OB NCLEX questions set 1

A pregnant woman with chronic hypertension comes to the clinic for evaluation. The last several blood pressure readings were gradually increasing. On today's visit her blood pressure is 166/100 mm Hg. The health care provider prescribes an antihypertensive agent. The nurse anticipates which agent as being most commonly prescribed?

methyldopa Although labetalol, atenolol, and nifedipine may be ordered, methyldopa is the most commonly prescribed agent because of its safety record during pregnancy. It is a slow-acting antihypertensive agent that also helps to improve uterine perfusion.

A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn?

microcephaly Signs that are likely to be present in the 10 percent of newborns who are symptomatic at birth include microcephaly, seizures, IUGR, hepatosplenomegaly, jaundice, and rash.

A nurse is client teaching with a 28 weeks' gestation woman 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 II diabetes mellitus after her baby is born. The woman who develops GDM is at increased risk for developing type 2 diabetes mellitus after pregnancy.

Which factor would contribute to a high-risk pregnancy?

type 1 diabetes A woman with a history of diabetes has an increased risk for perinatal complications, including hypertension, preeclampsia, and neonatal hypoglycemia. The age of 33 without other risk factors does not increase risk, nor does type O-positive blood or environmental allergens.

For which problem would the nurse be alert in a pregnant woman with gestational diabetes?

hydramnios related to glucose/insulin imbalance Hyperglycemia tends to lead to excessive amniotic fluid (hydramnios) because of osmotic pressure fluid shifts.

A pregnant woman is determined to be at high risk for gestational diabetes. At which time would the nurse expect the client to undergo rescreening?

24 to 28 weeks

A nurse is teaching a woman diagnosed with gestational diabetes about meal planning and nutrition. The nurse determines that additional teaching is needed based on which client statement?

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

A pregnant client with sickle cell anemia is at an increased risk for having a sickle cell crisis during pregnancy. Aggressive management for a client experiencing a sickle cell crisis with severe pain includes which measure?

I.V. fluids 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 usually needs a stronger analgesic than acetaminophen to control the pain of a crisis.

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?

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 woman with cardiac disease gave birth to a 7 lb (3.2 kg) baby by cesarean birth. Which intervention should be implemented during the immediate postpartum period?

Rest, use stool softeners, and monitor tolerance of activity. A woman who has a cardiac condition is at increased risk in the postpartum period. She needs frequent assessment and observation for tolerance. She would also be given education to avoid straining activities such as bowel movements and would be encouraged to have stool softeners and increase fluid and fiber. Restricting the client's activity to bed rest could be detrimental to the client, as could be ambulating to the bathroom only. There is no reason to limit the visits with the infant

A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer?

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

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 do which action?

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 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?

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.

A pregnant woman who is HIV-positive comes to the labor and birth unit in labor. When developing the plan of care for this client, which intervention would be most important for the nurse to include?

adhering to standard precautions For the pregnant woman who is HIV-positive, standard precautions must be used to reduce the risk of HIV transmission. Educating the woman about family planning methods is not as important as adhering to standard precautions. The decision about the mode of delivery is based on the woman's viral load, duration of ruptured membranes, progress of labor, and other clinical factors. Breast-feeding is contraindicated, so helping her choose a feeding method would be inappropriate.

A client in her fifth month of pregnancy is having a routine clinic visit. The nurse should assess the client for which common second trimester condition?

physiological anemia Hemoglobin level and hematocrit decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production. Mastitis is an infection in the breast characterized by a swollen tender breast and flu-like symptoms. This condition is most commonly seen in breastfeeding clients. Alterations in acid-base balance during pregnancy result in a state of respiratory alkalosis, compensated by mild metabolic acidosis.

A pregnant woman with sickle cell anemia comes to the emergency department in crisis. Which finding would the nurse expect? Select all that apply.

fever joint pain Signs and symptoms of a sickle cell crisis commonly include severe abdominal pain, muscle spasm, leg pains, joint pain, fever, stiff neck, nausea and vomiting, and seizures. Skin turgor would most likely be poor because the client would probably be dehydrated. Pallor and fatigue are associated with sickle cell anemia and would not help identify a crisis.

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply.

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

A woman with class II heart disease is in the third trimester of her pregnancy. She has been taking good care of herself and has had little difficulty, but to be on the safe side the obstetrician has prescribed bed rest for her for the final month. For her own and the baby's safety, in what position should the nurse advise the client to sleep?

