Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations- ML4

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"

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 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?

6.5%

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

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 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

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 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"

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) - placenta previa - preterm labor and birth - tubal ectopic pregnancy - premature rupture of membranes

A client with rheumatoid arthritis (RA) is in week 38 of her pregnancy. Which intervention should the nurse make with this client?

Ask the client to decrease her intake of salicylates

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 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

What is the role of the nurse during the preconception counseling of a pregnant client with chronic hypertension?

stressing the positive benefits of a healthy lifestyle

A pregnant single mom living alone tells the nurse she is considering getting a cat for her 2-year-old daughter. Which is the best response by the nurse?

"you should wait until after you give birth to obtain the cat for your daughter"

A nurse in the hospital is caring for a client at 37 weeks' gestation who experienced premature rupture of the membranes (PROM) more than 24 hours prior to coming to the hospital. The client presents with a fever of 100.4°F (38°C). Complete the following sentence(s) by choosing from the lists of options.

1.) group B streptococcus 2.) administer intravenous antibiotics

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

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 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?

6%

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 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 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?

"the antibodies may be those transferred across the placenta; the baby may not develop AIDS"

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 is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy should the nurse expect to administer to the client?

restricted sodium intake

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?

continue taking iron supplements but increase fluids and high-fiber foods; exercise more

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 caring for a pregnant client suspects substance use during pregnancy. What is the priority nursing intervention for this client?

obtain a urine specimen for a drug screening

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?

placental abnormalities

When dealing with a pregnant adolescent, the nurse assists the client to integrate the tasks of pregnancy while at the same time fostering development of which trait?

self-identity

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 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 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"

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

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

less effective than normal

A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth?

the viral load

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 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?

decrease activity and rest more often

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 G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control?

exercise

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?

gestational diabetes

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

Which changes in pregnancy would the nurse identify as a contributing factor for arterial thrombosis, especially for the woman with atrial fibrillation?

hypercoagulable state

A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn?

microcephaly

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

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 malf3 types ormations in newborn - newborn with macrosomia - newborn with respiratory disorder

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