OB CH20 PREPU

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." Explanation: When a woman enters a pregnancy with a chronic illness, it can put both her and the fetus at risk. She needs to be cautious about developing a new illness during her pregnancy as well as having an accident during the pregnancy.

The nurse is assessing a pregnant client who has a long history of asthma treated with albuterol and montelukast. The client states, "I am trying not to use my asthma medications because I do not want my baby exposed to them." Which response should the nurse prioritize? "Your health care provider will likely agree with your decision." "In fact, most modern asthma medications are categorized as safe for use in pregnancy." "I am glad to hear that you are focused on ensuring your baby's health." "Actually, having uncontrolled asthma is much riskier for your baby than the medication."

"Actually, having uncontrolled asthma is much riskier for your baby than the medication." Explanation: The priority is for pregnant clients with asthma to keep taking their medications because the risks of exacerbations exceed the risks of the medications to both the client and fetus. Some medications used to treat asthma (short-acting inhaled bronchodilators, antileukotriene agents, some inhaled corticosteroids) have minimal to no effects on the pregnancy. The other statements would be inappropriate.

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?" "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." "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." Explanation: The nurse needs to be supportive, empathic and accepting of the client, asking open-ended questions and acting calm and reassuring to her. By acknowledging her fears for her fetus, the nurse is demonstrating respect for her and conveying confidence that the client is trying to take care of her fetus.

A nurse is teaching a woman diagnosed with gestational diabetes about meal planning and nutrition. The nurse determines that additional teaching is needed based on which client statement? "Having a bedtime snack is good for me." "I should get most of my calories from good complex carbs." "I need to avoid any fat with my meals." "It's okay to eat small meals or snacks throughout the day."

"I need to avoid any fat with my meals." Explanation: Recommendations for nutrition and diet with gestational diabetes include: eating three meals a day plus three snacks to promote glycemic control with 40% of calories from good-quality complex carbohydrates, 35% of calories from protein sources, and 25% of calories from unsaturated fats; eating small frequent feedings throughout the day; having bedtime snacks; and including protein and fat at each meal.

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction? "I need to be aware of my triggers and avoid them as much as possible." "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on." "It is fine for me to use my albuterol inhaler if I begin to feel tight."

"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." Explanation: A pregnant woman with a history of asthma needs to be proactive, taking her inhalers and other asthma medications to prevent an acute asthma attack. She needs to understand that it is far more dangerous to not take the medications and have an asthma attack. She also needs to monitor her peak flow for decreases, be aware of triggers, and avoid them if possible. However, a pregnant woman should never begin allergy shots if she has not been taking them previously, due to the potential of an adverse reaction.

A pregnant client with a history of asthma since childhood presents for a prenatal visit. What statement by the client alerts the nurse to perform further assessment? "I sometimes get a feeling of euphoria." "I sometimes get a bit wheezy." "I have trouble getting comfortable in bed." "Certain substances make me sneeze."

"I sometimes get a bit wheezy." Explanation: Wheezing is a classic symptom of asthma. This statement should alert the nurse to the possibility that the client's asthma is not being well-controlled and needs further evaluation and possible intervention. The other statements do not relate to the typical presentation of this disease in pregnancy nor are they cause for concern.

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 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."

"I understand that my fetus and I both are at risk for complications." Explanation: When a woman enters pregnancy with a preexisting condition, both she and her fetus can be at risk of developing 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? "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day." "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born." "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." Explanation: Elevated blood sugars delay the maturation of fetal lungs, not increase maturation time, resulting in potential respiratory distress in newborns born to mothers with diabetes. Doing fetal movement (kick) counts is standard practice, as is the possibility of an amniocentesis to determine lung maturity during the third trimester. Health care personnel should also prepare the mother for the potential of a cesarean birth if the infant is too large.

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? "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." "HIV antibodies do not cross the placenta; this means the baby will 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." Explanation: Infants born of HIV-positive women test positive for HIV antibodies at birth because these have crossed the placenta. An accurate disease status cannot be determined until the antibodies fade at about 18 months. Testing positive for HIV antibodies does not mean the infant has AIDS. Having a cesarean birth does decrease the risk of transmitting the virus to the infant at birth; it does not prevent the transmission of the disease. HIV antibodies do cross the placenta, which is why babies born of HIV positive mothers are HIV positive.

A nurse is caring for a 45-year-old pregnant client with a cardiac disorder who has been instructed by her primary care provider to follow class I functional activity recommendations. The nurse correctly instructs the client to follow which limitations? "It is important for you to rest after any physical activity in order to prevent any cardiac complications." "You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or shortness of breath." "It will be beneficial if you plan rest periods throughout your day." "You will need to be on bedrest for the remainder of your pregnancy."

"You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or shortness of breath." Explanation: Class I recommendations (no physical activity limitations) are suggested for clients who are asymptomatic and exhibit no objective evidence of cardiac disease. The functional classifications system consists of classes I to IV, based on past and present disability and physical signs resulting from cardiac disease.

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? "This will cut down on the jealousy for your two-year-old when the baby comes." "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."

"You should wait until after you give birth to obtain the cat for your daughter." Explanation: Toxoplasma gondii is a protozoan that can be transmitted via undercooked meat and through cat litter. Having a cat is not an issue, but cleaning the litter box may expose the mother to the infection and result in fetal anomalies. Exposure to the cat litter will not necessitate a cesarean section, and having a cat will not cut down on any jealousy the 2-year-old might feel when the new baby is born. The nurse would discourage the mother from getting cat until after the baby is born.

A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response? "I'll let your primary care provider know how you feel about it." "Your primary care provider will order safe doses of your medication." "It's OK to not use them if you would feel more comfortable." "They won't cause any major defects."

"Your primary care provider will order safe doses of your medication." Explanation: Women should take no medication during pregnancy except that prescribed by their primary care provider. The PCP will work with the mother to ensure the safest amount is given to adequately handle the mother's health issues and not injure the fetus. The PCP must weigh the risks against the benefits for both the mother and her fetus. The nurse should not encourage the client to stop her asthma medication as that may result in the client having an asthma attack, which could result in injury to the fetus or even miscarriage. The nurse should not tell the client a drug will not cause any defects, especially if it is known that it can. That could make the nurse liable for damages. The nurse should inform the PCP of the client's concerns; however, it is more important for the nurse to calm the client's anxiety and offer positive reinforcement that the PCP is working hard to protect the mother and infant from harm.