Lie in a semirecumbent position. Semirecumbent position is the best position for circulation of the mother and fetus. Laying flat on the back can induce supine hypotensive syndrome and fully recumbent impedes other circulation.

A nurse informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night's sleep. The nurse further instructs the client that which position for this rest is best?

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

A pregnant woman diagnosed with diabetes should be instructed to perform which action?

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.

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 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 nurse is conducting a class on gestational diabetes for a group of pregnant women who are at risk for the condition. The nurse determines that additional teaching is needed when the class identifies which complication as affecting the neonate?

hyperglycemia Gestational diabetes is associated with either neonatal complications such as macrosomia, hypoglycemia, and birth trauma or maternal complications such as preeclampsia and cesarean birth.

A woman with a long history of controlled asthma has just had her first antenatal visit for her fourth child. She is late for a meeting and says she knows what to do. What is the best action the nurse can take?

Acknowledge her need to leave but ask her to demonstrate the use of her inhaler and her peak flow meter before she goes; make any necessary corrections to her technique. Remind her to take her regular medications. Management of asthma during pregnancy is very important; the nurse must document 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 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 her obligation to ensure that the woman knows how to use her inhaler and her peak flow meter.

The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of abusing heroin. The nurse would be alert for which finding when assessing the neonate?

hypertonicity Newborns of mothers who abuse heroin or other narcotics display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures

A pregnant client has tested positive for hepatitis B virus. When discussing the situation with the client, the nurse explains that her infant should be vaccinated with an initial HBV vaccine dose at which time?

within 12 hours of birth If a woman tests positive for HBV, the newborn will receive HBV vaccine within 12 hours of birth. The second dose will be given at 1 month and the third dose at 6 months.

A 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 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 cardiac disease has come to the office for prenatal counseling. According to the functional classification system developed by the Criteria Committee of the New York Heart Association, the woman would be cautioned against pregnancy based on which category?

class IV A woman with class IV disease should avoid pregnancy. These individuals can be symptomatic at rest or with any physical activity resulting in inability to carry on any physical activity without discomfort. Symptoms or heart failure or the anginal syndrome may be present even at rest. The pregnancy may put too much stress on the woman's body increasing her risk of serious complications or even death

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?

cytomegalovirus 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 breastfeeding. Chlamydia, gonorrhea, and toxoplasmosis are not spread through contact with children in day care centers.

A nurse is conducting a presentation about prenatal care and preexisting maternal conditions. When discussing the various risks to the mother and infant, the nurse would include information about which condition as the leading cause of intellectual disability in the United States?

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

A pregnant client with mitral stenosis needs to begin taking an anticoagulant. The nurse identifies the drug of choice, which is used in early pregnancy and again during the last month of pregnancy, to be which medication?

heparin If an anticoagulant is required, heparin is the drug of choice for the beginning and the end of pregnancy. Heparin does not cross the placenta barrier.

A pregnant woman diagnosed with cardiac disease 4 years ago is told that her pregnancy is a high-risk pregnancy. The nurse then explains that the danger occurs primarily because of the increase in circulatory volume. The nurse informs the client that the most dangerous time for her is when?

in weeks 28 to 32 The danger of pregnancy in a woman with cardiac disease occurs primarily because of the increase in circulatory volume. The most dangerous time for a woman is in weeks 28 to 32, just after the blood volume peaks

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:

orange juice.

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 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

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 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 fourteen-year-old client and her parents have presented at the obstetrician's office in the second trimester; the teen had been hiding the pregnancy. The nurse is helping them develop a plan of care. What is the best thing the nurse can say to the clearly angry parents?

"I know you must be very upset and angry about your daughter's pregnancy, but because she's still an adolescent herself, she'll need your guidance in making nutritional and health choices that will be good for the baby and for herself." The nurse needs to acknowledge the anger of the parents but remember her role is as the client advocate. The nurse needs to encourage the relationship of support between the parents and the client. The nurse should not attempt to lay down ground rules between the client and her parents, and the nurse should acknowledge the parents' feelings in this situation. It is inappropriate to lecture or place blame on the parents.

A nurse is caring for a 45-year-old pregnant client with a cardiac disorder who has been instructed by her primary care provider to follow class I functional activity recommendations. The nurse correctly instructs the client to follow which limitations?

"You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or shortness of breath." Class I recommendations (no physical activity limitations) are suggested for client's who are asymptomatic and exhibit no objective evidence of cardiac disease. The functional classifications system consists of classes I to IV, based on past and present disability and physical signs resulting from cardiac disease.

