Chapter 20

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or during the birth for the infant. Which statement by the mother indicates that further teaching is needed by the nurse? A."My baby may be very large and I may need a cesarean birth to have him." B."If my blood sugars are elevated, my baby's lungs will mature faster, which is good." C."Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day." D."I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born."

B."If my blood sugars are elevated, my baby's lungs will mature faster, which is good."

Which factor would contribute to a high-risk pregnancy? A.blood type O positive B.first pregnancy at age 33 C.history of allergy to honey bee pollen D.type 1 diabetes

D.type 1 diabetes 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 does not increase risk, nor does type O-positive blood or environmental allergens.

A woman with known cardiac disease from childhood presents at the obstetrician's office 6 weeks pregnant. What recommendations would the nurse make to the client to address the known cardiac problems for this pregnancy? Select all that apply -Plan periods of rest into the workday. -Continue taking the scheduled warfarin. -Receive pneumococcal and influenza vaccines. -Let the physician know if you become short of breath or have a nighttime cough. -Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus.

-Plan periods of rest into the workday. -Receive pneumococcal and influenza vaccines. -Let the physician know if you become short of breath or have a nighttime cough. Women with known heart conditions need to be closely followed by both the obstetrician and a cardiologist. Recommendations would include rest periods, reduction of stress, getting immunizations, and monitoring for heart failure as demonstrated by a nighttime cough and shortness of breath. Consuming more sodium in the diet is not recommended due of the potential of developing hypertension. Warfarin is contraindicated during pregnancy since it crosses the placental barrier and can cause spontaneous abortion (miscarriage), stillbirth or preterm birth.

A nurse is teaching a pregnant client methods to prevent urinary tract infections (UTIs). The nurse determines that more teaching is needed based on which client statement? A. "I need to drink about 1 liter of fluid each day." B."I should get into a knee-chest position 15 minutes each morning and night." C."I should go to the bathroom as soon as I feel the urge to go." D."I am going to make sure that my underwear is cotton

A. "I need to drink about 1 liter of fluid each day." All pregnant clients should be reminded of common measures to prevent urinary tract infections, such as frequent voiding (at least every 2 hours); urinating as soon as the need is felt; emptying the bladder completely when urinating; wearing cotton, not synthetic fiber, underwear; and drinking up to 3 to 4 liters per day (1 liter = 4 glasses). In addition, a pregnant client can promote urine drainage by assuming a knee-chest position for 15 minutes each morning and evening. In this position, the weight of the uterus is shifted forward, releasing the pressure on the ureters and allowing urine to drain more freely.

A 15-year-old adolescent arrives at the office with a report of flu symptoms, including nausea and vomiting and recent weight loss. A pregnancy test is done and is positive. The client begins crying and tells the nurse her mother will be furious with her. What can the nurse do to assist this adolescent at this point? A. Support her by respecting her right to privacy and confidentiality. B. Contact the mother of the adolescent to be sure the child gets prenatal care. C. Tell the adolescent that this is too big of a problem for her to make decisions about and she needs to listen to her mother. D. Recommend some adoption agencies for her to talk to in the near future.

A. Support her by respecting her right to privacy and confidentiality. The nurse needs to be an advocate for the adolescent and respect her privacy and confidentiality. It would be advisable for the nurse to encourage the adolescent to talk to her mother or some other support person for help. The nurse has no right to contact the adolescent's mother or to share any information with her. Also, the nurse should not mention adoption at this point to the adolescent. That would be a topic for later discussion.

The nurse is caring for a client who desires to become pregnant within a few months. Which outcome regarding folic acid intake would be appropriate for this client? A. The client will begin taking 400 μg of folic acid every day. B. The client will begin taking 400 μg of folic acid with every meal. C. The client will ingest foods high in folic acid to avoid needing to take folic acid supplements. D. The client will begin taking 400 μg of folic acid immediately after confirmation of pregnancy.

