Chapter 14 Pregnancy at Risk: Pregestational Problems
19) What normal change could pose serious problems to the postpartum woman with cardiac disease? 1. WBC decrease 2. Diuresis 3. Involution 4. Increased protein intake
Answer: 2 2. Diuresis increases cardiac output and in turn increases the risk of cardiac decompensation.
3) A woman's history and appearance suggest drug abuse. The nurse's best approach would be to: 1. Ask the woman directly, "Do you use any street drugs?" 2. Ask the woman if she would like to talk to a counselor. 3. Ask some questions about over-the-counter medications and avoid the mention of illicit drugs. 4. Explain how harmful drugs can be for her baby.
Answer: 1
18) The client was found to have hepatitis B surface antigen (HBsAG) early in her pregnancy. The nurse is explaining to the client what will happen during labor and birth because the client is contagious for hepatitis B. Which statement by the client indicates that additional teaching is needed? 1. "An internal fetal monitor will be applied as soon as possible during labor." 2. "My baby will get a bath as soon as its temperature is stable." 3. "Two shots will be given to my baby to prevent transmission of hepatitis B." 4. "Breastfeeding is a good feeding method for my baby."
Answer: 1 Explanation: 1. An internal fetal monitor will be avoided.
17) The prenatal clinic nurse has received four phone calls. Which client should be called first? 1. Primip at 28 weeks with history of asthma reporting difficulty breathing and shortness of breath 2. Multip at 6 weeks with a seizure disorder inquiring what foods are good folic acid sources for her 3. Primip at 35 weeks with a positive HBsAG wondering what treatment her baby will receive after birth 4. Multip at 11 weeks with untreated hyperthyroidism describing the onset of vaginal bleeding
Answer: 1 Explanation: 1. Asthma exacerbations are most common between 24 and 36 weeks. Asthma attacks can lead to maternal hypoxia, which can lead to fetal hypoxia. This client is the top priority.
11) A client who is at 18 weeks' gestation has been newly diagnosed with megaloblastic anemia. Which statement by the client indicates that she understands the teaching? 1. "I should include fresh leafy green vegetables, red meat, fish, poultry, and legumes in my diet." 2. "Whenever possible, I should boil my vegetables in at least 2 quarts of water." 3. "Megaloblastic anemia is not known to cause any serious risks to my baby." 4. "My body makes red blood cells that are smaller than they should be."
Answer: 1 Explanation: 1. Folic acid, which is used to treat megaloblastic anemia, is readily available in foods such as fresh leafy green vegetables, red meat, fish, poultry, and legumes.
1) The nurse is caring for a pregnant woman who admits to cocaine and ecstasy use on a regular basis. The client states, "Everybody knows that alcohol is bad during pregnancy, but what's the big deal about ecstasy?" The best response by the nurse is: 1. "Ecstasy can cause a high fever in you and therefore cause the baby harm." 2. "Ecstasy leads to deficiencies of thiamine and folic acid, which help the baby develop." 3. "Ecstasy produces babies with small heads and short bodies with brain function alterations." 4. "Ecstasy produces intrauterine growth restriction and meconium aspiration."
Answer: 1 Explanation: 1. High body temperature is a side effect of MDMA (ecstasy). Increased body temperature increases fetal oxygen needs, which can lead to hypoxia and subsequent brain and major organ damage.
5) The client with insulin-dependent type 2 diabetes and an HbA1c of 5.0% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client? 1. Insulin needs decrease in the first trimester and increase during the third trimester. 2. The risk of ketoacidosis decreases during the length of the pregnancy. 3. Vascular disease that accompanies diabetes slows progression. 4. The baby is likely to have a congenital abnormality because of the diabetes.
Answer: 1 Explanation: 1. In addition, insulin requirements drop suddenly after delivery of the placenta.
7) A 26-year-old multigravida is 28 weeks pregnant. She has developed gestational diabetes. She is following a program of regular exercise, which includes walking, bicycling, and swimming. What instructions should be included in a teaching plan for this client? 1. "Exercise either just before meals or wait until two hours after a meal." 2. "Carry hard candy (or other simple sugar) when exercising." 3. "If your blood sugar is 120 mg/dL, eat 20 g of carbohydrate." 4. "If your blood sugar is more than 120 mg/dL, drink a glass of whole milk."
Answer: 2 2. A client should be encouraged to continue any exercise programs in which she already is involved. She should keep hard candy (simple sugar) with her at all times, just in case the exercise induces hypoglycemia.
12) The patient at 9 weeks' gestation has been told that her HIV test was positive. The patient is very upset and tells the nurse, "I didn't know I had HIV! What will this do to my baby?" The nurse knows teaching has been effective when the patient states: 1. "I cannot take the medications that control HIV during my pregnancy because they will harm the baby." 2. "My baby will probably be born with anti-HIV antibodies, but that doesn't mean it is infected." 3. "The pregnancy will increase the progression of my disease and will reduce my CD4 counts." 4. "The HIV won't affect my baby, and I will have a low-risk pregnancy without additional testing."
Answer: 2 2. Babies of HIV-positive women or women with AIDS are born with maternal anti-HIV antibodies. These antibodies clear over time, and an accurate test can be obtained by 15 months of age.
14) A woman is 32 weeks pregnant. She is HIV-positive, but asymptomatic. What would be important in managing her pregnancy and delivery? 1. An amniocentesis at 30 and 36 weeks 2. Weekly nonstress testing beginning at 32 weeks' gestation 3. Application of a fetal scalp electrode as soon as her membranes rupture in labor 4. Administration of intravenous antibiotics during labor and delivery
Answer: 2 2. Clients who are HIV-positive are considered high-risk pregnancies. Therefore, beginning at about 32 weeks, these clients have weekly nonstress tests to assess for placental function and an ultrasound every 2 to 3 weeks to assess for intrauterine growth retardation (IUGR).