A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response? "I'll let your primary care provider know how you feel about it." "They won't cause any major defects." "Your primary care provider will order safe doses of your medication." "It's OK to not use them if you would feel more comfortable.

"Your primary care provider will order safe doses of your medication." Explanation: Women should take no medication during pregnancy except that prescribed by their primary care provider. The PCP will work with the mother to ensure the safest amount is given to adequately handle the mother's health issues and not injure the fetus. The PCP must weigh the risks against the benefits for both the mother and her fetus. The nurse should not encourage the client to stop her asthma medication as that may result in the client having an asthma attack, which could result in injury to the fetus or even miscarriage. The nurse should not tell the client a drug will not cause any defects, especially if it is known that it can. That could make the nurse liable for damages. The nurse should inform the PCP of the client's concerns; however, it is more important for the nurse to calm the client's anxiety and offer positive reinforcement that the PCP is working hard to protect the mother and infant from harm

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? 8% 12% 6% 14%

6% Explanation: The upper normal level of HbA1C is 6% of total hemoglobin.

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% 7.5% 6.5%

6.5% Explanation: A hemoglobin (glycosylated) level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. A glycosylated hemoglobin level less than 7% indicates that the plan is working and should be continued.

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? 6.0% 7% 5.5% 8.5%

8.5% Explanation: A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. Therefore, the nurse would need to revise the plan of care.

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% 6.0% 7% 8.5%

8.5% Explanation: A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. Therefore, the nurse would need to revise the plan of care.

A client is 33 weeks' pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled? 136 mg/dl 45 mg/dl 85 mg/dl 120 mg/dl

85 mg/dl Explanation: Recommended fasting blood glucose levels in pregnant clients with diabetes are 60 to 95 mg/dl. A fasting blood glucose level of 45 g/dl is low and may result in symptoms of hypoglycemia. A blood glucose level below 120 mg/dl is recommended for 2-hour postprandial values. A blood glucose level above 136 mg/dl in a pregnant client indicates hyperglycemia.

At 24 weeks' gestation, a client's 1-hour glucose tolerance test is elevated. The nurse explains that, based on this finding, the client will need to take which action? Monthly hemoglobin A1C levels to rule out diabetes A 3-hour glucose tolerance test for follow-up Daily fingersticks for a fasting blood glucose level Daily insulin injections for gestational diabetes

A 3-hour glucose tolerance test for follow-up Explanation: The 1-hour glucose tolerance test is a screening procedure. If the results are elevated, the client needs a 3-hour glucose tolerance test, which is diagnostic of gestational diabetes. Since this is only a screening test, no treatment for gestational diabetes, such as finger-sticks or insulin, is implemented until the 3-hour glucose tolerance test result determines if the client has gestational diabetes. An HgbA1C level does not rule out diabetes; it monitors average blood glucose level over an extended period of time.

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? Note in the chart that the woman was not counseled about her asthma. 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. Schedule an appointment for her to return to discuss her asthma management.

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. Explanation: Management of asthma during pregnancy is very important; the nurse must document that the client has the proper ability to manage her asthma for her health and the health of the fetus. Reminding the client to continue taking her prescribed medication and to monitor her peak flow daily is not enough. It is the nurse's responsibility to know that the client knows how to take her medications. Monitoring the baby's kicks in the second and third trimester is an appropriate action. Scheduling a return appointment to discuss asthma management is not appropriate. She could have an asthma attack between the time the nurse sees her and the time of the return appointment. Noting in the chart that the woman was not counseled does not relieve the nurse of his/her obligation to ensure that the woman knows how to use her inhaler and her peak flow meter.

A postpartum mother has the following lab data recorded: a negative rubella titer. What is the appropriate nursing intervention? No action needed. Administer rubella vaccine before discharge. Assess the rubella titer of the baby. Notify the health care provider.

Administer rubella vaccine before discharge. Explanation: 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 pregnant client is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. Which sign would indicate a positive test result? An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. An indurated wheal under 10 mm in diameter appears in 6 to 12 hours. A flat circumscribed area over 10 mm in diameter appears in 48 to 72 hours. A flat, circumscribed area under 10 mm in diameter appears in 6 to 12 hours.

An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. Explanation: A positive PPD result would be an indurated wheal over 10 mm in diameter that appears in 48 to 72 hours. The area must be a raised wheal, not a flat, circumscribed area.

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? Inquire about any family history of chromosomal abnormalities since older women are more likely to have infants with a chromosomal defect. Offer genetic counseling and an early amniocentesis to determine if termination is needed. Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore. Ask about chronic illnesses that the health care provider should know about due to the client being older.

Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore. Explanation: This client is pregnant for the first time later in life. The nurse must be supportive of this choice. Most women realize the increased risks for having giving birth after 35 years of age and do not need constant reminding of the potentially poor outcomes that can occur. The majority of pregnancies to women older than 35 years of age end with healthy newborns and mothers.

A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse? There is a good chance the infant will inherit the disease from the mother. Both parents have to carry the trait. The infant inherits the disease from the father. If the mother goes into a crisis while pregnant, the baby will develop sickle cell anemia.

Both parents have to carry the trait. Explanation: Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. If one parent has the disease and the other is free of the disease and trait, the chances of the child inheriting the disease is zero. The infant will not develop the disease just because the mother has a crisis during the pregnancy.

The nurse is assessing a 35-year-old woman at 22 weeks' gestation who has had recent laboratory work. The nurse notes fasting blood glucose 146 mg/dl (8.10 mmol/L), hemoglobin 13 g/dl (130 g/L), and hematocrit 37% (0.37). Based on these results, which instruction should the nurse prioritize? the signs and symptoms of urinary tract infection Include iron-enriched foods in the diet. Check blood sugar levels daily. Take daily iron supplements.

Check blood sugar levels daily. Explanation: An elevated blood glucose is concerning for diabetes. A fasting blood glucose level of greater than 140 mg/dl (7.77 mmol/L) or random level of greater than 200 mg/dl (11.10 mmol/L) is concerning; this must be followed up to ensure the client is not developing gestational diabetes. The hemoglobin and hematocrit are within normal limits for this client. The values should be hemoglobin greater than 11 g/dl (110 g/L) and hematocrit greater than 33% (0.33). Values lower than that are possible indications of anemia and would necessitate further evaluation. An individual with higher than normal blood glucose levels is at risk for developing urinary tract infection. This will usually happen after the glucose levels are elevated. Anemia can be treated by increasing the consumption of iron-enriched foods and taking a daily iron supplement.

