MNB Chapter 16
A pregnant woman with diabetes is having a glycosylated hemoglobin (HbA1C) level drawn. Which result would require the nurse to revise the client's plan of care? 5.5% 6.0% 8.5% 7%
8.5% Explanation: An HbA1C level of more than 8% indicates poor control and the need for intervention, necessitating a revision in the woman's plan of care.
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? 136 mg/dL 120 mg/dL 45 mg/dL 85 mg/dL
85 mg/dL Explanation: 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 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? "If you get pregnant, you are likely to face many complications." "Cardiovascular problems are not a concern during pregnancy." "Because of improved management, more women with cardiac problems can complete pregnancies successfully." "Women with your problem should never get pregnant because the risks and dangers are too high for you and the fetus."
"Because of improved management, more women with cardiac problems can complete pregnancies successfully." Explanation: Because of improved management of cardiac disease, women who might never have risked pregnancy in the past can complete pregnancies successfully today.
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 needs to be careful of and cautious about accidents and illnesses during her pregnancy." "A pregnant woman with a chronic condition can put herself at risk." "A pregnant woman does not have to worry about contracting new illnesses during pregnancy." "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." Explanation: 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.
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? "Your health care provider will likely agree with your decision." "In fact, most modern asthma medications are categorized as safe for use in pregnancy." "Actually, having uncontrolled asthma is much riskier for your baby than the medication." "I'm glad to hear that you're focused on ensuring your baby's health."
"Actually, having uncontrolled asthma is much riskier for your baby than the medication." Explanation: It is important for pregnant clients with asthma to keep taking their medications because the risks of exacerbations exceed the risks of the medications.
The nurse is caring for a pregnant client in the first trimester with a preexisting condition of rheumatic heart disease. The client reports mild shortness of breath with strenuous activity. When teaching the client, which statement(s) will the nurse include? Select all that apply. "Maintain bed rest to avoid cardiac exertion." "Be sure to receive an influenza vaccine." "Avoid cardiac medications in the first trimester." "Be sure to drink an adequate amount of fluids." "Perform moderate exercises as tolerated."
"Be sure to drink an adequate amount of fluids." "Be sure to receive an influenza vaccine." "Perform moderate exercises as tolerated." Explanation: A woman with a preexisting cardiac valve disease is at an increased risk for heart failure during pregnancy, especially during certain periods of time of the client's pregnancy. The client should be advised to maintain hydration, avoid infection (by receiving the influenza vaccine), and perform moderate exercise as tolerated. The client with only mild cardiovascular disease may not require total bed rest and should be encouraged to maintain activity level as tolerated. The health care provider will advise the nurse regarding stopping or starting any cardiac medications during pregnancy.
A patient with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The patient explains that she has been "eating for two" so the baby is healthy. How should the nurse respond to the patient? "Elevated blood glucose levels cause low birth weights in infants." "Elevated blood glucose levels ensure the baby has mature lungs at birth." "Elevated blood glucose levels in the first trimester have been linked to congenital anomalies." "Elevated blood glucose levels hasten the development of the fetus in utero."
"Elevated blood glucose levels in the first trimester have been linked to congenital anomalies." Explanation: The first trimester of pregnancy is the most important time for fetal development. If the patient can control hyperglycemia during this time, the chances of a congenital anomaly are greatly reduced. Infants of patients with poorly controlled diabetes tend to be large. At birth, babies born to patients with uncontrolled diabetes are prone to respiratory distress syndrome. Elevated blood glucose levels do not hasten the development of the fetus in utero and can lead to hydramnios.
A pregnant client is diagnosed with syphilis. Which interviewing question would demonstrate respect for the client and therapeutic communication? "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?" "Why didn't you use protection when having intercourse with your partner?": "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." Explanation: 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 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? "It is fine for me to use my albuterol inhaler if I begin to feel tight." "I need to be aware of my triggers and avoid them as much as possible." "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on."
"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." Explanation: 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.
The nurse instructs a pregnant patient with sickle cell anemia on ways to prevent a crisis. Which patient statement indicates that teaching has been effective? "I should make sure I stand for at least 4 hours every day." "I should drink eight glasses of water every day." "I should take an iron supplement every day." "I should avoid sitting with my legs elevated during the day."
"I should drink eight glasses of water every day." Explanation: The fluid status of a pregnant patient with sickle-cell anemia is important because dehydration can precipitate a crisis. The patient should drink at least eight glasses of fluid each day to prevent dehydration. Patients with sickle-cell anemia should not take an iron supplement because the sickled cells cannot incorporate iron in the same way as nonsickled cells. Standing for long periods of time can cause red cell destruction in the patient with sickle-cell anemia. The patient should sit with the legs elevated to encourage venous return of blood from the lower extremities.
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 sometimes get a feeling of euphoria." "Certain substances make me sneeze." "I have trouble getting comfortable in bed."
"I sometimes get a bit wheezy." Explanation: 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 nurse is talking to a newly pregnant woman who had a mitral valve replacement in the past. Which statement by the client reveals an understanding about the preexisting condition? "I know I will be fine, but I worry about the fetus." "I know my baby will be fine, but I am worried about having a personal complication." "I don't have to worry about this because I had the problem fixed before I became pregnant." "I understand that my fetus and I both are at risk for complications."
"I understand that my fetus and I both are at risk for complications." Explanation: When a woman enters pregnancy with a preexisting condition, both she and her fetus can be at risk of developing complications.