10) A woman at 30 weeks' gestation and a history including sickle cell anemia presents to the clinic complaining of fever, chills, and diarrhea for 3 days. What are the most serious potential complications faced by this client? 1. Electrolyte imbalance 2. Sickle cell crisis 3. Fetal neural tube defects 4. Severe lethargy
Answer: 2 2. Dehydration and fever can trigger sickling and crisis; for this reason, maternal infections are treated promptly.
13) During her first antepartal visit, a client who is at 10 weeks' gestation reports that she is HIV-positive. Which statement made by the client indicates an understanding of the plan of care both during the pregnancy and postpartally? 1. "I'm supposed to take highly active antiretroviral therapy (HAART), but only during the first trimester." 2. "I should not breastfeed my baby." 3. "If I have a cesarean section, there's an increased risk that my HIV will be passed to my baby." 4. "When my baby is 2 months old, he or she will be tested for HIV."
Answer: 2 2. HIV transmission can occur during pregnancy and through breast milk; however, it is believed that the majority of all infections occur during labor and birth.
6) A newly diagnosed type 1, insulin-dependent diabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. The best explanation would include: 1. "Your baby may be smaller than average at birth." 2. "Your baby will probably be larger than average at birth." 3. "As long as you control your blood sugar, your baby will not be affected at all." 4. "Your baby might have high blood sugar for several days."
Answer: 2 2. The infant of a diabetic mother produces excessive amounts of insulin in response to the high blood sugar. This hyper-insulinism stimulates growth (or macrosomia) in the infant because the infant utilizes the glucose in the bloodstream.
9) The pregnant client at 23 weeks' gestation has a hemoglobin of 9.5. Which diet choice indicates that teaching has been effective? 1. Tofu with mixed vegetables in curry, milk, whole-wheat bun 2. Roast beef, steamed spinach, tomato soup, orange juice 3. Pork chop, mashed potatoes and gravy, cauliflower, tea 4. Broiled fish, lettuce salad, grapefruit half, carrot sticks
Answer: 2 2. This client is anemic and needs iron. This meal contains iron in the beef, folic acid in the spinach, and vitamin C in the tomato soup and orange juice. Vitamin C helps absorption of the iron; folic acid is needed for production of red cells.
2) The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which of the following statements made by the client indicates to the nurse that the client has understood the teaching? 1. "I can continue to drink alcohol until I am diagnosed as pregnant." 2. "I need to stop drinking alcohol completely when I start trying to get pregnant." 3. "A beer once a week will not damage the fetus." 4. "I can drink alcohol while breastfeeding since it doesn't pass into breast milk."
Answer: 2 2. Women should discontinue drinking alcohol when they start to attempt pregnancy.
20) The woman with diabetes mellitus is prone to what factors during pregnancy? Select all that apply. 1. Diarrhea 2. Infection 3. Palpitations 4. Decreased tissue perfusion 5. Preeclampsia
Answer: 2, 4, 5 2. The pregnant woman with diabetes is also at increased risk for monilial vaginitis and urinary tract infections because of increased glycosuria, which contributes to a favorable environment for bacterial growth. 4. Reassuring fetal heart rate variability and accelerations are interpreted as adequate placental oxygenation. 5. Preeclampsia-eclampsia occurs more often in diabetic pregnancies than in normal pregnancies, especially when vascular changes already exist.
16) The nurse is reviewing prenatal charts. A patient at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What would the nurse expect to see in the chart? 1. Dyspnea and chest pain with mild exertion 2. Elective cesarean birth scheduled for 37 weeks 3. Discussed need for labor epidural and vacuum extraction 4. Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally
Answer: 3 3. Lumbar epidural analgesia decreases the stress response during labor, while vacuum extraction or forceps decreases maternal pushing efforts. Both of these decrease stress on the heart during birth.
15) A pregnant woman is married to an intravenous drug user. She had a negative HIV screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for HIV? 1. Hemoglobin of 11 g/dL and a rapid weight gain 2. Elevated blood pressure and ankle edema 3. Shortness of breath and frequent urination 4. Unusual fatigue and recurring Candida vaginitis
Answer: 4 4. The client who is HIV-positive would have a suppressed immune system and would experience symptoms of fatigue and opportunistic infections such as Candida vaginitis.
8) A 31-year-old woman who is at high risk for diabetes is at 18 weeks' gestation. During her first antenatal visit, which is the accurate approach to evaluating the patient for diabetes? 1. Begin serial testing of the patient's serum glucose and HA1c at 24 weeks' gestation. 2. If diabetes is diagnosed, consider this condition to be gestational diabetes mellitus (GDM). 3. Recognize HA1c equal to or greater than 4.5 percent or a fasting plasma glucose level equal to or greater than 90 mg/dL as being diagnostic of diabetes. 4. Conduct screening for type 2 diabetes mellitus as soon as possible.
Answer: 4 4. Women at high risk for type 2 DM should be screened for diabetes as soon as possible.
4) A 20-year-old woman is at 28 weeks' gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used heroin. The nurse should recognize that the woman is at increased risk for: 1. Erythroblastosis fetalis. 2. Diabetes mellitus. 3. Abruptio placentae. 4. Pregnancy-induced hypertension.
Answer: 4 4. Women who use heroin are at risk for poor nutrition, anemia, and pregnancy-induced hypertension (or pre-eclampsia).