CHAPTER 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply. - maternal age less than 18 years - genitourinary tract abnormalities - obesity - hypertension - previous large-for-gestational-age (LGA) infant

Answer: - obesity - hypertension - previous large-for-gestational-age (LGA) infant Rationale: Obesity, hypertension, and a previous infant weighing more than 9 lb (4 kg) are risk factors for developing gestational diabetes. Maternal age less than 18 years and genitourinary tract abnormalities do not increase the risk of developing gestational diabetes.

Cytomegalovirus infection can result in different congenital anomalies. It can also be transmitted via different routes. When discussing this infection with a pregnant woman, the nurse integrates understanding that permanent fetal disability can occur with which type of transmission of CMV? A.) in utero transmission B.) during birth transmission C.) after birth transmission D.) with any transmission

Answer: A.) in utero transmission Rationale: There are three time periods during which mother-to-child transmission can occur; however, permanent disability occurs only in association with in utero infection. Such disability can result from maternal infection during any point in the pregnancy, but more severe disabilities are usually associated with maternal infection during the first trimester.

What is the role of the nurse during the preconception counseling of a pregnant client with chronic hypertension? A.) stressing the avoidance of dairy products B.) stressing the positive benefits of a healthy lifestyle C.) stressing the increased use of Vitamin D supplements D.) stressing regular walks and exercise

Answer: B.) stressing the positive benefits of a healthy lifestyle Rationale: The nurse should stress the positive benefits of a healthy lifestyle during the preconception counseling of a client with chronic hypertension. The client need not avoid dairy products or increase intake of vitamin D supplements. It may not be advisable for a client with chronic hypertension to exercise without consultation.

A pregnant client has a history of asthma. After reviewing the possible medications that may be prescribed during her pregnancy to control her asthma, the nurse determines additional teaching is needed when the client identifies which drug as being used? A.) misoprostol B.) ipratropium C.) albuterol D.) salmeterol

Answer: A.) misoprostol Rationale: Pharmacologic agents used to treat asthma in pregnancy fall into two categories: rescue agents and maintenance agents. Rescue agents provide immediate symptomatic relief by reducing acute bronchospasm. Agents used in this category include albuterol and ipratropium. Maintenance agents, by contrast, reduce the inflammation that leads to bronchospasm. Agents used in this category are inhaled steroids. Common ones prescribed include beclomethasone and salmeterol. Misoprostol is a prostaglandin that is used for treating postpartum hemorrhage but is contraindicated with asthma clients due to the risk of bronchial spasm and bronchoconstriction.

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

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

A nurse is caring for a newborn with fetal alcohol spectrum disorder. What characteristic of the fetal alcohol spectrum disorder should the nurse assess for in the newborn? A.) small head circumference B.) decreased blood glucose level C.) poor breathing pattern D.) wide eyes

Answer: A.) small head circumference Rationale; The nurse should assess for small head circumference in a newborn being assessed for fetal alcohol spectrum disorder. Fetal alcohol spectrum disorder does not cause decreased blood glucose level, a poor breathing pattern, or wide eyes.

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.0 begin oral hyperglycemic medications along with the insulin she is currently taking.

Answer: B.) check her blood sugars frequently and adjust insulin accordingly.

A nurse is caring for a pregnant client with sickle cell anemia. What should the nursing care for the client include? Select all that apply. - Teach the client meticulous handwashing. - Assess serum electrolyte levels of the client at each visit. - Instruct the client to consume protein-rich food. - Assess hydration status of the client at each visit. - Urge the client to drink 8 to 10 glasses of fluid daily.

Answer: - Teach the client meticulous handwashing. - Assess hydration status of the client at each visit. - Urge the client to drink 8 to 10 glasses of fluid daily.

A nurse is teaching a prenatal client with class III heart failure the signs and symptoms which should be reported to the health care provider. The nurse determines the teaching has been effective when the client states which statement? - "I will call the clinic when I have a cough at night." - "I will avoid dental work and other invasive procedures." - "I will call the clinic when I get shortness of breath after exercising." - "I will take an antibiotic throughout my pregnancy."

Answer: - "I will call the clinic when I have a cough at night." Rationale: The earliest warning sign of cardiac decompensation in clients with heart failure is persistent rales in the bases of the lungs. The client will probably notice a nocturnal cough as the first sign. A sudden decrease in the ability to perform normal duties, exertional dyspnea, and attacks of coughing are other signs of cardiac decompensation. The dentist should be informed of the client's status and procedures planned accordingly. Antibiotics will not address the decompensation issue but should only be used when there is an active infection or taken prophylactically with certain procedures to decrease the risk of developing an infection.

