OB PrepU: Chapter 20

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? a) Diet b) Glucagon c) Long-acting insulin d) Oral hypoglycemic drugs

a) Diet Rationale: Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually isn't needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are contraindicated in pregnancy. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.

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

a) False Rationale: Caution women with diabetes to eat almost immediately after injecting short-acting insulin to prevent hypoglycemia before mealtimes.

A pregnant woman with sickle cell anemia comes to the emergency department in crisis. Which of the following would the nurse expect to find? Select all that apply. a) Fever b) Pallor c) Increased skin turgor d) Joint pain e) Fatigue

a) Fever d) Joint pain Rationale: Signs and symptoms of a sickle cell crisis commonly include severe abdominal pain, muscle spasm, leg pains, joint pain, fever, stiff neck, nausea and vomiting, and seizures. Skin turgor would most likely be poor because the client would probably be dehydrated. Pallor and fatigue are associated with sickle cell anemia and would not help identify a crisis.

Which of the following would the nurse expect to find in a newborn of a mother who abuses heroin? a) Sneezing b) Easy consolability c) Vigorous sucking d) Hypotonicity

a) Sneezing Rationale: Newborns of mothers who abuse heroin or other narcotics display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

As a rule, women can receive chemotherapy in the second and third trimesters without adverse fetal effects. a) True b) False

a) True Rationale: none

Which factor would contribute to a high-risk pregnancy? a) First pregnancy at age 33 b) Type 1 diabetes c) History of allergy to honey bee pollen d) Blood type O positive

b) Type 1 diabetes Rationale: A woman with a history of diabetes has an increased risk for perinatal complications, including hypertension, preeclampsia, and neonatal hypoglycemia. The age of 33 without other risk factors doesn't increase risk, nor does type O-positive blood or environmental allergens.

A woman with cardiac disease delivered a seven pound baby by C-Section. Which of the following interventions should be implemented during the immediate postpartum period? a) Limit visits with the infant so mom may rest. b) Ambulate to bathroom only. c) Rest, stool softeners, and monitoring tolerance of activity. d) Restrict activity to bedrest.

c) Rest, stool softeners, and monitoring tolerance of activity. Rationale: A woman who has a cardiac condition is at increased risk in the postpartum period. She needs frequent assessment and observation for tolerance. She would also be given education to avoid straining activities such as bowel movements and would be encouraged to have stool softeners and increase fluid and fiber. Restricting the patient's activity to bed rest could be detrimental to the patient, as could be ambulating to the bathroom only. There is no reason to limit the visits with the infant.

When providing education to a teenage prenatal class, the nurse states that infants born to teenage mothers are more likely to have which of the following? a) Lower mortality rates b) Genetic problems c) Post-date delivery d) Low-birth weight

d) Low-birth weight Rationale: Infants born to adolescent mothers are more likely to have a low-birth weight and poor outcomes and higher mortality rates when compared to infants of older mothers. Infants born to teenage mothers are not more likely to have genetic problems; they are more likely to be born pre-term rather than post-date.

When developing a plan of care for a pregnant woman who is HIV-positive, which of the following is essential? a) Helping her choose a newborn feeding method b) Preparing the woman for cesarean birth c) Educating her about family planning d) Using Standard Precautions

d) Using Standard Precautions Rationale: For the pregnant woman who is HIV-positive, nurses must always use Standard Precautions 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. Breast-feeding is contraindicated, so helping her choose a feeding method would be inappropriate.

Your pregnant patient has had asthma since she was a teenager. What statement by the patient would alert you to the fact her asthma may not be in control? a) Daytime cough b) Decreased respiratory rate c) Feeling of euphoria d) "I keep waking up at night."

d) "I keep waking up at night." Rationale: Complaint of nocturnal awakening is a classic symptom.

Fourteen-year-old Ann and her parents have presented at the obstetrician's office in the second trimester, the teen had been hiding the pregnancy. The nurse is helping them develop a plan of care. What is the best thing she can say to the clearly angry parents? a) "I know you must be very upset and angry about Ann's pregnancy but because she's still an adolescent herself, she'll need your guidance in making nutritional and health choices that will be good for the baby and for herself." b) "Anger won't help this situation at all. You'll only push Ann away and she'll be less likely to make good choices." c) "Ann needs to make decisions about this pregnancy for herself." d) "I understand your anger but if you had encouraged Ann to use condoms she would probably not be in this situation."

a) "I know you must be very upset and angry about Ann's pregnancy but because she's still an adolescent herself, she'll need your guidance in making nutritional and health choices that will be good for the baby and for herself." Rationale: The nurse needs to acknowledge the anger of the parents but remember her role is as the patient advocate. The nurse needs to encourage the relationship of support between the parents and the patient. Option A is incorrect as it is attempting to lay down ground rules between the patient and her parents, it also does not acknowledge the parents' feelings in this situation. Option C is incorrect as it might be interpreted as a lecture to the parents, and it does not acknowledge their feelings in this situation. Option D is incorrect; again it sounds like lecturing and it places blame on the parents, which is inappropriate.

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA). What does the nurse tell the patient is a normal level for this test? a) 6% b) 14% c) 8% d) 12%

a) 6% Rationale: The upper normal level of HbA is 6% of total hemoglobin.