A pregnant single mom living alone tells the nurse she is considering getting a cat for her two-year-old daughter. Which is the best response by the nurse?

"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 not encourage the mother to get her child a cat until after the new baby is born.

A 25-year-old pregnant client comes to the office for the first prenatal visit. During the history, the client tells the nurse she had tuberculosis 5 years ago. What is the nurse's best response?

"You will have to maintain an adequate level of calcium during your pregnancy." A client who had tuberculosis earlier in life must be especially careful to maintain an adequate level of calcium during pregnancy to ensure the calcium tuberculosis pockets in her lungs are not broken down and the disease is not reactivated. The tuberculosis may reoccur if the intra-abdominal pressure (from pushing) breaks the calcified pockets open; if the woman is positive for active tuberculosis she will have to take isoniazid (INH), rifampin (RIF), and ethambutol HCL, and if the woman has a positive reaction, a chest X-ray or a sputum culture is needed to confirm the diagnosis.

A woman at 26 weeks' gestation is undergoing screening for diabetes with a 1-hour oral glucose challenge test. On the client's return visit, the nurse anticipates the need to schedule a 3-hour glucose challenge test based on which result of the previous test?

146 mg/dL For a 1-hour glucose challenge test, a 75-g oral glucose load is given, without regard to the timing or content of the last meal. Blood glucose is measured 1 hour later; a level above 140 mg/dL is abnormal. If the result is abnormal, a 3-hour glucose tolerance test is done.

Part of the assessment of the first prenatal visit includes screening for rubella antibodies. The nurse determines that a client with which titer shows evidence of immunity against rubella?

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

A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant?

6 months If the woman is considering pregnancy, it is recommended that she postpone conception until the disease has been stable or in remission for six months. Active disease at the time of conception and history of renal disease increase the likelihood of a poor pregnancy outcome.

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test?

6% The upper normal level of HbA1C is 6% of total hemoglobin.

A pregnant woman with diabetes is having her glycosylated hemoglobin 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?

6.5% A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. A glycosylated hemoglobin level of more than 8.0% indicates poor blood glucose control and the need for intervention, necessitating a revision in the woman's plan of care.

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?

8.5% 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 postpartum mother has the following lab data recorded: a negative rubella titer. What is the appropriate nursing intervention?

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

An alert, diabetic, pregnant woman in the hospital experiences some shakiness and diaphoresis with a fasting blood sugar of 60 mg/dL when she awakens in the morning. Which action should the nurse take first?

Administer the client's glucose tablets. The client is hypoglycemic when awakening in the morning. The nurse should provide glucose and be prepared to reassess. The nurse should not recheck at this point, since the client is symptomatic. She does not need insulin, and she will have her morning dose adjusted after breakfast.

A pregnant client is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. Which sign would indicate a positive test result?

An indurated wheal over 10 mm in diameter appears in 48 to 72 hours A positive PPD result would be an indurated wheal over 10 mm in diameter that appears in 48 to 72 hours. The area must be a raised wheal, not a flat, circumscribed area.

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?

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

A woman with cardiac disease is 32 weeks' gestation and alerts the nurse she has been having spells of light-headedness and dizziness every few days. The nurse provides which intervention as an option to the client?

Decrease activity and rest more often. If the client is developing symptoms associated with her heart condition, the first intervention is to monitor activity levels, decrease activity, and treat the symptoms. At 32 weeks' gestation, the suggestion to induce labor is not appropriate, and without knowledge of the type of heart condition one would not recommend increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity.

A nurse is documenting a dietary plan for a pregnant client with pregestational diabetes. What instruction should the nurse include in the dietary plan for this client?

Include complex carbohydrates in the diet. The nurse should stress the inclusion of complex carbohydrates in the diet in the dietary plan for a pregnant woman with pregestational diabetes. The pregnant client with pregestational diabetes need not include more dairy products in the diet, eat only two meals per day, or eat at least one egg per day; these have no impact on the client's condition.

A nurse caring for a pregnant client suspected substance use during pregnancy. What is the priority nursing intervention for this client?

Obtain a urine specimen for a drug screening. Substance use during pregnancy is associated with preterm labor, abortion, 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.

The nurse is caring for a 2-day-old newborn whose mother was diagnosed with cytomegalovirus during the first trimester. On which health care provider prescription should the nurse place the priority?

Perform a hearing screen test. Symptoms of CMV in the fetus and newborn, known as CMV inclusion disease, include hepatomegaly, thrombocytopenia, IUGR, jaundice, microcephaly, hearing loss, chorioretinitis, and intellectual disability. A hearing screen would be priority over monitoring growth and development because that will have to be done over an extended period of time. Urine and pulse are not important with this diagnosis.

