Ch 20: Nursing Care of a Family Experiencing a Pregnancy Complication From a Preexisting or Newly Acquired Illness
a) Support her by respecting her right to privacy and confidentiality Pg. 568, 570 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.
1. 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? a) Support her by respecting her right to privacy and confidentiality b) Contact the mother of the adolescent to be sure the child gets prenatal care c) Recommend some adoption agencies for her to talk to in the near future d) 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
c) Dyspnea, crackles, and irregular weak pulse Pg. 492 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.
10. 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? a) Increased urinary output, tachycardia, and dry cough b) Regular heart rate and hypertension c) Dyspnea, crackles, and irregular weak pulse d) Shortness of breath, bradycardia, and hypertension
c) Orange juice Pg. 499 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. Dried fruit (such as apples), fortified grains, and dried beans are additional food choices that are rich in iron and should be included in her daily diet.
11. The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement? a) Dried apples b) Dried beans c) Orange juice d) Fortified grains
a) IV fluids Pg. 500 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.
12. A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? a) IV fluids b) Diuretic drugs c) Antihypertensive drugs d) Antibiotics
d) Decrease activity and rest more often Pg. 495 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.
13. 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? a) Discuss induction of labor with the health care provider b) Increase fluids and take more vitamins c) Bed rest and bathroom privileges only until birth d) Decrease activity and rest more often
c) Maintain a daily blood glucose log Pg. 519 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.
14. 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? a) Report any signs of possible urinary tract infection b) Long-term therapy goals c) Maintain a daily blood glucose log d) Plan daily menus with dietitian
c) Observe the client for signs of petechiae and premature separation of the placenta Pg. 497 Subclinical bleeding from continuous anticoagulant therapy in the woman has the potential to cause placental dislodgement. Observe a woman who is taking an anticoagulant for signs of petechiae and signs of premature separation of the placenta during both pregnancy and labor. The nurse should not urge the client to discontinue the anticoagulant, as this is not within the nurse's scope of practice and, in any case, the client still needs the anticoagulant to prevent clots. Bed rest is prescribed for clients with a thrombus to prevent it from moving and becoming a pulmonary embolus. Avoiding the use of constrictive knee-high stockings is to prevent thrombus formation.
15. A nurse is assessing a client in her seventh month of pregnancy who has an artificial valve prosthesis. The client is taking an oral anticoagulant to prevent the formation of clots at the valve site. Which of the following nursing interventions is most appropriate in this situation? a) Put the client on bed rest b) Urge the client to discontinue the anticoagulant to prevent pregnancy complications c) Observe the client for signs of petechiae and premature separation of the placenta d) Instruct the client to avoid wearing constrictive knee-high stockings
d) "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring" Pg. 504 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.
16. 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? a) "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on" b) "I need to be aware of my triggers and avoid them as much as possible" c) "It is fine for me to use my albuterol inhaler if I begin to feel tight" d) "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring"
a) "If my blood sugars are elevated, my baby's lungs will mature faster, which is good" Pg. 513 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.
17. 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? a) "If my blood sugars are elevated, my baby's lungs will mature faster, which is good" b) "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born" c) "My baby may be very large and I may need a cesarean birth to have him" d) "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day"
c) Jugular distention Pg. 493-494 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.
18. 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? a) Nausea and vomiting b) Urinary retention c) Jugular distention d) Abdominal cramps
c) Iron-deficiency anemia Pg. 498 Iron-deficiency anemia accounts for approximately 95% of anemia in pregnancy. Thalassemias are the most common genetic disorders of the blood. These anemias cause a reduction or absence of the alpha or beta hemoglobin chain. Sickle cell anemia is an inherited chronic disease that results from abnormal hemoglobin synthesis.
