ch20: pregnancy at risk2
The nurse is assessing a pregnant client who has a long history of asthma treated with albuterol and montelukast. The client states, "I am trying not to use my asthma medications because I do not want my baby exposed to them." Which response should the nurse prioritize? "I am glad to hear that you are focused on ensuring your baby's health." "Actually, having uncontrolled asthma is much riskier for your baby than the medication." "In fact, most modern asthma medications are categorized as safe for use in pregnancy." "Your health care provider will likely agree with your decision."
"Actually, having uncontrolled asthma is much riskier for your baby than the medication." The priority is for pregnant clients with asthma to keep taking their medications because the risks of exacerbations exceed the risks of the medications to both the client and fetus. Some medications used to treat asthma (short-acting inhaled bronchodilators, antileukotriene agents, some inhaled corticosteroids) have minimal to no effects on the pregnancy. The other statements would be inappropriate.
A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn? bicuspid valve stenosis clubbed fingers and toes microcephaly hypertension
microcephaly v 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 nurse is teaching a woman diagnosed with gestational diabetes about meal planning and nutrition. The nurse determines that additional teaching is needed based on which client statement? "I need to avoid any fat with my meals." "It's okay to eat small meals or snacks throughout the day." "Having a bedtime snack is good for me." "I should get most of my calories from good complex carbs."
"I need to avoid any fat with my meals." Recommendations for nutrition and diet with gestational diabetes include: eating three meals a day plus three snacks to promote glycemic control with 40% of calories from good-quality complex carbohydrates, 35% of calories from protein sources, and 25% of calories from unsaturated fats; eating small frequent feedings throughout the day; having bedtime snacks; and including protein and fat at each meal.
A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction? "I need to be aware of my triggers and avoid them as much as possible." "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on." "It is fine for me to use my albuterol inhaler if I begin to feel tight."
"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." A pregnant woman with a history of asthma needs to be proactive, taking her inhalers and other asthma medications to prevent an acute asthma attack. She needs to understand that it is far more dangerous to not take the medications and have an asthma attack. She also needs to monitor her peak flow for decreases, be aware of triggers, and avoid them if possible. However, a pregnant woman should never begin allergy shots if she has not been taking them previously, due to the potential of an adverse reaction.
A nurse is conducting a class for a group of pregnant women about ways to minimize the risk of infection during pregnancy. One of the infections that the nurse is discussing is toxoplasmosis. The nurse determines that the class was successful when the group identifies which action(s) as helpful in preventing this infection. Select all that apply. "It is important to wear gardening gloves when digging in the soil." "Peeling any raw vegetables is a good idea before eating them." "A house cat should be kept outside to prevent bringing things inside the house." "It is important to cook any meat that we will eat to at least a temperature of 145°F (62.8°C)." "Any cutting surface used for raw meats should be washed afterwards with hot, soapy water."
"It is important to wear gardening gloves when digging in the soil." "Peeling any raw vegetables is a good idea before eating them." "Any cutting surface used for raw meats should be washed afterwards with hot, soapy water." Pregnant women should do the following to prevent toxoplasmosis: avoid eating raw or undercooked meat, especially lamb or pork. Cook all meat to an internal temperature of 160°F (71°C) throughout; clean cutting boards, work surfaces, and utensils with hot, soapy water after contact with raw meat or unwashed fruits and vegetables. Peel or thoroughly wash all raw fruits and vegetables before eating them; keep the cat indoors to prevent it from hunting and eating birds or rodents; and wear gardening gloves when in contact with outdoor soil.
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? "HIV antibodies do not cross the placenta; this means the baby will develop AIDS." "HIV is transmitted at birth; having a cesarean birth prevented transmission." "She already has AIDS. That's what being HIV positive means." "The antibodies may be those transferred across the placenta; the baby may not develop AIDS."
"The antibodies may be those transferred across the placenta; the baby may not develop AIDS." 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 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? "You will need to have another test to confirm the diagnosis." "You will need to have an amniocentesis to check on the baby." "You will need testing for other infections like gonorrhea or syphilis." "First you will get treated with antibiotics and then antiviral medicines."
"You will need to have another test to confirm the diagnosis."
A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response? "They won't cause any major defects." "I'll let your primary care provider know how you feel about it." "Your primary care provider will order safe doses of your medication." "It's OK to not use them if you would feel more comfortable."