A pregnant woman at 36 weeks' gestation comes to the care center for a follow-up visit. The woman is to be screened for group B streptococcus (GBS) infection. When describing this screening to the woman, the nurse would explain that a specimen will be taken from which area(s)? Select all that apply. - throat - nasal cavity - vagina - rectum - conjunctiva

Answer: - vagina - rectum Rationale: According to Centers for Disease Control and Prevention guidelines, all pregnant women should be screened for GBS at 35 to 37 weeks' gestation and treated. Vaginal and rectal specimens are cultured for the presence of the bacterium. Specimens from the throat, nasal cavity, or conjunctiva are not used.

The nurse is assessing a pregnant client who has a long history of asthma. She states, "I'm trying not to use my asthma medications because I certainly don't want my baby exposed to them." What is the nurse's best response? A.) "Actually, having uncontrolled asthma is much riskier for your baby than the medication." B.) "In fact, most modern asthma medications are categorized as safe for use in pregnancy." C.) "I'm glad to hear that you're focused on ensuring your baby's health." D.) "Your health care provider will likely agree with your decision."

Answer: A.) "Actually, having uncontrolled asthma is much riskier for your baby than the medication." Rationale: It is important for pregnant clients with asthma to keep taking their medications because the risks of exacerbations exceed the risks of the medications.

A nurse is teaching a woman diagnosed with gestational diabetes about meal planning and nutrition. The nurse determines that additional teaching is needed based on which client statement? A.) "I need to avoid any fat with my meals." B.) "I should get most of my calories from good complex carbs." C.) "Having a bedtime snack is good for me." D.) "It's okay to eat small meals or snacks throughout the day."

Answer: A.) "I need to avoid any fat with my meals." Rationale: Recommendations for nutrition and diet with gestational diabetes include: eating three meals a day plus three snacks to promote glycemic control with 40% of calories from good-quality complex carbohydrates, 35% of calories from protein sources, and 25% of calories from unsaturated fats; eating small frequent feedings throughout the day; having bedtime snacks; and including protein and fat at each meal.

A pregnant client with a history of asthma since childhood presents for a prenatal visit. What statement by the client would the nurse prioritize? A.) "I sometimes get a bit wheezy." B.) "I have trouble getting comfortable in bed." C.) "I sometimes get a feeling of euphoria." D.) "Certain substances make me sneeze."

Answer: A.) "I sometimes get a bit wheezy."

A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response? A.) "Your primary care provider will order safe doses of your medication." B.) "It's OK to not use them if you would feel more comfortable." C.) "They won't cause any major defects." D.) "I'll let your primary care provider know how you feel about it."

Answer: A.) "Your primary care provider will order safe doses of your medication."

A woman with diabetes is in labor. To promote optimal outcomes for the mother and neonate, the nurse monitors the client's blood glucose level closely ensuring that it is maintained below which level? A.) 110 mg/dl B.) 150 mg/dl C.) 130 mg/dl D.) 120 mg/dl

Answer: A.) 110 mg/dl

A woman comes to the clinic for her first prenatal visit. As part of the assessment, the woman is screened for rubella antibodies. The nurse determines that a client has immunity against rubella based on which rubella titer? A.) 1:8 B.) 1:6 C.) 1:0 D.) 1:4

Answer: A.) 1:8 Rationale: A rubella antibody titer of 1:8 or greater proves evidence of immunity. Women with titers of less than 1:8 should be immunized.

At 24 weeks' gestation, a client's 1-hour glucose tolerance test is elevated. The nurse explains that, based on this finding, the client will need to take which action? A.) A 3-hour glucose tolerance test for follow-up B.) Daily insulin injections for gestational diabetes C.) Monthly hemoglobin A1C levels to rule out diabetes D.) Daily fingersticks for a fasting blood glucose level

Answer: A.) A 3-hour glucose tolerance test for follow-up Rationale: The 1-hour glucose tolerance test is a screening procedure. If the results are elevated, the client needs a 3-hour glucose tolerance test, which is diagnostic of gestational diabetes. Since this is only a screening test, no treatment for gestational diabetes, such as finger-sticks or insulin, is implemented until the 3-hour glucose tolerance test result determines if the client has gestational diabetes. An HgbA1C level does not rule out diabetes; it monitors average blood glucose level over an extended period of time.