A. The client will begin taking 400 μg of folic acid every day. Vitamin B12 or B9 (commonly called folate) deficiency anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that cannot function properly. All clients expecting to become pregnant are advised to begin a supplement of 400 μg folic acid daily in addition to eating foods rich in folic acid. The folic acid supplement is not needed with each meal. Foods high in folic acid should be consumed in addition to the supplement. The client should take folic acid supplements before becoming pregnant and not wait until the pregnancy is confirmed. Folate-deficiency anemia during pregnancy may cause a neural tube defect. This is when the brain or spinal cord doesn't develop normally. It can cause death before or soon after birth. Or it may cause paralysis of the legs.

When providing nutritional counseling to a pregnant woman with diabetes, the nurse would urge the client to obtain most of her calories from which source? A.complex carbohydrates B.protein C.unsaturated fats D.saturated fats

A.complex carbohydrates 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 an artificial mitral valve develops heart failure at the 20th week of pregnancy. Which measure would the nurse stress with her during the remainder of the pregnancy? A. obtaining enough rest B. maintaining a high fluid intake C. beginning a low-impact aerobics program D. discontinuing her prepregnancy anticoagulant

A.obtaining enough rest 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 client 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. "Because of improved management, more women with cardiac problems can complete pregnancies successfully." C. "Women with your problem should never get pregnant because the risks and dangers are too high for you and the fetus." D. "If you get pregnant, you are likely to face many complications."

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

In women with cardiac failure, the maternal blood pressure becomes insufficient to provide an adequate supply of blood to the placenta. The infant will likely experience some undesired effects, including which of the following? A.hypoglycemia B. low birth weight C. hyperglycemia D. high birth weight

B. low birth weight Cardiac failure can affect fetal growth at the point at which maternal blood pressure becomes insufficient to provide an adequate supply of blood and nutrients to the placenta. For this reason, the infant may tend to have a low birth weight, be preterm, and respond poorly to labor.

Which condition is the most common cause of anemia in pregnancy? A.alpha thalassemia B.beta thalassemia C.iron-deficiency anemia D.sickle cell anemia

C. .iron-deficiency anemia Iron-deficiency anemia accounts for approximately 95% of anemia in pregnancy. Thalassemias are the most common genetic disorders of the blood. These anemias cause a reduction or absence of the alpha or beta hemoglobin chain. Sickle cell anemia is an inherited chronic disease that results from abnormal hemoglobin synthesis.

A nurse is conducting a class for a group of pregnant women about ways to minimize the risk of infection during pregnancy. One of the infections that the nurse is discussing is toxoplasmosis. The nurse determines that the class was successful when the group identifies which action(s) is NOT helpful in preventing this infection. Select all that apply. A.Make sure meats are cooked to 152ºF (66.7℃); do not eat raw or rare meats. B.Any cutting surface used for raw meats should be washed afterwards with hot, soapy water. C.Receive the vaccination as soon as possible to prevent contracting the disease. D.A house cat should be kept indoors to prevent it from hunting and eating birds.

C. Receive the vaccination as soon as possible to prevent contracting the disease. There is currently no vaccine to prevent toxoplasmosis. Hence, pregnant women should do the following to prevent it: avoid eating raw or undercooked meat, especially lamb or pork. Cook all meat to an internal temperature of 160°F (71°C) throughout; clean cutting boards, work surfaces, and utensils with hot, soapy water after contact with raw meat or unwashed fruits and vegetables. Peel or thoroughly wash all raw fruits and vegetables before eating them; keep the cat indoors to prevent it from hunting and eating birds or rodents; and wear gardening gloves when in contact with outdoor soil.

A young client with heart disease asks the physician if it would be safe for her to have a baby. The physician responds that it is possible but she would have to maintain almost complete bed rest. Which classification of heart disease is this woman? A.class I B.class II C.class III D.class IV

C. class III To predict pregnancy outcome, heart disease is divided into four categories. A woman with class I or II heart disease can expect to experience a normal pregnancy and birth. A woman with class III can complete a pregnancy by maintaining almost complete bed rest. Women with class IV heart disease are poor candidates for pregnancy because they are in cardiac failure even at rest and when not pregnant. They are usually advised to avoid pregnancy.

