Chapter 30 - Medical-Surgical Disorders

A nurse is reviewing the clinical diagnosis of thalassemia. Which statement should the nurse identify as being accurate?

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

A client who has cystic fibrosis (CF) is pregnant. Which weight gain recommendation should the nurse suggest?

Approximately 25 pounds Recommendations for weight gain during pregnancy in a client with CF range between 24 and 26 pounds. A well-balanced diet is important, but the client with CF is encouraged to be at 90% of her IBW prior to pregnancy.

The nurse is caring for a pregnant woman with a history of asthma. Which finding would the nurse anticipate as causing the greatest impact on fetal well-being?

Associated with intrauterine growth restriction and preterm birth. Asthma appears to be associated with intrauterine growth restriction and preterm birth. Asthma is a chronic condition which can have considerable impact on pregnancy for those woman who are either poorly controlled or who may have exacerbations during pregnancy. As such there is a need for maternal medication during pregnancy as well as monitoring the client's oxygenation status. An increased need for US examination would not be considered to be a problem. The method of planned delivery is based on clincial presentation.

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the bases of the lungs, and some pulse irregularity. What clinical finding should the nurse anticipate based on these findings?

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

A client who is pregnant also has a history of psoriasis. What information can the nurse provide to the client relative to this disease process?

Clients who have psoriasis during pregnancy experience a varied response. Psoriasis responds variably to pregnancy; in some women there is no change, in some the disease gets better, and in about 20% of women it gets worse. There is no direct correlation between sunlight and psoriasis.

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. What should the nurse tell the patient as being the earliest sign of decompensation?

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

A nurse is reviewing care and management of the pregnant client who is diagnosed with appendicitis. What physical location factor would the nurse identify as making this harder to diagnose?

High and to the right. The appendix is not hidden by the uterus; rather, it is pushed upward and to the right from its usual anatomic location, making diagnosis of appendicitis difficult.

A nurse is reviewing the clinical diagnosis of adult respiratory distress syndrome (ARDS) during pregnancy. Which clinical factor would the nurse associate as being present during pregnancy in the presence of ARDS?

Magnesium sulfate The use of tocolytics, such as magnesium sulfate, can be associated with the development of ARDS. Pitocin induction, cholecystitis, and hyperemesis gravidarum are not associated with ARDS.

A nurse is caring for a woman with mitral stenosis who is in the active stage of labor. Which action should the nurse take to promote cardiac function?

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

A pregnant woman with cystic fibrosis (CF) wants to breastfeed her infant. Which assessments by the nurse would have to be performed in order to make sure that the breastfeedings were safe and effective? (Select all that apply.)

Monitor total fat levels in breast milk Breast milk should be monitored for sodium, total fat, and chloride levels in order to establish its safety. Monitoring of the infant's growth pattern would provide evidence that breastfeeding is adequate. Maternal weight monitoring and urinalysis would not be indicated with regard to the safety of breastfeeding in this case. Monitor infant growth pattern Breast milk should be monitored for sodium, total fat, and chloride levels in order to establish its safety. Monitoring of the infant's growth pattern would provide evidence that breastfeeding is adequate. Maternal weight monitoring and urinalysis would not be indicated with regard to the safety of breastfeeding in this case. Monitor sodium levels in breast milk Breast milk should be monitored for sodium, total fat, and chloride levels in order to establish its safety. Monitoring of the infant's growth pattern would provide evidence that breastfeeding is adequate. Maternal weight monitoring and urinalysis would not be indicated with regard to the safety of breastfeeding in this case.