The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of having a heroin use disorder. The nurse would be alert for which finding when assessing the neonate? A.) low, feeble cry B.) hypertonicity C.) easy consolability D.) vigorous sucking

Answer: B.) hypertonicity Rationale: Newborns of mothers with heroin or other opioid use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

A client with rheumatoid arthritis (RA) is in week 38 of her pregnancy. Which intervention should the nurse make with this client? A.) Ask the client to decrease her intake of salicylates. B.) Urge the client to be on bed rest. C.) Advise the client to continue her normal dosage of methotrexate. D.) Perform the Snellen eye test.

Answer: A.) Ask the client to decrease her intake of salicylates. Rationale: Although women with RA should continue to take their medications during pregnancy to prevent joint damage, large amounts of salicylates have the potential to lead to increased bleeding at birth or prolonged pregnancy. The infant may be born with a bleeding defect and may also experience premature closure of the ductus arteriosus because of the drug's effects. For this reason, a woman is asked to decrease her intake of salicylates approximately 2 weeks before term. A number of women also take low-dose methotrexate, a carcinogen. As a rule, they should stop taking this prepregnancy because of the danger of head and neck defects in the fetus. There is no need for the client to be on bed rest or to perform the Snellen eye test.

A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse? A.) Both parents have to carry the trait. B.) There is a good chance the infant will inherit the disease from the mother. C.) The infant inherits the disease from the father. D.) If the mother goes into a crisis while pregnant, the baby will develop sickle cell anemia

Answer: A.) Both parents have to carry the trait.

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.

Answer: A.) Check blood sugar levels daily.

A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize? A.) Decrease activity and rest more often. B.) Increase fluids and take more vitamins. C.) Bed rest and bathroom privileges only until birth. D.) Discuss induction of labor with the health care provider.

Answer: A.) Decrease activity and rest more often.

The nurse is preparing information for a client who has just been diagnosed with gestational diabetes. Which instruction should the nurse prioritize in this information? A.) Maintain a daily blood glucose log B.) Report any signs of possible urinary tract infection C.) Plan daily menus with dietitian D.) Long-term therapy goals

Answer: A.) Maintain a daily blood glucose log

A pregnant client with diabetes in the hospital reports waking up with shakiness and diaphoresis. Which action should the nurse prioritize after discovering the client's fasting blood sugar is 60 mg/dl (3.33 mmol/L)? A.) Provide the client some milk to drink. B.) Recheck her blood sugar for accuracy. C.) Withhold her insulin, and notify the health care provider. D.) Stay with her, and ask another nurse to bring her insulin.

Answer: A.) Provide the client some milk to drink. Rationale: The client is hypoglycemic when awakening in the morning. The nurse should provide glucose in the form of carbohydrates, such as crackers, and milk, and be prepared to reassess. The nurse should not recheck at this point, since the client is symptomatic. She does not need insulin, and she will have her morning dose adjusted after breakfast.

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.

Answer: A.) She is at increased risk for type 2 diabetes mellitus after her baby is born.

A new young mother has tested positive for HIV. When discussing the situation with the client, the nurse should advise the mother that she should avoid which activity? A.) breastfeeding B.) future pregnancies C.) cesarean birth D.) handling the infant with open sores

Answer: A.) breastfeeding Rationale: Breastfeeding is a major contributing factor for mother-to-child transmission of HIV. Cesarean birth before the onset of labor and/or rupture of membranes can greatly reduce the chance of transmitting the infection to the infant. Future pregnancies should be discussed and decided on an individual basis. Proper treatment of any open wounds and education should be provided to the mother to ensure she reduces the chance of transmitting HIV to her infant.

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

Answer: A.) complex carbohydrates Rationale: The pregnant woman with diabetes is encouraged to eat three meals a day plus three snacks, with 40% of calories derived from good-quality complex carbohydrates, 35% of calories from protein sources, and 35% of calories from unsaturated fats. The intake of saturated fats should be limited during pregnancy, just as they should be for any person to reduce the risk of heart disease.

A nurse is conducting a presentation about prenatal care and preexisting maternal conditions. When discussing the various risks to the mother and infant, the nurse would include information about which condition as the leading cause of intellectual disability in the United States? A.) fetal alcohol spectrum disorder B.) genetic anomalies C.) maternal drug addiction D.) pregnancy category X medications

Answer: A.) fetal alcohol spectrum disorder Rationale: Fetal alcohol spectrum disorder is a lifelong yet completely preventable set of physical, mental, and neurobehavioral birth defects. It is the leading cause of intellectual disability in the United States.

