Ch 22: Nursing Care of a Pregnant Family With Special Needs
d) Ask the client in a nonthreatening way if she wishes to have an epidural, and then speak with the primary health care provider Pg. 576 A pregnant adolescent is considered to be emancipated and entitled to make her own decisions. It is the adolescent's right to decide whether she wants to have an epidural. The nurse should act as the adolescent's advocate and ask her whether she wants an epidural and then speak with the health care provider. The adolescent's mother and other family members can't override her decision. The nurse may not request that an anesthesiologist administer the epidural without the adolescent's verbal consent.
1. An adolescent client in labor is dilated 4 cm and on admission asks for an epidural. For cultural reasons, the client's mother states that her daughter "has to bite the bullet, just like I did." The adolescent does not respond to the mother's statement. What should the nurse do to make sure the client's request is honored? a) Request that an anesthesiologist administer the epidural at this time because the client is uncomfortable and has requested it b) Knowing the client's cultural background, suggest that the family call a meeting to make the best decision for the client c) Follow the mother's request as the client did not indicate a continued desire for an epidural once the mother made the request d) Ask the client in a nonthreatening way if she wishes to have an epidural, and then speak with the primary health care provider
d) Inadequate milk production Pg. 585 A woman who frequently uses marijuana may have a reduction in milk production. She is no more likely than any other woman to have postpartum hemorrhage, infection, or hemorrhoids.
10. Which postpartum complication is the nurse most likely to see in a mother who abuses marijuana? a) Infection b) Postpartum hemorrhage c) Hemorrhoids d) Inadequate milk production
b) Provide educational pamphlets on topics such as nutrition and exercise c) Provide time for the client and support person to ask questions e) Stress the importance of attending monthly health care provider appointments Pg. 582 Interventions for the high-risk pregnant client include promoting a healthy pregnancy and preventing pregnancy complications. Care focuses on teaching, maintaining appointments, and encouraging a client with any special needs to determine how best to manage the pregnancy according to the client's situation. Providing educational pamphlets on related topics allows the client to review information at home. Maintaining health care appointments is essential in monitoring the progress of the client and fetus. Allowing the opportunity to ask questions clarifies any misconceptions. Discussing consequences and potential negative outcomes may be considered punitive and deter therapeutic communication. Bed rest during pregnancy is not encouraged unless medically necessary. Exercise throughout pregnancy is more common.
11. The nurse is caring for a pregnant client considered at high risk for pregnancy complications. What nursing action(s) included in the plan of care help achieve a positive outcome? Select all that apply. a) Make sure the client maintains bed rest for the duration of the pregnancy b) Provide educational pamphlets on topics such as nutrition and exercise c) Provide time for the client and support person to ask questions d) Inform the client of consequences and potential negative outcomes e) Stress the importance of attending monthly health care provider appointments
d) Assess the impact of the disability on the client's lifestyle before offering assistance Pg. 566 When caring for a client with physical challenges, keep in mind that physical disabilities occur in degrees; therefore, the nurse should first establish the effects of the disability on the client's lifestyle before offering any guidance for care measures during pregnancy. The capacity of a woman with special needs to adapt to pregnancy depends both on her physical capabilities and on her ability to persevere against odds, to overcome obstacles. Be certain to assess physical strengths as well as limitations and psychosocial strengths as well as challenges. Once the nurse has completed the assessment, assistants may be helpful in lifting the client onto the exam table. There is no reason to believe that the client is unable to take care of her baby just because of the physical disability. Planning may be needed to identify difficulties and develop solutions. Many clients with physical disabilities are able to have a normal pregnancy, labor, and delivery.
