N144 HESI Patient Review - Donna Prow

Question 9 of 12 Which of the following are TRUE with regard to maternal cocaine use and possible effects on the fetus/newborn? Select all that apply Cocaine is considered a teratogenic substance Cocaine use during pregnancy is associated with an increased incidence of stillbirth Cocaine use during pregnancy may cause the newborn to be hypoglycemic Cocaine use during pregnancy is associated with an increase in IUGR (intrauterine growth restriction) Psychomotor delays are more common in infants/children born to women who used cocaine during pregnancy

Cocaine is considered a teratogenic substance Cocaine use during pregnancy is associated with an increased incidence of stillbirth Cocaine use during pregnancy is associated with an increase in IUGR (intrauterine growth restriction) Psychomotor delays are more common in infants/children born to women who used cocaine during pregnancy Infants born to women who use drugs early in their pregnancy may be born with congenital anomalies. Although not conclusive, current research indicates that cocaine use is associated with central nervous system abnormalities, heart defects, and genitourinary anomalies. Additionally, these babies may be born with 'prune-belly' syndrome, in which the abdominal muscles fail to develop normally. Uterine blood flow is decreased by as much as 50% with cocaine use. Prolonged fetal hypoxia may lead to stillbirth. Infants of mothers who used cocaine during pregnancy remain at risk after birth for Sudden Infant Death Syndrome (SIDS). Uterine blood flow is decreased by as much as 50% with cocaine use. The availability of nutrients and oxygen is significantly reduced. Subsequently, cocaine users frequently give birth to small infants with intrauterine growth restriction (IUGR). Infants exposed to cocaine in utero may exhibit psychomotor and learning delays. At school age, a high rate of inattention and hyperactivity may be noted. The vasoconstrictive effects of cocaine reduce the availability of nutrients and oxygen to the developing fetus.

Donna admits to taking cocaine within the last few hours, as well as to drinking some beer and wine. Question 7 of 12 Which of the following considerations is important when planning pain relief measures for Donna? Donna may not really be in pain during contractions, but may desire drugs to satisfy her addiction Donna may develop an addiction to drugs administered during labor Donna's reaction to any administered drugs will require close monitoring With administration of drugs, Donna may become too sedated to cooperate with delivery

Donna's reaction to any administered drugs will require close monitoring Drug effects vary among individuals. As with any patient, response to any administered drug must be closely monitored. Given Donna's recent drug use, response to drugs may be especially variable. Psychomotor agitation and irritability associated with recent cocaine use may counter the effects of drugs intended to relax Donna and control her pain. Recent alcohol use may increase any sedative effects of administered drugs. Regional pain blocks such as epidural anesthesia are the preferred pain management modality for Donna.

Question 8 of 12 You take Donna's blood pressure, noting an elevated reading of 152/94. You recognize that: Donna may be developing preeclampsia Donna's recent cocaine use may be responsible for her elevated blood pressure Donna's recent drinking may be responsible for her elevated blood pressure Donna's high anxiety about her labor may be responsible for her elevated blood pressure Submit

Donna's recent cocaine use may be responsible for her elevated blood pressure High blood pressure, in the absence of proteinuria, and in the presence of known cocaine abuse, should be viewed as related to cocaine use. Cocaine is a central nervous system stimulant that precipitates tachycardia and vasoconstriction, with an elevated blood pressure, secondary to catecholamine release.

Question 10 of 12 What other fetal outcomes could be associated with prenatal cocaine use? Select all that apply Microcephaly Kernicterus Stroke Transient tachypnea of the newborn ABO incompatibility

Microcephaly Stroke The vasoconstrictive effects of cocaine reduce the availability of nutrients and oxygen to the developing fetus. Microcephaly can be associated with prenatal cocaine use. In microcephaly, the head is well-formed but small. It is accompanied by varying degrees of psychomotor retardation. Cocaine use in pregnancy, with subsequent changes in maternal blood pressure, can result in fetal strokes, secondary to hemorrhage or infarction. Developmental problems, poor coordination, and visual difficulties may occur as consequences of strokes in utero.

