Chapter 11: High Risk Perinatal Care: Pre-existing Conditions NCLEX

The prenatal medical record for a pregnant patient with diabetes states that amniotic fluid phosphatidylglycerol is greater than 3%. What does this indicate? A. The fetal lung maturation is normal. B. The mother may develop hydramnios. C. There is a chance of fetal macrosomia. D. The mother is at risk for hypoglycemia

A (Fetal lung maturation is predicted by the presence by amniotic fluid phosphatidylglycerol. If it is greater than 3%, the fetal lung maturation is normal. The risk for hypoglycemia can be confirmed by evaluating blood glucose levels. The risk for fetal macrosomia is increased if there is poor glycemic control in pregnancy. If hyperglycemia occurs, the patient is at risk for hydramnios. Test-Taking Tip: Survey the test before you start answering the questions. Plan how to complete the examination in the time allowed. Read the directions carefully and answer the questions you know for sure first.)

Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes? A. Heroin B. Alcohol C. Phencyclidine palmitate (PCP) D. Cocaine

A (Heroin The opiates include opium, heroin, meperidine, morphine, codeine, and methadone. The signs and symptoms of heroin use are euphoria, relaxation, relief from pain, detachment from reality, impaired judgment, drowsiness, constricted pupils, nausea, constipation, slurred speech, and respiratory depression. Possible effects on pregnancy include preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. Alcohol is not an opiate. PCP is not an opiate. Cocaine is not an opiate.)

Which action does the nurse take to determine whether the carbohydrate intake is inadequate in a pregnant patient with diabetes? A. Monitor for urine ketones. B. Evaluate the nonstress test results. C. Determine the degree of glycosuria. D. Schedule a baseline fetal sonogram.

A (If a patient with diabetes does not take in enough carbohydrates, the body resorts to breaking down fats for energy. The by-product of fat metabolism is ketones. Therefore the nurse monitors the urine for ketones. The amount of ketones in the urine helps detect inadequate carbohydrate intake. Nonstress tests will help assess the well-being of the fetus. Glycosuria does not accurately reflect the blood glucose levels because of a lowered renal threshold for glucose during pregnancy. The nurse obtains a baseline sonogram to assess gestational age in the first trimester. Test-Taking Tip: Relax during the last hour before an examination. Your brain needs some recovery time to function effectively.)

Which condition does the nurse expect to find in the medical record of a pregnant patient with diabetes mellitus? A. Hypoglycemia B. Cyanosis of lips C. Increasing fatigue D. Generalized edema

A (In the first trimester of pregnancy, there is an increase in insulin production and a decrease in hepatic glucose production because of the rising levels of estrogen and progesterone. This lowers the glucose levels and makes the pregnant patient prone to hypoglycemia. Cyanosis of lips, increasing fatigue, and generalized edema are signs of cardiac decompensation in a pregnant patient with preexisting cardiac disease. It occurs because the heart is unable to maintain sufficient cardiac output because of pregnancy.)

A nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function? A. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. B. Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics. C. Encourage the woman to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function. D. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.

A (Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. The side-lying position with the head and shoulders elevated helps facilitate hemodynamics during labor. A vaginal delivery is the preferred method for a woman with cardiac disease because it sustains hemodynamics better than a cesarean section. The use of supportive care, medication, and narcotics or epidural regional analgesia is not contraindicated with a woman with heart disease. Epidural anesthesia for labor is preferred. (Easterling and Stout, 2012). Using the Valsalva maneuver during pushing in the second stage should be avoided because it reduces diastolic ventricular filling and obstructs left ventricular outflow.)

Which factor is known to increase the risk of gestational diabetes mellitus? A. Previous birth of large infant B. Maternal age younger than 25 C. Underweight before pregnancy D. Previous diagnosis of type 2 diabetes mellitus

A (Previous birth of a large infant suggests gestational diabetes mellitus. A woman younger than 25 is not at risk for gestational diabetes mellitus. Obesity (greater than 90 kg or 198 lb) creates a higher risk for gestational diabetes. The person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or (in some cases) responses.)

Thalassemia is a relatively common anemia in which: A. an insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). Correct B. RBCs have a normal life span but are sickled in shape. C. folate deficiency occurs. D. there are inadequate levels of vitamin B12 .

