Test 2 Review - Ch 20

A nurse is counseling a pregnant woman with rheumatoid arthritis about medications that can be used during pregnancy. Which drug would the nurse emphasize as being contraindicated at this time? Hydroxychloroquine Nonsteroidal anti-inflammatory drug Glucocorticoid Methotrexate

Methotrexate

S/S of neonates born to mothers who abuse narcotics.

Newborns of mothers who abuse heroin or other narcotics display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

A 10-week pregnant woman with diabetes has a glycosylated hemoglobin (HbA1C. level of 13%. At this time the nurse should be most concerned about which of the following possible fetal outcomes? Congenital anomalies Incompetent cervix Placenta previa Abruptio placentae

Congenital Anomalies

When would a nurse screen a woman for group B streptococcus infection?

36 weeks gestation

A nurse has been invited to speak at a local high school about adolescent pregnancy. When developing the presentation, the nurse would incorporate information related to which of the following? (Select all that apply.) Peer pressure to become sexually active Rise in teen birth rates over the years. Latinas as having the highest teen birth rate Loss of self-esteem as a major impact Majority of teen pregnancies in the 1517-year-old age group

A C D

How are sickle cell crises managed during pregnancy?

A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and I.V. 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.

After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which of the following as being good sources of iron in her diet? (Select all that apply.) Dried fruits Peanut butter Meats Milk White bread

ABC

A neonate born to a mother who was abusing heroin is exhibiting signs and symptoms of withdrawal. Which of the following would the nurse assess? (Select all that apply.) Low whimpering cry Hypertonicity Lethargy Excessive sneezing Overly vigorous sucking Tremors

B, D, F

What are some of the symptoms of CMV?

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

The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion? Wide large eyes Thin upper lip Protruding jaw Elongated nose

Thin Upper Lip. Other facial signs could be: low nasal bridge, short palpebral fissures, short nose, flat midface, receding jaw, minor ear abnormalities, and epicanthal folds, small head circumference, small eyes,

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

Cytomegalovirus

The nurse is assessng a newborn male in the presence of the parents and notes that he has a hypospadias. How should the nurse respond when questioned by the parents as to what this means? "He has normal male genitalia." "His testicles have not descended into the scrotal sac." "His urinary meatus in located on the under surface of the glans." "He has fluid in the scrotal sac."

Correct response: "His urinary meatus in located on the under surface of the glans." Explanation: The term "hypospadias" refers to the urinary meatus being abnormally located on the ventral (under) surface of the glans. There are no special terms to indicate normal genitalia. Cryptorchidism refers to undescended testes. Hydrocele refers to the collection of fluid in the scrotal sac

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or at delivery for her baby. Which statement by the mother indicates that further teaching is needed by the nurse? "My baby may be very large and I may need a cesarean section to have him." "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."

Correct response: "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 diabetic mothers. Doing "kick counts", as the fetal movement monitoring is often called, 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 section delivery 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? "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." "HIV is transmitted at birth; having a cesarean birth prevented transmission." "HIV antibodies do not cross the placenta; this means the baby will develop AIDS."

Correct response: "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 woman at 26 weeks' gestation is undergoing screening for diabetes with a 1-hour oral glucose challenge test. On the client's return visit, the nurse anticipates the need to schedule a 3-hour glucose challenge test based on which result of the previous test? 100 mg/dL 114 mg/dL 130 mg/dL 146 mg/dL

Correct response: 146 mg/dL Explanation: For a 1-hour glucose challenge test, a 75-g oral glucose load is given, without regard to the timing or content of the last meal. Blood glucose is measured 1 hour later; a level above 140 mg/dL is abnormal. If the result is abnormal, a 3-hour glucose tolerance test is done.

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? 45 mg/dL 85 mg/dL 120 mg/dL 136 mg/dL

Correct response: 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.

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

Correct response: 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? Nausea and vomiting Jugular distention Abdominal cramps Urinary retention

Correct response: 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.

