Chapter 16: Pregnancy at Risk: Conditions that Complicate Pregnancy Prep-U

A pregnant client is diagnosed with syphilis. Which response would demonstrate respect for the client and therapeutic communication?

"I am sure it is frightening to you to be diagnosed with a disease that can affect your baby."

The maternal health nurse is caring for a pregnant client with sickle cell anemia. Which statement(s) will the nurse include in the teaching specific to this condition? Select all that apply.

"Try to avoid extreme temperatures." "Try to avoid large crowds." "Inspect your legs daily for the development of ulcers."

Which initial interview technique would be least effective in gathering information from a suspected abuse victim?

Ask the client to strip down and show you where she has been hurt.

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?

Drug metabolism changes during pregnancy.

A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize?

IV fluids

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.

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?

avoidance of infection

Which change in insulin is most likely to occur in a woman during pregnancy?

less effective than normal

In which age range are women most vulnerable for intimate partner violence?

16 to 24 years

A client is 33 weeks' pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled?

85 mg/dl

A client with heart disease who is 28 weeks pregnant asks the nurse why office appointments have been scheduled every week for the next 4 weeks. What should the nurse respond to the client?

During weeks 28 and 32, blood volume peaks, and heart function can be affected.

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 III

A client with asthma who is 32 weeks' pregnant is concerned that the health care provider has reduced the doses of asthma maintenance medications. How should the nurse respond to this client's concern?

Asthma medication may reduce labor contractions and should be reduced.

A pregnant woman in her second trimester comes to the prenatal clinic for a routine visit. She reports that she has a new kitten. The nurse would have the woman evaluated for which infection?

toxoplasmosis

A nurse is talking to a newly pregnant woman who had a mitral valve replacement in the past. Which statement by the client reveals an understanding about the preexisting condition?

"I understand that my fetus and I both are at risk for complications."

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.

"Any cutting surface used for raw meats should be washed afterwards with hot, soapy water." "Peeling any raw vegetables is a good idea before eating them." "It is important to wear gardening gloves when digging in the soil."

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 begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring."

The nurse instructs a pregnant client with sickle cell anemia on ways to prevent a crisis. Which client statement indicates that teaching has been effective?

"I should drink eight glasses of water every day."

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."

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?

1500

The nurse is caring for a client diagnosed with gestational diabetes. Which prescription will the nurse question?

Consume a regular diet with three meals each day.

A nurse caring for a pregnant woman with a pre-existing heart problem realizes the importance of doing which of the following at the very beginning of the pregnancy to help diagnose a complication?

Establish baseline vital signs.

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?

Support her by respecting her right to privacy and confidentiality.

A nurse is caring for a 28-year-old female client in the emergency department (ED) who is accompanied by their partner. The client reports accidentally falling down stairs. Assessment reveals bruising at multiple stages of healing on upper extremities, back, and abdomen. X-ray reveals a right wrist fracture. The client does not make eye contact with the nurse and allows their partner to answer most of the questions.

intimate partner violence stages of bruising

A pregnant client is reporting of a large amount of malodorous vaginal discharge that is foamy and yellow-green in color, vaginal itching and painful intercourse. When asked, she also reports that urination is somewhat painful. She is diagnosed with trichomoniasis. What treatment would the nurse anticipate the client receiving?

oral metronidazole

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.

A client who is 36 weeks' pregnant has been taking phenytoin for a seizure disorder. Which supplement should the nurse anticipate being prescribed for this client?

vitamin K

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

A client with type 2 diabetes mellitus is planning to become pregnant within the next several months. What should the nurse instruct the client to support the 2020 National Health Goals of reducing the complications of pregnancy from diabetes?

Avoid episodes of hyperglycemia.

The nurse should encourage a pregnant client who is taking short-acting insulin for her diabetes to avoid eating after self-administering the insulin.

False

A woman develops gestational diabetes. Which assessment should she make daily?

Measure serum for glucose level by a finger prick.

The maternal health nurse is caring for a pregnant client with a history of asthma who requires maintenance medication for the management of the disease. Which action by the nurse best reinforces information provided to the client regarding maintenance of her health?

Observe the client taking her inhaler.

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?

Pulmonary hypertension

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.

The maternal health nurse is caring for a pregnant client with iron-deficiency anemia who reports "extreme fatigue and shortness of breath" during a prenatal checkup at the outpatient clinic. The nurse prepares to educate the client regarding proper nutrition for this condition. Which dietary choice(s) will the nurse suggest? Select all that apply.

beef stew with potatoes and milk fortified dried cereal with milk and orange juice dark leafy green salad with sunflower seeds and water red beans and rice with cranberry juice

The nurse is caring for a pregnant client who has a history of asthma, which is poorly controlled. Which clinical finding(s) might alert the nurse to a complication associated with the client's medical history? Select all that apply.

blood pressure 140/94 mm Hg client-reported headache

A client in her first trimester comes to the clinic for an evaluation. Assessment reveals reports of fatigue, anorexia, and frequent upper respiratory infections. The client's skin is pale and the client is slightly tachycardic. The client also reports drinking about 6 cups of coffee on average each day. A diagnosis of iron-deficiency anemia is suspected. The client is scheduled for laboratory testing and the results are as follows: Hemoglobin 11.5 g/dL (115 g/L) Hematocrit 35% (0.35) Serum iron 32 µg/dL (5.73 µmol/L) Serum ferritin 90 ng/dL (90 µg/L) Which laboratory finding would the nurse correlate with the suspected diagnosis?

serum ferritin level

A client with epilepsy who is taking phenytoin sodium has just learned that they are pregnant. When planning this client's care, which intervention will the nurse include?

teaching about vitamin K during the last 4 weeks of pregnancy

Which medication would you expect to see prescribed for a pregnant woman with an artificial heart valve shortly before or during labor?

penicillin

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 does not have to worry about contracting new illnesses during pregnancy."

