Ch 17 Pregnancy at Risk: Pregestational Problems
25) During a routine prenatal visit, the nurse suspects that the patient is experiencing undiagnosed depression. What findings did the nurse use to make this clinical determination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Insomnia 2. Headaches 3. Fear of labor 4. Ritualistic behavior 5. Lack of interest in the pregnancy
Answer: 1, 2, 5 Explanation: Manifestations of depression in the pregnant patient include withdrawn behavior, physical fatigue due to insomnia, crying spells, sadness, hopelessness, feelings of guilt, lack of interest in the baby, thoughts of suicide, and headaches. Fear of labor is associated with a panic disorder. Ritualistic behavior is associated with obsessive-compulsive disorder (O C D). Page Ref: 367
26) The nurse is preparing teaching material for a patient with multiple sclerosis who is in the third trimester of pregnancy. What information should the nurse emphasize with this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Plan for frequent rest periods 2. Breastfeeding should be avoided 3. Plan to experience heightened pain during labor 4. Determine the need for childcare help after delivery 5. Relapses may increase during the first 3 months after delivery
Answer: 1, 4, 5 Explanation: For the pregnant patient with multiple sclerosis, the nurse should emphasize that the relapse rate is reduced during the second and third trimester but increased during the 3 months following birth. Exclusive breastfeeding for the first 2 months postpartum may be independently associated with decreased post-pregnancy relapse rate. Rest is important; help with childcare should be planned. Uterine contraction strength is not diminished, but because sensation is frequently lessened, labor may be almost painless. Page Ref: 383
24) A patient with gestational diabetes (G D M) is instructed to measure capillary blood glucose levels 4 times a day. If the patient eats meals at 8 a.m., 1 p.m., and 7 p.m., at which times should the nurse reinforce glucose testing to occur? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. 10 a.m. 2. 12 noon 3. 4 p.m. 4. 3 p.m. 5. 9 p.m.
Answer: 1, 4, 5 Explanation: Women with G D M typically measure their blood glucose four times a day - fasting and 1 to 2 hours after meals. Page Ref: 362
1) The nurse is caring for a pregnant woman who admits to using cocaine and ecstasy on a regular basis. The client states, "Everybody knows that alcohol is bad during pregnancy, but what's the big deal about ecstasy?" What is the nurse's best response? A) "Ecstasy can cause a high fever in you and therefore cause the baby harm." B) "Ecstasy leads to deficiencies of thiamine and folic acid, which help the baby develop." C) "Ecstasy produces babies with small heads and short bodies with brain function alterations." D) "Ecstasy produces intrauterine growth restriction and meconium aspiration."
Answer: A Explanation: A) Hyperthermia (elevated temperature) is a side effect of M D M A (ecstasy). B) Alcohol, not ecstasy, causes deficiencies of thiamine and folic acid. Folic acid helps prevent neural tube defects. C) Cocaine, not ecstasy, causes these fetal effects (small heads and short bodies with brain function alterations). D) Heroin, not ecstasy, causes these fetal effects (intrauterine growth restriction and meconium aspiration). Page Ref: 368
3) A woman's history and appearance suggest drug abuse. What is the nurse's best approach? A) Ask the woman directly, "Do you use any street drugs?" B) Ask the woman whether she would like to talk to a counselor. C) Ask some questions about over-the-counter medications and avoid mention of illicit drugs. D) Explain how harmful drugs can be for her baby.