A client with juvenile rheumatoid arthritis (JRA) is in week 38 of her pregnancy. Which of the following interventions should the nurse make with this client? a) Ask the client to decrease her intake of salicylates b) Perform the Snellen eye test c) Urge the client to be on bed rest d) Advise the client to continue her normal dosage of methotrexate

a) Ask the client to decrease her intake of salicylates Rationale: Although women with JRA 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 woman in week 40 of her pregnancy has developed a urinary tract infection (UTI). The nurse recognizes that which of the following treatments would be safe and appropriate to use with this client? (Select all that apply.) a) Cephalosporins b) Heparin c) Amoxicillin d) Sulfonamides e) Tetracyclines f) Ampicillin

a) Cephalosporins c) Amoxicillin f) Ampicillin Rationale: Amoxicillin, ampicillin, and cephalosporins are effective against most organisms causing UTIs and are safe antibiotics during pregnancy. The sulfonamides can be used early in pregnancy but not near term because they can interfere with protein binding of bilirubin, which then leads to hyperbilirubinemia in the newborn. Tetracyclines are contraindicated during pregnancy as they cause retardation of bone growth and staining of the fetal teeth. Heparin is an anticoagulant and is used to prevent clot formation; it would not be prescribed for a UTI.

A woman with a positive history of genital herpes is in active labor. She has small pin-point vesicles in the perineum area. Her membranes are ruptured, she is dilated 5cm, effaced 70%. The nurse should anticipate what type of delivery? a) Cesarean. b) Forceps assisted. c) Spontaneous vaginal. d) Vacuum assisted.

a) Cesarean. Rationale: An active herpes infection can be passed to the fetus during labor or with ruptured amniotic membranes. The nurse should anticipate the infant will be delivered via a cesarean birth. The risk of transmitting herpes to the baby would be increased if the baby were born by spontaneous vaginal delivery, vacuum assisted delivery, or forceps assisted delivery.

You are the clinic nurse caring for a pregnant woman in her third trimester. The woman is HIV positive and voices concerns about passing the infection on to her baby. What is your best response? a) If you are taking antiretroviral medications and you don't breastfeed your baby, you greatly reduce the risk of perinatal transmission of the disease. b) Perinatal transmission of the virus is a real fear. Would you like to talk to a social worker? c) There is nothing you can do. You will just have to wait and see if your baby is born HIV positive. d) Do you have other children? Your baby has a one-in-four chance of having HIV at birth, so if you have three other children who are not HIV positive, then this one will be HIV positive.

a) If you are taking antiretroviral medications and you don't breastfeed your baby, you greatly reduce the risk of perinatal transmission of the disease. Rationale: Receiving appropriate antiretroviral treatment during pregnancy and childbirth and refraining from breastfeeding substantially reduce the risk of perinatal transmission.

A pregnant woman at 4 weeks' gestation who has preexisting diabetes mellitus visits her primary care provider for a check-up. Which fetal complications might occur because of this maternal condition? Select all that apply. a) Macrosomia (oversized fetus) b) Respiratory disorder c) Congenital malformations d) Fetus with juvenile diabetes e) Smaller than gestational age baby

a) Macrosomia (oversized fetus) b) Respiratory disorder c) Congenital malformations Rationale: Potential problems during pregnancy involving maternal diabetes mellitus include fetal death, macrosomia (oversized fetus), a fetus with a respiratory disorder, difficult labor, preeclampsia or eclampsia, polyhydramnios, and congenital malformations.

A pregnant woman diagnosed with diabetes should be instructed to do which of the following? a) Notify the physician if unable to eat because of nausea and vomiting. b) Prepare foods with increased carbohydrates to provide needed calories. c) Ingest a smaller amount of food prior to sleep to prevent nocturnal hyperglycemia. d) Discontinue insulin injections until 15 weeks gestation.

a) Notify the physician if unable to eat because of nausea and vomiting. Rationale: During pregnancy, the insulin levels change in response to the production of HPL. The patient needs to alert her provider if she is not able to eat or hold down appropriate amounts of nutrition. The patient 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.

A nurse is assessing a client in her seventh month of pregnancy who has an artificial valve prosthesis. The client is taking an oral anticoagulant to prevent the formation of clots at the valve site. Which of the following nursing interventions is most appropriate in this situation? a) Observe the client for signs of petechiae and premature separation of the placenta b) Instruct the client to avoid wearing constrictive knee-high stockings c) Urge the client to discontinue the anticoagulant to prevent pregnancy complications d) Put the client on bed rest

a) Observe the client for signs of petechiae and premature separation of the placenta Rationale: Subclinical bleeding from continuous anticoagulant therapy in the woman has the potential to cause placental dislodgement. Observe a woman who is taking an anticoagulant for signs of petechiae and signs of premature separation of the placenta, therefore, during both pregnancy and labor. The nurse should not urge the client to discontinue the anticoagulant, as this is not within the nurse's scope of practice and, in any case, the client still needs the anticoagulant to prevent clots. Bed rest is prescribed for clients with a thrombus, to prevent it from moving and becoming a pulmonary embolus. Avoiding the use of constrictive knee-high stockings is to prevent thrombus formation.

A woman with an artificial mitral valve develops heart failure at the 20th week of pregnancy. Which of the following measures would you stress with her during the remainder of the pregnancy? a) Obtaining enough rest b) Beginning a low-impact aerobics program c) Discontinuing her prepregnancy anticoagulant d) Maintaining a high fluid intake

a) Obtaining enough rest Rationale: As the blood volume doubles during pregnancy, heart failure can occur. The pregnant woman needs to obtain adequate rest to prevent overworking the heart. Fluid may need to be restricted.

A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. Which of the following does the nurse anticipate in this woman's pregnancy? a) Potential for greater than usual back pain b) Cesarean birth c) Increased risk of fetal trauma d) Increased risk of miscarriage

a) Potential for greater than usual back pain Rationale: Surgical correction of scoliosis (lateral curvature of the spine) involves implanting stainless-steel rods on both sides of the vertebrae to strengthen and straighten the spine. Such rod implantations do not interfere with pregnancy; a woman may notice more than usual back pain, however, from increased tension on back muscles. If a woman's pelvis is distorted due to scoliosis, a cesarean birth may be scheduled to ensure a safe birth, but this is not required in this scenario. Vaginal birth, if permitted, requires the same management as for any woman. With the improved management of scoliosis, the high maternal and perinatal risks associated with the disorder reported in earlier literature no longer exist.