Baby Girl Prow will be closely observed. A thorough evaluation will be done by a pediatrician. Question 11 of 12 Baby Girl Prow may exhibit effects of Donna's recent cocaine use. The nurse caring for Baby Girl Prow can expect which of the following? Select all that apply Tachycardia Irritability Hypersomnia High-pitched cry Increased appetite Tachypnea

Tachycardia Irritability High-pitched cry Tachypnea Cocaine crosses the placental barrier and affects the fetus. After delivery, Baby Girl Prow can be expected to exhibit signs of central nervous system stimulation, including tachycardia. Cocaine crosses the placental barrier and affects the fetus. After delivery, Baby Girl Prow can be expected to exhibit signs of central nervous system stimulation, including irritability. Irritability should diminish over a 2-3 week period. Cocaine crosses the placental barrier and affects the fetus. After delivery, the newborn can be expected to exhibit signs of central nervous system stimulation. A high-pitched cry in a neonate or infant often characterizes central nervous system irritation and would be expected in Baby Girl Prow. Cocaine crosses the placental barrier and affects the fetus. After delivery, Baby Girl Prow can be expected to exhibit signs of central nervous system stimulation, including tachypnea. Cocaine crosses the placental barrier and affects the fetus. After delivery, Baby Girl Prow can be expected to exhibit signs of central nervous system stimulation, including a disturbed sleep pattern with easy wakefulness, not hypersomnia. Feeding difficulties are common in neonates who have experienced prenatal exposure to drugs, including cocaine. Baby Girl Prow can be expected to feed poorly, not have an increased appetite.

After delivery, Donna's blood pressure, which was monitored closely during the labor and delivery process, steadily moves to normal. Donna occasionally shows interest in her new baby, but prefers to have the nurses feed and change the baby. Question 12 of 12 patient review image The mother of a neonate with perinatal cocaine exposure is likely to experience difficulty in caring for and bonding with her infant. Which of the following is often the cause for this difficulty? The mother is overwhelmed with feelings of guilt for causing her baby's problems The newborn is too lethargic to respond effectively to the mother The infant exhibits irritability, disorganized behaviors, and is difficult to console

The infant exhibits irritability, disorganized behaviors, and is difficult to console The neonate of a substance abuser has a physiological addiction that causes irritability. The infant is also difficult to console. These behaviors interfere with bonding. Although the mother may have feelings of guilt about causing her baby's distress, this is not usually the cause of impaired bonding. Rather than being lethargic, cocaine-exposed neonates are irritable, with exaggerated reflexes, tremors, and other symptoms of CNS stimulation.

Question 2 of 12 To effectively evaluate the extent of Donna's substance abuse problems, which of the following should be determined? Select all that apply The names of drugs that are being used The frequency of drug use in any 24-hour period The amount of each drug being used The length of time Donna was hospitalized after the births of her children

The names of drugs that are being used The frequency of drug use in any 24-hour period The amount of each drug being used Drugs vary in their action and effect on the mother and fetus. The names of specific drugs being used must be known so that relevant care can be provided and related problems can be anticipated. The frequency of drug use is important to determine. More frequent drug use would suggest a greater physical dependence on drugs. It would also likely have a potentially greater effect on the fetus. For each drug, the amount being used is important to determine. With increased drug use, more and more drug is generally required to achieve the desired drug effect. This would reflect a greater physical dependence on the drug. Also, the more drug being used, the potentially greater effect on the fetus. While Donna may have had extended hospitalizations with previous births as a result of drug use, this information would not provide relevant data with regard to the current extent of Donna's drug problem.

Question 6 of 12 Which of the following is most important to determine at this time to plan for a safe labor and delivery? The duration of Donna's previous labors The reason for Donna's missing so many prenatal appointments The types, amounts, and times of last drug use The availability of any support persons

The types, amounts, and times of last drug use Specific details about Donna's most recent drug use are critical to determine. The possibilities of drug overdose or interaction must be considered as plans for pain control during labor are considered. Drugs administered for pain control during labor might potentiate the effects of other drugs taken prior to admission (synergistic drug effects). Possible fetal effects must also be anticipated. Drug metabolism and excretion will be prolonged in the baby, subsequent to immature liver and kidney function, and may persist through delivery and into the post-delivery period.