Answer: A Explanation: A) If drug abuse is suspected, the nurse should ask direct questions and be matter-of-fact and nonjudgmental to elicit honest responses. B) Advising the client to seek counseling would not occur until the nurse verifies that the woman uses street drugs. C) If abuse is suspected, the nurse should ask direct questions, beginning with less threatening questions about the use of tobacco, caffeine, and over-the-counter medications, but not avoid the mention of illicit drugs. D) When talking to clients in a therapeutic manner, it is important not to be threatening or judgmental; an example of judgmental behavior would be stating that the drugs will harm the baby. Page Ref: 370
23) The prenatal clinic nurse has received four phone calls. Which client should the nurse call back first? A) Pregnant woman at 28 weeks with history of asthma who is reporting difficulty breathing and shortness of breath B) Pregnant woman at 6 weeks with a seizure disorder who is inquiring which foods are good folic acid sources for her C) Pregnant woman at 35 weeks with a positive H B s A G who is wondering what treatment her baby will receive after birth D) Pregnant woman at 11 weeks with untreated hyperthyroidism who is describing the onset of vaginal bleeding
Answer: A Explanation: A) The goal of therapy is to prevent maternal exacerbations, because even a mild exacerbation can cause severe hypoxia-related complications in the fetus. B) Women with seizure disorders should be started on folic acid supplements prior to pregnancy, and should continue throughout pregnancy. However, this client is not the highest priority. C) A client with a positive H B s A G is contagious for hepatitis B. Within 12 hours of birth, infants born to women with H B V infection should receive hepatitis B immune globulin and the first dose of the H B V vaccine series. However, this client is not the highest priority. D) Pregnant women with untreated hyperthyroidism have increased rates of abortion, intrauterine death, and stillbirth. Vaginal bleeding at 11 weeks could indicate that spontaneous abortion is taking place. However, this client is not the highest priority. Page Ref: 381
31) The nurse is providing care to a client in labor who admits to using heroin throughout the pregnancy. Which will the neonate be at risk for following birth? A) Seizure activity B) Congenital anomalies C) Large for gestational age D) Cardiac anomalies
Answer: A Explanation: A) The neonate who has been exposed to heroin in utero is at an increased risk for seizure activity following birth. B) The neonate who has been exposed to heroin in utero is not at an increased risk for congenital anomalies. This is expected if the neonate was exposed to lithium carbonate while in utero. C) The neonate who has been exposed to heroin in utero is not an increased risk for being large for gestational age. This is expected for the neonate who is born to a mother who is diagnosed with gestational diabetes mellitus. D) The neonate who has been exposed to heroin in utero is not at an increased risk for cardiac anomalies. This is expected for the neonate who is exposed to cocaine in utero. Page Ref: 367
22) Which of the following symptoms, if progressive, are indicative of C H F, the heart's signal of its decreased ability to meet the demands of pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Palpitations B) Heart murmurs C) Dyspnea D) Frequent urination E) Rales
Answer: A, B, C, E Explanation: A) Palpitations are indicative of C H F. B) Heart murmurs are indicative of C H F. C) Dyspnea is indicative of C H F. D) Frequent urination is not indicative of C H F. E) Rales are indicative of C H F. Page Ref: 378—379
15) During the history, the client admits to being H I V-positive and says she knows that she is about 16 weeks pregnant. Which statements made by the client indicate an understanding of the plan of care both during the pregnancy and postpartally? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "During labor and delivery, I can expect the zidovudine (Z D V) to be given in my Ⅳ." B) "After delivery, the dose of zidovudine (Z D V) will be doubled to prevent further infection." C) "My baby will be started on zidovudine (Z D V) for six weeks following the birth." D) "My baby's zidovudine (Z D V) will be given in a cream form." E) "My baby will not need zidovudine (Z D V) if I take it during my pregnancy."