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? "Pregnancy taxes the circulatory system of every woman." "Don't worry. You have an excellent primary care provider." "The fact that you are receiving prenatal care will help." "Our facility has a lot of experience in dealing with this."
"Pregnancy taxes the circulatory system of every woman." Explanation: 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.
The maternal health nurse is caring for a pregnant client with sickle cell anemia. Which statement(s) will the nurse include in the teaching specific to this condition? Select all that apply. "Inspect your legs daily for the development of swelling." "Try to limit caffeine intake." "Try to avoid extreme temperatures." "Inspect your legs daily for the development of ulcers." "Try to avoid large crowds."
"Try to avoid extreme temperatures." "Try to avoid large crowds." "Inspect your legs daily for the development of ulcers." Explanation: The pregnant client with sickle cell disease is at an increased risk for venous stasis and the development of venous ulcers. Extreme temperatures and infection increases the risk for sickle cell crisis and should be avoided. Lower extremity edema and decreased caffeine intake are universal to all pregnant women and are not specific to the client with sickle cell disease.
The nurse is caring for a pregnant woman is determined to be at high risk for gestational diabetes. The nurse prepares to rescreen this client at which time frame? 24 to 28 weeks 20 to 24 weeks 16 to 20 weeks 28 to 32 weeks
24 to 28 weeks Explanation: 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 nurse is assessing a pregnant client in the client who has a history of heart disease. The nurse will prioritize assessments focusing on the heart during which time frame? 20 to 24 weeks' gestation 16 to 20 weeks' gestation 28 to 32 weeks' gestation 24 to 28 weeks' gestation
28 to 32 weeks' gestation Explanation: A pregnant woman with heart disease is most vulnerable for cardiac decompensation from 28 to 32 weeks' gestation just after the blood volume peaks. It would be important to assess the client's heart at each visit; however, the client's heart would be more stressed at this time due to the increased blood volume and identifying a serious situation early provides the best opportunity for treatment and preventing complications.
The maternal health nurse is caring for a group of pregnant clients with heart disease. Which client will the nurse see first? 6-week pregnant client with pulmonary hypertension 28-week pregnant client with a mechanical heart 16-week pregnant client with an unrepaired ventricular septal defect 8-week pregnant client with mild pulmonic stenosis
6-week pregnant client with pulmonary hypertension Explanation: Pregnant clients with heart disease may have a varying degree of impairment and risk to pregnancy. The client with pulmonary hypertension has the greatest risk to pregnancy with an extremely high risk of maternal mortality, class IV heart disease. This client should be seen first. Mild pulmonic stenosis is considered class I heart disease with no increase to maternal health risks during pregnancy. An unrepaired ventricular septal defect is class II heart disease, carrying a mild increase to maternal mortality risk in pregnancy. The client with a mechanical heart is considered to have class III heart disease, which carries a significantly increased risk of maternal death in pregnancy; this client will be seen second.
What criteria would the physician base his decision on to begin insulin therapy for a gestational diabetic mother? Client cannot keep fasting blood sugar lower than 90 mg/dL. Urine is 2+ for glucose and serum blood glucose is 120. A 2-hour postprandial glucose level cannot be kept below 120 mg/dL. Weight gain is over 30 pounds (13.6 kg) and blood sugars are fluctuating between 95 and 130 throughout the day.
A 2-hour postprandial glucose level cannot be kept below 120 mg/dL. Explanation: A physician usually recommends beginning a woman with gestational diabetes on insulin therapy when exercise and diet are ineffective and if she is unable to keep her fasting blood sugar levels below 95 mg/dL or her 2-hour postprandial glucose levels below 120 mg/dL.
Which neonate is at highest risk for developing neonatal herpes following birth? A newborn who was a vaginal delivery to a mother with no active lesions but a history of herpes A newborn who was delivered by cesarean section following prolonged rupture of membranes to a herpes positive mother with no active lesions A newborn who was a vaginal delivery to a mother who had her initial outbreak during the third trimester of pregnancy and has active lesions A newborn who was delivered by cesarean section to a mother with genital herpes
A newborn who was a vaginal delivery to a mother who had her initial outbreak during the third trimester of pregnancy and has active lesions Explanation: The newborn most likely to develop a herpetic infection is the one delivered vaginally to a mother who is experiencing her first outbreak, may or may not know she has herpes, and has active lesions. Delivery by cesarean section reduces the chance of the newborn developing herpes, even if there is premature rupture of membranes prior to delivery. Vaginal deliveries are recommended for mothers with a history of herpes but no current active lesions.
The nurse is caring for a pregnant client with asthma that is well managed with long- and short-acting bronchodilators. Which statement(s) does the nurse associate with the client's condition? Select all that apply. Labor will exacerbate the woman's symptoms. The woman should increase her maintenance medications during labor. The woman should receive her regularly scheduled bronchodilators during labor. Adequate analgesia decreases the woman's risk for exacerbation during labor. Adequate hydration decreases the woman's risk for exacerbation during labor.
Adequate analgesia decreases the woman's risk for exacerbation during labor. The woman should receive her regularly scheduled bronchodilators during labor. Adequate hydration decreases the woman's risk for exacerbation during labor. Explanation: Two concepts must be understood by the nurse who is caring for a pregnant client with asthma: labor does not necessarily exacerbate the woman's symptoms and adequate analgesia and hydration during labor decreases the risk for exacerbation of symptoms. The woman should receive her regularly scheduled bronchodilators during labor, not increase them.