19. Which condition is the most common cause of anemia in pregnancy? a) Sickle cell anemia b) Alpha thalassemia c) Iron-deficiency anemia d) Beta thalassemia
c) "You will need to have another test to confirm the diagnosis" Pg. 1175-1178 The client with a reactive screening test, such as the ELISA test, needs to be prepared for an additional test, such as the Western blot or an immunofluorescence assay. The Western blot is the confirmatory diagnostic test. A positive antibody test confirmed by a supplemental test indicates that the client has been infected with HIV and can pass it on to others. Antiviral therapy and testing for other sexually transmitted infections will be done, but the diagnosis must be confirmed first. Antibiotics are not used for HIV. Also, amniocentesis is to be avoided to prevent contamination of the amniotic fluid with maternal blood.
2. A pregnant client has tested positive for HIV using an enzyme-linked immunoassay (ELISA) test. When talking with the client about the results, she asks, "So what happens next?" Which response by the nurse would be appropriate as the next step? a) "You will need testing for other infections like gonorrhea or syphilis" b) "You will need to have an amniocentesis to check on the baby" c) "You will need to have another test to confirm the diagnosis" d) "First you will get treated with antibiotics and then antiviral medicines"
d) Anticoagulant Pg, 493 In mitral valve stenosis, it is difficult for blood to leave the left atrium. A secondary problem of thrombus formation may develop as a result of noncirculating blood. A woman may need to be prescribed an anticoagulant to prevent this complication. Vasodilators are used for peripartum cardiomyopathy. Inotropics are used for heart failure. Angiotensin receptor blockers are used for congestive heart failure.
28. A pregnant woman with a history of mitral valve stenosis is to be prescribed medication as treatment. Which medication class would the nurse expect the client to be prescribed? a) Inotropic b) Angiotensin receptor blockers c) Vasodilator d) Anticoagulant
a) "I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet" Pg. Any woman with epilepsy needs to discuss medication management with her provider. The current research indicates the medications used for epileptic management are the major cause of birth defects for these clients. The nurse should be careful about mentioning that some epilepsy medications are teratogenic; some women may stop taking their medications in order to get pregnant. Suggesting adoption is inappropriate as the mother has given no indication she is interested in adoption; also, the mother needs to discuss this with the physician so that she can get accurate information about being on anti-seizure medications and being pregnant. The nurse should not share personal information as it does not assist this client in making a serious decision. The client should be referred to the health care provider to help the client make the best decision.
20. A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse? a) "I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet" b) "Do you want to talk to a counselor who can help you weigh the pros and cons of having your own child rather than adopting?" c) "That's great. I've got a 4-year-old and a 2-year-old myself" d) "You should talk to the doctor about that; the medications you're on can damage the fetus"
c) Ampicillin d) Cephalosporins f) Amoxicillin Pg. 502 Amoxicillin, ampicillin, and cephalosporins are effective against most organisms causing UTIs and are safe antibiotics during pregnancy. The sulfonamides can be used early in pregnancy but not near term because they can interfere with protein binding of bilirubin, which then leads to hyperbilirubinemia in the newborn. Tetracyclines are contraindicated during pregnancy as they cause retardation of bone growth and staining of the fetal teeth. Heparin is an anticoagulant and is used to prevent clot formation; it would not be prescribed for a UTI.
21. A woman in week 40 of her pregnancy has developed a urinary tract infection (UTI). The nurse anticipates which medication would be safe and appropriate to use with this client? Select all that apply. a) Tetracyclines b) Sulfonamides c) Ampicillin d) Cephalosporins e) Heparin f) Amoxicillin
c) Pulmonary hypertension Pg. 492 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.
22. 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? a) Secondary hypertension b) Repaired atrial septal defect c) Pulmonary hypertension d) Loud systolic murmur
c) Drug metabolism changes during pregnancy Pg. 510 Drug metabolism changes during pregnancy which may alter the therapeutic AED levels in the pregnant client. Some AEDs cannot be given in pregnancy due to risk of harm to the fetus; however, there are some that may be given. Pregnant clients do not have high rates of noncompliance and the action of medications does not change in pregnancy.