The nurse is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize? A. regular heart rate and hypertension B. increased urinary output, tachycardia, and dry cough C. shortness of breath, bradycardia, and hypertension D. dyspnea, crackles, and irregular weak pulse

D. dyspnea, crackles, and irregular weak pulse The nurse should be alert for signs of cardiac decompensation due to congestive heart failure, which 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 woman develops gestational diabetes. Which assessment should she make daily? A. Test her urine for protein with a chemical reagent strip. B. Measure her abdominal diameter with a tape measure. C. Measure her uterine height by hand-span distance. D.Measure serum for glucose level by a finger prick.

D.Measure serum for glucose level by a finger prick. Assessing serum glucose reveals both hyperglycemia and hypoglycemia.

A 17-year-old primigravida with type 1 diabetes is at 37 weeks' gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next? A. Scheduling the woman for induction of labor today. B.Allowing her to continue without plans for delivery. C.Scheduling a cesarean delivery at 39 weeks. D.Preparing for amniocentesis and fetal lung maturity assessment

D.Preparing for amniocentesis and fetal lung maturity assessment If the infant has macrosomia, is large for gestation age, and the mother has had poor blood-sugar control, the provider will want further information on the fetus and readiness for delivery before making any decisions on delivery. After determining the readiness of the fetus, then plans for delivery can be determined and scheduled.

The maternal health nurse is caring for a pregnant client with pre-existing heart disease. Which concept will the nurse identify as a priority? A.balancing weight gain B.restricting sodium intake C.supplementing potassium intake D.restricting exercise

A. balancing weight gain The pregnant client with pre-existing heart disease must gain adequate weight for a healthy baby, but not too much weight to tax the cardiovascular system further. Not all cardiac diseases require sodium restriction and this may not be the case for this client. Potassium may not be needed for this client. Exercise restriction may not be what is needed for this client and, in most cases, moderate exercise promotes a healthy pregnancy.

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. long-acting insulin C. oral hypoglycemic drugs D. glucagon

A. diet Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are usually not given during pregnancy and would not be the first option. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.

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 client most likely is experiencing which condition? A.left sided heart failure B. right-sided heart failure C. peripartum cardiomyopathy D. pulmonary embolism

A. left sided heart failure 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 bloodspeckled 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 peripartum 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.

A pregnant client has developed iron-deficiency anemia and has been prescribed 200 mg of elemental iron per day. The nurse should encourage the client to take this medication with which substance? A. orange juice B. milk C. water D. a full meal

A. orange juice Iron is absorbed best from an acid medium. Advise women, therefore, to take iron supplements with orange juice or a vitamin C supplement, which supplies ascorbic acid

The nurse is assessing a 35-year-old woman at 22 weeks' gestation who has had recent laboratory work. The nurse notes fasting blood glucose 146 mg/dl (8.10 mmol/L), hemoglobin 13 g/dl (130 g/L), and hematocrit 37% (0.37). Based on these results, which instruction should the nurse prioritize? A.Check blood sugar levels daily. B.the signs and symptoms of urinary tract infection C.Include iron-enriched foods in the diet. D.Take daily iron supplements

A.Check blood sugar levels daily. We suggest the following target for women testing blood glucose levels during pregnancy: Before a meal: 95 mg/dl or less. One hour after a meal: 140 mg/dl or less. Two hours after a meal: 120 mg/dl or less. An elevated blood glucose is concerning for diabetes. A fasting blood glucose level of greater than 140 mg/dl (7.77 mmol/L) or random level of greater than 200 mg/dl (11.10 mmol/L) is concerning; this must be followed up to ensure the client is not developing gestational diabetes. The hemoglobin and hematocrit are within normal limits for this client. The values should be hemoglobin greater than 11 g/dl (110 g/L) and hematocrit greater than 33% (0.33). Values lower than that are possible indications of anemia and would necessitate further evaluation. An individual with higher than normal blood glucose levels is at risk for developing urinary tract infection. This will usually happen after the glucose levels are elevated. Anemia can be treated by increasing the consumption of ironenriched foods and taking a daily iron supplement.