A (an insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). Thalassemia is a hereditary disorder that involves the abnormal synthesis of the á or â chains of hemoglobin. An insufficient amount of hemoglobin is produced to fill the RBCs. This is the underlying description for sickle cell anemia. Folate deficiency is the most common cause of megaloblastic anemias during pregnancy. B12 deficiency must also be considered if the pregnant woman presents with anemia.)

The nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function? A. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics B. Prepare the woman for delivery by cesarean section since this is the recommended delivery method to sustain hemodynamics C. Encourage the woman to avoid the use of narcotics or epidural regional analgesia since this alters cardiac function D. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling

A (Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics The side-lying position with the head and shoulders elevated helps to facilitate hemodynamics during labor. A vaginal delivery is the preferred method of delivery for a woman with cardiac disease as it sustains hemodynamics better than a cesarean section. The use of supportive care, medication, and narcotics or epidural regional analgesia is not contraindicated with a woman with heart disease. The use of the Valsalva maneuver during pushing in the second stage should be avoided because it reduces diastolic ventricular filling and obstructs left ventricular outflow. Awarded 0.0 points out of 1.0 possible points.)

What does the nurse include in the plan of care of a patient with a cardiac disorder during the postpartum period? Select all that apply. A. Monitor oxygen saturation levels. B. Place the newborn at the bedside. C. Put the patient on a full liquid diet. D. Teach the patient how to breastfeed. E. Have the patient talk to the newborn.

A, B, D, E (The nurse monitors oxygen saturation levels in the patient to assess for adequate oxygenation. The nurse places the infant at the bedside so that the patient can touch the infant without expending energy. This also helps establish an emotional bond. The nurse assists the patient in breastfeeding by positioning the infant correctly for feeding. The nurse encourages the patient to talk to the newborn to involve the mother in the infant's care and help the patient feel vitally important. A fluid diet is not prescribed, because it does not ensure adequate nutrition for the infant.)

The nurse is developing the plan of care for a pregnant patient with an underlying history of cardiovascular disease. Which conditions would this patient be at risk for? Select all that apply. A. Stillbirth B. Miscarriage C. Hypoglycemia D. Atrial septal defect E. Intrauterine growth restriction

A, B, E (Stillbirth and miscarriage may occur because of cardiovascular problems in pregnancy. Intrauterine growth restriction results in a pregnant patient with cardiovascular disease because of low oxygen pressure. Hypoglycemia is seen in a pregnant patient with diabetes because a decrease in glucose levels. An atrial septal defect is a congenital birth defect that is not related to underlying maternal cardiac disease.)

A pregnant woman is being examined by the nurse in the outpatient obstetric clinic. The nurse suspects systemic lupus erythematosus (SLE) after the examination reveals which symptoms? Select all that apply. A. Muscle aches B. Hyperactivity C. Weight changes D. Fever E. Hypotension

A, C, D (Common symptoms, including myalgias, fatigue, weight change, and fevers, occur in nearly all women with SLE at some time during the course of the disease. Fatigue, rather than hyperactivity, is a common sign of SLE. Hypotension is not a characteristic sign of SLE. Although a diagnosis of SLE is suspected based on clinical signs and symptoms, it is confirmed by laboratory testing that demonstrates the presence of circulating autoantibodies. As with other autoimmune diseases, SLE is characterized by a series of exacerbations (flares) and remissions (Chin and Branch, 2012).)

A pregnant woman is being examined by the nurse in the outpatient obstetric clinic. The nurse suspects systemic lupus erythematosus (SLE) after revealing which symptoms? (Select all that apply.) A. Muscle aches B. Hyperactivity C. Weight changes D. Fever E. Hypotension

A, C, D (Fatigue, rather than hyperactivity is a common sign of SLE. Hypotension is not a characteristic sign of SLE. Common symptoms, including myalgias, fatigue, weight change, and fevers, occur in nearly all women with SLE at some time during the course of the disease. Although a diagnosis of SLE is suspected based on clinical signs and symptoms, it is confirmed by laboratory testing that demonstrates the presence of circulating autoantibodies. As is the case with other autoimmune diseases, SLE is characterized by a series of exacerbations (flares) and remissions.)

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for: (Select all that apply.) A. miscarriage. B. macrosomia. C. gestational hypertension. D. placental abruption. E. stillbirth.

A, C, D, E (Hypothyroidism is often associated with both infertility and an increased risk of miscarriage. Infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm. These outcomes can be improved with early diagnosis and treatment. Pregnant women with hypothyroidism are more likely to experience both preeclampsia and gestational hypertension. Placental abruption and stillbirth are risks associated with hypothyroidism. Placental abruption and stillbirth are risks associated with hypothyroidism.)