23. The maternal health nurse is caring for a pregnant client with a history of epilepsy. The client's antiepileptic drug (AED) levels have been in the non-therapeutic range the last two times the labs were drawn. Which factor does the nurse associate with this finding? a) The action of many medications varies in pregnancy b) Most maintenance medications cannot be given in pregnancy c) Drug metabolism changes during pregnancy d) Pregnant clients have high rates of noncompliance with maintenance medications
d) Congenital anomalies Pg. 490 A HbA1c level of 13% indicates poor glucose control. This, in conjunction with the woman being in the first trimester, increases the risk for congenital anomalies in the fetus. Elevated glucose levels are not associated with incompetent cervix, placenta previa, or placental abruption (abruptio placentae).
24. A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome? a) Placenta previa b) Incompetent cervix c) Placental abruption (abruptio placentae) d) Congenital anomalies
c) A diagnostic test such as an abdominal ultrasound Pg. 507 All of the symptoms point to a diagnosis of acute appendicitis. With appendicitis, the nausea and vomiting are much more intense than with morning sickness and the pain is sharp and localized at McBurney's point (a point halfway between the umbilicus and the iliac crest on the lower right abdomen). When identifying, it is best to recommend a diagnostic test such as an abdominal ultrasound to confirm the diagnosis. It is important to confirm the diagnosis as surgery needs to be completed to prevent a rupture. It is important to do an abdominal assessment but that will not confirm a diagnosis. The symptoms do not indicate a urinary issue. There is no data to indicate an issue with the fetus.
25. A woman at 38 weeks' gestation arrives at the hospital reporting a sharp pain between her umbilicus and the iliac crest that is increasing in intensity in the right lower quadrant. She reports having experienced intense nausea and vomiting for the past 3 hours. The nurse will report which recommendation to the primary health care provider? a) An abdominal assessment with bowel sounds b) A fetal nonstress test and fetal movement (kick) counts c) A diagnostic test such as an abdominal ultrasound d) A urine culture and broad-spectrum antibiotic
c) Restricted sodium intake Pg. 495 The client with peripartum cardiomyopathy should be prescribed a 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 a substance use disorder during pregnancy. Complementary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum, not peripartum cardiomyopathy.
26. A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client? a) Methadone therapy b) Monoamine oxidase inhibitors (MAOIs) c) Restricted sodium intake d) Ginger therapy
d) 24 to 28 weeks Pg. 514 A woman identified as high risk for gestational diabetes would undergo rescreening between 24 and 28 weeks; however, some health care providers can choose to conduct this screening earlier.
27. The nurse is caring for a pregnant woman determined to be at high risk for gestational diabetes. The nurse prepares to rescreen this client at which time frame? a) 20 to 24 weeks b) 16 to 20 weeks c) 28 to 32 weeks d) 24 to 28 weeks
c) Polyhydramnios Pg. 519 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.
29. 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? a) Postterm birth b) Hypotension of pregnancy c) Polyhydramnios d) Small-for-gestational-age (SGA) infant
c) "Your risk during pregnancy is small, but you should see your cardiologist first before getting pregnant" Pg. 491 Typically, a woman with class I or II cardiac disease can go through a pregnancy without major complications. For class I disease, there is no detectable increased risk of maternal mortality and no increase or a mild increase in morbidity. For class II disease, there is a small increased risk of maternal mortality or moderate increase in morbidity and cardiac consultation should occur every trimester. It is best to have the woman see her cardiologist before becoming pregnant. A woman with class III disease needs frequent visits with the cardiac care team throughout pregnancy. There is a significantly increased risk of maternal mortality or severe morbidity and cardiologist consult should occur every other month with prenatal care and delivery occurring at an appropriate level hospital. A woman with class IV disease is typically advised to avoid pregnancy.
3. The nurse reviews the medical record of a woman who has come to the clinic for an evaluation. The client has a history of mitral valve prolapse and is listed as risk class II. During the visit, the woman states, "We want to have a baby, but I know I am at higher risk. But what is my risk, really?" Which response by the nurse would be appropriate? a) "Your heart disease would put too much strain on your heart if you were to get pregnant" b) "If you do get pregnant, you will need to be seen by a cardiologist every other month for monitoring" c) "Your risk during pregnancy is small, but you should see your cardiologist first before getting pregnant" d) "Your pregnancy would be uneventful, but you would need specialized care for labor and birth"
b) Amoxicillin Pg. 502 Amoxicillin is a penicillin antibiotic and can be used in the pregnant woman to treat a UTI. Tetracycline should never be given to a pregnant woman, because it may cause retardation of bone growth and staining of the fetal teeth. The sulfonamides (bactrim and septra) can be used in early pregnancy but not near term, because they can interfere with protein binding of bilirubin, which then can lead to hyperbilirubinemia in the newborn.