12. The nurse is preparing for a prenatal visit with a pregnant woman who cannot ambulate because of a thoracic spine injury several years ago. What should the nurse do first to prepare for this client's visit? a) Educate the client on the effects of pregnancy and birth on women with disabilities b) Have assistants available to lift the client onto the examining room table c) Discuss the client's inability to provide care for her child adequately d) Assess the impact of the disability on the client's lifestyle before offering assistance
c) Deliver chest thrusts Pg. 591-593 To effectively dislodge a food object from a choking pregnant woman, the nurse should start chest thrusts. Pressure on the chest compresses the ribs, increasing chest and lung pressure. This increased pressure forces an object lodged in the airway to move upward.
13. The nurse is eating lunch in the hospital cafeteria when she notices a pregnant woman, apparently in her third trimester, choking on her food. After assessing that the client cannot speak, what should be the nurse's next intervention? a) Deliver back blows b) Deliver abdominal thrusts c) Deliver chest thrusts d) Perform a blind finger sweep
b) Elevate the client's head, maintaining spinal precautions Pg. 581 The client with a preexisting spinal cord injury is at risk for autonomic dysreflexia, manifested with severe hypertension and a sudden severe headache. The nurse must immediately elevate the client's head to relieve the cerebral pressure before assessing for the cause and before calling for help or contacting the health care provider. Rotating the client is not an intervention to help a client with this condition.
14. The nurse is caring for a pregnant client who has a preexisting spinal cord injury. During labor, the client suddenly experiences a headache and blood pressure of 298/100 mm Hg. What is the nurse's priority intervention? a) Call for assistance b) Elevate the client's head, maintaining spinal precautions c) Contact the health care provider d) Rotate the client into the side-lying position using the log-rolling method
c) Iron-deficiency anemia d) Preterm labor e) Preeclampsia Pg. Adolescents are at increased risk of iron-deficiency anemia, preeclampsia, and preterm labor. Older clients, not adolescents, are at increased risk for multiple gestation pregnancy and gestational diabetes.
15. The nurse is caring for a pregnant adolescent client. Which complication(s) of pregnancy is this client at increased risk for due to age? Select all that apply. a) Multiple gestation b) Gestational diabetes c) Iron-deficiency anemia d) Preterm labor e) Preeclampsia
d) Tetanus, diphtheria, pertussis (Tdap) vaccine e) Tetanus immunoglobulin Pg. The client should receive the Tdap vaccine to reduce the risk of tetanus infection. Because the most recent tetanus vaccine is greater than 10 years ago, tetanus immunoglobulin is also indicated. Rh immunoglobulin is not required, because there is no risk factor indicating its use or risk of mixing of fetal/pregnant client blood. Hepatitis B vaccine and immunoglobulin are not indicated for this client.
16. A pregnant client at 22 weeks' gestation is cut on the finger by some rusty metal fencing. What medication(s) will the nurse anticipate in the primary health care provider's prescriptions for this client? Select all that apply. a) Hepatitis B vaccine b) Hepatitis B immunoglobulin c) Rh immunoglobulin d) Tetanus, diphtheria, pertussis (Tdap) vaccine e) Tetanus immunoglobulin
d) "We will check her hemoglobin level. Often, iron deficiency anemia will cause a craving for inedible substances" Pg. 574 The nurse is correct to advise the parent of potential causes for the pregnant adolescent's desire to ingest chalk. As if the girl's body has identified a mineral lack, iron deficiency anemia is associated with pica (ingestion of inedible substances). Cravings for ice cubes or blackboard chalk may develop because of this deficiency. There is no relationship between eating chalk and high-risk behaviors such as substance use disorders. Chalk does not help gastrointestinal upset such as morning sickness. Pica is related to iron deficiency anemia and not to pregnancy-related cravings.