The nurse is assessing a woman with class III heart disease who is in for a prenatal visit. What would be the first recognizable sign that this client is in heart failure? A.) audible wheezes B.) persistent rales in the bases of the lungs C.) elevated blood pressure D.) low blood pressure

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

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."

Answer: B.) "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." Rationale: Elevated blood sugars delay the maturation of fetal lungs, not increase maturation time, resulting in potential respiratory distress in newborns born to mothers with diabetes. Doing fetal movement (kick) counts is standard practice, as is the possibility of an amniocentesis to determine lung maturity during the third trimester. Health care personnel should also prepare the mother for the potential of a cesarean birth if the infant is too large.

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

Answer: B.) "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." Rationale: Infants born of HIV-positive women test positive for HIV antibodies at birth because these have crossed the placenta. An accurate disease status cannot be determined until the antibodies fade at about 18 months. Testing positive for HIV antibodies does not mean the infant has AIDS. Having a cesarean birth does decrease the risk of transmitting the virus to the infant at birth; it does not prevent the transmission of the disease. HIV antibodies do cross the placenta, which is why babies born of HIV positive mothers are HIV positive.

A client is 33 weeks' pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled? A.) 45 mg/dl B.) 85 mg/dl C.) 120 mg/dl D.) 136 mg/dl

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

A G4P3 client with a history of controlled asthma is upset her initial prenatal appointment is taking too long, making her late for another appointment. What is the nurse's best response when the client insists she knows how to handle her asthma and needs to leave? A.) Remind her to continue taking asthma medications, to monitor peak flow daily, and to monitor the baby's kicks in the second and third trimesters. B.) Acknowledge her need to leave but ask her to demonstrate the use of inhaler and peak flow meter before she goes; remind her to take regular medications. C.) Schedule an appointment for her to return to discuss her asthma management. D.) Note in the chart that the woman was not counseled about her asthma.

Answer: B.) Acknowledge her need to leave but ask her to demonstrate the use of inhaler and peak flow meter before she goes; remind her to take regular medications. Rationale: Management of asthma during pregnancy is very important; the nurse must document that the client has the proper ability to manage her asthma for her health and the health of the fetus. Reminding the client to continue taking her prescribed medication and to monitor her peak flow daily is not enough. It is the nurse's responsibility to know that the client knows how to take her medications. Monitoring the baby's kicks in the second and third trimester is an appropriate action. Scheduling a return appointment to discuss asthma management is not appropriate. She could have an asthma attack between the time the nurse sees her and the time of the return appointment. Noting in the chart that the woman was not counseled does not relieve the nurse of his/her obligation to ensure that the woman knows how to use her inhaler and her peak flow meter.

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

Answer: B.) Administer rubella vaccine before discharge. Rationale: Rubella is a virus, which when contracted during pregnancy has significant complications for the fetus. The illness is mild to the adult but can result in the infant being born deaf and blind. There is no cure; the CDC recommends all individuals be vaccinated against rubella. If the titer is negative, the mother does not have protection against rubella, and the next pregnancy would be at risk. She should receive the vaccination prior to discharge from the hospital. Assessing the rubella titer of the baby would not mean anything. The baby has not had rubella and has not received antibodies against rubella from the mother. Notifying the health care provider is not a priority, as most institutions have standing orders to administer the rubella vaccine if the mother's rubella titer is negative.

A pregnant client is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. Which sign would indicate a positive test result? A.) An indurated wheal under 10 mm in diameter appears in 6 to 12 hours. B.) An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. C.) A flat, circumscribed area under 10 mm in diameter appears in 6 to 12 hours. D.) A flat circumscribed area over 10 mm in diameter appears in 48 to 72 hours.

Answer: B.) An indurated wheal over 10 mm in diameter appears in 48 to 72 hours.

A nurse caring for a pregnant client suspects substance use during pregnancy. What is the priority nursing intervention for this client? A.) Determine how long the client has been using drugs. B.) Obtain a urine specimen for a drug screening. C.) Determine if the client has emotional support. D.) Provide education material on cessation of substance use.