"Your primary care provider will order safe doses of your medication." Women should take no medication during pregnancy except that prescribed by their primary care provider. The PCP will work with the mother to ensure the safest amount is given to adequately handle the mother's health issues and not injure the fetus. The PCP must weigh the risks against the benefits for both the mother and her fetus. The nurse should not encourage the client to stop her asthma medication as that may result in the client having an asthma attack, which could result in injury to the fetus or even miscarriage. The nurse should not tell the client a drug will not cause any defects, especially if it is known that it can. That could make the nurse liable for damages. The nurse should inform the PCP of the client's concerns; however, it is more important for the nurse to calm the client's anxiety and offer positive reinforcement that the PCP is working hard to protect the mother and infant from harm.
A woman comes to the clinic for her first prenatal visit. As part of the assessment, the woman is screened for rubella antibodies. The nurse determines that a client has immunity against rubella based on which rubella titer? 1:0 1:8 1:6 1:4
1:8 A rubella antibody titer of 1:8 or greater proves evidence of immunity. Women with titers of less than 1:8 should be immunized.
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? 16 to 20 weeks 20 to 24 weeks 24 to 28 weeks 28 to 32 weeks
24 to 28 weeks 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.
A client with systemic lupus erythematosus is attending preconception counseling regarding their desire to get pregnant. The nurse explains that it would be best if the client is symptom-free or in remission for how long before getting pregnant? 6 months 3 months 9 months 12 months
6 months If the client with systemic lupus erythematosus is considering pregnancy, it is recommended that the client postpone conception until the disease has been stable or in remission for 6 months. Active disease at the time of conception and a history of kidney disease increase the likelihood of a poor pregnancy outcome.
A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? 8% 12% 14% 6%
6% The upper normal level of HbA1C is 6% of total hemoglobin.
What criteria would the practitioner base a decision on to begin insulin therapy for a mother with gestational diabetes? Weight gain is over 30 pounds (13.6 kg) and blood sugars are fluctuating between 95 and 130 throughout the day. Client cannot keep fasting blood sugar lower than 90 mg/dl. Urine is 2+ for glucose and serum blood glucose is 120. A 2-hour postprandial glucose level cannot be kept below 120 mg/dl.
A 2-hour postprandial glucose level cannot be kept below 120 mg/dl. A practitioner usually recommends beginning a woman with gestational diabetes on insulin therapy when exercise and diet are ineffective and if she is unable to keep her fasting blood sugar levels below 95 mg/dl or her 2-hour postprandial glucose levels below 120 mg/dl.
A G4P3 client with a history of controlled asthma is upset her initial prenatal appointment is taking too long, making her late for another appointment. What is the nurse's best response when the client insists she knows how to handle her asthma and needs to leave? Note in the chart that the woman was not counseled about her asthma. Acknowledge her need to leave but ask her to demonstrate the use of inhaler and peak flow meter before she goes; remind her to take regular medications. Remind her to continue taking asthma medications, to monitor peak flow daily, and to monitor the baby's kicks in the second and third trimesters. Schedule an appointment for her to return to discuss her asthma management.
Acknowledge her need to leave but ask her to demonstrate the use of inhaler and peak flow meter before she goes; remind her to take regular medications. Management of asthma during pregnancy is very important; the nurse must document that the client has the proper ability to manage her asthma for her health and the health of the fetus. Reminding the client to continue taking her prescribed medication and to monitor her peak flow daily is not enough. It is the nurse's responsibility to know that the client knows how to take her medications. Monitoring the baby's kicks in the second and third trimester is an appropriate action. Scheduling a return appointment to discuss asthma management is not appropriate. She could have an asthma attack between the time the nurse sees her and the time of the return appointment. Noting in the chart that the woman was not counseled does not relieve the nurse of his/her obligation to ensure that the woman knows how to use her inhaler and her peak flow meter.
A postpartum mother has the following lab data recorded: a negative rubella titer. What is the appropriate nursing intervention? No action needed. Administer rubella vaccine before discharge. Assess the rubella titer of the baby. Notify the health care provider.
Administer rubella vaccine before discharge. Rubella is a virus, which when contracted during pregnancy has significant complications for the fetus. The illness is mild to the adult but can result in the infant being born deaf and blind. There is no cure; the CDC recommends all individuals be vaccinated against rubella. If the titer is negative, the mother does not have protection against rubella, and the next pregnancy would be at risk. She should receive the vaccination prior to discharge from the hospital. Assessing the rubella titer of the baby would not mean anything. The baby has not had rubella and has not received antibodies against rubella from the mother. Notifying the health care provider is not a priority, as most institutions have standing orders to administer the rubella vaccine if the mother's rubella titer is negative.