An infant is born to a mother with gestational diabetes. Which long-term maternal complication is associated with this diagnosis? A.Increased risk of development of type 2 diabetes B.Weight gain that is not lost after the pregnancy C.Development of long-term hypertension D. Heart disease

A.Increased risk of development of type 2 diabetes A mother who had gestational diabetes is at a 30% to 50% higher risk of developing type 2 diabetes mellitus than the general population. Long-term hypertension and heart disease are not associated with gestational diabetes, nor is weight gain following pregnancy. There is no data that validates long-term weight gain as a complication of gestational diabetes.

A nurse is providing education to a woman at 28 weeks' gestation who has tested positive for gestational diabetes mellitus (GDM). What would be important for the nurse to include in the client teaching? A.She is at increased risk for type 2 diabetes mellitus after her baby is born B.Her baby is at increased risk for neonatal diabetes mellitus. C.Her baby is at increased risk for type 1 diabetes mellitus. D.She is at increased risk for type 1 diabetes mellitus after her baby is born.

A.She is at increased risk for type 2 diabetes mellitus after her baby is born. The woman who develops GDM is at increased risk for developing type 2 diabetes mellitus after pregnancy.

A woman in week 40 of her pregnancy has developed a urinary tract infection (UTI). The nurse anticipates which medication would be safe and appropriate to use with this client? Select all that apply. A.amoxicillin B. ampicillin C. cephalosporins D. sulfonamides E. tetracyclines F. heparin

A.amoxicillin B. ampicillin C. cephalosporins 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 pregnant woman with cardiac disease tells the nurse that she wants to have a healthy baby and likes babies who have some extra weight. What would be the nurse's best response to this patient? A."You may want to supply more cells with nutrients." B. "Too much weight gain could overburden your heart and circulatory system." C."It should not be a problem to gain a few extra pounds." D. "As long as you take your prenatal vitamins, you should not have a problem."

B. "Too much weight gain could overburden your heart and circulatory system." A woman with cardiac disease may need closer supervision of nutrition during pregnancy than the average woman, because she must gain enough weight to ensure a healthy pregnancy and baby, but she not so much that she has to supply additional cells with nutrients. This could overburden her heart and circulatory system.

The nurse reviews the medical record of a woman who has come to the clinic for an evaluation. The client has a history of mitral valve prolapse and is listed as risk class II. During the visit, the woman states, "We want to have a baby, but I know I am at higher risk. But what is my risk, really?" Which response by the nurse would be appropriate? A. "If you do get pregnant, you will need to be seen by a cardiologist every other month for monitoring." B. "Your risk during pregnancy is small, but you should see your cardiologist first before getting pregnant." C. "Your heart disease would put too much strain on your heart if you were to get pregnant." D. "Your pregnancy would be uneventful, but you would need specialized care for labor and birth."

B. "Your risk during pregnancy is small, but you should see your cardiologist first before getting pregnant." Typically, a woman with class I or II cardiac disease can go through a pregnancy without major complications. For class I disease, there is no detectable increased risk of maternal mortality and no increase or a mild increase in morbidity. For class II disease, there is a small increased risk of maternal mortality or moderate increase in morbidity and cardiac consultation should occur every trimester. It is best to have the woman see her cardiologist before becoming pregnant. A woman with class III disease needs frequent visits with the cardiac care team throughout pregnancy. There is a significantly increased risk of maternal mortality or severe morbidity and cardiologist consult should occur every other month with prenatal care and delivery occurring at an appropriate level hospital. A woman with class IV disease is typically advised to avoid pregnancy.