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? Continue taking iron supplements but increase fluids and 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. Take the iron supplement every other day, increase fluid intake and consumption of high-fiber foods; exercise more. 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. Explanation: Constipation is a common side effect of iron supplementation. The diagnosis of anemia indicates a true need for the iron supplementation; she needs to increase fluid and fiber to relieve the constipation associated with the iron preparations. The nurse should not advise this client to stop taking her iron supplements, even for a few days. The nurse should not advise the client to increase her iron supplementation, nor take the supplements on an every other day basis. These supplements are ordered by the primary care provider based on the client's hematologic status.

A pregnant client with type 1 diabetes is in labor. The client's blood glucose levels are being monitored every hour and she has a prescription for an infusion of regular insulin as needed based on the client's blood glucose levels. Her levels are as follows: 1300: 105 mg/dL (5.83 mmol/L) 1400: 100 mg/dL (5.55 mmol/L) 1500: 120 mg/dL (6.66 mmol/L) 1600: 106 mg/dl (5.88 mmol/L) Based on the recorded blood glucose levels, at which time would the nurse likely administer the regular insulin infusion? 1500 1400 1300 1600

Correct response: 1500 Explanation: For the laboring woman with diabetes, intravenous (IV) saline or lactated Ringer's is given, and blood glucose levels are monitored every 1 to 2 hours. Glucose levels are maintained below 110 mg/dL (6.11 mmol/L) throughout labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level. The insulin infusion would be given at 1500, based on the blood glucose level being higher than 110 mg/dL (6.11 mmol/L).

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? Increase fluids and take more vitamins. Bed rest and bathroom privileges only until birth. Decrease activity and rest more often. Discuss induction of labor with the health care provider.

Decrease activity and rest more often. Explanation: If the client is developing symptoms associated with her heart condition, the first intervention is to monitor activity levels, decrease activity, and treat the symptoms. At 32 weeks' gestation, the suggestion to induce labor is not appropriate, and without knowledge of the type of heart condition one would not recommend an increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity.

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. Discuss induction of labor with the health care provider. Decrease activity and rest more often.

Decrease activity and rest more often. Explanation: If the client is developing symptoms associated with her heart condition, the first intervention is to monitor activity levels, decrease activity, and treat the symptoms. At 32 weeks' gestation, the suggestion to induce labor is not appropriate, and without knowledge of the type of heart condition one would not recommend an increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity.

A 20-year-old pregnant client is positive for hemoglobin S. The nurse explains to the client that she will need perform which actions during her pregnancy? Select all that apply. Be on bed rest. Eat high-protein meals. Drink lots of fluids. Avoid conditions of low oxygen tension, such as high altitudes.

Drink lots of fluids. Avoid conditions of low oxygen tension, such as high altitudes. Explanation: When oxygen tension becomes reduced, as occurs at high altitudes, or blood becomes more viscid than usual, such as occurs with dehydration, the cells of a client with hemoglobin S clump together because of their irregular shape, resulting in vessel blockage with reduced blood flow to organs. Drinking fluids and avoiding high altitudes will help to prevent this occurrence. High-protein meals and bed rest will have no effect.

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

Eat a sustaining-carbohydrate snack. Explanation: Because exercise uses up glucose, women with diabetes should take a sustaining-carbohydrate snack before hard exercise to prevent hypoglycemia.

A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control? Exercise Vitamin supplements Plenty of rest Oral hypoglycemic agents

Exercise Explanation: The three main facets to glycemic control for the woman with pregestational diabetes are diet, exercise, and insulin. An individual with type 1 diabetes uses insulin and not oral hypoglycemic agents. Vitamin supplements may assist with helping to keep the woman healthy but not necessarily through glycemic control. It will be important for the woman to get enough rest throughout the pregnancy but this will not assist with glycemic control.

The nurse is appraising the laboratory results of a pregnant client who is in her second trimester and notes the following: thyroid stimulating hormone (TSH) slightly elevated, glucose in the urine, complete blood count (CBC) low normal, and normal electrolytes. The nurse prioritizes further testing to rule out which condition? Preeclampsia Anemia Gestational diabetes Hyperthyroidism

Gestational diabetes Explanation: Glycosuria, glucose in the urine, may occur normally during pregnancy; however, if it appears in the urine, the client should be sent for testing to rule out gestational diabetes. Preeclampsia, anemia, and hyperthyroidism are not related to glucose nor to renal function. A slightly elevated TSH would indicate possible hypothyroidism instead of hyperthyroidism. Anemia would be indicated by below normal hematocrit. If the client's CBC is low normal than the nurse should monitor future results to ensure the client's counts are not dropping. It would also be appropriate for the nurse to investigate possible dietary issues. Preeclampsia would be best monitored by the blood pressure readings.

A nurse in the hospital is caring for a client at 37 weeks' gestation who experienced premature rupture of the membranes (PROM) more than 24 hours prior to coming to the hospital. The client presents with a fever of 100.4°F (38°C). Due to the client's PROM more than 24 hours prior to arriving to the hospital, the nurse determines the client is at risk for contracting (trichomoniasis, chlamydia, group B streptococcus, bacterial vaginosis). and should plan to implement (administer intravenous antibiotics, administer metronidazole, recommend including probiotics in their diet, request fluconazole for external use) to prevent complications.

Group B; Administer antibiotics Explanation: Group B streptococcus infection is a bacterial infection that can be transmitted to the fetus during labor. This can have cause serious complications to the newborn, including respiratory distress and sepsis. Group B streptococcus infection can be transmitted to the fetus during labor. The client is at risk for contracting group B streptococcus due to premature rupture of membranes (PROM) more than 24 hours prior to arriving at the hospital. The nurse will plan to administer intravenous antibiotics to the client prior to birth of the fetus. Chlamydia, trichomoniasis, and bacterial vaginosis are sexually transmitted infections (STIs). Unlike group B streptococcus infection, these infections are not transmitted to the fetus during labor. As STIs, the client is not at risk for contracting these infections because of PROM. Metronidazole is an anti-infective that is used to treat bacterial vaginosis, not group B streptococcus. Probiotics are used to maintain natural flora in the gastrointestinal (GI) system, not to treat group B streptococcus. Fluconazole is used to treat vaginal candidiasis, not group B streptococcus infections.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? Hemoglobin of 13 g/dl (130 g/L) or lower Blood pressure of 100/68 mm Hg Heart rate of 84 beats/min Hematocrit of 32% or less

Hematocrit of 32% or less Explanation: Iron-deficiency anemia is diagnosed in a pregnant woman if the hematocrit is less that 33% or the hemoglobin is less than 11 g/dl (110 g/L). Tachycardia, hypotension, and tachypnea are all symptoms of iron-deficiency anemia but are not diagnostic criteria.