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 for the nurse to give her regarding this?

Prednisone is considered safe in the doses prescribed by her care provider. 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. The nurse would not recommend changing the dosage of any medication prescribed by the woman's care provider. Nor would the nurse recommend that the woman stop taking the drug during pregnancy. These are decisions made between the woman and her care provider. The woman's need to control her asthma symptoms is not related to the fact that prednisone is teratogenic in animal models since it does not appear to be teratogenic in humans.

Which measure is recommended to prevent transmission of HIV to a newborn if the mother has AIDS?

Prepare for cesarean birth. When a client is HIV positive, the method of birth preferred is cesarean. This method has the lowest transmission rate for passage of the HIV infection to the infant. The nurse should educate the woman on the standard of care for birth in an HIV- or AIDS-positive mother. Avoiding scalp electrodes for internal fetal monitoring, admitting the infant to NICU, and performing an amniotomy are not recommended methods for preventing transmission of HIV to a newborn.

A nurse is caring for a pregnant client with sickle cell anemia. What should the nursing care for the client include? Select all that apply.

Teach the client meticulous handwashing. Assess hydration status of the client at each visit. Urge the client to drink 8 to 10 glasses of fluid daily. The nurse caring for a pregnant client with sickle cell anemia should teach the client meticulous hand-washing to prevent the risk of infection, assess the hydration status of the client at each visit, and urge the client to drink 8 to 10 glasses of fluid daily. The nurse need not assess serum electrolyte levels of the client at each visit or instruct the client to consume protein-rich food.

The clinic nurse teaches a pregestational type 1 diabetic client that constant insulin levels are very important in during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use:

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. The initial interview reveals that the client is accustomed to drinking coffee at regular intervals. For which increased risk should the nurse make the client aware?

anemia The nurse should make the client aware of increased risk of anemia as a possible effect of maternal coffee consumption during pregnancy, as it decreases iron absorption. Maternal coffee consumption during pregnancy does not increase the risk of heart disease, rickets, or scurvy

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?

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 of 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.

When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation (congestive heart failure), which include:

dyspnea, crackles, and irregular weak pulse. Signs of cardiac decompensation to congestive heart failure include crackles in the lungs from fluid, difficulty breathing, and weak pulse from heart exhaustion. The heart rate would not be regular, and a cough would not be dry. The heart rate would increase rather than decrease.

A woman at 38 weeks' gestation with a history of heroin abuse has given birth to a newborn several hours ago. The nurse assesses the newborn and determines that he is experiencing withdrawal based on which findings? Select all that apply

high-pitched shrill cry almost constant sneezing nasal stuffiness poor sucking reflex The most common harmful effect of heroin and other narcotics on newborns is withdrawal, or neonatal abstinence syndrome. This collection of symptoms may include irritability, hypertonicity, jitteriness, fever, excessive and often high-pitched cry, vomiting, diarrhea, feeding disturbances, respiratory distress, disturbed sleeping, excessive sneezing and yawning, nasal stuffiness, diaphoresis, fever, poor sucking, tremors, and seizures.

Which changes in pregnancy would the nurse identify as a contributing factor for arterial thrombosis, especially for the woman with atrial fibrillation?

hypercoagulable state The nurse should identify that the increased risk of arterial thrombosis in atrial fibrillation is due to hypercoagulable state of pregnancy. During pregnancy there is a state of hypercoagulation. This increases the risk of arterial thrombosis in clients having atrial fibrillation and artificial valves. Increased cardiac output and blood volume do not cause arterial thrombosis. Elevation of the diaphragm is due to the uterine distension, and it causes a shift in the QRS axis and is not a associated with arterial thrombosis.

When educating a client about pregestational diabetes on how to control blood sugar, the nurse knows there are three main facets to glycemic control. In addition to diet and exercise, which is a main facet?

insulin The three main facets to glycemic control for the woman with pregestational diabetes are diet, exercise, and insulin. Folic acid does not impact glycemic control. Glucose tablets are not a facet of glycemic control.

Which condition is the most common cause of anemia in pregnancy?

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

A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client?

knowledge of child development The nurse should address the client's knowledge of child development during assessment of the pregnant adolescent client. The nurse need not address the sexual development of the client or whether sex was consensual. This would not be an opportune time to discuss birth control methods to be used after the pregnancy.