A client with rheumatoid arthritis (RA) is in week 38 of her pregnancy. Which intervention should the nurse make with this client? Advise the client to continue her normal dosage of methotrexate. Urge the client to be on bed rest. Ask the client to decrease her intake of salicylates. Perform the Snellen eye test.
Ask the client to decrease her intake of salicylates. Although women with RA should continue to take their medications during pregnancy to prevent joint damage, large amounts of salicylates have the potential to lead to increased bleeding at birth or prolonged pregnancy. The infant may be born with a bleeding defect and may also experience premature closure of the ductus arteriosus because of the drug's effects. For this reason, a woman is asked to decrease her intake of salicylates approximately 2 weeks before term. A number of women also take low-dose methotrexate, a carcinogen. As a rule, they should stop taking this prepregnancy because of the danger of head and neck defects in the fetus. There is no need for the client to be on bed rest or to perform the Snellen eye test.
A nurse is caring for a client with cardiovascular disease who has just given birth. What nursing interventions should the nurse perform when caring for this client? Select all that apply. Assess for edema and note any pitting. Monitor the client's hemoglobin and hematocrit. Assess for shortness of breath. Assess for a moist cough. Auscultate heart sounds for abnormalities.
Assess for edema and note any pitting. Assess for shortness of breath. Assess for a moist cough. Auscultate heart sounds for abnormalities. The nurse should assess for possible fluid overload in a client with cardiovascular disease who has just given birth. Signs of fluid overload in the client who has just labored include cough, progressive dyspnea, edema, palpitations, and crackles in the lung bases. Hemoglobin and hematocrit levels are not affected by laboring of the client with cardiovascular disease.
After conducting a refresher class on possible congenital infections with a group of perinatal nurses, the nurse recognizes the class was successful when the group identifies which congenital viral infection as the most common? HPV RSV HIV CMV
CMV Cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. Human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus (HSV) are other potential viruses.
A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize? Bed rest and bathroom privileges only until birth. Discuss induction of labor with the health care provider. Increase fluids and take more vitamins. Decrease activity and rest more often.
Decrease activity and rest more often. If the client is developing symptoms associated with her heart condition, the first intervention is to monitor activity levels, decrease activity, and treat the symptoms. At 32 weeks' gestation, the suggestion to induce labor is not appropriate, and without knowledge of the type of heart condition one would not recommend an increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity.
A 20-year-old pregnant client is positive for hemoglobin S. The nurse explains to the client that she will need perform which actions during her pregnancy? Select all that apply. Be on bed rest. Drink lots of fluids. Avoid conditions of low oxygen tension, such as high altitudes. Eat high-protein meals.
Drink lots of fluids. Avoid conditions of low oxygen tension, such as high altitudes. When oxygen tension becomes reduced, as occurs at high altitudes, or blood becomes more viscid than usual, such as occurs with dehydration, the cells of a client with hemoglobin S clump together because of their irregular shape, resulting in vessel blockage with reduced blood flow to organs. Drinking fluids and avoiding high altitudes will help to prevent this occurrence. High-protein meals and bed rest will have no effect.
The nurse is appraising the laboratory results of a pregnant client who is in her second trimester and notes the following: thyroid stimulating hormone (TSH) slightly elevated, glucose in the urine, complete blood count (CBC) low normal, and normal electrolytes. The nurse prioritizes further testing to rule out which condition? Preeclampsia Anemia Hyperthyroidism Gestational diabetes
Gestational diabetes Glycosuria, glucose in the urine, may occur normally during pregnancy; however, if it appears in the urine, the client should be sent for testing to rule out gestational diabetes. Preeclampsia, anemia, and hyperthyroidism are not related to glucose nor to renal function. A slightly elevated TSH would indicate possible hypothyroidism instead of hyperthyroidism. Anemia would be indicated by below normal hematocrit. If the client's CBC is low normal than the nurse should monitor future results to ensure the client's counts are not dropping. It would also be appropriate for the nurse to investigate possible dietary issues. Preeclampsia would be best monitored by the blood pressure readings.