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

IV fluids Explanation: A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and IV fluids. Antihypertensive drugs usually aren't necessary. Diuretics would not be used unless fluid overload resulted. The client would be given antibiotics only if there were evidence of an infection.

An infant is born to a mother with gestational diabetes. Which long-term maternal complication is associated with this diagnosis? Heart disease Weight gain that is not lost after the pregnancy Development of long-term hypertension Increased risk of development of type 2 diabetes

Increased risk of development of type 2 diabetes Explanation: A mother who had gestational diabetes is at a 30% to 50% higher risk of developing type 2 diabetes mellitus than the general population. Long-term hypertension and heart disease are not associated with gestational diabetes, nor is weight gain following pregnancy. There is no data that validates long-term weight gain as a complication of gestational diabetes.

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? Abdominal cramps Nausea and vomiting Urinary retention Jugular distention

Jugular distention Explanation: A woman who has a cardiac condition is at increased risk in the postpartum period. The most important nursing action is to monitor for signs of cardiac decompensation. The nurse should monitor for and report jugular distention, clubbing, and slow capillary refill time. If an irregular pulse is noted, compare it to the apical pulse. The abdominal cramps may be related to the uterus involution. The nausea and vomiting and urinary retention may be related to the surgical procedure and not necessarily the cardiac issue.

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

Maintain a daily blood glucose log Explanation: Control of the blood glucose throughout the pregnancy is the primary goal to help decrease potential complications to both the mother and fetus. The mother should keep a daily log of her blood glucose levels and bring this log to each visit for the nurse to evaluate. The other choices of reporting possible signs of a UTI and working with a dietitian to plan menus would also be important but would be secondary to the blood glucose control. It would be inappropriate to discuss long-term goals at this time. This would be handled at a later time and would depend on the mother's situation.

What important instruction should the nurse give a pregnant client with tuberculosis? Wear light, cotton clothes. Avoid red meat. Avoid direct sunlight. Maintain adequate hydration.

Maintain adequate hydration. Explanation: The nurse should instruct the pregnant client with tuberculosis to maintain adequate hydration as a health-promoting activity. The client need not avoid direct sunlight or red meat, or wear light clothes; these have no impact on the client's condition.

A pregnant woman diagnosed with diabetes should be instructed to perform which action? Prepare foods with increased carbohydrates to provide needed calories. Discontinue insulin injections until 15 weeks gestation. Notify the primary care provider if unable to eat because of nausea and vomiting. 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. Explanation: During pregnancy, the insulin levels change in response to the production of HPL. The client needs to alert her provider if she is not able to eat or hold down appropriate amounts of nutrition. The client is at risk for episodes of hypoglycemia during the first trimester. She should never discontinue insulin therapy without her provider's directions. The increase of carbohydrates needs to be balanced with protein, and smaller meals would result in hypoglycemia rather than hyperglycemia.

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

Obtain a urine specimen for a drug screening. Explanation: Substance use during pregnancy is associated with preterm labor, spontaneous abortion (miscarriage), low birth weight, central nervous system and fetal anomalies, and long-term childhood developmental consequences. It is most important to know what the client is taking in order to provide the best care for the client and newborn.

A woman with known cardiac disease from childhood presents at the obstetrician's office 6 weeks' pregnant. What recommendations would the nurse make to the client to address the known cardiac problems for this pregnancy? Select all that apply. Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus. Continue taking the scheduled warfarin. Let the physician know if you become short of breath or have a nighttime cough. Plan periods of rest into the workday. Receive pneumococcal and influenza vaccines.

Plan periods of rest into the workday. Receive pneumococcal and influenza vaccines. Let the physician know if you become short of breath or have a nighttime cough. Explanation: Women with known heart conditions need to be closely followed by both the obstetrician and a cardiologist. Recommendations would include rest periods, reduction of stress, getting immunizations, and monitoring for heart failure as demonstrated by a nighttime cough and shortness of breath. Consuming more sodium in the diet is not recommended due of the potential of developing hypertension. Warfarin is contraindicated during pregnancy since it crosses the placental barrier and can cause spontaneous abortion (miscarriage), stillbirth or preterm birth.

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 Hypotension of pregnancy Polyhydramnios Small-for-gestational-age (SGA) infant

Polyhydramnios Explanation: Polyhydramnios is an increase, or excess, in amniotic fluid and is a pregnancy-related complication associated with diabetes. An infant who is small-for-gestational-age is not associated with a mother who had diabetes prior to pregnancy. Other pregnancy-related complications associated with pregestational diabetes mellitus include hypertensive disorders, preterm birth, and shoulder dystocia.

A 17-year-old primigravida with type 1 diabetes is at 37 weeks' gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next? Allowing her to continue without plans for delivery. Scheduling the woman for induction of labor today. Preparing for amniocentesis and fetal lung maturity assessment Scheduling a cesarean delivery at 39 weeks.

Preparing for amniocentesis and fetal lung maturity assessment Explanation: If the infant has macrosomia, is large for gestation age, and the mother has had poor blood-sugar control, the provider will want further information on the fetus and readiness for delivery before making any decisions on delivery. After determining the readiness of the fetus, then plans for delivery can be determined and scheduled.

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 Pulmonary hypertension Repaired atrial septal defect Secondary hypertension

Pulmonary hypertension Explanation: Pulmonary hypertension is considered the greatest risk to a pregnancy because of the hypoxia that is associated with the condition. The remaining conditions represent potential cardiac complications that may increase the client's risk in pregnancy; however, these do not present the greatest risk in pregnancy.

A nurse is providing education to a woman at 28 weeks' gestation who has tested positive for gestational diabetes mellitus (GDM). What would be important for the nurse to include in the client teaching? Her baby is at increased risk for type 1 diabetes mellitus. Her baby is at increased risk for neonatal diabetes mellitus. She is at increased risk for type 1 diabetes mellitus after her baby is born. She is at increased risk for type 2 diabetes mellitus after her baby is born.