Which initial interview technique would be least effective in gathering information from a suspected abuse victim? Avoid questions that appear accusatory such as "Why don't you just leave him?" Ask the client to strip down and show you where she has been hurt. Convey to the client that the abuse is not her fault, such as "No one deserves to be treated like this." Ask open-ended, non-judgmental questions of the client.
Ask the client to strip down and show you where she has been hurt. Explanation: When interviewing a suspected abuse victim initially, the nurse needs to be supportive and respectful of her. Always talk to the victim alone and in a private place. Ask simple, direct, open-ended questions that allow the client to describe her experiences. Never imply that the woman is in any way responsible for the abuse by asking questions about why she stays with the abuser or what she did to make him mad. Never ask the client to strip for you to inspect her body initially. The nurse needs to establish a rapport with the woman first so trust can be established.
A patient with asthma who is 32 weeks' pregnant is concerned that the health care provider has reduced the doses of asthma maintenance medications. How should the nurse respond to this patient's concern? Asthma improves during pregnancy so higher doses are not needed. Asthma medication is ineffective during pregnancy and should be stopped. Asthma medication may reduce labor contractions and should be reduced. Asthma medication is teratogenic and should not be taken.
Asthma medication may reduce labor contractions and should be reduced. Explanation: Some asthma maintenance medication such as beta-adrenergic agonists may be taken safely during pregnancy, but they have the potential to reduce labor contractions. The doses of these medications may be reduced as the patient approaches the time of delivery. Not all asthma medication is teratogenic. Asthma can improve during pregnancy because of circulating corticosteroids; however, the doses of the medications should have already been adjusted according to the patient's symptoms. There is no evidence to support that asthma medication is ineffective during pregnancy.
A 38-year-old woman comes into the obstetrician's office for prenatal care, stating that she is about 12 weeks pregnant with her first child. What questions would the nurse ask this client, considering her age and potential sensitivity to being labeled an "older" primipara? Offer genetic counseling and an early amniocentesis to determine if termination is needed. Inquire about any family history of chromosomal abnormalities since older women are more likely to have infants with a chromosomal defect. Ask the mother if she has any chronic illnesses that the doctor needs to know about due to her being older. Be non-judgmental in your history gathering and offer her pregnancy resources to read and explore.
Be non-judgmental in your history gathering and offer her pregnancy resources to read and explore. Explanation: Women are having babies later in life and nurses must be supportive of their choices to postpone pregnancy. Most women realize the increased risks for having a baby after 35 years of age and don't need constant reminding of all the potentially bad outcomes that can occur. The majority of pregnancies to women over 35 years of age end up with healthy babies and mothers.
The nurse is caring for a pregnant client who has a history of asthma, which is poorly controlled. Which clinical finding(s) might alert the nurse to a complication associated with the client's medical history? Select all that apply. Client-reported headache Blood pressure 140/94 mmHg White blood cells present in the urine Client-reported flank pain Heart rate 50 beats/minute
Blood pressure 140/94 mmHg Client-reported headache Explanation: The client with poorly-controlled asthma is at an increased risk for preeclampsia, manifesting with increased blood pressure and a client-reported headache. White blood cells in the urine and flank pain indicate a urinary infection, which the client is not at an increased risk for developing. The client with poorly-controlled asthma may have tachycardia from increased cardiac demand, not bradycardia.
In preparing a class for a group of pregnant couples, the nurse includes information about possible newborn complications associated with smoking during pregnancy. Which complications will the nurse include? Select all that apply. Cleft lip and palate Trisomy 21 Cerebral palsy Sudden infant death syndrome Low birth weight
Cerebral palsy Low birth weight Cleft lip and palate Sudden infant death syndrome Explanation: Smoking during pregnancy is associated with multiple perinatal and childhood risks including: Low birth weight, SIDS, cerebral palsy, cleft lip and palate, clubfoot, asthma, altered brainstem development, middle ear infections, and reduced head circumference. Trisomy 21, or Down syndrome, is a genetic disorder caused by abnormal cell division, not the effects of nicotine.
The nurse preceptor is working with a novice maternal health nurse. The novice nurse is caring for a pregnant client with an insulin pump due to pregestational type 1 diabetes. Which action by the novice nurse requires the preceptor to intervene? Choosing the lower abdomen for the insertion site Changing the insertion site every 12 hours Cleansing the insertion site daily Covering the pump insertion site with a piece of gauze
Changing the insertion site every 12 hours Explanation: The maternal health nurse must be familiar with insulin pumps for clients requiring continuous insulin replacement. The insertion site of the insulin pump should be changed every 24 to 48 hours, not every 12 hours. The remaining actions are correct interventions and would not require intervention by the nurse preceptor, as these are correct interventions.
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? Administer intramuscular (IM) vitamin K Check the infant's blood glucose level Check the infant's axillary temperature Administer glucose
Check the infant's blood glucose level Explanation: 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.
The nurse is doing meal planning with a pregnant woman with iron-deficiency anemia. What dietary recommendations would the nurse make to enhance the woman's intake of iron? Select all that apply. Increase intake of dried beans and green leafy vegetables. Since fortified cereals are a poor source of iron, eat eggs or pancakes for breakfast. Drink orange juice with the iron supplement. Cook food in an iron skillet, if possible. Limit intake of dried fruits, eating only fresh fruit.
Drink orange juice with the iron supplement. Increase intake of dried beans and green leafy vegetables. Cook food in an iron skillet, if possible. Explanation: Dried fruits, fortified grains and cereals, and animal protein are all good sources of iron for a pregnant woman. Cooking in an iron skillet also will increase the amount of iron ingested. Vitamin C, like what is found in orange juice, enhances absorption of iron and is recommended to drink when taking iron supplements. Folate also increases the effectiveness of iron supplements; foods high in folate include green leafy vegetables, fortified grains and dried beans.