Working with pregnant teenagers as a special population requires the nurse to have knowledge of adolescent development. Which of the following is crucial for a positive pregnancy and outcome for the mother and fetus? a) Support network b) Cultural sensitivity c) Acceptance by peers d) Involvement of the father

a) Support network Rationale: One crucial part of management of teenage adolescent pregnancy includes helping the teens to develop an adequate support network. The network may include parents, teachers, friends and the father of the baby in addition to resources needed to provide care for the infant and self. Cultural sensitivity, involvement of the father, and acceptance by peers are important to the teenager who is pregnant, but they are not considered crucial for a positive pregnancy and outcome for the mother and fetus.

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? a) Toxoplasmosis b) Parvovirus B19 c) Cytomegalovirus d) Herpes simplex virus

a) Toxoplasmosis Rationale: Toxoplasmosis is transferred by hand to mouth after touching cat feces while changing the litter box or through gardening in contaminated soil. Cytomegalovirus is transmitted via sexual contract, blood transfusions, kissing, and contact with children in daycare centers. Parvovirus B19 is a common self-limiting benign childhood virus that causes fifth disease. A pregnant woman may transmit the virus transplacentally to her fetus if she is exposed to an infected child. Herpesvirus infection occurs by direct contact of the skin or mucous membranes with an active lesion through kissing, sexual contact, or routine skin-to-skin contact.

A woman with a long history of controlled asthma has just had her first antenatal visit for her fourth child. She is late for a meeting and says she knows what to do. What is the best action the nurse can take? a) Note in the chart that the woman was not counseled about her asthma. b) Acknowledge her need to leave but ask her to demonstrate the use of her inhaler and her peak flow meter before she goes; make any necessary corrections to her technique. Remind her to take her regular medications. c) Remind her to continue taking her asthma medications, to monitor her peak flow daily, and to monitor the baby's kicks in the second and third trimesters. d) Schedule an appointment for her to return to discuss her asthma management.

b) Acknowledge her need to leave but ask her to demonstrate the use of her inhaler and her peak flow meter before she goes; make any necessary corrections to her technique. Remind her to take her regular medications. Rationale: Management of asthma during pregnancy is very important, the nurse must document the patient has the proper ability to manage her asthma for her health and the health of the fetus. Reminding the patient to continue taking her prescribed medication to monitor her peak flow daily is not enough. It is the nurse's responsibility to KNOW that the patient 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 you see her and the time you schedule a return appointment. Noting in the chart that the woman was not counseled does not relieve the nurse of her obligation to ensure that the woman knows how to use her inhaler and her peak flow meter.

A pregnant client with a history of heart disease has been admitted to a healthcare center with complaints of breathlessness. The client also complains of 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? a) Class IV b) Class III c) Class I d) Class II

b) Class III Rationale: 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.

You encourage a woman with gestational diabetes to maintain an active exercise period during pregnancy. Prior to this exercise period, you would advise her to do which of the following? a) Eat a high-carbohydrate snack b) Eat a sustaining-carbohydrate snack c) Inject a bolus of insulin d) Add a bolus of long-acting insulin

b) Eat a sustaining-carbohydrate snack Rationale: Because exercise uses up glucose, women with diabetes should take a sustaining-carbohydrate snack before hard exercise to prevent hypoglycemia.

When educating a pregestational patient on how to control her blood sugar, the nurse knows there are three main facets to glycemic control: diet, exercise and _______. Which of the following is the third facet? a) Glucose tablets b) Insulin c) Folic acid d) Niacin

b) Insulin Rationale: The three main facets to glycemic control for the woman with pregestational diabetes are diet, exercise, and insulin. Folic acid does not impact glycemic control. Glucose tablets are not a facet of glycemic control.

The nurse explains to a pregnant patient 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 of the following? a) Milk b) Orange juice c) Meals high in iron d) Legumes

b) Orange juice Rationale: Anemia is a condition in which the blood is deficient in red blood cells, from an underlying cause. The woman needs to take iron to manufacture enough red blood cells. Taking an iron supplement will help improve her iron levels, and taking iron with foods containing ascorbic acid, such as orange juice, improves the absorption of iron.

The nurse is teaching a pregnant woman with iron deficiency anemia about foods high in iron. Which food(s) if selected by the woman indicates a successful teaching program? Select all that apply. a) Potatoes b) Peanut butter c) Corn d) Raisins e) Yogurt f) Broccoli

b) Peanut butter d) Raisins f) Broccoli Rationale: Foods high in iron include dried fruits such as raisins, whole grains, green leafy vegetables such as broccoli and spinach, peanut butter, and iron-fortified cereals. Potatoes and corn are high in carbohydrates. Yogurt is a good source of calcium.

A client in her fifth month of pregnancy is having a routine clinic visit. The nurse should assess the client for which common second trimester condition? a) Metabolic alkalosis b) Physiological anemia c) Mastitis d) Respiratory acidosis

b) Physiological anemia Rationale: Hemoglobin level and hematocrit decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production. Mastitis is an infection in the breast characterized by a swollen tender breast and flulike symptoms. This condition is most commonly seen in breast-feeding clients. Alterations in acid-base balance during pregnancy result in a state of respiratory alkalosis, compensated by mild metabolic acidosis.

