Conditions Existing Before Conception

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 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 multiple sclerosis (MS) is recovering from a vaginal birth. How will the nurse respond when the client asks if breastfeeding can occur as desired?

"Breastfeeding may help your condition."

A nurse is discussing smoking cessation with a pregnant client. The client tells the nurse that they do not want to stop smoking because it helps them remain calm. Which response by the nurse will best promote change in the client's behavior?

"Even if you are not ready to stop smoking, reducing the amount you smoke is also beneficial."

The nurse reviews the ultrasound report for a client who is in the 30th week of gestation. Which question will the nurse ask when the report identifies a fracture of the fetal femur in utero?

"Have you been injured while pregnant?"

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."

A pregnant client diagnosed with depression has been prescribed a selective serotonin reuptake inhibitor (SSRI) as part of the treatment regimen. The client tells the nurse "I am not taking this medication. I am afraid it could cause problems with my baby!" How will the nurse respond?

"I understand your concern for your baby. This type of medication is not known for adverse fetal effects. "

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."

A client with systemic lupus erythema (SLE) wants to have a baby. Which response will the nurse make after learning the client had an exacerbation of SLE 3 months ago?

"It is best to wait until you have not had an exacerbation for 6 months."

A couple has been referred to the genetic clinic for testing prior to conception due to the family history of a child with Marfan syndrome. Which response by the nurse explains how this condition occurs?

"Only one of you needs to carry the gene for the syndrome to occur in your child."

A pregnant woman who has had cardiovascular disease for the last 3 years asks the nurse why this disorder makes her pregnancy an "at-risk" pregnancy. What is the nurse's best response?

"Pregnancy taxes the circulatory system of every woman."

A client presents to the clinic for an initial prenatal visit. The client has a history of systemic lupus erythematosus (SLE). Which question is most important for the nurse to ask to determine risks to pregnancy outcomes?

"When was your last exacerbation episode?"

A young adult client with anorexia nervosa is concerned about missing menstrual periods for several months. How will the nurse respond?

"You may still ovulate and can be pregnant."

A client presents to the prenatal clinic for a first trimester visit. The client has a history of Class A pregestational diabetes. The client asks the nurse how the disease will be managed during their pregnancy. How will the nurse respond?

"Your diabetes will be managed based on your glucose levels."

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?

"Your primary care provider will order safe doses of your medication."

The nurse is caring for a client with sickle cell disease who is in the 24th week of pregnancy. Which response will the nurse make when the client asks why weekly examinations are needed for the remainder of the pregnancy?

"Your risk of having a crisis increases as the pregnancy progresses."

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?

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.

Charlene McCoy, who has several children already, reports for a first prenatal visit. She seems preoccupied and withdrawn, and she makes consistently negative remarks about the pregnancy. Reviewing her records, you note that she is receiving a serotonin reuptake inhibitor. What should you do?

Alert the RN or health care provider.

A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse?

Both parents have to carry the trait.

Which response is most appropriate for a client with diabetes who wants to breastfeed but is concerned about the effects of breastfeeding on her health?

Diabetic clients may breastfeed; insulin requirements may decrease from breastfeeding

A woman at 30 weeks' gestation reports to the nurse that she has been monitoring fetal movement counts (kick counts) several times a day. She states the fetus has been kicking 10 to 12 times per hour, on average. Which nursing action is indicated?

Document the findings in the client's chart.

A nurse is providing care to a client during the initial prenatal visit. The client has been newly diagnosed with depression and is to begin a regimen of antidepressants and psychotherapy. Which intervention(s) will the nurse implement to further ensure an optimum outcome for this client? Select all that apply.

Encourage the client to keep all prenatal appointments. Provide education on the importance of good nutrition. Reassure the client that depression is a common occurrence in pregnancy.

The nurse is planning to instruct a client at 12 weeks' gestation on interventions to stop smoking. What should the nurse include in these instructions? Select all that apply.

Follow a smoking cessation plan. Ask a friend to help with smoking cessation actions. Ask the physician if a smoking cessation medication can be used.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman?

Hematocrit of 32% or less

The nurse is preparing a client for an epidural block. Which intervention is a priority before the epidural anesthesia is started?

IV fluid bolus

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

IV fluids

A pregnant client asks why a maternal serum alpha-fetoprotein level has been ordered. What should the nurse explain to the client about this test?

It may reveal chromosomal abnormalities.

A client who has cardiac disease and is at 36 weeks' gestation presents for a scheduled prenatal visit. The nurse has completed an assessment (above). Which is the appropriate action for the nurse to take?