The maternal health nurse is caring for a pregnant client with a history of epilepsy. The client's antiepileptic drug (AED) levels have been in the non-therapeutic range the last two times the labs were drawn. Which factor does the nurse associate with this finding? Drug metabolism changes during pregnancy Most maintenance medications cannot be given in pregnancy The action of many medications vary in pregnancy Pregnant clients have high rates of noncompliance with maintenance medications
Drug metabolism changes during pregnancy Explanation: Drug metabolism changes during pregnancy which may alter the therapeutic AED levels in the pregnant client. Some AEDs cannot be given in pregnancy due to risk of harm to the fetus; however, there are some that may be given. Pregnant clients do not have high rates of noncompliance and the action of medications do not change in pregnancy.
A patient with heart disease who is 28 weeks pregnant asks the nurse why office appointments have been scheduled every week for the next 4 weeks. What should the nurse respond to the patient? Extra care is needed to make sure the fetus is developing normally during this time period. During weeks 28 and 32, blood volume peaks, and heart function can be affected. This is the routine schedule for all pregnant patients. This is when most patients have a risk of going into early labor.
During weeks 28 and 32, blood volume peaks, and heart function can be affected. Explanation: The danger of pregnancy in a patient with heart disease occurs primarily because of this increase in circulatory volume. The most dangerous time for the patient is in weeks 28 to 32, just after the blood volume peaks. Weekly appointments are not routine for all pregnant patients at this part of the pregnancy. This is not the time when most patients have a risk of going into early labor. The extra appointments are not needed to make sure the fetus is developing normally during this time period.
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 sustaining-carbohydrate snack. Add a bolus of long-acting insulin. Eat a high-carbohydrate snack.
Eat a sustaining-carbohydrate snack. Explanation: Because exercise uses up glucose, women with diabetes should take a sustaining-carbohydrate snack before hard exercise to prevent hypoglycemia.
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? Establish baseline vital signs. Instruct the patient to discontinue her exercise program of walking daily. Help the woman to establish a daily routine. Advise the patient to make plans to quit her job.
Establish baseline vital signs. Explanation: It is important to establish baseline vital signs to later identify a complication related to a pre-existing condition.
The nurse should encourage a pregnant client who is taking short-acting insulin for her diabetes to avoid eating after self-administering the insulin. True False
False Explanation: Strongly encourage women with diabetes to eat almost immediately after injecting short-acting insulin to prevent hypoglycemia before mealtimes.
A woman in her 20s has a long history of sickle cell anemia and is 18 weeks' pregnant. What precautions would the nurse recommend the woman take to minimize the chance of experiencing a sickle cell crisis? Notify the health care provider immediately if she develops any jaundice. Get at least 8 hours sleep each night. Keep the home temperature around 70°F (21°C) to lessen the heart's workload. If she is feeling well, she needs to come to the office once a month until she is in her third trimester.
Get at least 8 hours sleep each night. Explanation: A pregnant woman with sickle cell anemia needs to get adequate rest, drink fluids to maintain hydration, avoid extreme cold situations, go bi-weekly for doctor visits during the second trimester for closer monitoring, and eat a well-balanced diet. Jaundice may be noted due to the breakdown of RBCs and does not necessitate immediate notification of the physician
The maternal health nurse is caring for a client with epilepsy who wants to become pregnant and is seeking advice on vitamin and mineral supplementation prior to and during pregnancy. Which supplementation(s) will the nurse associate with the client's pregestational condition? Select all that apply. High-dose folic acid before pregnancy High-dose calcium in the first trimester Vitamin K in the last weeks of pregnancy Vitamin C during active labor Vitamin E in the second and third trimesters
High-dose folic acid before pregnancy Vitamin K in the last weeks of pregnancy Explanation: A woman who is planning on becoming pregnant who also has epilepsy may take specific vitamin and mineral supplementation to prevent complications. The client may be advised to use high-dose folic acid prior to conception to avoid neural tube defects in the fetus. Additionally, the medication phenytoin sodium is most frequently prescribed during pregnancy but may cause a vitamin K deficiency. This may be counteracted with vitamin K supplementation in the last weeks of pregnancy. The remaining supplementation actions are not correlated with epilepsy.
A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? I.V. fluids antihypertensive drugs antibiotics diuretic drugs
I.V. fluids Explanation: A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and I.V. 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 patient with diabetes who is in the second trimester of pregnancy notes that the usual dose of insulin to maintain blood glucose levels has been increasing over the last few weeks. What should the nurse explain to the patient about insulin during pregnancy? The fetus is using insulin to maintain blood glucose level in utero. Insulin resistance develops because of human placental lactogen hormone and other hormones. The change in diet causes an increased need for insulin to maintain blood glucose levels. An increase in circulating blood volume during pregnancy deactivates insulin.
Insulin resistance develops because of human placental lactogen hormone and other hormones. Explanation: Patients with diabetes who become pregnant develop insulin resistance as the pregnancy progresses, or insulin does not seem as effective during pregnancy. This phenomenon is believed to be caused by the presence of the hormone human placental lactogen and high levels of cortisol, estrogen, progesterone, and catecholamines. The increased need for insulin is not because of the fetus using insulin to maintain blood glucose level in utero. The patient's increased circulating blood volume is not deactivating insulin. The patient's change in diet might necessitate an adjustment in insulin dosage, but this would vary according to blood glucose level.