17. The parent of a pregnant adolescent says to the nurse, "I don't know what is wrong with my daughter. I found her eating chalk the other day and she says she is craving it!" What information can the nurse give to the parent? a) "Gastrointestinal upset may be causing this behavior. Is she having a lot of morning sickness with her pregnancy?" b) "That is not so unusual. Pregnant people often crave strange things during pregnancy and this must just be a craving" c) "This could be related to a substance use disorder. Do you know of any other high-risk behavior?" d) "We will check her hemoglobin level. Often, iron deficiency anemia will cause a craving for inedible substances"
c) "Would you please tell me what you ate in the last 24 hours? I would like a clear idea of your intake" Pg. 569-570 Specifics are important to accurately judge nutrition. When interviewing adolescents, the nurse should press them for the responses needed to assess accurately, especially food eaten within the past 24 hours (when taking a nutrition history). The nurse does not accept statements such as "I eat well" as a nutrition history or "I am a very active person" as a history of rest and activity. The nurse asks for details. Also, the nurse will use open-ended questions not closed-ended ones with a "yes" or "no" answer. (e.g, "Yes, I eat fruits and vegetables.") All pregnant clients are encouraged to take daily vitamins.
18. The nurse is asking a pregnant adolescent client about dietary intake. The client states, "I eat well." How will the nurse respond? a) "When you say well, would you say that includes fruits and vegetables but not refined sugar?" b) "If you are not eating fruits and vegetables, you will need to take your prenatal vitamins daily" c) "Would you please tell me what you ate in the last 24 hours? I would like a clear idea of your intake" d) "That is great. It is good to hear that you know you will need to eat well for you and the baby"
c) "As your abdomen gets larger, what will you need to maintain your mobility?" Pg. A client who uses crutches for mobility may have additional challenges in later pregnancy due to the increasing weight and changing center of balance. Asking the client an open-ended question about their mobility needs is the best way to assess this need. Specific baby care items (wagon, crib) could better be addressed by asking open-ended questions about the client's plans. Intimacy with the partner is not a specific need for a client with challenges concerning mobility.
19. The nurse is caring for a pregnant client with cerebral palsy who uses forearm crutches for mobility. Which question will help the nurse assess this client's mobility needs as the pregnancy progresses? a) "How will you maintain intimacy with your partner during the pregnancy?" b) "Will you need a crib with an adjustable side-rail to use for your baby?" c) "As your abdomen gets larger, what will you need to maintain your mobility?" d) "Do you have a wagon you can use to transport your baby?"
c) The client stated, "I use cocaine about four times per week" Pg. 584-585 The nurse must quickly assess the client for potential causes of abdominal pain and bleeding as this is an obstetric emergency. The nurse is correct to identify that cocaine causes vasoconstriction, which affects placental circulation and can cause a separation of the placenta, premature delivery, or fetal death. Working in a restaurant and being on one's feet for lengthy periods of time, riding a motorcycle, or being HIV-positive may put the client at risk medically, but these factors do not cause placental abruption.
2. A labor and delivery nurse is caring for a woman with no prenatal care who presented with vaginal bleeding and abdominal pain. Late decelerations were noted on the fetal heart monitor. Which finding in the client history would cause the nurse to suspect placental abruption? a) The client has had multiple sexual partners and is positive for HIV b) The client works 12-hour shifts in a busy restaurant in the city c) The client stated, "I use cocaine about four times per week" d) The client rides a motorcycle to and from work
d) "This is ultimately your decision. You do not need your parent's permission for this procedure" Pg. 577 A pregnant teenager younger than 18 years of age is an emancipated minor and does not require parental permission for any health care procedures. Thus, the client can decide and then give consent. There are also no requirements for the father of the baby to give consent to the procedure.