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which of the following would the nurse expect to administer to the client? a) Methadone therapy b) Restricted sodium intake c) Ginger therapy d) Monoamine oxidase inhibitors

b) Restricted sodium intake Rationale: The client with peripartum cardiomyopathy should be prescribed restricted sodium intake to control the BP. Monoamine oxidase inhibitors are given to treat depression in pregnancy, and not peripartum cardiomyopathy. Methadone is a drug given for the treatment of substance abuse during pregnancy. Complimentary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum, and not peripartum cardiomyopathy.

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 of the following? a) Trust b) Self-identity c) Autonomy d) Dependence

b) Self-identity Rationale: The nurse assists the pregnant adolescent to integrate the tasks of pregnancy, bonding, and preparing to care for another with the tasks of developing self-identity and independence. Trust is a developmental task of infancy. Autonomy is a developmental task of toddlerhood. Independence, not dependence, is fostered.

You are doing a nursing assessment on a new patient in the obstetric clinic. The woman estimates that she is approximately 16 weeks pregnant. While assessing her you ask about what appear to be scratch marks on her hands, and she tells you that she has three cats at home. What screening would be ordered for this woman? a) Cytomegalovirus b) Toxoplasmosis c) Herpes Simplex Virus d) Hepatitis C

b) Toxoplasmosis Rationale: Toxoplasmosis is an infection caused by the protozoan Toxoplasma gondii, also referred to as T. gondii. Transmission is via undercooked meat and through cat feces. Toxoplasmosis is a common infection in humans and usually produces no symptoms. However, when the infection passes from the woman through the placenta to the fetus, a condition called congenital toxoplasmosis can occur. Approximately 400 to 4,000 cases of congenital toxoplasmosis occur per year in the United States (Williams, 2007). The classic triad of symptoms for congenital toxoplasmosis is chorioretinitis, intracranial calcification, and hydrocephalus in the newborn.

A pregnant single mom living alone tells the nurse she is considering getting a cat for her two year old daughter. Which is the best response by the nurse? a) The exposure to the cat litter may cause you to need a C-section b) You should wait until after you deliver to obtain the cat for your daughter c) This will cut down on the jealousy for your two year old when the baby comes d) If you don't think caring for a cat is too much work, that would be great

b) You should wait until after you deliver to obtain the cat for your daughter Rationale: Toxoplasma gondii is a protozoan that can be transmitted via undercooked meat and through cat litter. Having a cat is not an issue, but cleaning the litter box may expose the mother to the infection and result in fetal anomalies. Option A is incorrect; exposure to the cat litter will not necessitate a cesarean section. Option B is incorrect; having a cat will not cut down on any jealousy the 2-year-old might feel when the new baby is born. Option C is incorrect; the nurse would not encourage the mother to get her child a cat until after the new baby is born.

A pregnant client is screened for tuberculosis 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? a) An indurated wheal under 10 mm in diameter appears in 6 to 12 hours. b) A flat circumscribed area over 10 mm in diameter appears in 48 to 72 hours. c) An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. d) A flat, circumscribed area under 10 mm in diameter appears in 6 to 12 hours.

c) An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. Rationale: A positive PPD result would be an indurated wheal over 10 mm in diameter that appears in 48 to 72 hours. The area must be a raised wheal, not a flat, circumscribed area.

A woman with a positive history of genital herpes is in active labor. She has small pin-point vesicles in the perineum area. Her membranes are ruptured, she is dilated 5cm, effaced 70%. The nurse should anticipate what type of delivery? a) Forceps assisted. b) Vacuum assisted. c) Cesarean. d) Spontaneous vaginal.

c) Cesarean. Rationale: An active herpes infection can be passed to the fetus during labor or with ruptured amniotic membranes. The nurse should anticipate the infant will be delivered via a cesarean birth. The risk of transmitting herpes to the baby would be increased if the baby were born by spontaneous vaginal delivery, vacuum assisted delivery, or forceps assisted delivery.

Nursing care for women diagnosed with gestational diabetes includes which of the following? a) Education for the women on life-long diabetic needs b) Counseling the patient on the need for cesarean birth c) Encourage blood glucose control d) Referral for the infant to diabetic care after delivery

c) Encourage blood glucose control Rationale: The patient will need to have control of her blood sugar during her pregnancy to decrease any complications associated with gestational diabetes. The patient with gestational diabetes does not need to be counseled on the need to have a cesarean delivery, receive education on life-long diabetic needs, or have the infant referred for diabetic care after delivery.

Human papillomavirus (HPV) can cause condylomata acuminata that can develop in clusters on the vulva, within the vagina, on the cervix, or around the anus. What is their risk? a) Neonatal auricular papillomas b) Blockage of the birth canal c) Heavy bleeding during vaginal delivery d) Neonatal hemorrhage

c) Heavy bleeding during vaginal delivery Rationale: Genital warts have a tendency to increase in size during pregnancy. This may result in heavy bleeding during vaginal delivery. The pregnant woman can pass HPV to her fetus during the birth process. In rare instances, neonatal HPV infection can result in life-threatening laryngeal papillomas. HPV infection transmitted to the infant may not appear for as long as 10 years after birth.

For which of the following problems would the nurse be alert in a pregnant woman with gestational diabetes? a) Placenta previa related to diabetes mellitus b) Hypotension related to glucose/insulin imbalance c) Hydramnios related to glucose/insulin imbalance d) Cerebral vascular accident related to diabetes mellitus

c) Hydramnios related to glucose/insulin imbalance Rationale: Hyperglycemia tends to lead to excessive amniotic fluid (hydramnios) because of osmotic pressure fluid shifts.