Answer: A, C Explanation: A) A R T therapy generally includes oral Zidovudine (Z D V) daily, Ⅳ Z D V during labor and until birth, and Z D V therapy for the infant for 6 weeks following birth. B) The mother will continue with her oral dosage of zidovudine (Z D V) after delivery just as prior to delivery. C) A R T therapy generally includes oral Zidovudine (Z D V) daily, Ⅳ Z D V during labor and until birth, and Z D V therapy for the infant for 6 weeks following birth. D) The initial treatment is zidovudine (Z D V) orally every day. E) The infant will be started on oral zidovudine (Z D V) after birth for 6 weeks. Page Ref: 372—373
29) The nurse is providing care to a laboring pregnant client who is diagnosed with sickle cell disease. What will the nurse prepare for upon delivery of the client's newborn, based on this diagnosis? A) Hemorrhage B) Intrauterine growth restriction C) Neonatal resuscitation D) Cesarean birth
Answer: B Explanation: A) A pregnant client diagnosed with sickle cell anemia is not at an increased risk for hemorrhage. B) When providing care for a pregnant client diagnosed with sickle cell anemia, the nurse will prepare for a neonate experiencing intrauterine growth restriction, as this is a known consequence during pregnancy. C) The newborn of a client diagnosed with sickle cell anemia is not at an increased risk for requiring neonatal resuscitation. D) A pregnant client diagnosed with sickle cell anemia is not at an increased for cesarean birth. Page Ref: 363
14) The client at 9 weeks' gestation has been told that her H I V test was positive. The client is very upset, and tells the nurse, "I didn't know I had H I V! What will this do to my baby?" The nurse knows teaching has been effective when the client makes which statement? A) "I cannot take the medications that control H I V during my pregnancy, because they will harm the baby." B) "My baby can get H I V during the pregnancy and through my breast milk." C) "The pregnancy will increase the progression of my disease and will reduce my C D4 counts." D) "The H I V won't affect my baby, and I will have a low-risk pregnancy without additional testing."
Answer: B Explanation: A) Antiretroviral therapy is recommended to all infected pregnant women, regardless of whether or not they are symptomatic, to reduce the rate of perinatal transmission. B) H I V transmission can occur during pregnancy and through breast milk; however, it is believed that the majority of all infections occur during labor and birth. C) There is no evidence to indicate that pregnancy increases the progression of H I V/A I D S. D) A pregnancy complicated by H I V infection, even if asymptomatic, is considered high risk, and the fetus is monitored closely. Weekly non-stress testing (N S T) is begun at 32 weeks' gestation. Page Ref: 372—373
7) A newly diagnosed insulin-dependent type 1 diabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. What would the best explanation include? A) "Your baby could be smaller than average at birth." B) "Your baby will probably be larger than average at birth." C) "As long as you control your blood sugar, your baby will not be affected at all." D) "Your baby might have high blood sugar for several days."
Answer: B Explanation: A) Characteristically, infants of mothers with diabetes are large for gestational age (L G A). B) Characteristically, infants of mothers with diabetes are large for gestational age (L G A), as a result of high levels of fetal insulin production stimulated by the high levels of glucose crossing the placenta from the mother. Sustained fetal hyperinsulinism and hyperglycemia ultimately lead to excessive growth, called macrosomia, and deposition of fat. C) The demands of pregnancy will make it difficult for the best of clients to control blood sugar on a regular basis. D) After birth, the umbilical cord is severed, and, thus, the generous maternal blood glucose supply is eliminated. Page Ref: 355
20) A client is at 12 weeks' gestation with her first baby. She has cardiac disease, class Ⅲ. She states that she had been taking sodium warfarin (Coumadin), but her physician changed her to heparin. She asks the nurse why this was done. What should the nurse's response be? A) "Heparin is used when coagulation problems are resolved." B) "Heparin is safer because it does not cross the placenta." C) "They are the same drug, but heparin is less expensive." D) "Coumadin interferes with iron absorption in the intestines."
Answer: B Explanation: A) Heparin is used when coagulation problems develop. B) Heparin is safest for the client to take because it does not cross the placental barrier. C) Heparin does not cost less than Coumadin. D) Coumadin does not interfere with iron absorption in the intestines. Page Ref: 378
8) A 26-year-old client is 28 weeks pregnant. She has developed gestational diabetes. She is following a program of regular exercise, which includes walking, bicycling, and swimming. What instructions should be included in a teaching plan for this client? A) "Exercise either just before meals or wait until 2 hours after a meal." B) "Carry hard candy (or other simple sugar) when exercising." C) "If your blood sugar is 120 m g/d L, eat 20 g of carbohydrate." D) "If your blood sugar is more than 120 m g/d L, drink a glass of whole milk."
