OB: Chapter 20 Nursing Management of the Pregnancy at Risk

A nursing instructor is teaching students about preexisting illnesses & 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 woman 26 weeks gestation is undergoing screening for diabetes with a 1 hr glucose challenge test. On the client's return visit, the nurse anticipates the need to schedule a 3 hr glucose challenge based on which result of the previous test?

146 mg/dL

Part of the assessment of the first prenatal visit includes screening for rubella antibodies. The nurse determines that a client with which a titer shows evidence of immunity against rubella?

1:8 A rubella antibody titer of 1:8 or greater proves evidence of immunity. <1:8 should be immunized.

A pregnant woman is determined to be at high risk for gestational diabetes. At which time would the nurse expect to undergo rescreening?

24-28 Weeks.

A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant?

6 Months

A pregnant woman with Type II diabetes is scheduled for a lab test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test?

6% Early Pregnancy: 4.5-5.7% Late Pregnancy: 4.4-5.6%

A woman with a long hx of controlled asthma has just had her first antenatal visit for her 4th child. She is late for a meeting & says she knows what to do. What is the best action the nurse can take?

Acknowledge her need to leave but ask her to demonstrate the use of her inhaler & peak flow meter before she goes. Mane any necessary corrections to her technique. Remind her to take her meds regularly.

A pregnant woman who is HIV positive comes to the L&D unit in labor. When developing the plan of care for this client, which intervention would be most important for the nurse to include?

Adhering to standard precautions

A pregnant client is screened for TB during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. Which sign would indicate a positive test result?

An indurated wheal over 10mm in diameter that appears in 48 - 72 hours.

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 pregnant woman in her 39th week of pregnancy presents with a vaginal infection. She tests positive for chlamydia. What would this disease make her infant at risk for?

Blindness

A young mother has tested positive for HIV. When discussing the situation with the client, the nurse should advise the mother that she should avoid which activity?

Breastfeeding

A woman with cardiac disease has come to the office for prenatal counseling. According to the functional classification system developed by the Criteria Committe of the New York Health Association, the woman would be cautioned against pregnancy based on which category?

Class IV These individuals can be symptomatic at rest or with any physical activity.

A woman with cardiac disease is 32 weeks gestation & alerts the nurse she has been having spells of light-headedness & dizziness every few days. The nurse provides which intervention as an option to the client?

Decrease activity & rest more often.

A nurse is conducting a presentation about prenatal care & 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 U.S.?

Fetal Alcohol Spectrum Disorder

A pregnant woman with sickle cell anemia comes to the ER in crisis. Which finding would the nurse expect?

Fever Joint Pain

A pregnant client with mitral stenosis needs to begin taking an anticoagulant. Then nurse identifies the drug of choice which is used in early pregnancy & again during the last month of pregnancy to be which medication?

Heparin

The nurse is providing care to a neonate. Review of the maternal hx reveals that the mother is suspected of abusing heroin. The nurse would be alert for which finding when assessing the neonate?

Hypertonicity

A nurse is caring for a pregnant adolescent client who is in her 1st trimester during a visit to the maternal child clinic. Which important area should the nurse address during assessment of this client?

Knowledge of child development.

A nurse informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night sleep. The nurse further instructs the client that which position for this rest is best?

Left Lateral Recumbent

The infant born to a woman with untreated TB is more likely to have which conditions?

Low APGAR score Perinatal Death Postnatal TB Underweight

A pregnant woman diagnosed with diabetes should be instructed to perform which action?

Notify the PCP if unable to eat because of nausea and vomiting.

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes?

Obesity Hypertension Previous LGA infant.

A nurse is caring for a pregnant client suspected of substance abuse during pregnancy. What is the priority nursing intervention for this client?

Obtain a urine specimen for drug screening

The nurse is providing education to women who had diabetes prior to pregnancy. The nurse is discussing pregnancy-related complications from diabetes. Which factor is a potential complication?