Which of the following changes in pregnancy would the nurse identify as a contributing factor for arterial thrombosis, especially for the woman with atrial fibrillation? a) Increased cardiac output b) Elevation of diaphragm c) Hypercoagulable state d) Increase in blood volume

c) Hypercoagulable state Rationale: The nurse should identify that the increased risk of arterial thrombosis in atrial fibrillation is due to hypercoagulable state of pregnancy. During pregnancy there is a state of hypercoagulation. This increases the risk of arterial thrombosis in clients having atrial fibrillation and artificial valves. Increased cardiac output and blood volume do not cause arterial thrombosis. Elevation of the diaphragm is due to the uterine distension and it causes a shift in the QRS axis and is not a associated with arterial thrombosis.

A client in her eighth month of pregnancy who has cardiac disease is experiencing profound shortness of breath and a cough that produces blood-speckled sputum, in addition to systemic hypotension. The nurse recognizes that this patient most likely is experiencing which of the following conditions? a) Peripartal cardiomyopathy b) Pulmonary embolism c) Left-sided heart failure d) Right-sided heart failure

c) Left-sided heart failure Rationale: In left-sided heart failure, the left ventricle cannot move the large volume of blood forward that it has received by the left atrium from the pulmonary circulation. It is characterized by a decrease in systemic blood pressure and pulmonary edema that produces profound shortness of breath. If pulmonary capillaries rupture under the pressure, small amounts of blood leak into the alveoli and the woman develops a productive cough with blood-speckled sputum. Right-sided heart failure is characterized by extreme liver enlargement, distention of abdominal and lower extremity vessels, ascites, and peripheral edema. A woman with peripartal cardiomyopathy develops signs of myocardial failure such as shortness of breath, chest pain, and nondependent edema. Her heart increases in size (cardiomegaly).The signs of a pulmonary embolism include chest pain, a sudden onset of dyspnea, a cough with hemoptysis, tachycardia or missed beats, or dizziness and fainting.

Which of the following changes in insulin is most likely to occur in a woman during pregnancy? a) Unavailable because it is used by the fetus b) Not released because of pressure on the pancreas c) Less effective than normal d) Enhanced secretion from normal

c) Less effective than normal Rationale: Somatotropin released by the placenta makes insulin less effective. This is a safeguard against hypoglycemia.

A woman with Class II heart disease is in the third trimester of her pregnancy. She's been taking good care of herself and has had little difficulty, but to be on the safe side the obstetrician has ordered bed rest for her for the final month. For her own and the baby's safety, in what position should the nurse advise the patient to sleep? a) Lie flat on her back. b) Stay in high Fowler's position. c) Lie in a semirecumbent position. d) Use pillows and wedges to stay in a fully recumbent position.

c) Lie in a semirecumbent position. Rationale: Semirecumbent position is the best position for circulation of the mother and fetus. Laying flat on the back can induce supine hypotensive syndrome and fully recumbent impedes other circulation. Therefore options A, B, and D are incorrect answers for this question.

During a routine prenatal check-up, the nurse interviews a pregnant client to identify possible risk factors for developing gestational diabetes. Which of the following would alert the nurse to an increased risk? Select all that apply. a) Previous history of spontaneous abortion b) Younger maternal age at pregnancy c) Maternal obesity with body mass index more than 35 d) Previous birth of small for gestational age baby e) Client of African-American lineage

c) Maternal obesity with body mass index more than 35 d) Previous birth of small for gestational age baby e) Client of African-American lineage Rationale: The risk factors for gestational diabetes include previous history of spontaneous abortion, maternal obesity with body mass index (BMI) more than 35, and client of African-American lineage. The other risk factors for gestational diabetes are previous history of stillbirth, birth of large for gestational age infant and advancing maternal age. High-risk ethnic groups include African American, Hispanic and Native North American.

Which medication is prescribed most commonly for a pregnant woman with chronic hypertension? a) Nifedipine b) Atenolol c) Methyldopa d) Labetolol

c) Methyldopa Rationale: Although labetolol, atenolol, and nifedipine may be ordered, methyldopa the most commonly prescribed agent because of its safety record during pregnancy. It is a slow-acting antihypertensive agent that also helps to improve uterine perfusion.

Your patient is pregnant and she has tested positive for cytomegalovirus. What can this cause in the newborn? a) Hypertension b) Clubbed fingers and toes c) Microcephaly d) Bicuspid valve stenosis

c) Microcephaly Rationale: Signs that are likely to be present in the 10 percent of newborns who are symptomatic at birth include microcephaly, seizures, IUGR, hepatosplenomegaly, jaundice, and rash.

You are doing patient teaching with a 28 weeks' gestation woman who has tested positive for gestational diabetes mellitus (GDM). What would be important to include in your patient teaching? a) Her baby is at increased risk for neonatal diabetes mellitus. b) She is at increased risk for type I diabetes mellitus after her baby is born. c) She is at increased risk for type II diabetes mellitus after her baby is born. d) Her baby is at increased risk for type I diabetes mellitus.

c) She is at increased risk for type II diabetes mellitus after her baby is born. Rationale: The woman who develops GDM is at increased risk for developing type 2 DM after pregnancy.

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 patient that the most dangerous time for her is when? a) in weeks 12-20 b) in weeks 8-12 c) in weeks 28-32 d) in weeks 20-28

c) in weeks 28-32 Rationale: 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 nursing instructor is teaching students about anemia during pregnancy. Which type of anemia does the instructor teach students is most prevalent during pregnancy? a) sickle-cell anemia b) pernicious anemia c) iron-deficiency anemia d) folic acid anemia

c) iron-deficiency anemia Rationale: Iron-deficiency anemia is the most common type in pregnancy. Many woman enter pregnancy with a low iron count because of poor diet, heavy menstrual periods, unwise weight-loss programs, or a combination of these.