Answer: B Explanation: A) It is best to exercise just after the meal, in order to utilize the glucose. B) The nurse should advise her to carry a simple sugar such as hard candy, because of the possibility of exercise-induced hypoglycemia. C) A finger stick result of 120 m g/d L is considered to be normal. D) Such clients need no additional carbohydrate or protein intake. Page Ref: 362
2) The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which statement made by the client indicates to the nurse that the client has understood the teaching? A) "I can continue to drink alcohol until I am diagnosed as pregnant." B) "I need to stop drinking alcohol completely when I start trying to get pregnant." C) "A beer once a week will not damage the fetus." D) "I can drink alcohol while breastfeeding because it doesn't pass into breast milk."
Answer: B Explanation: A) The expectant woman should avoid alcohol completely. B) Women should discontinue drinking alcohol when they start to attempt to become pregnant due to possible effects of alcohol on the fetus. C) The effects of alcohol on the fetus may include a group of signs referred to as fetal alcohol spectrum disorders (F A S D). D) Alcohol is excreted in breast milk; therefore, it should be avoided. Page Ref: 368
11) Which of the following may be the main presenting symptom of iron deficiency anemia? A) Frequent urination B) Fatigue C) Nausea D) Headaches
Answer: B Explanation: A) The main presenting symptom of iron deficiency anemia would not be frequent urination. B) The main presenting symptom of iron deficiency anemia may be fatigue. C) The main presenting symptom of iron deficiency anemia would not be nausea. D) The main presenting symptom of iron deficiency anemia would not be headaches. Page Ref: 363—364
18) Women with H I V should be evaluated and treated for other sexually transmitted infections and for what condition occurring more commonly in women with H I V? A) Syphilis B) Toxoplasmosis C) Gonorrhea D) Herpes
Answer: B Explanation: A) Women with H I V should be evaluated and treated for other sexually transmitted infections and for conditions occurring more commonly in women with H I V, such as tuberculosis, cytomegalovirus, toxoplasmosis, and cervical dysplasia. Syphilis occurs more often in men. B) Women with H I V should be evaluated and treated for other sexually transmitted infections and for conditions occurring more commonly in women with H I V, such as tuberculosis, cytomegalovirus, toxoplasmosis, and cervical dysplasia. C) Women with H I V should be evaluated and treated for other sexually transmitted infections and for conditions occurring more commonly in women with H I V, such as tuberculosis, cytomegalovirus, toxoplasmosis, and cervical dysplasia. Gonorrhea affects both men and women. D) Women with H I V should be evaluated and treated for other sexually transmitted infections and for conditions occurring more commonly in women with H I V, such as tuberculosis, cytomegalovirus, toxoplasmosis, and cervical dysplasia. Herpes affects both men and women. Page Ref: 373
6) The maternal health nurse is caring for a pregnant client with obsessive-compulsive disorder (O C D). Which action will the nurse take when teaching the client, based on the client's psychological disorder? A) Allow the client opportunity for repetitive rituals. B) Ask the client to follow along with written material. C) Repeat instructions as needed. D) Provide multiple handouts with various photographs
Answer: C Explanation: A) Although those with O C D may have repetitive rituals, this does not promote learning and is not the best action for the nurse. B) While written material may be helpful as a supplement to learning, it may be difficult for the client with O C D to follow along. C) The best action for the nurse is to repeat any instructions or teachings as needed. This allows the client more opportunity to learn. D) While multiple learning techniques and opportunities are helpful for most individuals, those with O C D have a difficult time following along with teaching material. Page Ref: 371
28) The nurse is providing care to a client who would like to become pregnant within the next year. The client has a history of folic acid deficiency anemia and asks, "What can I do to decrease the risk of neural tube defects?" Which response by the nurse is most appropriate? A) "You will need to have genetic testing done to identify your risk." B) "Do you have a family history of these disorders?" C) "Daily consumption of orange juice decreases your risk." D) "You will be prescribed an iron supplement, which decreases your risk."