She is at increased risk for type 2 diabetes mellitus after her baby is born. Explanation: The woman who develops GDM is at increased risk for developing type 2 diabetes mellitus after

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? Contact the mother of the adolescent to be sure the child gets prenatal care. Support her by respecting her right to privacy and confidentiality. Recommend some adoption agencies for her to talk to in the near future. 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.

Support her by respecting her right to privacy and confidentiality. Explanation: The nurse needs to be an advocate for the adolescent and respect her privacy and confidentiality. It would be advisable for the nurse to encourage the adolescent to talk to her mother or some other support person for help. The nurse has no right to contact the adolescent's mother or to share any information with her. Also, the nurse should not mention adoption at this point to the adolescent. That would be a topic for later discussion.

A nurse is caring for a pregnant client with sickle cell anemia. What should the nursing care for the client include? Select all that apply. Teach the client meticulous handwashing. Urge the client to drink 8 to 10 glasses of fluid daily. Instruct the client to consume protein-rich food. Assess serum electrolyte levels of the client at each visit. Assess hydration status of the client at each visit.

Teach the client meticulous handwashing. Assess hydration status of the client at each visit. Urge the client to drink 8 to 10 glasses of fluid daily. Explanation: The nurse caring for a pregnant client with sickle cell anemia should teach the client meticulous handwashing to prevent the risk of infection, assess the hydration status of the client at each visit, and urge the client to drink 8 to 10 glasses of fluid daily. The nurse need not assess serum electrolyte levels of the client at each visit or instruct the client to consume protein-rich food.

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

adhering to standard precautions Explanation: For the pregnant woman who is HIV-positive, standard precautions must be used to reduce the risk of HIV transmission. Educating the woman about family planning methods is not as important as adhering to standard precautions. The decision about the mode of delivery is based on the woman's viral load, duration of ruptured membranes, progress of labor, and other clinical factors. Breastfeeding is contraindicated, so helping her choose a feeding method would be inappropriate.

The clinic nurse teaches a client with pregestational type 1 diabetes that maintaining a constant insulin level is very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use: an insulin pump. an insulin drip. regular insulin twice a day. an insulin pen.

an insulin pump. Explanation: Because a pregnant client will have some periods of relative hyperglycemia and hypoglycemia no matter how carefully the client maintains diet and balances exercise levels, an effective method to keep serum glucose levels constant is to administer insulin with a continuous pump during pregnancy. Reference:

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

assessing for cardiac decompensation Explanation: The nurse should assess the client with heart disease for cardiac decompensation, which is most common from 28 to 32 weeks' gestation and in the first 48 hours postpartum. Limiting sodium intake, inspecting the extremities for edema, and ensuring that the client consumes a high-fiber diet are interventions during pregnancy not in the first 48 hours postpartum.

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

avoidance of infection Explanation: Prevention of crises, if possible, is the focus of treatment for the pregnant woman with sickle cell anemia. Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common-sense strategies that decrease the risk of a crisis. Fat intake does not need to be decreased and immunoglobulins are not normally administered. Constipation is not usually a result of sickle cell anemia.

A new young mother has tested positive for HIV. When discussing the situation with the client, the nurse should advise the mother that she should avoid which activity? future pregnancies breastfeeding handling the infant with open sores cesarean birth

breastfeeding Explanation: Breastfeeding is a major contributing factor for mother-to-child transmission of HIV. Cesarean birth before the onset of labor and/or rupture of membranes can greatly reduce the chance of transmitting the infection to the infant. Future pregnancies should be discussed and decided on an individual basis. Proper treatment of any open wounds and education should be provided to the mother to ensure she reduces the chance of transmitting HIV to her infant.

A new young mother has tested positive for HIV. When discussing the situation with the client, the nurse should advise the mother that she should avoid which activity? future pregnancies cesarean birth breastfeeding handling the infant with open sores

breastfeeding Explanation: Breastfeeding is a major contributing factor for mother-to-child transmission of HIV. Cesarean birth before the onset of labor and/or rupture of membranes can greatly reduce the chance of transmitting the infection to the infant. Future pregnancies should be discussed and decided on an individual basis. Proper treatment of any open wounds and education should be provided to the mother to ensure she reduces the chance of transmitting HIV to her infant.

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

check her blood sugars frequently and adjust insulin accordingly. Explanation: The goal for a mother who has type I diabetes mellitus is to keep tight control over her blood sugars throughout the pregnancy. Therefore, she needs to test her blood sugar frequently during the day and make adjustments in the insulin doses she is receiving.

A pregnant woman tests positive for tuberculosis (TB). The nurse explains to the woman that additional tests are needed to confirm the diagnosis. When describing these tests, which one(s) would the nurse likely include? Select all that apply. sputum culture chest x-ray whole-body CT scan abdominal ultrasound spirometry

chest x-ray sputum culture Explanation: If a TB screening test is positive, the woman will need a follow-up chest x-ray with lead shielding over the abdomen, as well as sputum cultures to confirm the diagnosis. A whole-body CT scan, spirometry, or abdominal ultrasound are not used to confirm the diagnosis.

When providing nutritional counseling to a pregnant woman with diabetes, the nurse would urge the client to obtain most of her calories from which source? saturated fats protein complex carbohydrates unsaturated fats

complex carbohydrates Explanation: The pregnant woman with diabetes is encouraged to eat three meals a day plus three snacks, with 40% of calories derived from good-quality complex carbohydrates, 35% of calories from protein sources, and 35% of calories from unsaturated fats. The intake of saturated fats should be limited during pregnancy, just as they should be for any person to reduce the risk of heart disease.

The nurse is caring for a pregnant client with diabetes mellitus. For which potential fetal complication(s) should the nurse monitor the client as the client presents for their scheduled prenatal visits? Select all that apply. newborn with respiratory disorder newborn with juvenile diabetes congenital malformations in newborn newborn with macrosomia small-for-gestational-age newborn

congenital malformations in newborn newborn with macrosomia newborn with respiratory disorder Explanation: Potential concerns during pregnancy involving a client with diabetes mellitus include fetal death, macrosomia (oversized newborn), a newborn with a respiratory disorder, difficult labor, preeclampsia or eclampsia, polyhydramnios, and congenital malformations.