A woman calls the obstetrician's office to inquire how long she needs to wait to get pregnant following a seizure she had last week. The nurse would tell her to wait how long? She needs to wait 2 months after seizures are controlled before conceiving. Most doctors recommend that a woman wait 1 year following a seizure to get pregnant. There is no set time to wait before conceiving following a seizure. It is recommended that she wait 6 months after seizures are under control before getting pregnant.
It is recommended that she wait 6 months after seizures are under control before getting pregnant. Explanation: Most physicians recommend that a woman wait 6 months after seizures are under control before getting pregnant to ensure that her fetus will be safe.
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 patient most likely is experiencing which condition? Pulmonary embolism Right-sided heart failure Left-sided heart failure Peripartal cardiomyopathy
Left-sided heart failure Explanation: 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 blood-speckled 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 peripartal 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.
The nurse is caring for a pregnant client with pregestational diabetes. Which goal does the nurse identify as priority during the client's pregnancy? Encourage minimal weight gain Maintain glycemic control Ensure compliance of glucose monitoring Monitor for associated complications
Maintain glycemic control Explanation: The most important goal when caring for a pregnant client with pregestational diabetes is to maintain glycemic control. The scenario does not give enough information on the client's weight to determine if the client should gain only minimal weight during pregnancy. Ensuring compliance of glucose monitoring and monitoring for associated complications are appropriate nursing interventions; however, these do not take priority.
A woman develops gestational diabetes. Which assessment should she make daily? Measure serum for glucose level by a finger prick. Measure her uterine height by hand-span distance. Measure her abdominal diameter with a tape measure. Test her urine for protein with a chemical reagent strip.
Measure serum for glucose level by a finger prick. Explanation: Assessing serum glucose reveals both hyperglycemia and hypoglycemia.
A pregnant woman diagnosed with diabetes should be instructed to perform which action? Prepare foods with increased carbohydrates to provide needed calories. Notify the primary care provider if unable to eat because of nausea and vomiting. Ingest a smaller amount of food prior to sleep to prevent nocturnal hyperglycemia. Discontinue insulin injections until 15 weeks gestation.
Notify the primary care provider if unable to eat because of nausea and vomiting. Explanation: 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 maternal health nurse is caring for a pregnant client with a history of asthma who requires maintenance medication for the management of the disease. Which action by the nurse best reinforces information provided to the client regarding maintenance of her health? Teach the client how to use a spacer with an inhaler. Review the client's peak flow meter readings. Observe the client taking her inhaler. Ask the client to show the nurse deep breathing techniques.
Observe the client taking her inhaler. Explanation: The best way to reinforce teaching is to observe the client performing the task taught by the nurse. This "teach back" technique is most effective in assessing if the teaching is effective. Teaching a client with asthma how to use a spacer device is an important nursing task; however, this task does not best reinforce the information provided to the client. Reviewing the client's peak flow readings does not reinforce client teaching. Deep breathing and coughing is not the primary technique that maintains the client's health.
The maternal health nurse is caring for a pregnant client with sickle cell disease. Which action(s) will the nurse take to help the client prevent complications related to her disease? Select all that apply. Emphasize the importance of maintaining the medication regimine established before pregnancy. Instruct the client on the warning signs of stroke. Obtain a urine sample at every prenatal visit. Instruct the client on the need for weekly intravenous fluid therapy. Observe the client's lower extremities for ulcers at every prenatal visit.
Obtain a urine sample at every prenatal visit. Instruct the client on the warning signs of stroke. Observe the client's lower extremities for ulcers at every prenatal visit. Explanation: Due to the risk for kidney damage from sickle cell disease, the pregnant client should have a urinalysis at every prenatal visit. Stroke is a risk in sickle cell disease and the client should be instructed on the warning signs of stroke. Vascular damage may occur in sickle cell disease and vascular ulcers may occur. Observing the client's lower extremities helps to identify these areas early, should they occur. The medication regime for sickle cell disease is often not maintained during pregnancy, due to the risk of the fetus. Weekly intravenous fluid therapy is not indicaated for clients with sickle cell disease.
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? Audible wheezes Persistent rales in the bases of the lungs Elevated blood pressure Low blood pressure
Persistent rales in the bases of the lungs Explanation: The earliest warning sign of cardiac decompensation is persistent rales in the bases of the lungs.
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. Receive pneumococcal and influenza vaccines. Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus. Continue taking the scheduled warfarin. Let the physician know if you become short of breath or have a nighttime cough. Plan periods of rest into the workday.
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. Explanation: 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.
A woman is pregnant and has asthma. Her primary care provider has told her to continue taking prednisone during pregnancy, but she is concerned the drug may be teratogenic. What advice would be best to give her regarding this? Prednisone is a teratogenic drug, but she may need it to control her asthma symptoms. Prednisone is considered safe in the doses prescribed by her care provider. She should half her dose during the first 3 months of pregnancy. She should omit the drug during pregnancy.
Prednisone is considered safe in the doses prescribed by her care provider. Explanation: Women should take no medication during pregnancy except that prescribed by their primary care provider. Prednisone may be prescribed safely because, although it may be teratogenic in animal models, it does not appear to be teratogenic in humans.
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? Allowing her to continue without plans for delivery. Scheduling a cesarean delivery at 39 weeks. Scheduling the woman for induction of labor today. Preparing for amniocentesis and fetal lung maturity assessment
Preparing for amniocentesis and fetal lung maturity assessment Explanation: 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 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? Recheck her blood sugar for accuracy. Withhold her insulin, and notify the health care provider. Stay with her, and ask another nurse to bring her insulin. Provide the client some milk to drink.
