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

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

"I sometimes get a bit wheezy." Wheezing is a classic symptom of asthma. This statement should alert the nurse to the possibility that the woman's asthma is not being well-controlled and needs further evaluation and possible intervention. The other statements do not relate to the typical presentation of this disease in pregnancy.

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? -"The fact that you are receiving prenatal care will help." -"Pregnancy taxes the circulatory system of every woman." -"Don't worry. You have an excellent primary care provider." -"Our facility has a lot of experience in dealing with this."

"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 woman with diabetes is having her hemoglobin (glycosylated) level evaluated. The nurse determines that the woman's glucose is under control and continues the woman's plan of care based on which result? -8.5% -8.0% -6.5% -7.5%

6.5% A hemoglobin (glycosylated) level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. A glycosylated hemoglobin level less than 7% indicates that the plan is working and should be continued.

A woman with class II heart disease is experiencing an uneventful pregnancy and is now prescribed bed rest at 36 weeks' gestation by her health care provider. The nurse should point out that this is best accomplished with which position? -Lie flat on her back. -Stay in high Fowler position. -Lie in a semi-recumbent position. -Use pillows and wedges to stay in a fully recumbent position.

Lie in a semi-recumbent position. Semi-recumbent position is the best position for circulation of the mother and fetus. Lying flat on the back can induce supine hypotensive syndrome and fully recumbent impedes other circulation. The high Fowler position would not be comfortable for sleeping, as well as possibly impede the blood flow through the hips and lower abdomen.

A pregnant woman in her 39th week of pregnancy presents to the clinic with a vaginal infection. She tests positive for chlamydia. What would this disease make her infant at risk for? -deafness -blindness -neonatal laryngeal papillomas -chickenpox

blindness A pregnant woman who contracts chlamydia is at increased risk for spontaneous abortion (miscarriage), preterm rupture of membranes, and preterm labor. The postpartum woman is at higher risk for endometritis (Fletcher & Ball, 2006). The fetus can encounter bacteria in the vagina during the birth process. If this happens, the newborn can develop pneumonia or conjunctivitis that can lead to blindness.

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? -breastfeeding -future pregnancies -cesarean birth -handling the infant with open sores

breastfeeding 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.

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? -obtaining enough rest -maintaining a high fluid intake -beginning a low-impact aerobics program -discontinuing her prepregnancy anticoagulant

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.

During the assessment of a laboring client, the nurse learns that the client has cardiovascular disease (CVD). Which assessment would be priority for the newborn? -respiratory function -heart rate -temperature -urine output

respiratory function The nurse should identify respiratory distress syndrome as a major risk that can be faced by the offspring of a client with cardiovascular disease. While the other assessments are important, they are not priority.

The clinic nurse teaches a pregestational type 1 diabetic client that constant insulin levels are very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use: -regular insulin twice a day. -an insulin pen. -an insulin drip. -an insulin pump.

an insulin pump. Because a pregnant client will have some periods of relative hyperglycemia and hypoglycemia no matter how carefully she maintains her diet and balances her exercise levels, an effective method to keep serum glucose levels constant is to administer insulin with a continuous pump during pregnancy.

A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum? -limiting sodium intake -inspecting the extremities for edema -ensuring that the client consumes a high fiber diet -assessing for cardiac decompensation

assessing for cardiac decompensation The nurse should assess the client with heart disease for cardiac decompensation, which is most common from 28 to 32 weeks' gestation and in the first 48 hours postpartum. Limiting sodium intake, inspecting the extremities for edema, and ensuring that the client consumes a high-fiber diet are interventions during pregnancy not in the first 48 hours postpartum.

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

Obtain a urine specimen for a drug screening. 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 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? -the viral load -amniocentesis results at 34 weeks' gestation -the mother's age -prophylactic antiretroviral therapy (ART) to the infant at birth

the viral load 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.

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? -Maintain a daily blood glucose log -Report any signs of possible urinary tract infection -Plan daily menus with dietitian -Long-term therapy goals

Maintain a daily blood glucose log Control of the blood glucose throughout the pregnancy is the primary goal to help decrease potential complications to both the mother and fetus. The mother should keep a daily log of her blood glucose levels and bring this log to each visit for the nurse to evaluate. The other choices of reporting possible signs of a UTI and working with a dietitian to plan menus would also be important but would be secondary to the blood glucose control. It would be inappropriate to discuss long-term goals at this time. This would be handled at a later time and would depend on the mother's situation.

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? -elevated -stage 1 -stage 2 -hypertensive crisis

stage 1 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.

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? -She is at increased risk for type 2 diabetes mellitus after her baby is born. -Her baby is at increased risk for neonatal diabetes mellitus. -Her baby is at increased risk for type 1 diabetes mellitus. -She is at increased risk for type 1 diabetes mellitus after her baby is born.