Answer: C Explanation: A) Genetic testing does not identify the risk for neural tube defects. This response is not appropriate by the nurse. B) Asking the client if there is a family history of neural tube defects will not decrease the client's risk. This response is not appropriate by the nurse. C) Daily consumption of foods rich in folic acid, such as orange juice, provides the client with the necessary amount of folic acid to decrease the risk of neural tube defects. This response is appropriate by the nurse. D) Folic acid supplements, not iron supplements, are prescribed to decrease the risk for neural tube defects. This response is not appropriate by the nurse. Page Ref: 363
27) The nurse is providing care to a pregnant client who is diagnosed with iron deficiency anemia. Which teaching statement from the nurse to the client is appropriate? A) "You will need to begin iron supplements at 30 m g/day." B) "You will need to increase your intake of bananas." C) "You will need to increase your intake of green leafy vegetables." D) "You will need to begin iron supplements at 150 m g/day."
Answer: C Explanation: A) Pregnant clients are prescribed 30 m g of iron daily to prevent anemia. Once anemia is diagnosed, the prescribed dosage is increased. This teaching statement is not appropriate. B) Pregnant clients diagnosed with anemia should increase their consumption of foods that are rich in iron. Bananas are not rich in iron. This teaching statement is not appropriate. C) Pregnant clients diagnosed with anemia should increase their consumption of foods that are rich in iron. Green, leafy vegetables are rich in iron. This teaching statement is appropriate. D) Pregnant clients diagnosed with iron deficiency anemia will require an increased dose of supplemental iron, typically 60 m g to 120 m g/day. Page Ref: 363
32) The nurse is conducting an admission assessment for a pregnant client who is in labor. Which finding would cause the nurse to expect that the client has been abusing an illegal substance? A) The client is asking for an epidural and rates pain as an 8 on a 0 to 10 numeric scale. B) The client is diaphoretic during the transition stage of labor. C) The client has constricted pupils and inflamed nasal mucosa. D) The client has a history of precipitous labor.
Answer: C Explanation: A) The nurse would not suspect that this client has been abusing an illegal substance based on asking for an epidural and rating pain as an 8 on a 0 to 10 numeric scale. B) The nurse would not suspect that this client has been abusing an illegal substance based on experiencing diaphoresis during the transition stage of labor. This is an expected finding. C) A client who has constricted pupils and inflamed nasal mucosa would be suspected of abusing illegal substances. D) A client who has a history of precipitous labor would not cause the nurse to expect substance abuse. Page Ref: 367
30) The nurse is caring for a postpartum client who is experiencing a sickle cell crisis. Which is the priority assessment by the nurse? A) Blood pressure B) Lochia C) Temperature D) Fundal height
Answer: C Explanation: A) The postpartum client experiencing a sickle cell crisis is at risk for infection. While monitoring blood pressure is important, this is not the priority assessment. B) The postpartum client experiencing a sickle cell crisis is at risk for infection. While monitoring lochia is important, this is not the priority assessment. C) The postpartum client experiencing a sickle cell crisis is at risk for infection. The priority assessment for this client is to closely monitor temperature. D) The postpartum client experiencing a sickle cell crisis is at risk for infection. While monitoring fundal height is important, this is not the priority assessment. Page Ref: 363
10) A woman asks her nurse what she can do before she begins trying to get pregnant to help her baby, as she is prone to anemia. What would the nurse correctly advise her to do? A) Get pregnant, then start iron supplementation. B) Add more carbohydrates to her diet. C) Begin taking folic acid supplements daily. D) Have a hemoglobin baseline done now so her progress can be followed.