Which change in insulin is most likely to occur in a woman during pregnancy?

less effective than normal Somatotropin released by the placenta makes insulin less effective. This is a safeguard against hypoglycemia.

The infant born to a woman with untreated tuberculosis (TB) is more likely to have which conditions? Select all that apply.

low Apgar score perinatal death postnatal TB underweight Pregnant women with untreated TB are more likely to have an underweight infant, an infant with a low Apgar score, and perinatal death (Mehta, Chen, Hardy, & Powrie, 2015). The newborn is at risk of postnatally acquired TB if the mother still has active TB at the time of birth.

When providing education to a teenage prenatal class, the nurse states that infants born to teenage mothers are more likely to have which outcome?

low-birth weight Infants born to adolescent mothers are more likely to have a low birth weight and poor outcomes and higher mortality rates when compared to infants of older mothers. Infants born to teenage mothers are not more likely to have genetic problems; they are more likely to be born preterm rather than postdate.

Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 124/86 mm Hg; week 20 - 138/90 mm Hg; week 24 - 140/92 mm Hg; and week 28 - 142/94 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure?

mild hypertensive 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. It has been classified as normotensive (systolic less than 120 mm Hg, diastolic less than 80 mm Hg); prehypertension (systolic 120 to 139 mm Hg, diastolic 80 to 89 mm Hg); mild hypertension (systolic 140 to 159 mm Hg, diastolic 90 to 99 mm Hg); and severe hypertension (systolic 160 mm Hg or higher, diastolic 100 mm Hg or higher).

A pregnant client has a history of asthma. After reveiwing the possible medications that may be prescribed during her pregnancy to control her asthma, the nurse determines additional teaching is needed when the client identifies which drug as being used?

misoprostol Three specific drugs recommended for use for controlling asthma during pregnancy are budesonide, albuterol, and salmeterol. Misoprostol is a prostaglandin that is used for treating postpartum hemorrhage but is contraindicated with asthma clients due to the risk of bronchial spasm and bronchoconstriction.

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?

persistent rales in the bases of the lungs The earliest warning sign of cardiac decompensation is persistent rales in the bases of the lungs.

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?

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.

The nurse is providing education to women who had diabetes prior to pregnancy. The nurse is discussing pregnancy-related complications from diabetes. Which factor is a potential complication?

polyhydramnios Polyhydramnios is an increase, or excess, in amniotic fluid and is a pregnancy-related complication associated with diabetes in pregnancy. An infant who is small for gestational age is not associated with a mother who had diabetes prior to pregnancy. Other pregnancy-related complications associated with pregestational DM include hypertensive disorders, preterm birth, and shoulder dystocia.

A nurse is conducting a teaching program for pregnant woman who are older than age 35. The nurse explains that although most women in their age group have healthy pregnancies and healthy newborns, they are at increased risk for possible complications. Which complications would the nurse include? Select all that apply

postpartum hemorrhage preterm labor preeclampsia Numerous studies have shown that increasing maternal age is a risk factor for infertility and spontaneous abortions, gestational diabetes, chronic hypertension, postpartum hemorrhage, preeclampsia, preterm labor and birth, multiple pregnancy, genetic disorders and chromosomal abnormalities, placenta previa, fetal growth restriction, low Apgar scores, and surgical births.

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client?

restricted sodium intake The client with peripartum cardiomyopathy should be prescribed 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 substance abuse during pregnancy. Complimentary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum not peripartum cardiomyopathy.

The nurse is providing care to a neonate whose mother abuses heroin. Which finding would the nurse expect to assess?

sneezing Newborns of mothers who abuse heroin or other narcotics display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

What is the role of the nurse during the preconception counseling of a pregnant client with chronic hypertension?

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

The nurse is caring for a pregnant client who is in her 30th week of gestation and has congenital heart disease. Which finding should the nurse recognize as a symptom of cardiac decompensation with this client?

swelling of the face Swelling of the face is a symptom of cardiac decompensation, along with moist, frequent cough and rapid respirations. Dry, rasping cough; slow, labored respiration; and an elevated temperature are not symptoms of cardiac decompensation.

A nurse is caring for a pregnant client who is human immunodeficiency virus (HIV) positive. What is a priority issue that the nurse should discuss with the client?

the need for the client to avoid breastfeeding The nurse should stress the avoidance of breastfeeding when counseling a pregnant client who is HIV positive. The client's relationship with the spouse, contact with the infant, and the plan for future pregnancies is not the highest priority at this time

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?

toxoplasmosis 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.