Notify the health care provider of the findings for further assessment.

Sickle cell anemia is recessively inherited.

Phenylalanine levels will be checked one to two times a week with diet adjustments accordingly. Clients with uncontrolled PKU can have pregnancies complicated by phenylalanine embryopathy (PE). Intellectual impairments can occur in pregnant clients with PKU that is not adequately managed.

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.

A client, at 22 weeks' gestation, presents to labor and delivery with symptoms of an asthma exacerbation. The client has a respiratory rate of 32 breaths/min and expiratory wheezes. The client's oxygen saturation level is 92% on room air. The client is placed on an electronic fetal monitor that shows a fetal heart rate of 160 beats/min. How does the nurse interpret these findings?

The pregnant client will require oxygen therapy.

A nurse is interviewing a pregnant client admitted to labor and delivery for observation after a fall down some stairs. The client has several bruises on the arms, wrists, and hip. The nurse suspects that the client is a victim of intimate partner violence (IPV). To confirm those suspicions, which action is best for the nurse to take?

Utilize a standardized screening tool during the interview.

A client diagnosed with anorexia nervosa presents to the clinic for a routine prenatal visit at 24 weeks' gestation. Which is an important action for the nurse to take during the visit?

Weigh the client in a hospital gown.

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?

anticoagulant

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.

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

assessing for cardiac decompensation

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?

assessing for cardiac decompensation

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

In preparing a class for pregnant couples, the nurse includes information about possible newborn complications associated with smoking during pregnancy. Which complication(s) will the nurse include? Select all that apply.

cerebral palsy low birth weight cleft lip and palate sudden unexplained infant death

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.

A client at 20 weeks' gestation experiences a miscarriage. For the use of which substance should the nurse assess this client?

cocaine

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 nurse reviews the note for a client who is 16 weeks' pregnant (above). For which potential condition will the nurse assess this client?

eating disorder

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. The client is at highest risk for developing _______________. The nurse provides discharge teaching to reduce the risks of developing this condition. Teaching should include _________________.

gestational diabetes change in lifestyle limit smoking

A nurse is monitoring for signs of cardiac decompensation in a client who is laboring and who has a history of cardiovascular disease. The nurse should be especially vigilant at which point during the labor and birth process?

immediate postpartum

A nursing instructor is teaching students about anemia during pregnancy. Which type of anemia does the instructor teach students is most prevalent during pregnancy?

iron-deficiency anemia

The nurse is caring for a postpartum client with diabetes who has developed an infection. The nurse is aware that infections in clients with diabetes tend to be more severe and can quickly lead to complications. Which complication should the nurse assess this client for?

ketoacidosis

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?

peripartum cardiomyopathy

A client who is 18 weeks' pregnant has a history of depression. For which potential effect should the nurse plan care for this client?

preterm birth

The nurse is teaching a client in the first trimester of pregnancy about the importance of folic acid in the diet and how folic acid supplements might be beneficial. For which reason is the nurse teaching the client about this vitamin?

prevents neural tube disorders in the developing fetus

A client with aortic stenosis is in the 16th week of pregnancy. Which assessment finding(s) indicates to the nurse that the client is experiencing cardiac decompensation? Select all that apply.

productive cough edema of the legs and face respirations 28 breaths/min heart rate 102 beats/min

A nurse is providing care to a pregnant client newly diagnosed with human chorionic gonadotropin (hCG)-mediated hyperthyroidism. The nurse is preparing educational materials on an appropriate treatment option for the client. On which treatment will the nurse provide information to the client?

serial T4 and thyroid-stimulating hormone (TSH) assessments

The nurse is assessing a client with a body mass index (BMI) of 34 who is in the 12th week of pregnancy. Which laboratory test does the nurse anticipate being prescribed for this client?

serum glucose

During the initial obstetrical clinic visit, the nurse shares with a client that several blood studies will be drawn. What screening is performed for Black women because of the ethnically inherited nature of the disease?

sickle-cell trait or disease

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?

swelling of the face

Which factor would contribute to a high-risk pregnancy?

type 1 diabetes

A client with a body mass index (BMI) of 32 states their last menstrual period was "about 3 months" ago. Which method will the nurse anticipate being used initially to help determine the week of gestation?

ultrasound

A nurse is interviewing a couple at a preconception counseling session. The couple is of Greek heritage and are concerned about the possibility of their children being born with a genetic disorder. Based on the nurse's understanding of genetic disorders, the nurse would identify this couple as being at risk for which condition?

β-thalassemia