A nursing instructor is teaching students about pre-existing 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) "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy." b) "A pregnant woman with a chronic illness can put the fetus at risk." c) "A pregnant woman with a chronic condition can put herself at risk." d) "A pregnant woman does not have to worry about contracting new illnesses during pregnancy."

d) "A pregnant woman does not have to worry about contracting new illnesses during pregnancy." Rationale: When a woman enters a pregnancy with a chronic illness, it can put both her and the fetus at risk. She needs to be cautious about developing a new illness during her pregnancy as well as having an accident during the pregnancy.

A young patient 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? a) "Cardiovascular problems are not a concern during pregnancy." b) "Women with your problem should never get pregnant, because the risks and dangers are too high for you and the fetus." c) "If you get pregnant, you are likely to face many complications." d) "Because of improved management, more women with cardiac problems can complete pregnancies successfully."

d) "Because of improved management, more women with cardiac problems can complete pregnancies successfully." Rationale: Because of improved management of cardiac disease, women who might never have risked pregnancy in the past can complete pregnancies successfully today.

The nurse is helping an indigent HIV-positive pregnant patient set up a postdelivery care plan for her baby. What is an appropriate question/statement during that discussion? a) "You understand that you can't breast-feed, right? Even though formula's expensive, you'll need to figure out a way to get it." b) "You're not planning to breast-feed are you? That would be dangerous for the baby." c) "HIV can be passed to the baby from breast-feeding so it's important that you give the baby formula. You probably can't afford formula can you?" d) "HIV can be passed to the baby from breast-feeding so it's important that you give the baby formula. Formula's pretty expensive so I'll give you some information for places you can contact if you ever need some help getting it."

d) "HIV can be passed to the baby from breast-feeding so it's important that you give the baby formula. Formula's pretty expensive so I'll give you some information for places you can contact if you ever need some help getting it." Rationale: HIV is possible to transmit via breastfeeding and formula is the only option for feeding. The nurse needs to provide positive information and offer to make referral or get assistance for the patient in financial need. Assuming the patient understands the reason she cannot breastfeed is not adequate nursing care. The patient needs the nurse to explain to her the reason for not breastfeeding her infant. Option B is incorrect as it does not fully answer the question being asked. Option C is inappropriate because telling the patient that she probably can't get formula since it is expensive is inappropriate. It is a negative comment about the patient and her status in life.

A nurse is talking to a newly pregnant woman who had a mitral valve replacement in the past. Which of the following statements by the patient reveals an understanding about the pre-existing condition? a) "I know I will be fine, but I worry about the fetus." b) "I know my baby will be fine, but I am worried about having a personal complication." c) "I don't have to worry about this, because I had the problem fixed before I became pregnant." d) "I understand that my fetus and I both are at risk for complications."

d) "I understand that my fetus and I both are at risk for complications." Rationale: When a woman enters pregnancy with a pre-existing condition, both she and her fetus can be at risk of developing complications.

A pregnant woman is determined to be at high risk for gestational diabetes. At which time would the nurse expect the client to undergo rescreening? a) 28 to 32 weeks b) 16 to 20 weeks c) 20 to 24 weeks d) 24 to 28 weeks

d) 24 to 28 weeks Rationale: A woman identified as high risk would undergo rescreening between 24 and 28 weeks.

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? a) Recheck her blood sugar for accuracy. b) Stay with her and ask another nurse to bring her insulin. c) Withhold her insulin and notify the health care provider. d) Administer the patient's glucose tablets.

d) Administer the patient's glucose tablets. Rationale: The patient is hypoglycemic when awakening in the morning. The nurse should provide glucose and be prepared to reassess. The nurse should not recheck at this point, since the patient is symptomatic. She does not need insulin, and she will have her morning dose adjusted after breakfast.

A client in week 38 of her pregnancy arrives at the emergency room reporting a sharp pain between her umbilicus and the iliac crest in her lower right abdomen that is increasing. She reports having experienced intense nausea and vomiting for the past 3 hours. Given these symptoms, the nurse suspects which of the following conditions? a) Ectopic pregnancy in conjunction with morning sickness b) Pulmonary embolism c) Left-sided heart failure d) Appendicitis

d) Appendicitis Rationale: With appendicitis, the nausea and vomiting is much more intense than with morning sickness and the pain is sharp and localized at McBurney's point (a point halfway between the umbilicus and the iliac crest on the lower right abdomen). With a ruptured ectopic pregnancy, a woman may experience abdominal pain that is either diffuse or sharp, but it is less likely to occur precisely at McBurney's point. The symptoms described do not match those of pulmonary embolism or left-sided heart failure.

You are doing patient teaching with a 30-year-old gravida 1 who has sickle cell anemia. She is not currently in crisis. Providing education on which topic is the highest nursing priority? a) Control of pain b) Constipation prevention c) Iron-rich foods d) Avoidance of infection

d) Avoidance of infection Rationale: Prevention of crises, if possible, is the focus of treatment for the pregnant woman with sickle cell anemia. Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common-sense strategies that decrease the risk of a crisis.

A pregnant woman in her 39th week of pregnancy presents to the clinic with a vaginal infection. She tests positive for chlamydia. What would this make her infant at risk for? a) Neonatal laryngeal papillomas b) Deafness c) Chicken pox d) Blindness

d) Blindness Rationale: A pregnant woman who contracts chlamydia is at increased risk for spontaneous abortion (miscarriage), pre-term rupture of membranes, and pre-term labor. The postpartum woman is at higher risk for endometritis (Fletcher & Ball, 2006). The fetus can encounter bacteria in the vagina during the birth process. If this happens, the newborn can develop pneumonia or conjunctivitis that can lead to blindness.