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

Notify the primary care provider if unable to eat because of nausea and vomiting. 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.

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? -regular heart rate and hypertension -increased urinary output, tachycardia, and dry cough -shortness of breath, bradycardia, and hypertension -dyspnea, crackles, and irregular weak pulse

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.

The health care provider of a newly pregnant client determines the woman also has mitral stenosis and will need appropriate therapy. Which medication should the nurse prepare to teach this client to provide her with the best possible care? -heparin -digoxin -aspirin -warfarin

heparin This client has an increased risk for developing blood clots. If an anticoagulant is required, heparin is the drug of choice as it does not cross the placenta barrier. Warfarin crosses the placenta and may have teratogenic effects. Aspirin is not recommended in this situation. Digoxin is not used to prevent blood clots.

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? -in utero transmission -during birth transmission -after birth transmission -with any transmission

in utero transmission 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.

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? -orange juice -milk -water -a full meal

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.

A 40-year-old woman comes to the clinic reporting having missed her period for two months. A pregnancy test is positive. What is she and her fetus at increased risk for? -type 2 diabetes mellitus -type 1 diabetes mellitus -placental abnormalities -postterm birth

placental abnormalities A woman older than 35 years is more likely to conceive a child with chromosomal abnormalities such as Down syndrome. She is also at higher risk for spontaneous abortion (miscarriage), preeclampsia-eclampsia, gestational diabetes, preterm birth, bleeding and placental abnormalities, and other intrapartum complications.

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

restricted sodium intake 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.

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? -45 mg/dl -85 mg/dl -120 mg/dl -136 mg/dl

85 mg/dl 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.

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? -Inject a bolus of insulin. -Eat a high-carbohydrate snack. -Eat a sustaining-carbohydrate snack. -Add a bolus of long-acting insulin.

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

A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control? -Vitamin supplements -Oral hypoglycemic agents -Exercise -Plenty of rest

Exercise The three main facets to glycemic control for the woman with pregestational diabetes are diet, exercise, and insulin. An individual with type 1 diabetes uses insulin and not oral hypoglycemic agents. Vitamin supplements may assist with helping to keep the woman healthy but not necessarily through glycemic control. It will be important for the woman to get enough rest throughout the pregnancy but this will not assist with glycemic control.

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? -Preeclampsia -Anemia -Hyperthyroidism -Gestational diabetes

Gestational diabetes 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.

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? -Secondary hypertension -Repaired atrial septal defect -Pulmonary hypertension -Loud systolic murmur

Pulmonary hypertension 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.

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? -avoidance of infection -constipation prevention -administration of immunoglobulins -consumption of a low-fat diet

avoidance of infection 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.

The nurse is preparing a postpartum nursing care plan for a single HIV-positive primigravida client. The nurse should prioritize in the plan how to acquire which resource? -breast pump -diapers -car seat -formula

formula It is possible to transmit HIV via breastfeeding, and formula is the only option for feeding. The nurse needs to provide positive information and offer to make a referral or get assistance for clients who may be in financial need. In this case, acquiring adequate amounts of formula would be the priority. The diapers and a car seat are also necessary but would follow the formula. The client would not need a breast pump since she cannot give the milk to her baby.

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 pregnant woman with a chronic condition can put herself at risk." -"A pregnant woman with a chronic illness can put the fetus at risk." -"A pregnant woman does not have to worry about contracting new illnesses during pregnancy." -"A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy."

"A pregnant woman does not have to worry about contracting new illnesses during pregnancy." When a woman enters a pregnancy with a chronic illness, it can put both her and the fetus at risk. She needs to be cautious about developing a new illness during her pregnancy as well as having an accident during the 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: -limit weight gain to 15 pounds during the pregnancy. -check her blood sugars frequently and adjust insulin accordingly. -exercise for 1 to 2 hours each day to keep the blood glucose down. -begin oral hyperglycemic medications along with the insulin she is currently taking.

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 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? -"The exposure to the cat litter may cause you to need a C-section." -"This will cut down on the jealousy for your two-year-old when the baby comes." -"If you don't think caring for a cat is too much work, that would be great." -"You should wait until after you give birth to obtain the cat for your daughter."

"You should wait until after you give birth to obtain the cat for your daughter." 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 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, stillbirth or preterm birth.

The nurse is caring for a pregnant client who indicates that she is fond of meat, works with children, and has a pet cat. Which instructions should the nurse give this client to prevent toxoplasmosis? Select all that apply . -Eat meat cooked to 160° F (71° C). -Avoid cleaning the cat's litter box. -Keep the cat outdoors at all times. -Avoid contact with children when they have a cold. -Avoid outdoor activities such as gardening.