Which interventions does the nurse implement to ease the labor process of a pregnant patient with heart disease? Select all that apply. A. Place the patient in a side-lying position. B. Use stirrups to facilitate an easy labor. C. Monitor the patient's oxygen saturation. D. Maintain a peaceful, calm environment. E. Provide the patient with a relaxing back rub.

A, C, D, E (The nurse places the patient in a side-lying position to facilitate uterine perfusion. The nurse monitors the patient's oxygen saturation to assess for adequate oxygenation. The nurse maintains a calm environment to minimize the patient's anxiety. The nurse also provides a back massage to comfort the patient. Stirrups are not used because they may prevent compression of the popliteal veins or increase in blood volume in the chest.)

Which is the ideal treatment for severe unmanageable hyperthyroidism in a patient who is pregnant? A. Radioactive iodine B. Subtotal thyroidectomy C. Methimazole (Tapazole) D. Propylthiouracil (Propacil

B (A subtotal thyroidectomy is prescribed for a pregnant patient with severe hyperthyroidism if the drug therapy proves toxic. Oral methimazole and propylthiouracils are prescribed for hyperthyroidism but may be ineffective in severe cases. Radioactive iodine is not used to treat hyperthyroidism in pregnant patients, because it may destroy the fetus's thyroid gland.)

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: A. with good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. B. the most important cause of perinatal loss in diabetic pregnancy is congenital malformations. C. infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. D. at birth, the neonate of a diabetic mother is no longer at any greater risk.

B (Congenital malformations account for 30% to 50% of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.)

When a pregnant woman with diabetes experiences hypoglycemia while hospitalized, what should the nurse have the woman do? A. Eat a candy bar. B. Eat six saltine crackers or drink 8 oz of milk. C. Drink 4 oz of orange juice followed by 8 oz of milk. D. Drink 8 oz of orange juice with 2 teaspoons of sugar added

B (Crackers provide carbohydrates in the form of polysaccharides. A candy bar provides only monosaccharides. Milk is a disaccharide and orange juice is a monosaccharide. This will provide an increase in blood sugar but will not sustain to level. Orange juice and sugar will increase the blood sugar, but not provide a slow-burning carbohydrate to sustain the blood sugar. Test-Taking Tip: Being prepared reduces your stress or tension level and helps you maintain a positive attitude.)

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often: A. orthopnea. B. decreasing energy levels. C. moist frequent cough and frothy sputum. D. crackles (rales) at the bases of the lungs on auscultation.

B (Decreasing energy level (fatigue) is an early finding of heart failure. Care must be taken to recognize it as a warning rather than a typical change of the third trimester. Cardiac decompensation is most likely to occur early in the third trimester, during childbirth, and during the first 48 hours following birth. Orthopnea, a moist, frequent cough, and crackles and rales appear later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema.)

How does the nurse advise the patient who has given birth to an infant with microcephaly in the past and is now planning for the next child? A. "There is a higher chance of having a preterm birth." B. "You should be screened for phenylketonuria (PKU)." C. "There may be a miscarriage in your second pregnancy." D. "You must go for genetic counseling before conception."

B (If a patient has given birth to an infant with microcephaly in the past, there is a possibility that the patient has phenylketonuria (PKU). PKU results from a deficiency in the enzyme phenylalanine hydrolase. Preterm birth is a possibility in pregnant women with untreated hypothyroidism. PKU affects brain development and function in the child; it does not cause miscarriage. Genetic counseling is more important for patients who have hereditary disorders, which can be passed on to the child. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct.)

Which medication is administered to a pregnant patient to treat hyperthyroidism? A. Isotretinoin (Accutane) B. Methimazole (Tapazole) C. Levothyroxine (Synthroid) D. Sodium iodide 131I (Hicon

B (Methimazole (Tapazole) is administered to a pregnant patient to control symptoms of hyperthyroidism, improve weight gain, and reduce tachycardia. Isotretinoin (Accutane) is prescribed for cystic acne. It is not prescribed during pregnancy, because it is highly teratogenic. Levothyroxine (Synthroid) is used to treat hypothyroidism in pregnant patients who do not have a functioning thyroid tissue. Sodium iodide 131I (Hicon) is radioactive iodine. It is not used to treat hyperthyroidism in pregnant patients, because it may destroy the fetal thyroid. Test-Taking Tip: Eat breakfast or lunch before an examination. Avoid greasy, heavy foods and overeating. This will help keep you calm and give you energy.)