20. A pregnant 16-year-old has decided to have an amniocentesis for a positive Down syndrome screen. How should the nurse counsel this client? a) "Because the father of the baby is over 18, he can sign the consent form for the procedure" b) "Because you are not married, you and the father of the baby have to sign for the procedure" c) "Because you are a minor, you will need one of your parents to sign consent for the procedure" d) "This is ultimately your decision. You do not need your parent's permission for this procedure"
a) "If we use throw rugs, they need to have non-skid backing on them" b) "We need to have good lighting when reading labels, especially ones on medication containers" c) "We need to take frequent rest periods so we don't get overtired" Pg. Appropriate suggestions to prevent unintentional (accidental) injury include the following: - Not standing on step stools or stepladders (it is difficult to maintain balance on a narrow base) - Avoiding throw rugs without a non-skid backing to prevent slipping on these - Not reading medication labels with poor lighting, as this could result in taking the incorrect dosage - Avoiding working to a point of fatigue, as fatigue lowers judgment - Avoiding long periods of standing because this can lead to a drop in blood pressure, causing dizziness and fainting
21. A nurse is conducting a class for pregnant women about prevention of unintentional (accidental) injury. The nurse determines the teaching was successful when the group makes which statement? Select all that apply. a) "If we use throw rugs, they need to have non-skid backing on them" b) "We need to have good lighting when reading labels, especially ones on medication containers" c) "We need to take frequent rest periods so we don't get overtired" d) "It's okay to use a small step stool but we shouldn't use any stepladders" e) "It's important to stand for longer periods of time so we don't have our knees flexed so much"
b) The daughter is an emancipated minor and has the right to speak with the nurse confidentially Pg. 568 Parents may have difficulty allowing a daughter to make her own health care decisions. Soon, however, she will be caring for an infant, so she needs this practice in independence and responsibility. You may need to remind parents a pregnant adolescent is regarded as an emancipated minor or a mature minor—a person capable of making health care decisions—and so may sign permission for her own care. The protection of confidentiality for adolescents is based on recognition some minors would not seek needed health care for such concerns as sexual activity, pregnancy, HIV, sexually transmitted infections (STIs), substance abuse or mental health if they could not receive it confidentially. The client in this case need not return to the office when she is 18 or obtain permission from her father to speak with the nurse confidentially.
22. A mother and her 17-year-old daughter, who is in her first trimester, arrive for the daughter's first prenatal visit. The daughter will turn 18 in 2 weeks. The mother is visibly upset about her daughter's pregnancy and interrupts her daughter to answer the nurse's questions that were addressed to the daughter. The nurse says that she would like to talk with the daughter alone. The mother objects. Which of the following should the nurse mention to the mother? a) The daughter can simply return in 2 weeks, when she is 18, and speak with the nurse confidentially without the mother's permission b) The daughter is an emancipated minor and has the right to speak with the nurse confidentially c) Because the daughter is still a minor, the nurse may not speak with her alone without the mother's permission d) If the daughter acquires permission from her father, she can speak with the nurse confidentially without the mother's permission
c) She should begin bed rest, preferably in a side-lying position Pg. 578 The best intervention for reducing an increasing blood pressure during pregnancy is bed rest, preferably in a side-lying position.
23. The nurse obtained a blood pressure of 160/96 on a pregnant adolescent at 32 weeks' gestation. A baseline blood pressure of 130/60 was obtained on her first visit. What intervention does the nurse anticipate advising the adolescent to begin? a) She should reduce her sodium intake b) She should begin taking a diuretic to decrease the amount of fluid accumulating c) She should begin bed rest, preferably in a side-lying position d) She will need to prepare for a cesarean birth immediately to deliver the baby
c) The fetus is past 24 weeks and no more than 5 minutes have passed since the mother died Pg. 594 If a pregnant woman does not survive serious trauma, it may still be possible for her child to be born safely by a postmortem cesarean birth. This is usually attempted if the fetus is past 24 weeks and fewer than 20 minutes have passed since the mother died. Infant survival is best in these circumstances if no more than 5 minutes have passed.