Answer: C Explanation: A) Waiting until one is pregnant to add iron or evaluate a diet is not being proactive. B) Adding carbohydrates to her diet will not help prevent anemia. C) The common anemias of pregnancy are due to insufficient hemoglobin production related to nutritional deficiency in either iron or folic acid during pregnancy. Folic acid deficiency during pregnancy is prevented by a daily supplement of 0.4 m g (400 micrograms) of folate. D) Having a hemoglobin baseline done will not help the patient prevent anemia in pregnancy. Page Ref: 363
9) A 26-year-old client is 26 weeks pregnant. Her previous births include two large-for-gestational-age babies and one unexplained stillbirth. Which tests would the nurse anticipate as being most definitive in diagnosing gestational diabetes? A) A 50g, 1-hour glucose screening test B) A single fasting glucose level C) A 100g, 1-hour glucose tolerance test D) A 100g, 3-hour glucose tolerance test
Answer: D Explanation: A) All women get the initial 50 g of glucose and a 1-hour screening. B) A single fasting glucose level is not an adequate indicator of the glucose level in relation to food. C) The 100g, 1-hour tolerance test is not an adequate indicator of the glucose level in relation to food. D) Gestational diabetes is diagnosed if two or more of the following values are met or exceeded after taking the 100 g, 3-hour O G T T: Fasting: 95 m g/d L; 1 hour: 180 m g/d L; 2 hours: 155 m g/d L; 3 hours: 140 m g/d L. Page Ref: 356
21) A 21-year-old woman is at 12 weeks' gestation with her first baby. She has cardiac disease, class Ⅲ, as a result of having had childhood rheumatic fever. Which planned activity would indicate to the nurse that the client needs further teaching? A) "I will be sure to take a rest period every afternoon." B) "I would like to take childbirth education classes in my last trimester." C) "I will have to cancel our trip to Disney World." D) "I am going to start my classes in water aerobics next week."
Answer: D Explanation: A) Because the heart disease is class Ⅲ, this client is encouraged to get adequate rest. B) Childbirth classes would be helpful for the client as long as she were careful not to overexert herself. C) Travel during the pregnancy would be based upon the tolerance of the client. However, a trip to Disney World would involve a large amount of activity, which would stress the pregnancy. D) With the slightest exertion, the client's heart rate will rise, and she will become symptomatic. Therefore, she should not establish a new exercise program. Page Ref: 378
4) A 20-year-old woman is at 28 weeks' gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used heroin. The nurse should recognize that the woman is at increased risk for which condition? A) Erythroblastosis fetalis B) Diabetes mellitus C) Abruptio placentae D) Pregnancy-induced hypertension
Answer: D Explanation: A) Erythroblastosis fetalis is secondary to physiological blood disorders such as R h incompatibility. B) Diabetes is an endocrine disorder that is unrelated to drug use and abuse. C) Abruptio placentae is seen more commonly with cocaine or crack use. D) Women who use heroin are at risk for poor nutrition, anemia, and pregnancy-induced hypertension (or preeclampsia-eclampsia). Page Ref: 369
17) A pregnant woman is married to an intravenous drug user. She had a negative H I V screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for H I V? A) Hemoglobin of 11 g/d L and a rapid weight gain B) Elevated blood pressure and ankle edema C) Shortness of breath and frequent urination D) Persistent candidiasis
Answer: D Explanation: A) Hemoglobin of 11 g/d L and a rapid weight gain do not indicate a need to be retested for H I V. B) Elevated blood pressure and ankle edema do not indicate a need to be retested for H I V. C) Shortness of breath and frequent urination do not indicate a need to retest for H I V. D) Signs and symptoms of infections include fever, weight loss, fatigue, persistent candidiasis, diarrhea, cough, and skin lesions (Kaposi's sarcoma and hairy leukoplakia in the mouth). Page Ref: 373
19) A 21-year-old at 12 weeks' gestation with her first baby has known cardiac disease, class Ⅲ, as a result of childhood rheumatic fever. During a prenatal visit, the nurse reviews the signs of cardiac decompensation with her. The nurse will know that the client understands these signs and symptoms if she states that she would notify her doctor if she had which symptom? A) "A pulse rate increase of 10 beats per minute" B) "Breast tenderness" C) "Mild ankle edema" D) "A frequent cough"
Answer: D Explanation: A) In most pregnant clients, the heart rate will increase. B) Most pregnant clients will develop breast tenderness. C) The client with rheumatic heart disease who develops congestive heart failure would have severe ankle edema. D) The heart's signal of its decreased ability to meet the demands of pregnancy includes frequent cough (with or without hemoptysis). Page Ref: 378
12) The client with thalassemia intermedia has a hemoglobin level of 9.0. The nurse is preparing an education session for the client. Which statement should the nurse include? A) "You need to increase your intake of meat and other iron-rich foods." B) "Your low hemoglobin could put you into preterm labor." C) "Increasing your vitamin C intake will help your hemoglobin level." D) "You should not take iron supplements."