A pregnant woman in her 39th week of pregnancy presents to the clinic with a vaginal infection. She tests positive for chlamydia. What would this disease make her infant at risk for? deafness blindness neonatal laryngeal papillomas chicken pox

Correct response: blindness Explanation: A pregnant woman who contracts chlamydia is at increased risk for spontaneous abortion (miscarriage), preterm rupture of membranes, and preterm labor. The postpartum woman is at higher risk for endometritis (Fletcher & Ball, 2006). The fetus can encounter bacteria in the vagina during the birth process. If this happens, the newborn can develop pneumonia or conjunctivitis that can lead to blindness.

The nurse is teaching a pregnant woman with iron-deficiency anemia about her prescribed iron supplement. The nurse determines that the teaching was successful when the client states that she will take the supplement with: citrus juice. coffee. tea. fiber-rich foods

Correct response: citrus juice. Explanation: Iron absorption is enhanced when taken with foods high in vitamin C, such as citrus juice. Foods such as coffee, tea, and those high in fiber should be avoided

A pregnant client with a history of heart disease has been admitted to a health care center reporting breathlessness. The client also reports shortness of breath and easy fatigue when doing ordinary activity. The client's condition is markedly compromised. The nurse would document the client's condition using the New York Heart Association (NYHA) classification system as which class? class I class II class III class IV

Correct response: class III Explanation: The nurse should classify the client's condition as belonging to class III of NYHA. In class III of NYHA classification, the client will be symptomatic with ordinary activity, and her condition is markedly compromised. The client is asymptomatic with all kinds of activity and is in uncompromised state in class I. The client is symptomatic with increased activity and is in slight compromised state in class II. The client is symptomatic when resting and is incapacitated in class IV

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? diet long-acting insulin oral hypoglycemic drugs glucagon

Correct response: 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 contraindicated in pregnancy. 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 shortness of breath, bradycardia, and hypertension dyspnea, crackles, and irregular weak pulse

Correct response: 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 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 28 to 32 in weeks 12 to 20 in weeks 20 to 28

Correct response: 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

Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 124/86 mm Hg; week 20 - 138/90 mm Hg; week 24 - 140/92 mm Hg; and week 28 - 142/94 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure? mild hypertensive normotensive prehypertensive severe hypertensive

Correct response: mild hypertensive 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. It has been classified as normotensive (systolic less than 120 mm Hg, diastolic less than 80 mm Hg); prehypertension (systolic 120 to 139 mm Hg, diastolic 80 to 89 mm Hg); mild hypertension (systolic 140 to 159 mm Hg, diastolic 90 to 99 mm Hg); and severe hypertension (systolic 160 mm Hg or higher, diastolic 100 mm Hg or higher)

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

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

The nurse is caring for a pregnant client who has condylomata acuminata as a result of HPV infection. The nurse should educate the client about: the need to discuss surgical options with her care provider. the importance of hygiene in preventing exacerbations. antibiotic treatments that are safe for the fetus. topical treatments.

Correct response: the need to discuss surgical options with her care provider. Explanation: Condylomata acuminata can be removed surgically; topical treatments are often teratogenic. Antibiotics are ineffective due to the viral etiology. Hygiene will not resolve these lesions

A group of students are reviewing information about sexually transmitted infections and their effect on pregnancy. The students demonstrate understanding of the information when they identify which infection as being responsible for ophthalmia neonatorum? Syphilis Gonorrhea Chlamydia HPV

Gonorrhea is associated with opthalma neonatorum. Syphilis is associated with congenital syphilis - jaundice, rhinitis, anemia, IUGR, and CNS issues. Chlamydia is associated with conjunctivitis or pneumonia. HPV is associated with laryngeal papillomas.

When will a newborn receive the HBV vaccine if born to a mother who tested positive for HBV?

If a woman tests positive for HBV, the newborn will receive HBV vaccine within 12 hours of birth. The second dose will be given at 1 month and the third dose at 6 months.

A pregnant woman asks the nurse, Im a big coffee drinker. Will the caffeine in my coffee hurt my baby? Which response by the nurse would be most appropriate? The caffeine in coffee has been linked to birth defects. Caffeine has been shown to cause growth restriction in the fetus. Caffeine is a stimulant and needs to be avoided completely. If you keep your intake to less than 300 mg/day, you should be okay.

If you keep your intake to less than 300 mg/day, you should be okay.