When providing nutritional counseling to a pregnant woman with diabetes, the nurse would urge the client to obtain most of her calories from which of the following? a) Protein sources b) Unsaturated fats c) Saturated fats d) Complex carbohydrates

d) Complex carbohydrates Rationale: 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 woman with cardiac disease is 32 weeks gestation and alerts the nurse she has been having spells of light-headedness and dizziness every few days. The nurse provides which of the following interventions as an option to the patient? a) Bed rest and bathroom privileges only until delivery. b) Increase fluids and take more vitamins. c) The patient needs to discuss induction of labor with the physician. d) Decrease activity and rest more often.

d) Decrease activity and rest more often. Rationale: If the patient 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 increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity. Therefore options B, C, and D are incorrect,

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? a) Acetaminophen (Tylenol) for pain b) Antihypertensive drugs c) Diuretic drugs d) I.V. fluids

d) I.V. fluids Rationale: A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and I.V. fluids. Antihypertensive drugs usually aren't necessary. Diuretics wouldn't be used unless fluid overload resulted. The client usually needs a stronger analgesic than acetaminophen to control the pain of a crisis.

A woman develops gestational diabetes. Which of the following assessments should she make daily? a) Test her urine for protein with a chemical reagent strip. b) Measure her uterine height by hand-span distance. c) Measure her abdominal diameter with a tape measure. d) Measure serum for glucose level by a finger prick.

d) Measure serum for glucose level by a finger prick. Rationale: Assessing serum glucose reveals both hyperglycemia and hypoglycemia.

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 patient is in heart failure? a) Elevated blood pressure b) Low blood pressure c) Audible wheezes d) Persistent rales in the bases of the lungs

d) Persistent rales in the bases of the lungs Rationale: The earliest warning sign of cardiac decompensation is persistent rales in the bases of the lungs.

A 40-year-old woman comes to the clinic complaining of having missed her period for two months. A pregnancy test is positive. What is she and her fetus at increased risk for? a) Post-term delivery b) Type I diabetes Mellituus c) Type II diabetes Mellitus d) Placental abnormalities

d) Placental abnormalities Rationale: A woman older than 35 years is more likely to conceive a child with chromosomal abnormalities, such as Down syndrome. She is also at higher risk for spontaneous abortion (miscarriage), preeclampsia-eclampsia, gestational diabetes, pre-term delivery, bleeding and placental abnormalities, and other intrapartum complications.

The nurse is providing education to women who had diabetes prior to pregnancy. The nurse is discussing pregnancy-related complications from diabetes. Which of the following is a potential complication? a) Post-term delivery b) Small for gestation age infant c) Hypotension of pregnancy d) Polyhydramnios

d) Polyhydramnios Rationale: Polyhydramnios is an increase, or excess, in amniotic fluid and is a pregnancy-related complication associated with diabetes in pregnancy. An infant who is small for gestational age is not associated with a mother who had diabetes prior to pregnancy. Other pregnancy-related complications associated with pregestational DM include hypertensive disorders, preterm delivery, and shoulder dystocia.

A woman who has sickle cell anemia asks you if her infant will develop sickle cell disease. The nurse would base the answer on which of the following? a) Sickle cell anemia is not inherited; it occurs following a malaria infection. b) Sickle cell anemia is dominantly inherited. c) Sickle cell anemia has more than one polygenic inheritance pattern. d) Sickle cell anemia is recessively inherited.

d) Sickle cell anemia is recessively inherited. Rationale: Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. If one parent has the disease and the other is free of the disease and trait, the chances of the child inheriting the disease is zero. Options B, C, and D are incorrect as they give misinformation to the patient and are inappropriate answers for the nurse to give.

While the nurse is weighing a pregnant woman at a regularly scheduled OB visit, the patient complains of vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. She says this is her first pregnancy and she didn't know this was what happened. What can the nurse tell her? a) This is not normal for pregnancy but the doctor might test her for a simple yeast infection. If it is a yeast infection, it can be treated with a single-dose suppository that will not harm the fetus. Remind the patient that she should call immediately if she has any symptoms that don't seem normal to her. b) This is not normal for pregnancy; the doctor might test her for chlamydia. If it is chlamydia, she and her partner can be treated with a 7-day course of antibiotics. Remind the patient that she should call immediately if she has any symptoms that don't seem normal to her. c) This is not normal for pregnancy; the doctor might test her for gonorrhea. If it is gonorrhea, she and her partner will be treated with antibiotics; they might be treated with different medications because some antibiotics normally used to treat gonorrhea are damaging to the fetus. Remind the patient that she should call immediately if she has any symptoms that don't seem normal to her. d) This is not normal for pregnancy; the doctor might test her for trichomoniasis. If it is trichomoniasis, she can be treated with an oral dose of metronidazole. Remind the patient that she should call immediately if she has any symptoms that don't seem normal to her.

d) This is not normal for pregnancy; the doctor might test her for trichomoniasis. If it is trichomoniasis, she can be treated with an oral dose of metronidazole. Remind the patient that she should call immediately if she has any symptoms that don't seem normal to her. Rationale: Trichomoniasis is caused by a one-celled protozoa. The symptoms include large amounts of foamy, yellow-green vaginal discharge. Treatment is with metronidazole, her partner needs to be treated as well. A yeast infection presents with a cottage-cheese like discharge, so option A is incorrect. Chlamydia often has no symptoms. If the woman does experience symptoms, these may include vaginal discharge, abnormal vaginal bleeding, and abdominal or pelvic pain. Gonorrhea may have symptoms so mild that they go unnoticed in the woman. The woman who contracts gonorrhea may have vaginal bleeding during sexual intercourse, pain, and burning while urinating, and a yellow or bloody vaginal discharge.