Provide the client some milk to drink. Explanation: The client is hypoglycemic when awakening in the morning. The nurse should provide glucose in the form of carbohydrate, 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.
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 Loud systolic murmur Pulmonary hypertension
Pulmonary hypertension Explanation: 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 woman with known cardiac disease is in labor. In what position would the nurse place the client? High-Fowler's with a pillow at the back Trendelenburg Supine Semi-recumbent with a pillow under one hip
Semi-recumbent with a pillow under one hip Explanation: 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.
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? Her baby is at increased risk for type 1 diabetes mellitus. She is at increased risk for type 2 diabetes mellitus after her baby is born. She is at increased risk for type 1 diabetes mellitus after her baby is born. Her baby is at increased risk for neonatal diabetes mellitus.
She is at increased risk for type 2 diabetes mellitus after her baby is born. Explanation: The woman who develops GDM is at increased risk for developing type 2 diabetes mellitus after pregnancy.
A woman who has sickle cell anemia asks the nurse if her infant will develop sickle cell disease. The nurse would base the answer on which information? Sickle cell anemia is recessively inherited. Sickle cell anemia has more than one polygenic inheritance pattern. Sickle cell anemia is dominantly inherited. Sickle cell anemia is not inherited; it occurs following a malaria infection.
Sickle cell anemia is recessively inherited Explanation: Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. If one parent has the disease and the other is free of the disease and trait, the chance of the child inheriting the disease is zero. If the woman has the disease and her partner has the trait, there is a 50% chance that the child will be born with the disease. If both parents have the disease, then all of their children also will have the disease.
A woman who has sickle cell anemia asks the nurse if her infant will develop sickle cell disease. The nurse would base the answer on which information? Sickle cell anemia has more than one polygenic inheritance pattern. Sickle cell anemia is not inherited; it occurs following a malaria infection. Sickle cell anemia is recessively inherited. Sickle cell anemia is dominantly inherited.
Sickle cell anemia is recessively inherited. Explanation: Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. If one parent has the disease and the other is free of the disease and trait, the chance of the child inheriting the disease is zero. If the woman has the disease and her partner has the trait, there is a 50% chance that the child will be born with the disease. If both parents have the disease, then all of their children also will have the disease.
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? Recommend some adoption agencies for her to talk to in the near future. Support her by respecting her right to privacy and confidentiality. 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. Contact the mother of the adolescent to be sure the child gets prenatal care.
Support her by respecting her right to privacy and confidentiality. Explanation: 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.
A woman arrives at the prenatal clinic and is accompanied by her partner. Which behaviors would be suggestive of intimate partner violence (IPV)? Select all that apply. The pregnant client looks at the examiner when asked questions. The partner is overly protective of the pregnant client. The partner answers questions for the pregnant client. The client asks questions of the nurse about her pregnancy. Poor weight gain during the pregnancy and low birth weight infant
The partner answers questions for the pregnant client. The partner is overly protective of the pregnant client. Poor weight gain during the pregnancy and low birth weight infant Explanation: Intimate partner violence (IPV) occurs in both heterosexual as well as same-sex relationships. The nurse needs to be on the lookout for signs of violence when caring for women. It is estimated that 4% to 8% of pregnant women experience abuse during the pregnancy. Signs include a passive or quiet client who may appear unkempt or depressed. The abuser often refuses to leave the client alone with the health care providers and answers questions posed to the mother. The abuser is often overly protective of the client. Consequences of abuse include poor weight gain during the pregnancy, late entry into prenatal care, preterm labor and fetal death.
Question 13 of 20 A woman arrives at the prenatal clinic and is accompanied by her partner. Which behaviors would be suggestive of intimate partner violence (IPV)? Select all that apply. The partner is overly protective of the pregnant client. Poor weight gain during the pregnancy and low birth weight infant The client asks questions of the nurse about her pregnancy. The partner answers questions for the pregnant client. The pregnant client looks at the examiner when asked questions.
The partner answers questions for the pregnant client. The partner is overly protective of the pregnant client. Poor weight gain during the pregnancy and low birth weight infant Explanation: Intimate partner violence (IPV) occurs in both heterosexual as well as same-sex relationships. The nurse needs to be on the lookout for signs of violence when caring for women. It is estimated that 4% to 8% of pregnant women experience abuse during the pregnancy. Signs include a passive or quiet client who may appear unkempt or depressed. The abuser often refuses to leave the client alone with the health care providers and answers questions posed to the mother. The abuser is often overly protective of the client. Consequences of abuse include poor weight gain during the pregnancy, late entry into prenatal care, preterm labor and fetal death.
A client who is 10 weeks' pregnant reports during a social assessment interview that she has two indoor cats, lives alone, fixes her own meals and enjoys gardening. What precautions would the nurse recommend the woman take to prevent the possibility of contracting toxoplasmosis? Select all that apply. Receive the vaccination as soon as possible to prevent contracting the disease. Wash all fruits and vegetables in hot, soapy water before eating. Make sure meats are cooked to 152ºF (66.7℃); do not eat raw or rare meats. Hire someone to empty the litter box in the house. Use gloves when planting her vegetable garden.