Which clinical finding in a pregnant patient will indicate proper fetal brain development? A. Hemoglobin A1c levels greater than 6 B. Normal maternal thyroxine (T4) levels C. 3% amniotic fluid phosphatidylglycerol D. Fasting glucose levels less than 95 mg/dL

B (Proper fetal brain development depends on normal maternal T4 levels early in pregnancy. Mild maternal hypothyroidism during the first trimester can cause neuropsychological damage in the infant. Hemoglobin A1c levels greater than 6 indicate long-term elevated glucose levels in the patient. A 3% amniotic fluid phosphatidylglycerol indicates proper lung maturation in the fetus. Fasting glucose levels less than 95 mg/dL indicate proper glycemic control in the pregnant patient.)

From 4% to 8% of pregnant women have asthma, making it one of the most common preexisting conditions of pregnancy. Severity of symptoms usually peaks: A. in the first trimester. B. between 24 to 36 weeks of gestation. C. during the last 4 weeks of pregnancy. D. immediately postpartum.

B (between 24 to 36 weeks of gestation. Women often have few symptoms of asthma during the first trimester. The severity of symptoms peaks between 24 and 36 weeks of gestation. Asthma appears to be associated with intrauterine growth restriction and preterm birth. During the last 4 weeks of pregnancy symptoms often subside. The period between 24 and 36 weeks of pregnancy is associated with the greatest severity of symptoms. Issues have often resolved by the time the woman delivers.)

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often: A. orthopnea. B. decreasing energy levels. C. moist frequent cough and frothy sputum. D. crackles (rales) at the bases of the lungs on auscultation.

B (decreasing energy levels. Orthopnea is a finding that appears later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema. Decreasing energy level (fatigue) is an early finding of heart failure. Care must be taken to recognize it as a warning rather than a typical change of the third trimester. Cardiac decompensation is most likely to occur early in the third trimester, during childbirth, and during the first 48 hours following birth. A moist, frequent cough appears later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema. Crackles and rales appear later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema.)

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: A. with good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. B. the most important cause of perinatal loss in diabetic pregnancy is congenital malformations. C. infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. D. at birth, the neonate of a diabetic mother is no longer at any greater risk.

B (the most important cause of perinatal loss in diabetic pregnancy is congenital malformations. Even with good control, sudden and unexplained stillbirth remains a major concern. Congenital malformations account for 30% to 50% of perinatal deaths. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.)

A pregnant woman in her first trimester with a history of epilepsy is transported to the hospital via ambulance after suffering a seizure in a restaurant. The nurse expects which health care provider orders to be included in the plan of care? (Select all that apply.) A. valproate (Depakote). B. Serum lab levels of medications. C. Abdominal ultrasounds. D. Prenatal vitamins with vitamin D. E. carbamazepine (Tegretol).

B, C, D (Carbamazepine (Tegretol) and valproate (Depakote) should be avoided if possible during pregnancy, especially during the first trimester, because their use is associated with NTDs in the fetus. Checking lab levels of medications, performing abdominal ultrasounds to assess fetal growth, and taking prenatal vitamins with vitamin D are all expected interventions for a pregnant woman diagnosed with epilepsy.)

A pregnant woman with type 1 diabetes is on rapid-acting, short-acting, and intermediate-acting insulin injections. Which are rapid and short-acting insulins? Select all that apply. A. NPH (Novolin N) B. Regular (Humalin) C. Lispro (Humalog) D. Aspart (NovoLog) E. Glargine (Lantus)

B, C, D (Humalog and NovoLog are rapid-acting insulins and Humalin is a short-acting insulin. Novolin N is an intermediate-acting insulin and Lantus is a long-acting insulin.)

A patient with gestational diabetes tells the nurse, "I'm extremely worried that my child will be diabetic, too." Which actions does the nurse take to alleviate the patient's anxiety? Select all that apply. A. Evaluate the test results to assess fetal growth. B. Listen to the feelings and concerns of the patient. C. Provide factual information of risks to the patient. D. Use therapeutic communication with the patient. E. Ask the patient to share any fears with the nurse.

