CH. 20 PREPU
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% 6.5% 7.5%
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.
What important instruction should the nurse give a pregnant client with tuberculosis? Maintain adequate hydration. Avoid direct sunlight. Avoid red meat. Wear light, cotton clothes.
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 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? She is at increased risk for type 2 diabetes mellitus after her baby is born. Her baby is at increased risk for neonatal diabetes mellitus. Her baby is at increased risk for type 1 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. Explanation: The woman who develops GDM is at increased risk for developing type 2 diabetes mellitus after pregnancy.
A woman with no previous history of heart disease begins to have symptoms of myocardial failure a few weeks before the birth of her first child. Findings include shortness of breath, chest pain, and edema, with her heart also showing enlargement. The nurse suspects which condition? mitral stenosis left-sided heart failure pulmonary valve stenosis peripartum cardiomyopathy
peripartum cardiomyopathy Explanation: Peripartum cardiomyopathy can occur in pregnancy without any previous history of heart disease. Symptoms include shortness of breath, chest pain, and edema; also, the heart begins to enlarge. Treatment is with a diuretic, an antiarrhythmic agent, digitalis, low weight heparin, and bed rest.
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 (5.55 mmol/L) 114 mg/dL (6.33 mmol/L) 130 mg/dL (7.21 mmol/L) 146 mg/dL (8.10 mmol/L)
146 mg/dL (8.10 mmol/L) 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 (7.77 mmol/L)is abnormal. If the result is abnormal, a 3-hour glucose tolerance test is done.
Which should the nurse identify as a risk associated with anemia during pregnancy? newborn with heart problems fetal asphyxia preterm birth newborn with an enlarged liver
preterm birth Explanation: The nurse should identify preterm birth as a risk associated with anemia during pregnancy. Anemia during pregnancy does not increase the risk of a newborn with heart problems, an enlarged liver, or fetal asphyxia.
Which factor would contribute to a high-risk pregnancy? blood type O positive first pregnancy at age 33 history of allergy to honey bee pollen type 1 diabetes
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 nurse is documenting a dietary plan for a pregnant client with pregestational diabetes. What instruction should the nurse include in the dietary plan for this client? Include more dairy products in the diet. Include complex carbohydrates in the diet. Eat only two meals per day. Eat at least one egg per day.
Include complex carbohydrates in the diet. Explanation: The nurse should stress the inclusion of complex carbohydrates in the dietary plan for a pregnant woman with pregestational diabetes. The pregnant client with pregestational diabetes need not include more dairy products in the diet, eat only two meals per day, or eat at least one egg per day; these have no impact on the client's condition.
A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn? microcephaly bicuspid valve stenosis hypertension clubbed fingers and toes
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 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 with a chronic condition can put herself at risk." "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 needs to be careful of and cautious about accidents and illnesses during her pregnancy."
"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.
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? 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. Continue taking iron supplements but increase fluids and high-fiber foods; exercise more. Increase the iron supplements, fluid intake, and consumption of high-fiber foods; exercise more. Take the iron supplement every other day, increase 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 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 bit wheezy." "I have trouble getting comfortable in bed." "I sometimes get a feeling of euphoria." "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 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% 14% 6% 12%
6% Explanation: The upper normal level of HbA1C is 6% of total hemoglobin.
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 pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? antihypertensive drugs diuretic drugs IV fluids antibiotics
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.
A nurse caring for a pregnant client suspects substance use during pregnancy. What is the priority nursing intervention for this client? Determine how long the client has been using drugs. Obtain a urine specimen for a drug screening. Determine if the client has emotional support. Provide education material on cessation of substance use.
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 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? right lateral recumbent left lateral recumbent on her back prone
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 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 chickenpox
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.
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? cytomegalovirus chlamydia gonorrhea 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 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? obtaining enough rest maintaining a high fluid intake beginning a low-impact aerobics program discontinuing her prepregnancy anticoagulant
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 woman with gestational diabetes is prescribed 10 units of an intermediate-acting insulin and 5 units of a short-acting insulin each day. The total dose is to be divided into two injections, a morning and an evening dose. To provide the most effective control of the woman's blood glucose levels, the nurse anticipates that the client is likely to be prescribed how many total units for the morning dose? 5 7 1/2 10 12 1/2
10 Explanation: The American College of Obstetricians and Gynecologists affirms the use of insulin as the first-line pharmacotherapy for gestational diabetes when medication is necessary to control blood glucose levels. Insulin, which does not cross the placenta, has historically been the medication of choice for treating hyperglycemia in pregnancy. Combining intermediate- and short-acting insulin yields the best result for most women. Two insulin doses are given daily with two-thirds of the total insulin in the morning to cover energy needs of the active day and one third at night. For this client, it would be a total of 10 units in the morning and 5 units at night.
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 high-carbohydrate snack. Eat a sustaining-carbohydrate snack. Add a bolus of long-acting insulin.
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.
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
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 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? Secondary hypertension Repaired atrial septal defect Pulmonary hypertension Loud systolic murmur
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.
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. milk.
citrus juice. Explanation: Iron absorption is enhanced when taken with foods high in vitamin C, such as citrus juice. The nurse should advise clients to avoid consuming milk, antacids, high-fiber foods, and caffeine for 2 hours after taking iron for superior absorption.
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?" "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?" "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." 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 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."
"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 pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum? limiting sodium intake inspecting the extremities for edema ensuring that the client consumes a high fiber diet assessing for cardiac decompensation
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 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.
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? A 3-hour glucose tolerance test for follow-up Daily insulin injections for gestational diabetes Monthly hemoglobin A1C levels to rule out diabetes Daily fingersticks for a fasting blood glucose level
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.
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. congenital malformations in newborn newborn with macrosomia newborn with juvenile diabetes small-for-gestational-age newborn newborn with respiratory disorder
ongenital 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 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? cytomegalovirus toxoplasmosis hepatitis C herpes simplex virus
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.