24. A pregnant woman is in an automobile accident and does not survive the trauma. The spouse requested that the physician do an emergency postmortem cesarean birth. Which conditions would most promote infant survival? a) The fetus is past 24 weeks and no more than 30 minutes have passed since the mother died b) The fetus is past 20 weeks and no more than 30 minutes have passed since the mother died c) The fetus is past 24 weeks and no more than 5 minutes have passed since the mother died d) The fetus is past 32 weeks and no more than 45 minutes have passed since the mother died
b) A lack of knowledge on which foods to consume to have adequate iron intake Pg. 574 From the analysis of the woman's symptoms, it is important to identify and plan care for a client with anemia. Many adolescent girls are deficient in iron because their low protein intake cannot balance the amount of iron lost with menstrual flows. Deficiency is revealed by chronic fatigue, pale mucous membranes, and a hemoglobin level less than 11 g/dl (110 g/L). The care plan will focus on ways to increase iron in the body. Interventions are not related to sleep, exercise, or a gastrointestinal disease process.
25. A pregnant adolescent comes to the clinic and reports that she "feels tired all the time." The nurses assesses pale mucous membranes. Laboratory tests show a hemoglobin of 10.2 g/dl (102 g/L). The nurse is most correct to base the plan of care off which anticipated complication? a) A physiologic illness such as gastrointestinal bleeding from a peptic ulcer b) A lack of knowledge on which foods to consume to have adequate iron intake c) Inadequate exercise to compensate for the increased blood to the tissues d) Unsure of how to maintain restful sleep during pregnancy
b) Imbalanced nutrition Pg. 566 A pregnant adolescent is at increased risk for imbalanced nutrition due to the increased nutritional demands of both pregnancy and adolescence. The remaining answer choices represent appropriate risks to address in the client's plan of care; however, these are not the priority for the pregnant client who is an adolescent.
26. The maternal health nurse is developing the plan of care for an adolescent client who is pregnant. Which risk will the nurse prioritize in the care plan? a) Fetal injury b) Imbalanced nutrition c) Disruption of social interactions d) Social isolation
d) The uterus may not be fully developed and may become overdistended Pg. 575 An overdistended uterus will have a more difficult time involuting. Uterine atony (failure of the uterus to involute) is the number one cause of postpartum hemorrhage. Because of the client's age, her body tissue usually would be very healthy. CPD is not related to postpartum hemorrhage. Iron deficiency is not more likely to cause postpartum hemorrhage, but it can make for a more complicated course if postpartum hemorrhage does occur.
27. Why is a young adolescent at higher risk for postpartum hemorrhage? a) Because of inadequate protein intake, her body tissue integrity is weak and feeble b) A young adolescent is more likely to be iron deficient c) A young adolescent has a higher likelihood of cephalopelvic disproportion (CPD) d) The uterus may not be fully developed and may become overdistended
a) Cephalopelvic disproportion Pg. 574-575 When caring for an adolescent client with a lack of labor progression due to fetal descent, the nurse first considers a cephalopelvic disproportion as the most likely complication. A cephalopelvic disproportion is suggested by lack of engagement at the beginning of labor, a prolonged first stage of labor, and poor fetal descent. A shortened umbilical cord might indicate that the fetus is not growing or moving appropriately. It is uncommon and can indicate other fetal anomalies may be present. Placenta previa is a condition where the fetus lies low in the uterus. Placenta previa includes painless bleeding. While client anxiety can impede the labor progress, it does not prohibit fetal engagement.
28. The nurse is caring for a 16-year-old client who has been in the first stage of labor for 20 hours. Despite cervical dilation, the client has had a lack of fetal engagement with poor fetal descent. As the client begins the 21st hour of labor, the nurse suspects which complication is affecting the client's labor progression? a) Cephalopelvic disproportion b) High client anxiety c) A short umbilical cord d) Placenta previa
d) The neonate should be observed closely for abstinence symptoms after birth Pg. Methadone is an opioid medication used to treat withdrawal symptoms in clients who have opioid addiction. After birth, the neonate may experience abstinence symptoms and should be observed closely. Breastfeeding is not contraindicated; breastfeeding may be recommended and may decrease the neonatal abstinence symptoms. Methadone should not be tapered in pregnancy (and some clients need an increase in dose due to changing metabolism as pregnancy progresses). If a client is stable on methadone, changing to buprenorphine is not recommended.