30. A woman who is 8 months pregnant comes to the clinic with urinary frequency and pain on urination. The client is diagnosed with a urinary tract infection (UTI). Which medication would the nurse anticipate the physician will prescribe? a) Bactrim b) Amoxicillin c) Tetracycline d) Septra
b) Maintain glycemic control Pg. 512 The most important goal when caring for a pregnant client with pregestational diabetes is to maintain glycemic control. The scenario does not give enough information on the client's weight to determine if the client should gain only minimal weight during pregnancy. Ensuring compliance of glucose monitoring and monitoring for associated complications are appropriate nursing interventions; however, these do not take priority.
31. The nurse is caring for a pregnant client with pregestational diabetes. Which goal does the nurse identify as priority during the client's pregnancy? a) Monitor for associated complications b) Maintain glycemic control c) Ensure compliance of glucose monitoring d) Encourage minimal weight gain
c) Fetal malnutrition Pg. 507 SLE is an autoimmune disorder in which there is a deposition of immune complexes in the capillaries and visceral structures. Clients with SLE who become pregnant are at an increased risk of fetal malnutrition due to decreased placental circulation. Pregnancy-related problems in SLE include prematurity, stillbirth, decreased placental weight, and thinner placental villi. In clients with SLE, there is preterm birth and decreased placental weight. Fetal macrosomia is seen in clients having gestational diabetes, not SLE.
32. A pregnant client with deep vein thrombosis has been diagnosed as having systemic lupus erythematosus (SLE). The nurse would monitor the client closely for the development of which complication? a) Fetal macrosomia b) Increased placental weight c) Fetal malnutrition d) Postterm birth of infant
b) An insulin pump Pg. 518 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.
33. 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: a) An insulin pen b) An insulin pump c) Regular insulin twice a day d) An insulin drip
d) Antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn Pg. 510 Antiepileptic therapy may cause vitamin K-deficient hemorrhage of the newborn. The vitamin K injection the newborn receives following birth can't fully correct this, so some physicians recommend a vitamin K supplement for their pregnant clients beginning at 36 weeks' gestation. If the mother should go into preterm labor, the newborn will have received the vitamin K prior to delivery. However, many physicians now question the usefulness of the prophylaxis.
34. A woman's obstetrician prescribes vitamin K supplements for a client who is on antiepileptic medications beginning at 36 weeks' gestation. The mother asks the nurse why she is taking this medication. The nurse's best response would be: a) The antiepileptic medications can cause the mother's platelets to drop b) Administration of vitamin K aids in lung maturity of the fetus c) Vitamin K helps in keeping the placenta healthy d) Antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn
d) Iron-deficiency anemia Pg. 498 Iron-deficiency anemia is the most common type in pregnancy. Many woman enter pregnancy with a low iron count because of poor diet, heavy menstrual periods, unwise weight-loss programs, or a combination of these.
35. A nursing instructor is teaching students about anemia during pregnancy. Which type of anemia does the instructor teach students is most prevalent during pregnancy? a) Sickle-cell anemia b) Folic acid anemia c) Pernicious anemia d) Iron-deficiency anemia
c) Lie in a semi-recumbent position Pg. 495 Semi-recumbent position is the best position for circulation of the mother and fetus. Lying flat on the back can induce supine hypotensive syndrome and fully recumbent impedes other circulation. The high Fowler position would not be comfortable for sleeping, as well as possibly impede the blood flow through the hips and lower abdomen.