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? chlamydia gonorrhea cytomegalovirus toxoplasmosis

cytomegalovirus Explanation: The nurse would be alert for the development of cytomegalovirus infection. Pregnant women acquire active disease primarily from sexual contact, blood transfusions, kissing, and contact with children in day care centers. It can also be spread through vertical transmission from mother to child in utero (causing congenital CMV), during birth, or through breastfeeding. Chlamydia, gonorrhea, and toxoplasmosis are not spread through contact with children in day care centers.

A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client? long-acting insulin diet oral hypoglycemic drugs glucagon

diet Explanation: Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are usually not given during pregnancy and would not be the first option. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.

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? regular heart rate and hypertension increased urinary output, tachycardia, and dry cough dyspnea, crackles, and irregular weak pulse shortness of breath, bradycardia, and hypertension

dyspnea, crackles, and irregular weak pulse Explanation: The nurse should be alert for signs of cardiac decompensation due to congestive heart failure, which include crackles in the lungs from fluid, difficulty breathing, and weak pulse from heart exhaustion. The heart rate would not be regular, and a cough would not be dry. The heart rate would increase rather than decrease.

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

fetal alcohol spectrum disorder Explanation: Fetal alcohol spectrum disorder is a lifelong yet completely preventable set of physical, mental, and neurobehavioral birth defects. It is the leading cause of intellectual disability in the United States

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 Select...spontaneous abortiongestational diabetesectopic pregnancygestational trophoblastic diseasegestational diabetes. The nurse provides discharge teaching to reduce the risks of developing this condition. Teaching should include Select...limit exercise during pregnancylimit smokingchange in lifestylerefrain from having intercourse during pregnancychange in lifestyle.

gestational diabetes change in lifestyle Explanation: Gestational diabetes occurs in pregnant clients who do not have a history of diabetes. Blood glucose and urine are monitored closely for changes in blood glucose levels and glucose or ketones in the urine. Gestational diabetes usually resolves a few weeks after childbirth. Obesity places the client at high risk for gestational diabetes. Pregnant clients with class III obesity (BMI ≥40.0) are more than five and one-half more times likely to develop gestational diabetes. The nurse should educate the client about positive lifestyle changes such as diet, exercise, and cessation of smoking. The client is too far into pregnancy to have an ectopic pregnancy. Gestational trophoblastic disease would have been detected before the end of the second trimester. Spontaneous abortion usually occurs in the first trimester. The nurse should encourage cessation of smoking, not to limit smoking. The nurse should encourage the client to maintain activity or increase it, depending on current activity level, during pregnancy, which will help with weight and blood pressure. The nurse would not recommend the client limit exercise during pregnancy; this would place the client at risk for conditions associated with limited mobility such as deep vein thrombosis. There is no reason the client should refrain from having intercourse during pregnancy.

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 pre-pregnancy obesity, hypertension, and smoking. Complete the following sentence(s) by choosing from the lists of options. The client is at highest risk for developing ________ (gestational diabetes, gestational trophoblastic disease, spontaneous abortion). The nurse provides discharge teaching to reduce the risks of developing this condition. Teaching should include ______ (change in lifestyle, limit exercise during pregnancy, refrain from having intercourse during pregnancy)

gestational diabetes; change in lifestyle. Explanation: Gestational diabetes occurs in pregnant clients who do not have a history of diabetes. Blood glucose and urine are monitored closely for changes in blood glucose levels and glucose or ketones in the urine. Gestational diabetes usually resolves a few weeks after childbirth. Obesity places the client at high risk for gestational diabetes. Pregnant clients with class III obesity (BMI ≥40.0) are more than five and one-half more times likely to develop gestational diabetes. The nurse should educate the client about positive lifestyle changes such as diet, exercise, and cessation of smoking. The client is too far into pregnancy to have an ectopic pregnancy. Gestational trophoblastic disease would have been detected before the end of the second trimester. Spontaneous abortion usually occurs in the first trimester. The nurse should encourage cessation of smoking, not to limit smoking. The nurse should encourage the client to maintain activity or increase it, depending on current activity level, during pregnancy, which will help with weight and blood pressure. The nurse would not recommend the client limit exercise during pregnancy; this would place the client at risk for conditions associated with limited mobility such as deep vein thrombosis. There is no reason the client should refrain from having intercourse during pregnancy.

A nurse in the hospital is caring for a client at 37 weeks' gestation who experienced premature rupture of the membranes (PROM) more than 24 hours prior to coming to the hospital. The client presents with a fever of 100.4°F (38°C). Complete the following sentence(s) by choosing from the lists of options. Due to the client's PROM more than 24 hours prior to arriving to the hospital, the nurse determines the client is at risk for contracting Select...bacterial vaginosischlamydiagroup B streptococcustrichomoniasisgroup B streptococcus and should plan to implement Select...administer metronidazolerecommend including probiotics in their dietrequest fluconazole for external useadminister intravenous antibioticsadminister intravenous antibiotics to prevent complications.

group B streptococcus administer intravenous antibiotics Explanation: Group B streptococcus infection is a bacterial infection that can be transmitted to the fetus during labor. This can have cause serious complications to the newborn, including respiratory distress and sepsis. Group B streptococcus infection can be transmitted to the fetus during labor. The client is at risk for contracting group B streptococcus due to premature rupture of membranes (PROM) more than 24 hours prior to arriving at the hospital. The nurse will plan to administer intravenous antibiotics to the client prior to birth of the fetus. Chlamydia, trichomoniasis, and bacterial vaginosis are sexually transmitted infections (STIs). Unlike group B streptococcus infection, these infections are not transmitted to the fetus during labor. As STIs, the client is not at risk for contracting these infections because of PROM. Metronidazole is an anti-infective that is used to treat bacterial vaginosis, not group B streptococcus. Probiotics are used to maintain natural flora in the gastrointestinal (GI) system, not to treat group B streptococcus. Fluconazole is used to treat vaginal candidiasis, not group B streptococcus infections.

Which changes in pregnancy would the nurse identify as a contributing factor for arterial thrombosis, especially for the woman with atrial fibrillation? hypercoagulable state increase in blood volume elevation of diaphragm increased cardiac output

hypercoagulable state Explanation: The nurse should identify that the increased risk of arterial thrombosis in atrial fibrillation is due to the hypercoagulable state of pregnancy. During pregnancy, there is a state of hypercoagulation. This increases the risk of arterial thrombosis in clients having atrial fibrillation and artificial valves. Increased cardiac output and blood volume do not cause arterial thrombosis. Elevation of the diaphragm is due to the uterine distension, and it causes a shift in the QRS axis and is not associated with arterial thrombosis.