Answer: B.) Obtain a urine specimen for a drug screening. Rationale: Substance use during pregnancy is associated with preterm labor, spontaneous abortion (miscarriage), low birth weight, central nervous system and fetal anomalies, and long-term childhood developmental consequences. It is most important to know what the client is taking in order to provide the best care for the client and newborn.

A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement? A.) "A pregnant woman with a chronic condition can put herself at risk." B.) "A pregnant woman with a chronic illness can put the fetus at risk." C.) "A pregnant woman does not have to worry about contracting new illnesses during pregnancy." D.) "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy."

Answer: C.) "A pregnant woman does not have to worry about contracting new illnesses during pregnancy."

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction? A.) "I need to be aware of my triggers and avoid them as much as possible." B.) "It is fine for me to use my albuterol inhaler if I begin to feel tight." C.) "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." D.) "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on."

Answer: C.) "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." Rationale: A pregnant woman with a history of asthma needs to be proactive, taking her inhalers and other asthma medications to prevent an acute asthma attack. She needs to understand that it is far more dangerous to not take the medications and have an asthma attack. She also needs to monitor her peak flow for decreases, be aware of triggers, and avoid them if possible. However, a pregnant woman should never begin allergy shots if she has not been taking them previously, due to the potential of an adverse reaction.

A pregnant client with type 1 diabetes is in labor. The client's blood glucose levels are being monitored every hour and she has a prescription for an infusion of regular insulin as needed based on the client's blood glucose levels. Her levels are as follows: A.) 1300 B.) 1400 C.) 1500 D.) 1600

Answer: C.) 1500 Rationale: For the laboring woman with diabetes, intravenous (IV) saline or lactated Ringer's is given, and blood glucose levels are monitored every 1 to 2 hours. Glucose levels are maintained below 110 mg/dL (6.11 mmol/L) throughout labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level. The insulin infusion would be given at 1500, based on the blood glucose level being higher than 110 mg/dL (6.11 mmol/L).

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? A.) 8% B.) 14% C.) 6% D.) 12%

Answer: C.) 6% Rationale; The upper normal level of HbA1C is 6% of total hemoglobin.

The nurse encourages a woman with gestational diabetes to maintain an active exercise period during pregnancy. Prior to this exercise period, the nurse would advise her to take which action? A.) Inject a bolus of insulin. B.) Eat a high-carbohydrate snack. C.) Eat a sustaining-carbohydrate snack. D.) Add a bolus of long-acting insulin.

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

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

Answer: C.) IV fluids Rationale: 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.

A pregnant woman diagnosed with diabetes should be instructed to perform which action? A.) Discontinue insulin injections until 15 weeks gestation. B.) Ingest a smaller amount of food prior to sleep to prevent nocturnal hyperglycemia. C.) Notify the primary care provider if unable to eat because of nausea and vomiting. D.) Prepare foods with increased carbohydrates to provide needed calories.

Answer: C.) Notify the primary care provider if unable to eat because of nausea and vomiting. Rationale: During pregnancy, the insulin levels change in response to the production of HPL. The client needs to alert her provider if she is not able to eat or hold down appropriate amounts of nutrition. The client is at risk for episodes of hypoglycemia during the first trimester. She should never discontinue insulin therapy without her provider's directions. The increase of carbohydrates needs to be balanced with protein, and smaller meals would result in hypoglycemia rather than hyperglycemia.

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client? A.) monoamine oxidase inhibitors (MAOIs) B.) methadone therapy C.) restricted sodium intake D.) ginger therapy

Answer: C.) restricted sodium intake Rationale: The client with peripartum cardiomyopathy should be prescribed a restricted sodium intake to control the blood pressure. Monoamine oxidase inhibitors are given to treat depression in pregnancy, not peripartum cardiomyopathy. Methadone is a drug given for the treatment of a substance use disorder during pregnancy. Complementary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum, not peripartum cardiomyopathy.

The nurse is assessing a primigravida woman who reports vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. The nurse suspects the woman has contracted which disorder? A.) chlamydia B.) simple yeast infection C.) trichomoniasis D.) gonorrhea

Answer: C.) trichomoniasis Rationale: Trichomoniasis is caused by a one-celled protozoa. The symptoms include large amounts of foamy, yellow-green vaginal discharge. Treatment is with metronidazole, and her partner needs to be treated as well. A yeast infection presents with a cottage cheese-like discharge. Chlamydia often has no symptoms. If the woman does experience symptoms, these may include vaginal discharge, abnormal vaginal bleeding, and abdominal or pelvic pain. Gonorrhea may have symptoms so mild that they go unnoticed in the woman. The woman who contracts gonorrhea may have vaginal bleeding during sexual intercourse, pain and burning while urinating, and a yellow or bloody vaginal discharge.