Between her regularly scheduled visits, a woman in her first trimester of pregnancy who is taking iron supplements for anemia calls the nurse at her obstetrician's office reporting constipation. She reports that she has never had this problem before and asks for some advice about how to get relief. What is the best advice the nurse can give her? A. Stop taking iron supplements for a few days, exercise more, drink more fluids, eat high-fiber, low-iron foods until the constipation is relieved, then resume the iron supplement. B. Continue taking iron supplements but increase fluids and high-fiber foods; exercise more. C. Increase the iron supplements, fluid intake, and consumption of high-fiber foods; exercise more. D. Take the iron supplement every other day, increase fluid intake and consumption of high-fiber foods; exercise more.

B. Continue taking iron supplements but increase fluids and high-fiber foods; exercise more. Constipation is a common side effect of iron supplementation. The diagnosis of anemia indicates a true need for the iron supplementation; she needs to increase fluid and fiber to relieve the constipation associated with the iron preparations. The nurse should not advise this client to stop taking her iron supplements, even for a few days. The nurse should not advise the client to increase her iron supplementation, nor take the supplements on an every other day basis. These supplements are ordered by the primary care provider based on the client's hematologic status

A nurse caring for a pregnant woman with a pre-existing heart problem realizes the importance of doing which of the following at the very beginning of the pregnancy to help diagnose a complication? A. Help the woman to establish a daily routine B. Establish baseline vital signs. C. Advise the patient to make plans to quit her job D. Instruct the patient to discontinue her exercise program of walking daily.

B. Establish baseline vital signs It is important to establish baseline vital signs to later identify a complication related to a pre-existing condition.

The nurse is educating a client with type 1 diabetes about the complications associated with diabetes and pregnancy. Which problems would the nurse include in her teaching? Select all that apply. A.Decreased birth weight B. Increased risk of spontaneous abortion (miscarriage) C. Polyhydramnios D. Hypertension E. Cystic fibrosis

B. Increased risk of spontaneous abortion (miscarriage) C. Polyhydramnios D. Hypertension Women with pregestational diabetes, which is type 1 diabetes, are at a higher risk of having an infant with complications during the pregnancy and at the birth. Spontaneous abortion (miscarriage) is higher in women who have pregestational diabetes. Also, they run a higher risk of having a pregnancy with polyhydramnios, and of developing maternal hypertension. The birth weight of an infant born to a mother with diabetes is increased, not decreased. Cystic fibrosis is not associated with maternal diabetes.

The nurse is preparing to instruct a pregnant patient with a history of tuberculosis on care needed while pregnant. What should the nurse include when teaching this patient? A.Maintain a high vitamin C intake. B. Maintain a high intake of calcium. C. Be prepared to have the child by cesarean birth. D. Avoid contracting an upper respiratory infection.

B. Maintain a high intake of calcium. A patient who had tuberculosis earlier in life must be especially careful to maintain an adequate level of calcium during pregnancy to ensure the calcium tuberculosis pockets in the lungs are not broken down and the disease reactivated. A high vitamin C intake is not indicated for this patient's health history. Pushing during labor might cause calcified tuberculosis pockets in the lungs to break, but this does not mean that all patients with a history of tuberculosis have to have cesarean deliveries. All pregnant patients should be instructed to avoid upper respiratory infections.

Which nursing instruction is most important to provide for the pregnant client who has a history of cardiac disease? A. having a prenatal visit every 2 weeks after the first trimester B. gaining no more than 25 to 30 lb (11.3 to 13.6 kg) throughout the pregnancy C. limiting exercise to brisk walking only D. monitoring edema in the feet and ankles

B. gaining no more than 25 to 30 lb (11.3 to 13.6 kg) throughout the pregnancy When a pregnant client has a history of cardiac disease, it is important for the nurse to follow the client's progress and instruct on weight gain throughout the pregnancy. The client needs closer supervision so that their heart and circulatory system do not become overwhelmed. Prenatal visits are not increased to every 2 weeks after the first trimester unless the client's health care provider sees the need. Exercise limitations are dependent upon client symptoms of shortness of breath or any other physical symptoms. Edema in the feet and ankles is common in pregnancy. If pulmonary edema occurs when the client is short of breath while resting, this indicates cardiac disease symptoms.