Eat meat cooked to 160° F (71° C). Avoid cleaning the cat's litter box. Avoid outdoor activities such as gardening. To minimize risk of toxoplasmosis, the nurse should instruct the client to eat meat that has been cooked to an internal temperature of 160° F (71° C) throughout and to avoid cleaning the cat's litter box or performing activities such as gardening. Avoiding children with colds is unreasonable when working with children, and contact with children with colds is not a cause of toxoplasmosis. The cat should be kept indoors to prevent it from hunting and eating birds or rodents.

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? -diet -long-acting insulin -oral hypoglycemic drugs -glucagon

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 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) as helpful in preventing this infection. Select all that apply. -"It is important to cook any meat that we will eat to at least a temperature of 145°F (62.8°C)." -"Any cutting surface used for raw meats should be washed afterwards with hot, soapy water." -"Peeling any raw vegetables is a good idea before eating them." -"It is important to wear gardening gloves when digging in the soil." -"A house cat should be kept outside to prevent bringing things inside the house."

"Any cutting surface used for raw meats should be washed afterwards with hot, soapy water." "Peeling any raw vegetables is a good idea before eating them." "It is important to wear gardening gloves when digging in the soil." Pregnant women should do the following to prevent toxoplasmosis: 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 pregnant client is diagnosed with syphilis. Which response would demonstrate respect for the client and therapeutic communication? -"Why didn't you use protection when having intercourse with your partner?" -"I am sure it is frightening to you to be diagnosed with a disease that can affect your baby." -"I noticed that you seem fidgety. Is there something wrong besides your STI?" -"You should have thought about what diseases you could be exposed to. At least you are HIV negative."

"I am sure it is frightening to you to be diagnosed with a disease that can affect your baby." The nurse needs to be supportive, empathic and accepting of the client, asking open-ended questions and acting calm and reassuring to her. By acknowledging her fears for her fetus, the nurse is demonstrating respect for her and conveying confidence that the client is trying to take care of her fetus.

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? -"Your primary care provider will order safe doses of your medication." -"It's OK to not use them if you would feel more comfortable." -"They won't cause any major defects." -"I'll let your primary care provider know how you feel about it."

"Your primary care provider will order safe doses of your medication." Women should take no medication during pregnancy except that prescribed by their primary care provider. The PCP will work with the mother to ensure the safest amount is given to adequately handle the mother's health issues and not injure the fetus. The PCP must weigh the risks against the benefits for both the mother and her fetus. The nurse should not encourage the client to stop her asthma medication as that may result in the client having an asthma attack, which could result in injury to the fetus or even miscarriage. The nurse should not tell the client a drug will not cause any defects, especially if it is known that it can. That could make the nurse liable for damages. The nurse should inform the PCP of the client's concerns; however, it is more important for the nurse to calm the client's anxiety and offer positive reinforcement that the PCP is working hard to protect the mother and infant from harm.

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? -Check blood sugar levels daily. -the signs and symptoms of urinary tract infection -Include iron-enriched foods in the diet. -Take daily iron supplements.

Check blood sugar levels daily. 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 iron-enriched foods and taking a daily iron supplement.

A nurse is assessing a newborn and suspects that newborn may have been exposed to alcohol during gestation. The nurse suspect this based on which newborn findings? Select all that apply. -thin upper lip -small head circumference -macrocephaly -limb abnormality large inset eyes

thin upper lip small head circumference limb abnormality Characteristics of a fetal alcohol spectrum disorder include craniofacial dysmorphia (thin upper lip, small head circumference, and small eyes), intrauterine growth restriction, microcephaly, and congenital anomalies such as limb abnormalities and cardiac defects.

A pregnant woman with gestational diabetes is prescribed 10 units of an intermediate-acting insulin and 5 units of a short-acting insulin each day. The total dose is to be divided into two injections, a morning and an evening dose. To provide the most effective control of the woman's blood glucose levels, the nurse anticipates that the client is likely to be prescribed how many total units for the morning dose? -5 -7 1/2 -10 -12 1/2

10 The American College of Obstetricians and Gynecologists affirms the use of insulin as the first-line pharmacotherapy for gestational diabetes when medication is necessary to control blood glucose levels. Insulin, which does not cross the placenta, has historically been the medication of choice for treating hyperglycemia in pregnancy. Combining intermediate- and short-acting insulin yields the best result for most women. Two insulin doses are given daily with two-thirds of the total insulin in the morning to cover energy needs of the active day and one third at night. For this client, it would be a total of 10 units in the morning and 5 units at night.

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? -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. -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. -Schedule an appointment for her to return to discuss her asthma management. -Note in the chart that the woman was not counseled about her asthma.

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. 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.

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? -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. -Continue taking iron supplements but increase fluids and high-fiber foods; exercise more. -Increase the iron supplements, fluid intake, and consumption of high-fiber foods; exercise more. -Take the iron supplement every other day, increase fluid intake and consumption of high-fiber foods; exercise more.

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.