The nurse is educating a client with type 1 diabetes about the complications associated with diabetes and pregnancy. Which problems would the nurse include in her teaching? Select all that apply. Hypertension Decreased birth weight Cystic fibrosis Increased risk of spontaneous abortion (miscarriage) Polyhydramnios
Increased risk of spontaneous abortion (miscarriage) Polyhydramnios Hypertension Women with pregestational diabetes, which is type 1 diabetes, are at a higher risk of having an infant with complications during the pregnancy and at the birth. Spontaneous abortion (miscarriage) is higher in women who have pregestational diabetes. Also, they run a higher risk of having a pregnancy with polyhydramnios, and of developing maternal hypertension. The birth weight of an infant born to a mother with diabetes is increased, not decreased. Cystic fibrosis is not associated with maternal diabetes.
A pregnant woman diagnosed with diabetes should be instructed to perform which action? Notify the primary care provider if unable to eat because of nausea and vomiting. Prepare foods with increased carbohydrates to provide needed calories. Discontinue insulin injections until 15 weeks gestation. Ingest a smaller amount of food prior to sleep to prevent nocturnal hyperglycemia.
Notify the primary care provider if unable to eat because of nausea and vomiting. During pregnancy, the insulin levels change in response to the production of HPL. The client needs to alert her provider if she is not able to eat or hold down appropriate amounts of nutrition. The client is at risk for episodes of hypoglycemia during the first trimester. She should never discontinue insulin therapy without her provider's directions. The increase of carbohydrates needs to be balanced with protein, and smaller meals would result in hypoglycemia rather than hyperglycemia.
The nurse is caring for a 2-day-old newborn whose mother was diagnosed with cytomegalovirus during the first trimester. On which health care provider prescription should the nurse place the priority? Assess pulse rate. Obtain a urine specimen. Perform a hearing screen test. Monitor growth and development.
Perform a hearing screen test. 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.
A 17-year-old primigravida with type 1 diabetes is at 37 weeks' gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next? Preparing for amniocentesis and fetal lung maturity assessment Scheduling a cesarean delivery at 39 weeks. Scheduling the woman for induction of labor today. Allowing her to continue without plans for delivery.
Preparing for amniocentesis and fetal lung maturity assessment If the infant has macrosomia, is large for gestation age, and the mother has had poor blood-sugar control, the provider will want further information on the fetus and readiness for delivery before making any decisions on delivery. After determining the readiness of the fetus, then plans for delivery can be determined and scheduled.
The maternal health nurse is caring for a group of high-risk pregnant clients. Which client condition will the nurse identify as being the highest risk for pregnancy? Repaired atrial septal defect Secondary hypertension Pulmonary hypertension Loud systolic murmur
Pulmonary hypertension 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 about how to prevent contracting cytomegalovirus (CMV) during pregnancy. What tips would the nurse share with this client? Select all that apply. If you contract CMV, your practitioner will give you some oral medicine to treat it. Wash your hands thoroughly with soap and water after touching saliva or urine. If you develop any flu-like symptoms, notify your pratitioner immediately to be evaluated for CMV. Do not share food or drinks with young children, especially if they are in day care. If you have CMV, it is suggested that you not breastfeed your infant.
Wash your hands thoroughly with soap and water after touching saliva or urine. Do not share food or drinks with young children, especially if they are in day care. If you develop any flu-like symptoms, notify your pratitioner immediately to be evaluated for CMV. Cytomegalovirus (CMV) is a mild infection and women may not know they have contracted it. The problem arises when a pregnant woman contracts it during the first 20 weeks of gestation. Prevention is the key, so the nurse would reinforce handwashing, not eating or drinking from a container after a small child has done so, and notifying the physician if the client develops mild flu-like symptoms so she can be tested to rule out CMV.
A pregnant woman who is HIV-positive comes to the labor and birth unit in labor. When developing the plan of care for this client, which intervention would be most important for the nurse to include? educating her about family planning preparing the woman for cesarean birth helping her choose a newborn feeding method adhering to standard precautions
adhering to standard precautions For the pregnant woman who is HIV-positive, standard precautions must be used to reduce the risk of HIV transmission. Educating the woman about family planning methods is not as important as adhering to standard precautions. The decision about the mode of delivery is based on the woman's viral load, duration of ruptured membranes, progress of labor, and other clinical factors. Breastfeeding is contraindicated, so helping her choose a feeding method would be inappropriate.