Polyhydramnios

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. (both parents need to have it & it is then only 50%)

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 nurse is caring for a pregnant client who is HIV positive. What is a priority issue that the nurse should discuss with the client.

The need for the client to avoid breastfeeding

A pregnant client has tested positive for Hepatitis B Virus. When discussing the situation with the client, the nurse explains that her infant should be vaccinated with an initial HBV vaccine dose at which time?

Within 12 Hours of Birth

A nurse is caring for a 45 y/o pregnant client with a cardiac disorder who has been instructed by her PCP to follow class I functional activity recommendations. The nurse correctly instructs the client to follow which limitations?

You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or SOB.

A pregnant single mother who lives alone tells the nurse she is considering getting a cat for her 2 y/o daughter. Which is the best response by the nurse?

You should wait until after you give birth to obtain the cat for your daughter. Toxoplasma gondi is a protozoan that can be transmitted through undercooked meat and through cat litter.

For which problem would the nurse be alert in a pregnant woman with gestational diabetes?

Hydramnios related to glucose/insulin imbalance.

When educating a client about pregestational diabetes on how to contrl her blood sugar, the nurse knows there are 3 main facets to glycemic control. In addition to diet and exercise, which is a main facet?

Insulin

Which condition is the most common cause of anemia in a pregnancy?

Iron-Deficiency Anemia

When providing education to a teenage prenatal class, the nurse states that infants born to teenage others are more likely to have which outcome?

Low Birth Weight

A nurse is client teaching with a 28 weeks gestation woman 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 II diabetes mellitus after her baby is born.

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

Microcephaly also, Seizures, IntraUterine Growth Retardation (IUGR), Hepatosplenomagaly, Jaundice, & Rash

A 14 y/o client & her parents have presented to the OB's office in the 2nd trimester. The teen had been hiding the pregnancy. The nurse is helping them develop a plan of care. What is the best thing the nurse can say to the clearly angry parents?

I know you must be very upset & angry about your daughter's pregnancy, but she's still an adolescent herself. She'll need your guidance in making nutritional & health choices that will be good for the baby and herself."

A pregnant woman with chronic HTN comes to the clinic for evaluation. The last several BP readings were gradually increasing. On today's visit her BP is 166/100. The healthcare provider prescribes an antihyptertensive agent. The nurse anticipates which agent as being most commonly prescribed?

Methyldopa

Over the past 20 weeks, the following BP readings are documented for a pregnant client with hypertension: Week 16 - 124/86, Week 20 - 138/90, Week 24 - 140/92, and Week 28 - 142/94. The nurse interprets these findings as indicating which classification of her BP?

Mild Hypertensive

During the assessment of a laboring client, the nurse learns that the client has CVD. Which assessment would be priority for this newborn?

Respiratory function

A woman with cardiac disease gave birth to a 7lb baby by cesarean birth. Which intervention should be implemented during the immediate postpartum period?

Rest, use stool softeners, and monitor tolerance of activity.

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 28-32. (increase of circulatory volume)

A pregnant client has a history of asthma. After reviewing the possible meds that may be prescribed during her pregnancy, the nurse determines additional teaching is needed when the client identifies which drug as being used?

Misoprostol Budesonide / Albuterol / Salmeterol are all good.

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.

A client in her 5th month of pregnancy is having a routine clinic visit. The nurse should assess the client for which common 2nd trimester condition?

Physiological Anemia

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 complex carbohydrates in the diet.

A woman is pregnant & has asthma. Her PCP has told her to continue taking prednisone during her pregnancy, but she is concerned the drug may be teratogenic. What advice would be best for the nurse to give her regarding this?

Prednisone is considered safe in the doses prescribed by her care provider.

A 25 y/l pregnant client comes to the office for the first prenatal visit. During the history, the client tells the nurse she had TB 5 years ago. What is the nurses best response?

You will have to maintain an adequate level of calcium during your pregnancy.