Use gloves when planting her vegetable garden. Make sure meats are cooked to 152ºF (66.7℃); do not eat raw or rare meats. Explanation: Toxoplasmosis is protozoan infection transmitted through contact with undercooked meats, contaminated soil and cat feces. There is no vaccination for toxoplasmosis. Since the woman lives alone, she needs to wear gloves when she is gardening or when she empties the litter box, then wash her hands thoroughly before and after coming in contact with the raw meat, soil or cat litter. It is not advised to wash the fruits and vegetables in hot, soapy water but they do need to be rinsed carefully before eating them.
A patient who is 36 weeks pregnant has been taking phenytoin for a seizure disorder. Which supplement should the nurse anticipate being prescribed for this patient? Vitamin C Vitamin E Vitamin K Vitamin D
Vitamin K Explanation: Phenytoin (Dilantin) is believed to cause a fetal syndrome that includes vitamin K deficiency. To counteract the vitamin K deficiency and prevent hemorrhage in the newborn, the patient may be prescribed vitamin K during the last 4 weeks of gestation. Vitamins C, D, or E have no impact on the pregnant patient who is taking phenytoin (Dilantin) for a seizure disorder.
The nurse is teaching a pregnant woman about how to prevent contracting cytomegalovirus (CMV) during pregnancy. What tips would the nurse share with this client? Select all that apply. Wash your hands thoroughly with soap and water after touching saliva or urine. If you contract CMV, your doctor will give you some oral medicine to treat it. If you have CMV, it is suggested that you not breast-feed your infant. Do not share food or drinks with young children, especially if they are in daycare. If you develop any flu-like symptoms, notify your physician immediately to be evaluated for CMV.
Wash your hands thoroughly with soap and water after touching saliva or urine. Do not share food or drinks with young children, especially if they are in daycare. If you develop any flu-like symptoms, notify your physician immediately to be evaluated for CMV. Explanation: Cytomegalovirus (CMV) is a mild infection and women may not know they have contracted it. The problem arises when a pregnant woman contracts it during the first 20 weeks of gestation. Prevention is the key, so the nurse would reinforce handwashing, not eating or drinking from a container after a small child has done so, and notifying the physician if the client develops mild flu-like symptoms so she can be tested to rule out CMV.
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: an insulin pen. regular insulin twice a day. an insulin drip. an insulin pump.
an insulin pump. Explanation: 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 woman's obstetrician prescribes vitamin K supplements for a client who is on antiepileptic medications beginning at 36 weeks' gestation. The mother asks the nurse why she is taking this medication. The nurse's best response would be: The antiepileptic medications can cause the mother's platelets to drop. vitamin K helps in keeping the placenta healthy. administration of vitamin K aids in lung maturity of the fetus. antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn.
antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn. Explanation: Antiepileptic therapy may cause vitamin K-deficient hemorrhage of the newborn that the vitamin K injection the newborn receives following birth cannot fully correct. Therefore, some physicians recommend a Vitamin K supplement for their pregnant patients beginning at 36 weeks' gestation. If the mother should go into preterm labor, the newborn will have received the vitamin K prior to delivery. However, many physicians now question the usefulness of the prophylaxis.
A pregnant client with a history of heart disease has been admitted to a health care center reporting breathlessness. The client also reports shortness of breath and easy fatigue when doing ordinary activity. The client's condition is markedly compromised. The nurse would document the client's condition using the New York Heart Association (NYHA) classification system as which class? class I class II class III class IV
class III Explanation: The nurse should classify the client's condition as belonging to class III of NYHA. In class III of NYHA classification, the client will be symptomatic with ordinary activity, and her condition is markedly compromised. The client is asymptomatic with all kinds of activity and is in uncompromised state in class I. The client is symptomatic with increased activity and is in slight compromised state in class II. The client is symptomatic when resting and is incapacitated in class IV.
A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome? incompetent cervix congenital anomalies abruptio placentae placenta previa
congenital anomalies Explanation: A HbA1c level of 13% indicates poor glucose control. This, in conjunction with the woman being in the first trimester, increases the risk for congenital anomalies in the fetus. Elevated glucose levels are not associated with incompetent cervix, placenta previa, or abruptio placentae.
A nurse is interviewing a pregnant woman who has come to the clinic for her first prenatal visit. During the interview, the client tells the nurse that she works in a day care center with 2- and 3-year olds. Based on the client's history, the nurse would be alert for the development of which condition? gonorrhea cytomegalovirus chlamydia toxoplasmosis
cytomegalovirus Explanation: The nurse would be alert for the development of cytomegalovirus infection. Pregnant women acquire active disease primarily from sexual contact, blood transfusions, kissing, and contact with children in daycare centers. It can also be spread through vertical transmission from mother to child in utero (causing congenital CMV), during birth, or through breast-feeding. Chlamydia, gonorrhea, and toxoplasmosis are not spread through contact with children in day care centers.
A nurse is conducting a program for pregnant women with gestational diabetes about reducing complications. The nurse determines that the teaching was successful when the group identifies which factor as being most important in helping to reduce complications associated with pregnancy and diabetes? control of blood urea nitrogen (BUN) levels for optimal kidney function reduction in retinopathy risk by frequent ophthalmologic evaluations stability of the woman's emotional and psychological status degree of blood glucose control achieved during the pregnancy
degree of blood glucose control achieved during the pregnancy Explanation: Therapeutic management for the woman with diabetes focuses on tight glucose control, thereby minimizing the risks to the mother, fetus, and neonate. The woman's emotional and psychological status is highly variable and may or may not affect the pregnancy. Evaluating for long-term diabetic complications such as retinopathy or nephropathy, as evidenced by laboratory testing such as BUN levels, is an important aspect of preconception care to ensure that the mother enters the pregnancy in an optimal state.