A woman with no previous history of heart disease begins to have symptoms of myocardial failure a few weeks before the delivery of her first child. Findings include shortness of breath, chest pain, and edema, with her heart also showing enlargement. Which disease should the nurse suspect? a) pulmonary valve stenosis b) left sided heart failure c) mitral stenosis d) peripartal cardiomyopathy

d) peripartal cardiomyopathy Rationale: Peripartal cardiomyopathy can occur in pregnancy without any previous history of heart disease. Symptoms include shortness of breath, chest pain, and edema; also, the heart begins to increase. Treatment is with a diuretic, an antidysrhythmic agent, digitalis, low weight heparin, and bed rest.

A 16-year-old girl comes to the public health office and tells you she is pregnant. She is afraid to tell her parents. As a nurse, what is important for you to know that can help this 16 year old? a) Know about community resources for the pregnant teen b) Know who the father of the baby is c) Know who the mother's parents are d) Know what school district she resides in

a) Know about community resources for the pregnant teen Rationale: Be knowledgeable regarding community resources for the pregnant teen. If you or the primary-care practitioner refers the teen to another entity, follow up to make certain the adolescent receives the services for which she was referred. If she does not, try to determine the barriers that prevent her from following through with treatment. Assist her to work through the barriers to obtain needed services.

When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation (congestive heart failure), which include a) dyspnea, crackles, irregular weak pulse. b) regular heart rate, hypertension. c) shortness of breath, bradycardia, hypertension. d) increased urinary output, tachycardia, dry cough.

a) dyspnea, crackles, irregular weak pulse. Rationale: Signs of cardiac decompensation to congestive heart failure 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 informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night's sleep. The nurse further instructs the patient that the best position for this rest is which of the following? a) left lateral recumbent b) right lateral recumbent c) prone d) on her back

a) left lateral recumbent Rationale: The pregnant woman should rest in the left lateral recumbent position to prevent supine hypotension syndrome and increased heart effort.

A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which of the following statements would be the nurse's best answer? a) "She already has AIDS. That's what being HIV positive means." b) "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." c) "HIV is transmitted at birth; having a cesarean birth prevented transmission." d) "HIV antibodies do not cross the placenta; this means the baby will develop AIDS."

b) "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." Rationale: 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 woman with diabetes is having a glycosylated hemoglobin level drawn. Which result would require the nurse to revise the client's plan of care? a) 6.0% b) 8.5% c) 7% d) 5.5%

b) 8.5% Rationale: A glycosylated hemoglobin level of more than 8% indicates poor control and the need for intervention, necessitating a revision in the woman's plan of care.

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? a) "The fact that you are receiving prenatal care will help." b) "Our facility has a lot of experience in dealing with this." c) "Pregnancy taxes the circulatory system of every woman." d) "Don't worry. You have an excellent doctor."

c) "Pregnancy taxes the circulatory system of every woman." Rationale: Pregnancy taxes the circulatory system of every woman because both the blood volume and cardiac output increase by approximately 30% to 50%. Half of these increases occur by 8 weeks; they are maximized by mid-pregnancy.

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? a) 45 mg/dl b) 120 mg/dl c) 85 mg/dl d) 136 mg/dl

c) 85 mg/dl Rationale: Recommended fasting blood glucose levels in pregnant clients with diabetes are 60 to 95 mg/dl. A fasting blood glucose level of 45 g/dl is low and may result in symptoms of hypoglycemia. A blood glucose level below 120 mg/dl is recommended for 2-hour postprandial values. A blood glucose level above 136 mg/dl in a pregnant client indicates hyperglycemia.

A postpartum mother has the following lab data recorded: a negative rubella titer. What is the appropriate nursing intervention? a) Assess the rubella of the baby b) No action needed. c) Administer rubella vaccine before discharge. d) Notify the health care provider.

c) Administer rubella vaccine before discharge. Rationale: 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. This makes option A incorrect. 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 pregnant patient with mitral stenosis needs to begin taking an anticoagulant. The nurse identifies the drug of choice, which is used in early pregnancy and again during the last month of pregnancy, to be which of the following? a) aspirin b) coumadin c) heparin d) levonox

c) heparin Rationale: If an anticoagulant is required, heparin is the drug of choice for the beginning and the end of pregnancy. Heparin does not cross the placenta barrier.

A woman is pregnant and has asthma. Her physician has told her to continue taking prednisone during pregnancy, but she is concerned the drug may be teratogenic. What advice would be best to give her regarding this? a) Prednisone is a teratogenic drug, but she may need it to control her asthma symptoms. b) You would recommend she omit the drug during pregnancy. c) She should half her dose during the first 3 months of pregnancy. d) Prednisone is considered safe in the doses prescribed by her physician.

d) Prednisone is considered safe in the doses prescribed by her physician. Rationale: Women should take no medication during pregnancy except that prescribed by their primary-care provider. Prednisone may be prescribed safely because, although it may be teratogenic in animal models, it does not appear to be teratogenic in humans.

Which of the following is recommended to prevent transmission of HIV to a newborn if the mother has AIDS? a) Avoid scalp electrodes for internal fetal monitoring. b) Admit infant to NICU after delivery. c) Perform amniotomy. d) Prepare for cesarean delivery.

d) Prepare for cesarean delivery. Rationale: When a patient is HIV positive, the method of delivery preferred is cesarean. This method has the lowest transmission rate for passage of the HIV infection to the infant. The nurse should educate the woman on the standard of care for delivery in an HIV or AIDS positive mother. Avoiding scalp electrodes for internal fetal monitoring, admitting the infant to NICU, and performing an amniotomy are not recommended methods for preventing transmission of HIV to a newborn.