A woman with class II heart disease is in the 3rd trimester of her pregnancy. She has been taking good care of herself & has had little difficulty, but to be on the safe side the obstetrician has prescribed bed rest for her for the final month. For her own and the baby's safety, in what position should the nurse advise the client to sleep?

Left lateral recumbent position.

A pregnant client with sickle cell anemia is at an increased risk for having a sickle cell crisis during pregnancy. Aggressive management for a client experiencing a sickle cell crisis with severe pain includes which measure?

IV Fluids

Which measure is recommended to prevent transmission of HIV to a newborn if the mother has AIDS?

Prepare for C-Section

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 do which action?

Eat a sustaining carbohydrate snack

A nurse is conducting a class on gestational diabetes for a group of pregnant women who are at risk for the condition. The nurse determines that additional teaching is needed when the class identifies which complication as affecting the neonate.

Hyperglycemia

A nurse is caring for a pregnant client with sickle cell anemia. What should the nursing care for the client include? Select all that apply.

Teach the client meticulous handwashing Assess hydration status at each visit Urge the client to drink 8-10 glasses of fluid daily.

An alert, diabetic, pregnant woman in the hospital experiences some shakiness and diaphoresis with a fasting blood sugar of 60 mg/dL when she awakens in the morning. Which action should the nurse take first?

Administer the client's glucose tablets.

The clinic nurse teaches a pregestational Type 1 diabetic client that constant insulin levels are 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 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?

Anemia

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

Restricted Sodium Intake

The nurse is caring for a pregnant client who is in her 30th week of gestation & 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 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 pregnant woman with diabetes is having her glycosylated hemoglobin level evaluated. The nurse determines that the woman's glucose is under control & continues the woman's plan of care based on which result?

6.5% <7% indicates good control. >8% indicates poor control

A pregnant woman with diabetes is having a glycoslated hemoglobin (HbA1C) level drawn. Which result would require the nurse to revise the clients plan of care?

8.5% More than 8% indicates poor control

A postpartum mother has the following lab data recorded: A negative rubella titer. What is the appropriate nursing intervention?

Administer rubella vaccine before discharge

Between her regularly scheduled visits, a woman in her 1st trimester of pregnancy who is taking iron supplements for anemia calls the nurse at her OB'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.

When caring for a woman with cardiac problems, the nurse must be alert for S&S of cardiac decompensation (congestive heart failure), which include:

Dyspnea Crackles Irregular Weak Pulse

A woman at 38 weeks gestation with a hx of heroin abuse has given birth to a newborn several hours ago. The nurse assess the newborn & determines that he is experiencing withdrawal based on which finding? Select all that apply

High-Pitched Shrill Cry Almost Constant Sneezing Nasal Stuffiness Poor Sucking Reflex

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 woman in her 2nd trimester comes to the prenatal clinic for a routine visit. She reports that she has a new kitten. Then nurse would have the woman evaluated for which infection?

Toxoplasmosis

A nurse is teaching a woman diagnosed with gestational diabetes about meal planning & nutrition. The nurse determines that additional teaching is needed based on which client statement?

I need to avoid any fat with my meals

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

Less effective than normal. Somatotropin released by the placenta makes insulin less effective.

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

85 mg/dL 60-95 is recommended.

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 & 3 year olds. Based on the client's history, the nurse should be alert for the development of which condition?

Cytomegalovirus - really common in daycares.

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 suggest that absorption of the supplemental iron can be increased by taking it with

Orange Juice

The nurse is caring for a 2 day old newborn whose mother was diagnosed with cytomegalovirus during the 1st trimester. On which healthcare provider prescription should the nurse place the priority?

Perform a hearing screen test.

A 40 y/o 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

A nurse is conducting a teaching program pregnant women who are older than age 35. The nurse explains that although most women in their age group have healthy pregnancies & healthy newborns, they are at increased risk for possible complications. Which complications would the nurse include? Select all that apply.

Postpartum Hemorrhage Preterm Labor Preeclampsia