29. A pregnant client at the initial prenatal visit reports using prescription methadone maintenance. What will the nurse include in the plan of care related to this medication? a) Buprenorphine should be substituted for methadone due to lower teratogenicity b) Methadone use should be tapered during pregnancy c) Breastfeeding will be contraindicated due to methadone use d) The neonate should be observed closely for abstinence symptoms after birth
c) "Marijuana use may affect fetal neurologic development and is not recommended" Pg. The nurse should advise the client that marijuana use in pregnancy is not recommended due to a risk of complications such as poor neurologic development. Marijuana may or may not be illegal depending on the jurisdiction. There is no known evidence that alternate preparations such as tinctures or edibles have less risk, nor that small doses have low risk.
3. A pregnant client in the first trimester is experiencing severe nausea. The client asks the nurse if marijuana could be used as a natural remedy to treat the nausea. How does the nurse best respond? a) "Marijuana smoking is not recommended; tinctures or edible preparations have less risk" b) "Marijuana use is illegal and should not be used in pregnancy" c) "Marijuana use may affect fetal neurologic development and is not recommended" d) "Using small doses of marijuana is believed to pose a low risk to the fetus"
c) Maternal serum alpha-fetoprotein, human chorionic gonadotropin (HCG), and unconjugated estriol levels Pg. 577 Pregnant clients older than 35 years are offered a triple-screen (maternal serum alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol levels) drawn on blood serum at the 15th week of pregnancy to detect whether an open spinal cord or chromosomal defect could be present in the fetus; risk for Down syndrome in clients over 35 is much higher than it is in younger clients (incidence of about 1 in 1000 compared to 1 in 1500 in younger clients). Screening for venereal disease is not linked to these fetal disorders. A metabolic profile, nonstress test, hemoglobin and hematocrit, and urinalysis are not used in identifying fetal spinal cord or chromosomal defects.
30. A 38-year-old woman at 15 weeks' gestation comes in for a prenatal visit. What test should the nurse offer at this time to detect an open fetal spinal cord or chromosomal defects? a) A clean catch urinalysis and basic metabolic panel (BMP) and human chorionic gonadotropin (HCG) levels b) A nonstress test using a fetal monitor and serum human chorionic gonadotropin (HCG), hemoglobin, and hematocrit levels c) Maternal serum alpha-fetoprotein, human chorionic gonadotropin (HCG), and unconjugated estriol levels d) Screening for venereal diseases: syphilis, gonorrhea, and human immunodeficiency virus (HIV)
b) Age Pg. 579 The nurse evaluates the client and assesses for potential risk factors for postpartum hemorrhage. The nurse identifies that age is the factor that places this client at highest risk. When considering risk factors, the nurse identifies that just as the cervix may not dilate as readily during labor due to inelasticity, the uterus may not contract as readily in the postpartum period. The result puts clients over 40 at a higher risk for postpartum hemorrhage. A sedentary lifestyle places the client at risk for thrombophlebitis. Late prenatal care places the fetus at risk for placental and fetal anomalies. There are no risk factors associated with being a primigravida.
31. The nurse is caring for a 44-year-old client experiencing postpartum hemorrhage soon after birth. This is the client's first child. The client has a history of a sedentary lifestyle, anemia, and poor nutritional intake. The client did not obtain prenatal care until 32 weeks' gestation. Which piece of data collected indicated to the nurse that the woman was at risk of postpartum hemorrhage? a) A sedentary lifestyle b) Age c) Late prenatal care d) Primigravida
c) Chromosomal assessment Pg. 577 The nurse is correct to review relevant lab work associated with the client's pregnancy. Because the risk for Down syndrome is higher in older clients than in younger ones, a quad-screen or an integrated screen (sometimes referred to as a sequential screen) is anticipated in order to detect if an open spinal-cord defect or chromosomal defect could be present in the fetus. Nutrition and mental health assessments are normal assessments that are made for any pregnant client, not specifically for those over age 40. A biophysical profile evaluates the current status of the fetus and consists of the fetal heartbeat via nonstress test with fetal ultrasound.