A nurse is caring for a 33-year-old primigravida client who is obese and near the end of their second trimester. The client has a history of prepregnancy obesity, hypertension, and smoking. Complete the following sentence(s) by choosing from the lists of options.

gestational diabetes change in lifestyle

A young client with a cardiac problem wants to get pregnant and tells the nurse that she is sad that she will never be able to have a baby. What is the best response by the nurse?

"Because of improved management, more women with cardiac problems can complete pregnancies successfully."

A client with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The client explains that she has been "eating for two" so the baby is healthy. How should the nurse respond to the client?

"Elevated blood glucose levels in the first trimester have been linked to congenital anomalies."

A pregnant client states, "I have noticed I am so thirsty, have to urinate a lot, and have become really hungry lately. I think it's because it has been so hot outside and my baby is probably growing." The client has been diagnosed with gestational diabetes. Which reply by the nurse is most appropriate?

"I am going to perform a fingerstick test to check your glucose level."

A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron supplement. After teaching her about the prescribed iron supplement, which statement indicates successful teaching?

"I need to drink plenty of fluids to prevent constipation."

A pregnant client with iron-deficiency anemia is prescribed an iron supplement. After teaching the woman about using the supplement, the nurse determines that more teaching is needed based on which client statement?

"I will take the iron with milk instead of orange or grapefruit juice."

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?

"If my blood sugars are elevated, my baby's lungs will mature faster, which is good."

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?

"Pregnancy affects insulin production, so I will need to make adjustments in my diet."

The nurse is assessing a pregnant client who has a history of heart disease. The nurse will prioritize assessments focusing on the heart during which time frame?

28 to 32 weeks' gestation

A young adult woman comes to the clinic for a routine check-up. During the visit, the woman who works in a day care facility tells the nurse that she and her partner are considering having a baby. "We are concerned that I might be exposed to common childhood illnesses." The woman undergoes testing and finds out that she is not immune from chickenpox. Based on this information, which information would the nurse give to the client?

"You will need to be vaccinated now and wait at least 1 month before getting pregnant."

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?

8.5%

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?

Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore.

The maternal health nurse cares for a homeless pregnant woman who presented to the emergency room in precipitous labor. The woman has not had prenatal care. Upon delivery, her infant weighs 4.6 kg and notes the infant appears to be jittery. Which nursing action will the nurse perform first?

Check the infant's blood glucose level.

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?

Eat a sustaining-carbohydrate snack.

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

A woman calls the obstetrician's office to inquire how long she needs to wait to get pregnant following a seizure she had last week. The nurse would tell her to wait how long?

It is recommended that she wait 6 months after seizures are under control before getting pregnant.

The nurse is caring for a pregnant client with pregestational diabetes. Which goal does the nurse identify as priority during the client's pregnancy?

Maintain glycemic control.

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

A woman who has sickle cell anemia asks the nurse if her infant will develop sickle cell disease. The nurse would base the answer on which information?

Sickle cell anemia is recessively inherited.

During a prenatal examination the nurse observes bruises on the client's arms and a black eye. When asked about the bruises, the client states, "It was an accident. My spouse just had a bad day at work, and I was late getting dinner prepared. But my spouse is being so kind now; my spouse brought me flowers yesterday. My spouse is looking for a new job, so it will not happen again." This client is in which phase of the cycle of violence?

The honeymoon phase

A woman arrives at the prenatal clinic and is accompanied by her partner. Which behaviors would be suggestive of intimate partner violence (IPV)? Select all that apply.

The partner answers questions for the pregnant client. The partner is overly protective of the pregnant client. Poor weight gain during the pregnancy and low-birth-weight infant

A client who is 10 weeks' pregnant reports during a social assessment interview that she has two indoor cats, lives alone, fixes her own meals and enjoys gardening. What precautions would the nurse recommend the woman take to prevent the possibility of contracting toxoplasmosis? Select all that apply.

Use gloves when planting her vegetable garden. Hire someone to empty the litter box in the house. Make sure meats are cooked to 152ºF (66.7℃); do not eat raw or rare meats.

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.

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.

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.

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:

antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn.

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?

congenital anomalies

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

A nurse is conducting a program for pregnant women with gestational diabetes that discusses reducing complications during the pregnancy. The nurse determines that the teaching was successful when the group identifies which factor as being most important in helping to reduce complications associated with pregnancy and diabetes?

degree of blood glucose control achieved during the pregnancy

A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client?

diet

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?

dyspnea, crackles, and irregular weak pulse

The health care provider has diagnosed a pregnant client with megaloblastic anemia and has prescribed treatment. When questioned by the client as to what this means, which is the best response from the nurse?

folic acid deficiency anemia

A woman with type 2 diabetes is considering becoming pregnant and asks the nurse whether she will be able to continue taking her current oral hypoglycemics. The nurse's response will point out which factor?

have been shown to be effective and safe in recent short term studies.

The nurse explains to a pregnant client that she will need to take iron during her pregnancy after being diagnosed with iron-deficiency anemia. The nurse suggests that absorption of the supplemental iron can be increased by taking it with which substance?

orange juice

The nurse is assessing a woman with class III heart disease who is in for a prenatal visit. What would be the first recognizable sign that this client is in heart failure?

persistent rales in the bases of the lungs

Which factor would contribute to a high-risk pregnancy?

type 1 diabetes