Question 1 of 12 Which of the following approaches would best facilitate getting more information about Donna's drug use and history? Telling Donna that drugs are harmful to her baby Showing your disapproval of drug use Using an accepting, nonjudgmental attitude Stating in a kind voice why she should not have gotten pregnant

Using an accepting, nonjudgmental attitude Being accepting and nonjudgmental, while actively listening, would facilitate disclosure, which is essential to your nursing assessment.

Question 3 of 12 You know that substance abuse during pregnancy can be associated with serious consequences. These include: Select all that apply lack of prenatal care poor maternal nutrition gestational diabetes teratogenic effects on the fetus maternal intolerance of the labor process postmaturity of the fetus increased incidence of sexually transmitted diseases

lack of prenatal care poor maternal nutrition teratogenic effects on the fetus maternal intolerance of the labor process increased incidence of sexually transmitted diseases Substance abusers often do not seek prenatal care, usually because they fear that their abuse will be discovered. Hence, optimal health of both mother and fetus is less likely to be assured. The lack of prenatal care may or may not result in serious consequences. Substance abusers are often malnourished, for a variety of reasons. Preoccupation with satisfying the physical craving for drugs can prevent the abuser from attending to her health. Money may be used to purchase drugs instead of the food necessary for a balanced prenatal diet. In addition, some drugs suppress appetite and alter metabolism. Poor nutrition during pregnancy may result in a low birth weight infant, and postpartal morbidity in mother and baby. Many drugs cross the placental barrier. Teratogenic effects (fetal deformities) are the most serious and enduring consequences of substance abuse during pregnancy. They range from being minor to life-threatening. Prolonged hospitalization is often required for the infant born with deformities. Substance abusers are often intolerant of pain and find the labor process difficult. Prematurity, not postmaturity, is common among pregnant women who are substance abusers. Prematurity generally requires prolonged hospitalization. Spontaneous abortion is also common when substance abuse exists. Postmaturity is associated with primiparity (first-time mothers) and grand-multiparity (four or more previous deliveries). It is not uncommon for substance abusers to barter sex for drugs, or engage in prostitution to get money for drugs. In addition, addiction clouds judgment, removes inhibitions, and prevents users from protecting themselves during sex or seeking medical treatment when signs of sexually transmitted diseases (STDs) are present. STDs may be transmitted to the fetus during pregnancy and/or delivery. They may be responsible for fetal death or premature delivery, and can cause a variety of fetal disabilities and deformities.

Question 5 of 12 You recognize that cocaine use in pregnancy puts Donna at risk for: Select all that apply myocardial infarction placenta previa stroke abruptio placentae gestational diabetes

myocardial infarction stroke abruptio placentae Cocaine is a potent vasoconstrictor. Arterial spasm associated with vasoconstriction can precipitate dysrhythmias and myocardial infarction. Cocaine is a potent vasoconstrictor. Arterial spasm associated with vasoconstriction can precipitate ischemic stroke. Cocaine is a potent vasoconstrictor. Arterial spasm associated with vasoconstriction can precipitate premature separation of the placenta (abruptio placentae). Placenta previa occurs when the placenta implants completely or partially over the cervix. Placental implantation occurs in the first month of pregnancy and is not associated with cocaine or other drug abuse. Cocaine is not associated with gestational diabetes.

Question 4 of 12 You determine that Donna practices polydrug abuse. This is defined as: the misuse of one drug repeatedly over a short period of time using more than one illegal drug simultaneously or sequentially to alter mood using more than one legal or illegal drug simultaneously or sequentially to alter mood the misuse of drugs by different routes

using more than one legal or illegal drug simultaneously or sequentially to alter mood Substance abuse includes the inappropriate use of both legal and illegal drugs. Inappropriately using two or more drugs, legal or illegal, simultaneously or in sequence (to cause a particular sensation), constitutes polydrug abuse.