A pregnant single mom living alone tells the nurse she is considering getting a cat for her 2-year-old daughter. Which is the best response by the nurse? A.) "The exposure to the cat litter may cause you to need a C-section." B.) "This will cut down on the jealousy for your two-year-old when the baby comes." C.) "If you don't think caring for a cat is too much work, that would be great." D.) "You should wait until after you give birth to obtain the cat for your daughter."

Answer: D.) "You should wait until after you give birth to obtain the cat for your daughter." Rationale: Toxoplasma gondii is a protozoan that can be transmitted via undercooked meat and through cat litter. Having a cat is not an issue, but cleaning the litter box may expose the mother to the infection and result in fetal anomalies. Exposure to the cat litter will not necessitate a cesarean section, and having a cat will not cut down on any jealousy the 2-year-old might feel when the new baby is born. The nurse would discourage the mother from getting cat until after the baby is born.

A pregnant woman with diabetes is having a glycosylated hemoglobin (HgbA1C) level drawn. Which result would require the nurse to revise the client's plan of care? A.) 5.5% B.) 6.0% C.) 7% D.) 8.5%

Answer: D.) 8.5%

The nurse is appraising the laboratory results of a pregnant client who is in her second trimester and notes the following: thyroid stimulating hormone (TSH) slightly elevated, glucose in the urine, complete blood count (CBC) low normal, and normal electrolytes. The nurse prioritizes further testing to rule out which condition? A.) Preeclampsia B.) Anemia C.) Hyperthyroidism D.) Gestational diabetes

Answer: D.) Gestational diabetes Rationale: Glycosuria, glucose in the urine, may occur normally during pregnancy; however, if it appears in the urine, the client should be sent for testing to rule out gestational diabetes. Preeclampsia, anemia, and hyperthyroidism are not related to glucose nor to renal function. A slightly elevated TSH would indicate possible hypothyroidism instead of hyperthyroidism. Anemia would be indicated by below normal hematocrit. If the client's CBC is low normal than the nurse should monitor future results to ensure the client's counts are not dropping. It would also be appropriate for the nurse to investigate possible dietary issues. Preeclampsia would be best monitored by the blood pressure readings.

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.

Answer: D.) Measure serum for glucose level by a finger prick.

The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement? A.) Dried apples B.) Fortified grains C.) Dried beans D.) Orange juice

Answer: D.) Orange juice

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

Answer: D.) Preparing for amniocentesis and fetal lung maturity assessment Rationale: 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.

A woman with known cardiac disease is in labor. In what position would the nurse place the client? A.) High-Fowler with a pillow at the back B.) Supine C.) Trendelenburg D.) Semi-recumbent with a pillow under one hip

Answer: D.) Semi-recumbent with a pillow under one hip Rationale: A laboring mother with known cardiac disease needs to be positioned in a semi-recumbent position and have a wedge or pillow placed under one hip. A cardiac client is never placed in a supine position because being flat on the back can lead to supine hypotensive syndrome, which leads to decreased placental perfusion and can increase the maternal cardiac output. Sitting straight up may be uncomfortable for the mother. Trendelenburg is definitely a wrong position due to the abdomen pressing against the diaphragm; it is also counter to the natural position of the uterus down toward the cervix.

The clinic nurse teaches a client with pregestational type 1 diabetes that maintaining a constant insulin level is very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use: A.) regular insulin twice a day. B.) an insulin pen. C.) an insulin drip. D.) an insulin pump.

Answer: D.) an insulin pump.

A 16-year-old girl comes to the public health office and tells the nurse she is pregnant. She is afraid to tell her parents. What is important for a nurse to know in order to properly inform this girl? A.) what school district she resides in B.) who the mother's parents are C.) who the father of the baby is D.) community resources for the pregnant teen

Answer: D.) community resources for the pregnant teen

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

Answer: D.) dyspnea, crackles, and irregular weak pulse Rationale: 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.