Answer: D Explanation: A) Iron-rich foods and supplementation should be avoided. B) Because the client's iron levels are normal, increasing dietary iron will not affect the hemoglobin. C) Vitamin C increases iron absorption, but a client with thalassemia does not need additional iron. D) Folic acid supplements are indicated for women with thalassemia, but iron supplements are not. Page Ref: 366
5) The client has just been diagnosed as diabetic. The nurse knows teaching was effective when the client makes which statement? A) "Ketones in my urine mean that my body is using the glucose appropriately." B) "I should be urinating frequently and in large amounts to get rid of the extra sugar." C) "My pancreas is making enough insulin, but my body isn't using it correctly." D) "I might be hungry frequently because the sugar isn't getting into the tissues the way it should."
Answer: D Explanation: A) Ketones are produced when fat is being utilized for glucose, and this is not a desirable response. B) Frequent urination is an indication of glucose above the renal threshold, and is not a good indicator of diabetic stability. C) Diabetes is a result of lack of insulin production. If the insulin is being produced, the body will utilize it. D) The client who understands the disease process is aware that if the body is not getting the glucose it needs, the message of hunger will be sent to the brain. Page Ref: 354—356
13) The client at 20 weeks' gestation has had an ultrasound that revealed a neural tube defect in her fetus. The client's hemoglobin level is 8.5. The nurse should include which statement when discussing these findings with the client? A) "Your low iron intake has caused anemia, which leads to the neural tube defect." B) "You should increase your vitamin C intake to improve your anemia." C) "You are too picky about food. Your poor diet caused your baby's defect." D) "You haven't had enough folic acid in your diet. You should take a supplement."
Answer: D Explanation: A) Low hemoglobin does not cause neural tube defects. B) Vitamin C will increase iron absorption, but this client is deficient in folic acid. C) Therapeutic communication requires that the nurse avoid making judgmental statements. D) An inadequate intake of folic acid has been associated with neural tube defects (N T Ds) (e.g., spina bifida, anencephaly, meningomyelocele) in the fetus or newborn. Page Ref: 364
16) A woman is 32 weeks pregnant. She is H I V-positive but asymptomatic. The nurse knows that what would be important in managing her pregnancy and delivery? A) An amniocentesis at 30 and 36 weeks B) Weekly non-stress testing beginning at 32 weeks' gestation C) Application of a fetal scalp electrode as soon as her membranes rupture in labor D) Administration of intravenous antibiotics during labor and delivery Answer: B
Explanation: A) Invasive procedures such as amniocentesis are avoided when possible to prevent the contamination of a noninfected infant. B) Weekly non-stress testing (N S T) is begun at 32 weeks' gestation and serial ultrasounds are done to detect I U G R. C) Invasive procedures are avoided when possible to prevent the contamination of a noninfected infant. D) Antibiotics would be ineffective for either the mother or the infant who was H I V-positive. Page Ref: 372—373
