that apply. A) Washing raw fruits and vegetables before eating them B) Cooking all meat to an internal temperature of 140° F C) Wearing gardening gloves when working in the soil D) Avoiding contact with a cat's litter box.

B

A nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world? A) Rubella B) Hepatitis B C) Cytomegalovirus D) Parvovirus B19

C

A nurse is preparing a teaching program for a group of pregnant women about preventing infections during pregnancy. When describing measures for preventing cytomegalovirus infection, which of the following would the nurse most likely include? A) Frequent handwashing B) Immunization C) Prenatal screening D) Antibody titer screening

A

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.

"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. "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 postpartum mother has the following lab data recorded: a negative rubella titer. What is the appropriate nursing intervention?

Administer rubella vaccine before discharge. Rubella is a virus, which when contracted during pregnancy has significant complications for the fetus. The illness is mild to the adult but can result in the infant being born deaf and blind. There is no cure; the CDC recommends all individuals be vaccinated against rubella. If the titer is negative, the mother does not have protection against rubella, and the next pregnancy would be at risk. She should receive the vaccination prior to discharge from the hospital. Assessing the rubella titer of the baby would not mean anything. The baby has not had rubella and has not received antibodies against rubella from the mother. Notifying the health care provider is not a priority, as most institutions have standing orders to administer the rubella vaccine if the mother's rubella titer is negative.

A young adult woman comes to the clinic for a routine check-up. During the visit, the woman who works in a day care facility tells the nurse that she and her partner are considering having a baby. "We are concerned that I might be exposed to common childhood illnesses." The woman undergoes testing and finds out that she is not immune from chickenpox. Based on this information, which information would the nurse give to the client?

"You will need to get vaccinated now and wait at least 1 months before getting pregnant" Preconception counseling is important for preventing chickenpox (varicella). A major component of counseling involves determining the woman's varicella immunity. Vaccination is the cornerstone of prevention. The vaccine is administered if needed. Varicella vaccine is a live attenuated viral vaccine. It should be administered to all adolescents and adults 13 years of age and older who do not have evidence of varicella immunity. Therefore, the woman should be vaccinated now before she becomes pregnant and then wait at least 1 month before getting pregnant. The varicella vaccine is contraindicated for pregnant women because the effects of the vaccine on the fetus are unknown. There is no need for the woman to quit her job once she is immunized nor does she need to take a leave of absence during the winter and spring months when the incidence is highest. Chickenpox does occur and is highly contagious. Maternal varicella can be transmitted to the fetus through the placenta, leading to congenital varicella syndrome if the mother is infected during the first half of pregnancy via an ascending aorta.