B, C, D, E (The nurse listens to the patient's feelings and concerns to assess for any misconception or misinformation that can be causing anxiety. The nurse provides factual information about any risks to the patient to correct any misconceptions. Using therapeutic communication will develop an open relationship that also helps promote trust. The nurse encourages the patient to share concerns with the nursing staff to promote collaboration in the care process. Evaluating test reports for fetal growth will help assess fetal well-being, although it does not help alleviate the patient's fears.)

What does the nurse recommend to a pregnant patient with diabetes who works long, irregular hours? A. "Eat a snack hourly when at work." B. "Try taking naps when you are free." C. "Keep fruits or fruit juice available." D. "Quit working for a while."

C (If the patient has to be away from home for long hours, the nurse advises the patient to carry fruits or fruit juices. They contain simple carbohydrates that help control blood glucose levels. The nurse should not advise the patient to quit working, because it may not be feasible for the patient. Instead, the nurse should encourage the patient to follow a consistent daily schedule. Taking naps when free ensures rest, but it does not help keep glucose levels in check. Eating a snack every hour is not advised, because it may fluctuate blood glucose levels. Instead, three meals and two or three snacks are advised.)

During pregnancy, alcohol withdrawal may be treated using: A. disulfiram (Antabuse). B. corticosteroids. C. benzodiazepines. D. aminophylline.

C (Symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. Disulfiram is contraindicated in pregnancy because it is teratogenic. Corticosteroids are not used to treat alcohol withdrawal. Aminophylline is not used to treat alcohol withdrawal. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet).)

Which condition should the nurse be alert for after administering terbutaline (Brethine) to a pregnant patient with diabetes mellitus? A. Dyspnea B. Infection C. Ketoacidosis D. Hypoglycemia

C (Terbutaline (Brethine) is a beta-mimetic drug administered for tocolysis to stop preterm labor. It may lead to hyperglycemia and cause ketoacidosis in the pregnant patient. Dyspnea on exertion may be seen in a pregnant patient with acquired cardiac disease. Infection in pregnant women happens because of an alteration in the normal resistance of the body to infection. Hypoglycemia occurs if there is an increase in the insulin levels.)

What instruction should the nurse give to a pregnant patient with hyperthyroidism who often gets fatigued and weak as a result of nervousness and hyperactivity? A. "Ensure that you wear warm clothes." B. "Perform aerobic exercises every day." C. "Become involved in reading or a craft." D. "Avoid going out in the cold or at night."

C (The nurse advises the patient to engage in quiet activities, such as reading or crafting, to prevent fatigue and weakness. Extreme cold temperature is prevented and warm clothing is suggested if the patient has cold intolerance because of hypothyroidism. The patient is hypersensitive to heat and gets easily fatigued; therefore aerobic exercises are not advised.)

A patient is diagnosed with severe cardiac disease in the fourth week of pregnancy. What should be the nurse's priority? A. Initiate fetal surveillance twice a week. B. Assess the patient for signs of heart failure. C. Explain the risks of continuing pregnancy. D. Tell the patient to end the pregnancy right away.

C (The nurse explains the risks of continuing the pregnancy to help the patient make an informed decision. Fetal surveillance begins after 28 weeks if there are any complications, such as diabetes mellitus, in the patient. The nurse informs the patient about the complications that may arise as the pregnancy progresses. If the pregnancy is continued, the nurse assesses for cardiac decompensation to evaluate if the heart is able to maintain a sufficient cardiac output. The nurse does not ask the patient to terminate the pregnancy.)

During pregnancy, alcohol withdrawal may be treated using: A. disulfiram (Antabuse). B. corticosteroids. C. benzodiazepines. D. aminophylline.

C (benzodiazepines. Disulfiram is contraindicated in pregnancy because it is teratogenic. Corticosteroids are not used to treat alcohol withdrawal. Symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. Aminophylline is not used to treat alcohol withdrawal.)

Maternal and neonatal risks associated with gestational diabetes mellitus are: A. maternal premature rupture of membranes and neonatal sepsis. B. maternal hyperemesis and neonatal low birth weight. C. maternal preeclampsia and fetal macrosomia. D. maternal placenta previa and fetal prematurity.

C (maternal preeclampsia and fetal macrosomia. Premature rupture of membranes and neonatal sepsis are not risks associated with gestational diabetes. Hyperemesis is not seen with gestational diabetes, nor is there an association with low birth weight of the infant. Women with gestational diabetes have twice the risk of developing hypertensive disorders such as preeclampsia, and the baby usually has macrosomia. Placental previa and subsequent prematurity of the neonate are not risks associated with gestational diabetes.)