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 client that which position for this rest is best? A.right lateral recumbent B. left lateral recumbent C. on her back D. prone

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

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."Pregnancy taxes the circulatory system of every woman." C."Don't worry. You have an excellent primary care provider." D."Our facility has a lot of experience in dealing with this."

B."Pregnancy taxes the circulatory system of every woman." 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 pregnant client with type I diabetes asks the nurse about how to best control her blood sugar while she is pregnant. The best reply would be for the woman to: A.limit weight gain to 15 pounds during the pregnancy B.check her blood sugars frequently and adjust insulin accordingly. C.exercise for 1 to 2 hours each day to keep the blood glucose down. D.begin oral hyperglycemic medications along with the insulin she is currently taking.

B.check her blood sugars frequently and adjust insulin accordingly. The goal for a mother who has type I diabetes mellitus is to keep tight control over her blood sugars throughout the pregnancy. Therefore, she needs to test her blood sugar frequently during the day and make adjustments in the insulin doses she is receiving.

A woman with a positive history of genital herpes is in active labor. Assessment reveals vesicles in the perineum area, membranes are ruptured, dilated 5 cm, and effaced 70%. The nurse should prepare the client for which type of birth? A. Spontaneous vaginal B. Vacuum-assisted C. Cesarean D. Forceps-assisted

C. Cesarean 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 born via a cesarean birth. The risk of transmitting herpes to the baby would be increased if the baby were born by spontaneous vaginal birth, vacuum-assisted birth, or forceps-assisted birth.

The maternal health nurse cares for a homeless pregnant woman who presented to the emergency room in precipitous labor. The woman has not had prenatal care. Upon delivery, her infant weighs 4.6 kg and notes the infant appears to be jittery. Which nursing action will the nurse perform first? A.Administer intramuscular (IM) vitamin K B.Administer glucose C.Check the infant's blood glucose level. D.Check the infant's axillary temperature.

C. Check the infant's blood glucose level. The infant larger than 4 kg is considered macrosomic (large birth weight), which may occur when the pregnant woman has pregestational or gestational diabetes. Babies born to mothers who have uncontrolled diabetes are at increased risk for hypoglycemia because the infant produces large amounts of insulin in order to compensate for the elevated serum glucose levels that may be present in the blood due to diabetes. An infant with macrosomia and a jittery appearance should have blood glucose levels checked immediately. Once the glucose level is determined, glucose may or may not need to be administered. Checking the infant's axillary temperature and administering IM vitamin K will occur after the assessment and stabilization of the infant's blood glucose level.

A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? A.antihypertensive drugs B.diuretic drugs C.IV fluids D.antibiotics

C. IV fluids A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and IV fluids. Antihypertensive drugs usually aren't necessary. Diuretics would not be used unless fluid overload resulted. The client would be given antibiotics only if there were evidence of an infection.

The nurse is teaching a pregnant client with type 2 diabetes about diet during pregnancy. Which client statement indicates that the nurse's teaching was successful? A."I'll basically follow the same diet that I was following before I became pregnant." B."Because I need extra protein, I will have to increase my intake of milk and meat." C."Pregnancy affects insulin production, so I will need to make adjustments in my diet." D."I will adjust my diet and insulin based on the results of my urine tests for glucose."

C."Pregnancy affects insulin production, so I will need to make adjustments in my diet." In pregnancy, placental hormones cause insulin resistance at a level that tends to parallel growth of the fetoplacental unit. Nutritional management focuses on maintaining balanced glucose levels. Thus, the client will probably need to make adjustments in the diet. Protein needs increase during pregnancy, but this is unrelated to diabetes. Blood glucose monitoring results typically guide therapy.

The nurse explains to a pregnant client that she will need to take iron during her pregnancy after being diagnosed with iron-deficiency anemia. The nurse suggests that absorption of the supplemental iron can be increased by taking it with which substance? A. meals high in iron B. milk C. legumes D. vitamin C

D. Vitamin C 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.