4. A 41-year-old client at 11 weeks' gestation has arrived for a prenatal visit. When reviewing the client's past office visit report, which assessment would the nurse anticipate specifically related to the client's age? a) Nutrition assessment b) Biophysical assessment c) Chromosomal assessment d) Mental health assessment
b) Establish the impact of the disability on a woman's lifestyle Pg. 566 When caring for a woman who is physically challenged, keep in mind that physical disabilities occur in degrees; therefore, first establish the impact of the disability on a woman's lifestyle before offering any guidance for care measures during pregnancy.
5. What is the first thing the nurse should do when caring for a pregnant woman with a disability? a) Offer guidance for care measures during pregnancy b) Establish the impact of the disability on a woman's lifestyle c) Make arrangements for a home birth d) Involve community and social supports for the client
b) Perform backward thrusts on the chest with the fists Pg. If a pregnant client chokes on a piece of food or a foreign object blocks the airway, attempting to dislodge the object with a sudden upward thrust to the upper abdomen can be difficult because there is a lack of space between the uterus and the end of the sternum. Also, the average person may not be able to reach around the client's enlarged abdomen to perform a usual chest thrust. The nurse performs chest thrusts by standing behind the client, encircling the chest with the nurse's arms. Then the nurse places the thumb side of one fist on the middle of the client's sternum, grabs the fist with the other hand and performs backward thrusts until the foreign body is expelled. Inserting a finger into the client's mouth would be inappropriate. Placing the client in a supine position would be appropriate if the client was or became unconscious.
6. While in the waiting room of the clinic, a pregnant client begins to choke on a piece of food. Which action by the nurse would be appropriate? a) Insert a finger in the mouth to grasp the object b) Perform backward thrusts on the chest with the fists c) Place the client in a supine position on the floor d) Use two fingers to compress the abdomen
d) Placental abruption (abruptio placentae) Pg. Cocaine use causes vasoconstriction, which leads to an increased risk of placental abruption in pregnancy. Gestational diabetes, hyperemesis gravidarum, and placenta previa are not associated with cocaine use.
7. What complication will the nurse be alert for in the client who uses cocaine during the pregnancy? a) Placenta previa b) Gestational diabetes c) Hyperemesis gravidarum d) Placental abruption (abruptio placentae)
b) Lethargy Pg. 584-585 Infants born to women who are cocaine and crack dependent are at risk for intracranial hemorrhage and often demonstrate tremors, irritability, and muscle rigidity—not lethargy.
8. All of the following are commonly seen in infants born to cocaine-addicted mothers except: a) Intracranial hemorrhage b) Lethargy c) Irritability d) Muscle rigidity
a) "You are considered emancipated and may receive health care for you and your baby without parental consent" Pg. 568 The school nurse is most correct to provide the facts of emancipation to the student. It is also important to answer the adolescent's question. A pregnant adolescent is regarded as an emancipated minor or a mature minor—a person capable of making health care decisions—and so may sign permission for their own care. Stating that it is important to see the health care provider does not answer the adolescent's question. Stating the nurse knows the reaction of the adolescent's parents is not appropriate.
9. A pregnant adolescent tells the school nurse, "I want to go to the primary health care provider and have them check my baby, but I don't want to tell my parents and the doctor probably will not see me without them." What is the best response by the nurse? a) "You are considered emancipated and may receive health care for you and your baby without parental consent" b) "You are probably correct. However, you should tell your parents and have them take you to see a health care provider" c) "I am sorry that you are in this situation, but it is important for you to see the health care provider" d) "I am sure your parents will be upset when they find out you are pregnant, but they will surely take you for health care"