The nurse is teaching a woman with gestational diabetes the technique to inject insulin. What should the nurse include in the teaching session? Select all that apply. A. Aspirate before injecting. B. Clean injection site with alcohol. C. Insert the needle at a 45- to 90-degree angle. D. Inject insulin slowly. E. After injection, cover site with sterile gauze.

C, D, E (Insulin should be injected with the short needle inserted at a 45- to 90-degree angle, depending on fatty tissue. Insulin is injected slowly to allow tissue expansion and minimize pressure, which can cause insulin leakage. After injection, the site should be covered with sterile gauze. Gentle pressure should be applied to prevent bleeding. Aspirating when injecting into subcutaneous tissue is not necessary. The injection site should be clean, but using alcohol is not necessary.)

Which medication does the primary health care provider ask the nurse to administer to a patient during labor in a vaginal delivery, who has a history of a myocardial infarction (MI)? A. Oxytocin B. Diuretics C. Anticoagulant D. Epidural analgesia

D (Epidural analgesia is administered during labor to a patient with MI to prevent pain, which can result in tachycardia and increased cardiac demands. Oxytocin is administered to a patient after birth to prevent hemorrhage. Diuretics are administered to prevent fluid retention in a pregnant patient with a heart disease. Anticoagulant therapy is administered for recurrent venous thrombosis in pregnancy. Test-Taking Tip: Notice how the subjects of the questions are related and, through that relationship, the answers to some of the questions you skipped may be provided within other questions of the test.)

Which medication is ideal for the treatment of systemic lupus erythematosus (SLE) in a pregnant patient? A. Aspirin (Ecotrin) B. Azathioprine (Imuran) C. Prednisone (Deltasone) D. Hydroxychloroquine (Plaquenil)

D (Hydroxychloroquine (Plaquenil) reduces SLE disease activity in a pregnant patient without any adverse effects on the fetus. Aspirin (Ecotrin) is not recommended during pregnancy, because it has an increased risk for premature closure of the fetal ductus arteriosus. Azathioprine (Imuran) is discontinued before conception, because it is fetotoxic. Prednisone (Deltasone) is prescribed to treat SLE during pregnancy, but it increases the risk for bone demineralization, gestational diabetes, preeclampsia, premature rupture of membranes (PROM), and intrauterine growth restriction (IUGR).)

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this woman understands that: A. oral hypoglycemic agents should not be used if the woman is reluctant to give herself insulin. B. dietary modifications and insulin are both required for adequate treatment. C. glucose levels are monitored by testing urine 4 times a day and at bedtime. D. dietary management involves distributing nutrient requirements over three meals and two or three snacks.

D (Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Oral hypoglycemic agents can be used as an alternative to insulin in women with GDM who require medication in addition to diet for blood glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative.)

What does the nurse inform a breastfeeding patient who is taking propylthiouracil (Propacil) for hyperthyroidism? A. "The medication is likely to decrease milk production." B. "Stop breastfeeding the child, and start infant formula." C. "It can adversely affect the neonate's thyroid function." D. "Take the medication immediately after breastfeeding."

D (The nurse advises the patient to take the medication immediately after breastfeeding to allow a 3- to 4-hour period for the medication to absorb before nursing again. Milk production decreases if there is poor metabolic control, not because of antithyroid medications. It is not necessary to stop breastfeeding or provide infant formula, because there are no side effects of the medication in the infant. The medication also does not adversely affect the neonate's thyroid function because the infant has a normal thyroid function.)

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of: A. euglycemia. B. rheumatic fever. C. pneumonia. D. cardiac decompensation.

D (cardiac decompensation. Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation. Rheumatic fever can cause heart problems, but it does not present with these symptoms, which indicate cardiac decompensation. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation. Symptoms of cardiac decompensation may appear abruptly or gradually.)

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: A. mother's age. B. number of years since diabetes was diagnosed. C. amount of insulin required prenatally. D. degree of glycemic control during pregnancy.

D (degree of glycemic control during pregnancy. Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy. The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control. The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control. Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes.)

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that: A. oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. B. dietary modifications and insulin are both required for adequate treatment. C. glucose levels are monitored by testing urine 4r times a day and at bedtime. D. dietary management involves distributing nutrient requirements over three meals and two or three snacks.

D (dietary management involves distributing nutrient requirements over three meals and two or three snacks. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative. Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis.)