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? birth trauma hypoglycemia hyperglycemia macrosomia

hyperglycemia Explanation: Gestational diabetes is associated with either neonatal complications such as macrosomia, hypoglycemia, and birth trauma or maternal complications such as preeclampsia and cesarean birth.

The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of having a heroin use disorder. The nurse would be alert for which finding when assessing the neonate? hypertonicity vigorous sucking easy consolability low, feeble cry

hypertonicity Explanation: Newborns of mothers with heroin or other opioid use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

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? during birth transmission with any transmission in utero transmission after birth transmission

in utero transmission Explanation: 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 woman diagnosed with cardiac disease 4 years ago is told that her pregnancy is a high-risk pregnancy. The nurse then explains that the danger occurs primarily because of the increase in circulatory volume. The nurse informs the client that the most dangerous time for her is when? in weeks 8 to 12 in weeks 20 to 28 in weeks 28 to 32 in weeks 12 to 20

in weeks 28 to 32 Explanation: The danger of pregnancy in a woman with cardiac disease occurs primarily because of the increase in circulatory volume. The most dangerous time for a woman is in weeks 28 to 32, just after the blood volume peaks.

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? knowledge of child development whether sex was consensual options for birth control in the future sexual development of the client

knowledge of child development Explanation: The nurse should address the client's knowledge of child development during assessment of the pregnant adolescent client. The nurse need not address the sexual development of the client or whether sex was consensual. This would not be an opportune time to discuss birth control methods to be used after the pregnancy.

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 Explanation: The nurse should address the client's knowledge of child development during assessment of the pregnant adolescent client. The nurse need not address the sexual development of the client or whether sex was consensual. This would not be an opportune time to discuss birth control methods to be used after the pregnancy.

A pregnant woman with chronic hypertension comes to the clinic for evaluation. The last several blood pressure readings have been gradually increasing. On today's visit her blood pressure is 166/100 mm Hg. The health care provider prescribes an antihypertensive agent. The nurse anticipates which agent as likely to be prescribed? hydroxychloroquine labetalol ipratropium albuterol

labetalol Explanation: Medications used to treat chronic hypertension with pregnancy include labetalol hydrochloride, hydralazine hydrochloride, and nifedipine. Hydroxychloroquine would be used to treat rheumatoid arthritis. Albuterol and ipratropium would be used to treat asthma.

A nurse informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night's sleep. The nurse further instructs the client that which position for this rest is best? on her back prone left lateral recumbent right lateral recumbent

left lateral recumbent Explanation: The pregnant woman should rest in the left lateral recumbent position to prevent supine hypotension syndrome and increased heart effort.

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

less effective than normal Explanation: Somatotropin released by the placenta makes insulin less effective. This is a safeguard against hypoglycemia.

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

microcephaly Explanation: 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.

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

obesity hypertension previous large-for-gestational-age (LGA) infant Explanation: Obesity, hypertension, and a previous infant weighing more than 9 lb (4 kg) are risk factors for developing gestational diabetes. Maternal age less than 18 years and genitourinary tract abnormalities do not increase the risk of developing gestational diabetes.

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? discontinuing her prepregnancy anticoagulant maintaining a high fluid intake beginning a low-impact aerobics program obtaining enough rest

obtaining enough rest Explanation: As the blood volume doubles during pregnancy, heart failure can occur. The pregnant woman needs to obtain adequate rest to prevent overworking the heart. Fluid may need to be restricted.

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? maintaining a high fluid intake beginning a low-impact aerobics program discontinuing her prepregnancy anticoagulant obtaining enough rest

obtaining enough rest Explanation: As the blood volume doubles during pregnancy, heart failure can occur. The pregnant woman needs to obtain adequate rest to prevent overworking the heart. Fluid may need to be restricted

A pregnant client is reporting of a large amount of malodorous vaginal discharge that is foamy and yellow-green in color, vaginal itching and painful intercourse. When asked, she also reports that urination is somewhat painful. She is diagnosed with trichomoniasis. What treatment would the nurse anticipate the client receiving? ceftriaxone IM oral erythromycin benzathine penicillin G IM oral metronidazole

oral metronidazole Explanation: Trichomoniasis is caused by a protozoan infection, which can cause preterm labor, low birth weight, and premature rupture of membranes. Treatment is oral metronidazole because it is more effective in treating the infection than the suppository or creams.

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 substance? meals high in iron orange juice legumes milk

orange juice Explanation: Anemia is a condition in which the blood is deficient in red blood cells, from an underlying cause. The woman needs to take iron to manufacture enough red blood cells. Taking an iron supplement will help improve her iron levels, and taking iron with foods containing ascorbic acid, such as orange juice, improves the absorption of iron.

The nurse is assessing a woman with class III heart disease who is in for a prenatal visit. What would be the first recognizable sign that this client is in heart failure? elevated blood pressure persistent rales in the bases of the lungs audible wheezes low blood pressure

persistent rales in the bases of the lungs Explanation: The earliest warning sign of cardiac decompensation is persistent rales in the bases of the lungs.

A 40-year-old woman comes to the clinic reporting having missed her period for two months. A pregnancy test is positive. What is she and her fetus at increased risk for? type 2 diabetes mellitus type 1 diabetes mellitus placental abnormalities postterm birth

placental abnormalities Explanation: A woman older than 35 years is more likely to conceive a child with chromosomal abnormalities such as Down syndrome. She is also at higher risk for spontaneous abortion (miscarriage), preeclampsia-eclampsia, gestational diabetes, preterm birth, bleeding and placental abnormalities, and other intrapartum complications

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 respiratory function temperature heart rate

respiratory function Explanation: The nurse should identify respiratory distress syndrome as a major risk that can be faced by the offspring of a client with cardiovascular disease. While the other assessments are important, they are not priority

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy should the nurse expect to administer to the client? ginger therapy restricted sodium intake methadone therapy monoamine oxidase inhibitors (MAOIs)

restricted sodium intake Explanation: The client with peripartum cardiomyopathy should be prescribed a restricted sodium intake to control their blood pressure. Monoamine oxidase inhibitors are given to treat depression in pregnancy, not peripartum cardiomyopathy. Methadone is given for the treatment of a substance use disorder during pregnancy. Complementary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum, not peripartum cardiomyopathy.