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? glucagon long-acting insulin oral hypoglycemic drugs diet
diet Explanation: 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 contraindicated in pregnancy. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.
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 dyspnea, crackles, and irregular weak pulse shortness of breath, bradycardia, and hypertension
dyspnea, crackles, and irregular weak pulse Explanation: 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 has diagnosed a pregnant client with megaloblastic anemia and has prescribed treatment. When questioned by the client as to what this means, which is the best response from the nurse? iron-deficiency anemia sickle-cell anemia folic acid deficiency anemia thalassemia
folic acid deficiency anemia Explanation: Folic acid anemia is a deficiency in folic acid. It is also called megaloblastic anemia, which means enlarged red blood cells. The mean corpuscular volume will be elevated. This deficiency takes several weeks to develop, so it may not be apparent until the second trimester of pregnancy.
A woman with type 2 diabetes is considering becoming pregnant and asks the nurse whether she will be able to continue taking her current oral hypoglycemics. The nurse's response will point out which factor? are usually suggested primarily for women who develop gestational diabetes. have been shown to be effective and safe in recent short term studies. can be taken until the degeneration of the placenta occurs. can be used as long as they control serum glucose levels.
have been shown to be effective and safe in recent short term studies. Explanation: Recent studies have examined the use of oral hypoglycemic medications in pregnancy with much success. Several studies have used glyburide with promising results. Many health care providers are using glyburide and metformin as an alternative to insulin therapy because they do not cross the placenta and therefore do not cause fetal/neonatal hypoglycemia. Some oral hypoglycemic medications are considered safe and may be used if nutrition and exercise are not adequate alone. Maternal and newborn outcomes are similar to those seen in women who are treated with insulin. Oral hypoglycemic agents, however, must be further investigated to determine their safety with confidence and provide better treatment options for diabetes in pregnancy. Currently, there is a growing acceptance of glyburide use as a primary therapy for gestational diabetes. Glyburide and metformin have also been found to be safe, effective, and economical for the treatment of gestational diabetes, although neither drug has been approved by the FDA for use in pregnancy.
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? digoxin aspirin heparin warfarin
heparin Explanation: 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. If digoxin is not used to prevent blood clots.
The nursing instructor is pointing out the various complcations which can occur during pregnancy in women with diabetes mellitus. The instructor determines the session is successful after the students correctly choose which complication that can occur if the diabetes is not kept under control? placenta previa hydramnios cerebral vascular accident hypotension
hydramnios Explanation: Out-of-control diabetes can result in hyperglycemia which tends to lead to excessive amniotic fluid (hydramnios or polyhydramnios) because of osmotic pressure fluid shifts. A small placenta is more common than placenta previa. The woman may experience hypertension versus hypotension if the diabetes is not controlled. Cerebral vascular accidents are usually not related to diabetes but to circulatory issues.
A nursing instructor is teaching students about anemia during pregnancy. Which type of anemia does the instructor teach students is most prevalent during pregnancy? iron-deficiency anemia pernicious anemia sickle-cell anemia folic acid anemia
iron-deficiency anemia Explanation: Iron-deficiency anemia is the most common type in pregnancy. Many woman enter pregnancy with a low iron count because of poor diet, heavy menstrual periods, unwise weight-loss programs, or a combination of these.
Which change in insulin is most likely to occur in a woman during pregnancy? unavailable because it is used by the fetus not released because of pressure on the pancreas enhanced secretion from normal less effective than normal
less effective than normal Explanation: Somatotropin released by the placenta makes insulin less effective. This is a safeguard against hypoglycemia.
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? discontinuing her prepregnancy anticoagulant obtaining enough rest beginning a low-impact aerobics program maintaining a high fluid intake
obtaining enough rest Explanation: 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 woman with a history of asthma comes to the clinic for evaluation for pregnancy. The woman's pregnancy test is positive. When reviewing the woman's medication therapy regimen for asthma, which medication would the nurse identify as problematic for the woman now that she is pregnant? albuterol salmeterol oral prednisone budesonide
oral prednisone Explanation: Oral corticosteroids such as prednisone are not preferred for the long-term treatment of asthma during pregnancy. However, they can be used to treat severe asthma attacks during pregnancy. Budesonide, albuterol, and salmeterol are recommended for use during pregnancy to control asthma.
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? meals high in iron milk legumes orange juice
orange juice Explanation: 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.
A pregnant woman in her second trimester comes to the prenatal clinic for a routine visit. She reports that she has a new kitten. The nurse would have the woman evaluated for which infection? cytomegalovirus parvovirus B19 toxoplasmosis herpes simplex virus
toxoplasmosis Explanation: Toxoplasmosis is transferred by hand to mouth after touching cat feces while changing the litter box or through gardening in contaminated soil. Cytomegalovirus is transmitted via sexual contract, blood transfusions, kissing, and contact with children in daycare centers. Parvovirus B19 is a common self-limiting benign childhood virus that causes fifth disease. A pregnant woman may transmit the virus transplacentally to her fetus if she is exposed to an infected child. Herpesvirus infection occurs by direct contact of the skin or mucous membranes with an active lesion through kissing, sexual contact, or routine skin-to-skin contact.
Which factor would contribute to a high-risk pregnancy? type 1 diabetes history of allergy to honey bee pollen blood type O positive first pregnancy at age 33
type 1 diabetes Explanation: 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.
Which factor would contribute to a high-risk pregnancy? blood type O positive history of allergy to honey bee pollen first pregnancy at age 33 type 1 diabetes
type 1 diabetes Explanation: 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.