36. A woman with class II heart disease is experiencing an uneventful pregnancy and is now prescribed bed rest at 36 weeks' gestation by her health care provider. The nurse should point out that this is best accomplished with which position? a) Lie flat on her back b) Stay in high Fowler position c) Lie in a semi-recumbent position d) Use pillows and wedges to stay in a fully recumbent position
d) Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore Pg. 520 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.
37. 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? a) Ask about chronic illnesses that the health care provider should know about due to the client being older b) Inquire about any family history of chromosomal abnormalities since older women are more likely to have infants with a chromosomal defect c) Offer genetic counseling and an early amniocentesis to determine if termination is needed d) Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore
d) A newborn who was a vaginal delivery to a mother who had her initial outbreak during the third trimester of pregnancy and has active lesions Pg. 272 The newborn most likely to develop a herpetic infection is the one delivered vaginally to a mother who is experiencing her first outbreak, may or may not know she has herpes, and has active lesions. Delivery by cesarean section reduces the chance of the newborn developing herpes, even if there is premature rupture of membranes prior to delivery. Vaginal deliveries are recommended for mothers with a history of herpes but no current active lesions.
38. Which neonate is at highest risk for developing neonatal herpes following birth? a) A newborn who was delivered by cesarean section following prolonged rupture of membranes to a herpes positive mother with no active lesions b) A newborn who was delivered by cesarean section to a mother with genital herpes c) A newborn who was a vaginal delivery to a mother with no active lesions but a history of herpes d) A newborn who was a vaginal delivery to a mother who had her initial outbreak during the third trimester of pregnancy and has active lesions
c) "Actually, having uncontrolled asthma is much riskier for your baby than the medication" Pg. 504 It is important for pregnant clients with asthma to keep taking their medications because the risks of exacerbations exceed the risks of the medications.
39. The nurse is assessing a pregnant client who has a long history of asthma. The client states, "I'm trying not to use my asthma medications because I certainly don't want my baby exposed to them." What is the nurse's best response? a) "Your health care provider will likely agree with your decision" b) "In fact, most modern asthma medications are categorized as safe for use in pregnancy" c) "Actually, having uncontrolled asthma is much riskier for your baby than the medication" d) "I'm glad to hear that you're focused on ensuring your baby's health"
c) Check her blood sugars frequently and adjust insulin accordingly Pg. 515 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.
4. 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: a) Begin oral hyperglycemic medications along with the insulin she is currently taking b) Exercise for 1 to 2 hours each day to keep the blood glucose down c) Check her blood sugars frequently and adjust insulin accordingly d) Limit weight gain to 15 pounds during the pregnancy
a) Diet Pg. 515 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.
5. 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? a) Diet b) Glucagon c) Long-acting insulin d) Oral hypoglycemic drugs
a) Avoidance of infection Pg. 499-500 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.
6. 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? a) Avoidance of infection b) Administration of immunoglobulins c) Consumption of a low-fat diet d) Constipation prevention
b) "Pregnancy affects insulin production, so I will need to make adjustments in my diet" Pg. 513 In pregnancy, placental hormones cause insulin resistance at a level that tends to parallel growth of the fetoplacental unit. Nutritional management focuses on maintaining balanced glucose levels. Thus, the client will probably need to make adjustments in the diet. Protein needs increase during pregnancy, but this is unrelated to diabetes. Blood glucose monitoring results typically guide therapy.
7. The nurse is teaching a pregnant client with type 2 diabetes about diet during pregnancy. Which client statement indicates that the nurse's teaching was successful? a) "Because I need extra protein, I will have to increase my intake of milk and meat" b) "Pregnancy affects insulin production, so I will need to make adjustments in my diet" c) "I'll basically follow the same diet that I was following before I became pregnant" d) "I will adjust my diet and insulin based on the results of my urine tests for glucose"
a) 1500 Pg. 601 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).
8. 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? a) 1500 b) 1400 c) 1600 d) 1300
b) Check blood sugar levels daily Pg. 500 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.
9. 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? a) The signs and symptoms of urinary tract infection b) Check blood sugar levels daily c) Take daily iron supplements d) Include iron-enriched foods in the diet