A nurse is caring for a newborn with fetal alcohol spectrum disorder. What characteristic of the fetal alcohol spectrum disorder should the nurse assess for in the newborn? poor breathing pattern small head circumference decreased blood glucose level wide eyes

small head circumference Explanation: The nurse should assess for small head circumference in a newborn being assessed for fetal alcohol spectrum disorder. Fetal alcohol spectrum disorder does not cause decreased blood glucose level, a poor breathing pattern, or wide eyes.

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? stage 1 stage 2 elevated hypertensive crisis

stage 1 Explanation: Chronic hypertension exists when the woman has high blood pressure before pregnancy or before the 20th week of gestation, or when hypertension persists for more than 12 weeks. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (Joint National Committee [JNC 8], 2018) blood pressure guidelines classify hypertension as follows: elevated: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg; Stage 1: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg; Stage 2: Systolic at least 140 mm Hg or diastolic at least 90 mm Hg; Hypertensive crisis: Systolic over 180 mm Hg and/or diastolic over 120 mm Hg (Alexander, 2019; Bakris, 2019). The client has stage 1 hypertension.

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

stressing the positive benefits of a healthy lifestyle Explanation: The nurse should stress the positive benefits of a healthy lifestyle during the preconception counseling of a client with chronic hypertension. The client need not avoid dairy products or increase intake of vitamin D supplements. It may not be advisable for a client with chronic hypertension to exercise without consultation.

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 Explanation: Swelling of the face is a symptom of cardiac decompensation, along with moist, frequent cough and rapid respirations. Dry, rasping cough; slow, labored respiration; and an elevated temperature are not symptoms of cardiac decompensation.

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

the viral load Explanation: A woman who has HIV during pregnancy is at risk for transmitting the infection to the fetus during pregnancy or childbirth and to the newborn while breastfeeding. The type of birth, vaginal or cesarean, depends on several factors, including the woman's viral load, use of ART during pregnancy (not waiting until the birth), length of time membranes have been ruptured, and gestational age (not mother's age). With prenatal ART and prophylactic treatment of the newborn, there is a reduced risk of perinatal HIV transmission. The amniocentesis results would not be a factor in preventing the spread of HIV to the infant and may actually lead to the fetus being infected through the puncture site and bleeding into the amniotic sac.

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 Explanation: Toxoplasmosis is an infection caused by the protozoan Toxoplasma gondii, also referred to as T. gondii. Transmission is via undercooked meat and through cat feces. Toxoplasmosis is a common infection in humans and usually produces no symptoms. However, when the infection passes from the woman through the placenta to the fetus, a condition called congenital toxoplasmosis can occur. Approximately 400 to 4,000 cases of congenital toxoplasmosis occur per year in the United States (Williams, 2007). The classic triad of symptoms for congenital toxoplasmosis is chorioretinitis, intracranial calcification, and hydrocephalus in the newborn.

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? herpes simplex virus parvovirus B19 toxoplasmosis cytomegalovirus

toxoplasmosis Explanation: Toxoplasmosis is transferred by hand to mouth after touching cat feces while changing the litter box or through gardening in contaminated soil. Cytomegalovirus is transmitted via sexual contract, blood transfusions, kissing, and contact with children in daycare centers. Parvovirus B19 is a common self-limiting benign childhood virus that causes fifth disease. A pregnant woman may transmit the virus transplacentally to her fetus if she is exposed to an infected child. Herpesvirus infection occurs by direct contact of the skin or mucous membranes with an active lesion through kissing, sexual contact, or routine skin-to-skin contact.

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? toxoplasmosis hepatitis C herpes simplex virus cytomegalovirus

toxoplasmosis Explanation: Toxoplasmosis is an infection caused by the protozoan Toxoplasma gondii, also referred to as T. gondii. Transmission is via undercooked meat and through cat feces. Toxoplasmosis is a common infection in humans and usually produces no symptoms. However, when the infection passes from the woman through the placenta to the fetus, a condition called congenital toxoplasmosis can occur. Approximately 400 to 4,000 cases of congenital toxoplasmosis occur per year in the United States (Williams, 2007). The classic triad of symptoms for congenital toxoplasmosis is chorioretinitis, intracranial calcification, and hydrocephalus in the newborn.

The nurse is assessing a primigravida woman who reports vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. The nurse suspects the woman has contracted which disorder? chlamydia simple yeast infection gonorrhea trichomoniasis

trichomoniasis Explanation: Trichomoniasis is caused by a one-celled protozoa. The symptoms include large amounts of foamy, yellow-green vaginal discharge. Treatment is with metronidazole, and her partner needs to be treated as well. A yeast infection presents with a cottage cheese-like discharge. Chlamydia often has no symptoms. If the woman does experience symptoms, these may include vaginal discharge, abnormal vaginal bleeding, and abdominal or pelvic pain. Gonorrhea may have symptoms so mild that they go unnoticed in the woman. The woman who contracts gonorrhea may have vaginal bleeding during sexual intercourse, pain and burning while urinating, and a yellow or bloody vaginal discharge.

Which factor would contribute to a high-risk pregnancy? first pregnancy at age 33 history of allergy to honey bee pollen type 1 diabetes blood type O positive

type 1 diabetes Explanation: A woman with a history of diabetes has an increased risk for perinatal complications, including hypertension, preeclampsia, and neonatal hypoglycemia. The age of 33 without other risk factors does not increase risk, nor does type O-positive blood or environmental allergens.

A pregnant woman at 36 weeks' gestation comes to the care center for a follow-up visit. The woman is to be screened for group B streptococcus (GBS) infection. When describing this screening to the woman, the nurse would explain that a specimen will be taken from which area(s)? Select all that apply. conjunctiva nasal cavity rectum vagina throat

vagina rectum Explanation: According to Centers for Disease Control and Prevention guidelines, all pregnant women should be screened for GBS at 35 to 37 weeks' gestation and treated. Vaginal and rectal specimens are cultured for the presence of the bacterium. Specimens from the throat, nasal cavity, or conjunctiva are not used.

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 48 hours of birth within 24 hours of birth within 12 hours of birth within 36 hours of birth

within 12 hours of birth Explanation: 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.