The clinic nurse teaches a client with pregestational type 1 diabetes that maintaining a constant insulin level is very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use: an insulin pump. an insulin pen. regular insulin twice a day. an insulin drip.
an insulin pump. 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.
A nurse is caring for a pregnant client. The initial interview reveals that the client is accustomed to drinking coffee at regular intervals. For which increased risk should the nurse make the client aware? heart disease anemia rickets scurvy
anemia The nurse should make the client aware of increased risk of anemia as a possible effect of maternal coffee consumption during pregnancy, as it decreases iron absorption. Maternal coffee consumption during pregnancy does not increase the risk of heart disease, rickets, or scurvy.
A woman who immigrated here from a third world country presents to the clinic to find out if she is pregnant. Which signs and/or symptoms would the nurse assess as possible indicators that she might have an active case of tuberculosis as well? Select all that apply. anorexia night sweats fatigue hemoptysis weight gain
anorexia night sweats fatigue hemoptysis Women emigrating from developing countries are at high risk for tuberculosis. Clinical manifestations include fatigue, fever or night sweats, nonproductive cough, weakness, slow weight loss, anemia, hemoptysis, and anorexia.
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: check her blood sugars frequently and adjust insulin accordingly. limit weight gain to 15 pounds during the pregnancy. exercise for 1 to 2 hours each day to keep the blood glucose down. begin oral hyperglycemic medications along with the insulin she is currently taking.
check her blood sugars frequently and adjust insulin accordingly. The goal for a mother who has type I diabetes mellitus is to keep tight control over her blood sugars throughout the pregnancy. Therefore, she needs to test her blood sugar frequently during the day and make adjustments in the insulin doses she is receiving.
A pregnant 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 III class II class IV
class III 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.
When providing nutritional counseling to a pregnant woman with diabetes, the nurse would urge the client to obtain most of her calories from which source? saturated fats protein complex carbohydrates unsaturated fats
complex carbohydrates The pregnant woman with diabetes is encouraged to eat three meals a day plus three snacks, with 40% of calories derived from good-quality complex carbohydrates, 35% of calories from protein sources, and 35% of calories from unsaturated fats. The intake of saturated fats should be limited during pregnancy, just as they should be for any person to reduce the risk of heart disease.
A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client? long-acting insulin glucagon oral hypoglycemic drugs diet
diet Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are usually not given during pregnancy and would not be the first option. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.
The nurse is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize? shortness of breath, bradycardia, and hypertension dyspnea, crackles, and irregular weak pulse regular heart rate and hypertension increased urinary output, tachycardia, and dry cough
dyspnea, crackles, and irregular weak pulse The nurse should be alert for signs of cardiac decompensation due to congestive heart failure, which include crackles in the lungs from fluid, difficulty breathing, and weak pulse from heart exhaustion. The heart rate would not be regular, and a cough would not be dry. The heart rate would increase rather than decrease.
A nurse is conducting a presentation about prenatal care and preexisting maternal conditions. When discussing the various risks to the mother and infant, the nurse would include information about which condition as the leading cause of intellectual disability in the United States? genetic anomalies pregnancy category X medications maternal drug addiction fetal alcohol spectrum disorder
fetal alcohol spectrum disorder Fetal alcohol spectrum disorder is a lifelong yet completely preventable set of physical, mental, and neurobehavioral birth defects. It is the leading cause of intellectual disability in the United States.
The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of having a heroin use disorder. The nurse would be alert for which finding when assessing the neonate? low, feeble cry hypertonicity vigorous sucking easy consolability
hypertonicity Newborns of mothers with heroin or other opioid use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.
Cytomegalovirus infection can result in different congenital anomalies. It can also be transmitted via different routes. When discussing this infection with a pregnant woman, the nurse integrates understanding that permanent fetal disability can occur with which type of transmission of CMV? with any transmission after birth transmission in utero transmission during birth transmission
in utero transmission There are three time periods during which mother-to-child transmission can occur; however, permanent disability occurs only in association with in utero infection. Such disability can result from maternal infection during any point in the pregnancy, but more severe disabilities are usually associated with maternal infection during the first trimester.