Which change in insulin is most likely to occur in a woman during pregnancy? A.) enhanced secretion from normal B.) not released because of pressure on the pancreas C.) unavailable because it is used by the fetus D.) less effective than normal

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

A woman with no previous history of heart disease begins to have symptoms of myocardial failure a few weeks before the birth of her first child. Findings include shortness of breath, chest pain, and edema, with her heart also showing enlargement. The nurse suspects which condition? A.) mitral stenosis B.) left-sided heart failure C.) pulmonary valve stenosis D.) peripartum cardiomyopathy

Answer: D.) peripartum cardiomyopathy Rationale: Peripartum cardiomyopathy can occur in pregnancy without any previous history of heart disease. Symptoms include shortness of breath, chest pain, and edema; also, the heart begins to enlarge. Treatment is with a diuretic, an antiarrhythmic agent, digitalis, low weight heparin, and bed rest.

A nurse is teaching a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority? A.) avoidance of infection B.) constipation prevention C.) administration of immunoglobulins D.) consumption of a low-fat diet

Answer; A.) avoidance of infection Rationale: Prevention of crises, if possible, is the focus of treatment for the pregnant woman with sickle cell anemia. Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common-sense strategies that decrease the risk of a crisis. Fat intake does not need to be decreased and immunoglobulins are not normally administered. Constipation is not usually a result of sickle cell anemia.

A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth? A.) the viral load B.) amniocentesis results at 34 weeks' gestation C.) the mother's age D.) prophylactic antiretroviral therapy (ART) to the infant at birth

Answer; A.) the viral load Rationale: A woman who has HIV during pregnancy is at risk for transmitting the infection to the fetus during pregnancy or childbirth and to the newborn while breastfeeding. The type of birth, vaginal or cesarean, depends on several factors, including the woman's viral load, use of ART during pregnancy (not waiting until the birth), length of time membranes have been ruptured, and gestational age (not mother's age). With prenatal ART and prophylactic treatment of the newborn, there is a reduced risk of perinatal HIV transmission. The amniocentesis results would not be a factor in preventing the spread of HIV to the infant and may actually lead to the fetus being infected through the puncture site and bleeding into the amniotic sac.

A pregnant woman with chronic hypertension comes to the clinic for evaluation. The last several blood pressure readings have been gradually increasing. On today's visit her blood pressure is 166/100 mm Hg. The health care provider prescribes an antihypertensive agent. The nurse anticipates which agent as likely to be prescribed? A.) hydroxychloroquine B.) labetalol C.) albuterol D.) ipratropium

Answer; B.) labetalol Rationale: Medications used to treat chronic hypertension with pregnancy include labetalol hydrochloride, hydralazine hydrochloride, and nifedipine. Hydroxychloroquine would be used to treat rheumatoid arthritis. Albuterol and ipratropium would be used to treat asthma.

Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 130/86 mm Hg; week 20 - 138/88 mm Hg; week 24 - 136/82 mm Hg; and week 28 - 138/88 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure? A.) elevated B.) stage 1 C.) stage 2 D.) hypertensive crisis

Answer; B.) stage 1 RationalE: Chronic hypertension exists when the woman has high blood pressure before pregnancy or before the 20th week of gestation, or when hypertension persists for more than 12 weeks. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (Joint National Committee [JNC 8], 2018) blood pressure guidelines classify hypertension as follows: elevated: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg; Stage 1: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg; Stage 2: Systolic at least 140 mm Hg or diastolic at least 90 mm Hg; Hypertensive crisis: Systolic over 180 mm Hg and/or diastolic over 120 mm Hg (Alexander, 2019; Bakris, 2019). The client has stage 1 hypertension.

The nurse is caring for a pregnant woman determined to be at high risk for gestational diabetes. The nurse prepares to rescreen this client at which time frame? A.) 16 to 20 weeks B.) 20 to 24 weeks C.) 24 to 28 weeks D.) 28 to 32 weeks

Answer; C.) 24 to 28 weeks Rationale: A woman identified as high risk for gestational diabetes would undergo rescreening between 24 and 28 weeks; however, some health care providers can choose to conduct this screening earlier.

The maternal health nurse is caring for a group of high-risk pregnant clients. Which client condition will the nurse identify as being the highest risk for pregnancy? A.) Secondary hypertension B.) Repaired atrial septal defect C.) Pulmonary hypertension D.) Loud systolic murmur

Answer; C.) Pulmonary hypertension Rationale: Pulmonary hypertension is considered the greatest risk to a pregnancy because of the hypoxia that is associated with the condition. The remaining conditions represent potential cardiac complications that may increase the client's risk in pregnancy; however, these do not present the greatest risk in pregnancy.