A pregnant woman diagnosed with cardiac disease 4 years ago is told that her pregnancy is a high-risk pregnancy. The nurse then explains that the danger occurs primarily because of the increase in circulatory volume. The nurse informs the client that the most dangerous time for her is when? in weeks 20 to 28 in weeks 28 to 32 in weeks 8 to 12 in weeks 12 to 20
in weeks 28 to 32 The danger of pregnancy in a woman with cardiac disease occurs primarily because of the increase in circulatory volume. The most dangerous time for a woman is in weeks 28 to 32, just after the blood volume peaks.
A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client? knowledge of child development sexual development of the client whether sex was consensual options for birth control in the future
knowledge of child development The nurse should address the client's knowledge of child development during assessment of the pregnant adolescent client. The nurse need not address the sexual development of the client or whether sex was consensual. This would not be an opportune time to discuss birth control methods to be used after the pregnancy.
Which should the nurse identify as a risk associated with anemia during pregnancy? newborn with heart problems preterm birth fetal asphyxia newborn with an enlarged liver
preterm birth 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.
A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply. previous large-for-gestational-age (LGA) infant genitourinary tract abnormalities obesity maternal age less than 18 years hypertension
previous large-for-gestational-age (LGA) infant obesity hypertension Obesity, hypertension, and a previous infant weighing more than 9 lb (4 kg) are risk factors for developing gestational diabetes. Maternal age less than 18 years and genitourinary tract abnormalities do not increase the risk of developing gestational diabetes.
During the assessment of a laboring client, the nurse learns that the client has cardiovascular disease (CVD). Which assessment would be priority for the newborn? heart rate temperature urine output respiratory function
respiratory function The nurse should identify respiratory distress syndrome as a major risk that can be faced by the offspring of a client with cardiovascular disease. While the other assessments are important, they are not priority.
A nurse is caring for a newborn with fetal alcohol spectrum disorder. What characteristic of the fetal alcohol spectrum disorder should the nurse assess for in the newborn? small head circumference wide eyes decreased blood glucose level poor breathing pattern
small head circumference The nurse should assess for small head circumference in a newborn being assessed for fetal alcohol spectrum disorder. Fetal alcohol spectrum disorder does not cause decreased blood glucose level, a poor breathing pattern, or wide eyes.
A nurse is conducting a class on the effects of nicotine during pregnancy. Which complication(s) will the nurse include in the teaching? Select all that apply. spontaneous abortion (miscarriage) premature rupture of membranes preterm labor and birth tubal ectopic pregnancy placenta previa
spontaneous abortion (miscarriage) premature rupture of membranes preterm labor and birth tubal ectopic pregnancy placenta previa Smoking during pregnancy increases the risk for spontaneous abortion (miscarriage), preterm labor and birth, hypertension in the pregnant client, placenta previa, and placental abruption (abruptio placentae). It has also been considered an important risk factor for low birth weight, sudden infant death syndrome, and cognitive defects.
A pregnant woman tests positive for tuberculosis (TB). The nurse explains to the woman that additional tests are needed to confirm the diagnosis. When describing these tests, which one(s) would the nurse likely include? Select all that apply. spirometry whole-body CT scan sputum culture abdominal ultrasound chest x-ray
sputum culture chest x-ray If a TB screening test is positive, the woman will need a follow-up chest x-ray with lead shielding over the abdomen, as well as sputum cultures to confirm the diagnosis. A whole-body CT scan, spirometry, or abdominal ultrasound are not used to confirm the diagnosis.
The nurse is caring for a pregnant client who is in her 30th week of gestation and has congenital heart disease. Which finding should the nurse recognize as a symptom of cardiac decompensation with this client? dry, rasping cough swelling of the face slow, labored respiration elevated temperature
swelling of the face Swelling of the face is a symptom of cardiac decompensation, along with moist, frequent cough and rapid respirations. Dry, rasping cough; slow, labored respiration; and an elevated temperature are not symptoms of cardiac decompensation.
The nurse is caring for a pregnant client who has condylomata acuminata (anogenital warts) 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.
the need to discuss surgical options with her care provider. Condylomata acuminata (anogenital warts) can be removed surgically; topical treatments are often teratogenic. Antibiotics are ineffective due to the viral etiology. Hygiene will not resolve these lesions.
A pregnant client has tested positive for hepatitis B virus. When discussing the situation with the client, the nurse explains that her newborn will be vaccinated with an initial HBV vaccine dose at which time? within 48 hours of birth within 12 hours of birth within 36 hours of birth within 24 hours of birth
within 12 hours of birth 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.
