Chapter 16: Pregnancy at Risk: Conditions that Complicate Pregnancy

A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron supplement. After teaching her about the prescribed iron supplement, which statement indicates successful teaching? "I should take my iron with milk." "I should avoid drinking orange juice." "I need to drink plenty of fluids to prevent constipation." "I will call the health care provider if my stool is black and tarry."

"I need to drink plenty of fluids to prevent constipation."

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful? "I'll basically follow the same diet that I was following before I became pregnant." "Because I need extra protein, I'll have to increase my intake of milk and meat." "Pregnancy affects insulin production, so I'll need to make adjustments in my diet." "I'll adjust my diet and insulin based on the results of my urine tests for glucose."

"Pregnancy affects insulin production, so I'll need to make adjustments in my diet."

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

24 to 28 weeks

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

8.5%

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? Changing the insertion site every 12 hours Choosing the lower abdomen for the insertion site Covering the pump insertion site with a piece of gauze Cleansing the insertion site daily

Changing the insertion site every 12 hours

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

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

A woman with an artificial mitral valve develops heart failure at the 20th week of pregnancy. Which measure would the nurse stress with her during the remainder of the pregnancy? obtaining enough rest maintaining a high fluid intake beginning a low-impact aerobics program discontinuing her prepregnancy anticoagulant

obtaining enough rest

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. Do not share food or drinks with young children, especially if they are in day care. 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 breastfeed your infant. 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 day care. If you develop any flu-like symptoms, notify your physician immediately to be evaluated for CMV.

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

avoidance of infection

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? ipratropium albuterol salmeterol prednisone

prednisone

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? "Actually, having uncontrolled asthma is much riskier for your baby than the medication." "In fact, most modern asthma medications are categorized as safe for use in pregnancy." "I'm glad to hear that you're focused on ensuring your baby's health." "Your health care provider will likely agree with your decision."

"Actually, having uncontrolled asthma is much riskier for your baby than the medication."

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

"I sometimes get a bit wheezy."

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? Scheduling the woman for induction of labor today. Allowing her to continue without plans for delivery. Scheduling a cesarean delivery at 39 weeks. Preparing for amniocentesis and fetal lung maturity assessment

Preparing for amniocentesis and fetal lung maturity assessment

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? Pregnant clients have high rates of noncompliance with maintenance medications Drug metabolism changes during pregnancy Most maintenance medications cannot be given in pregnancy The action of many medications vary in pregnancy

Drug metabolism changes during pregnancy

The nurse is caring for a pregnant client with pregestational diabetes. Which goal does the nurse identify as priority during the client's pregnancy? Ensure compliance of glucose monitoring Monitor for associated complications Maintain glycemic control Encourage minimal weight gain

Maintain glycemic control

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: vitamin K helps in keeping the placenta healthy. antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn. administration of vitamin K aids in lung maturity of the fetus. The antiepileptic medications can cause the mother's platelets to drop.

antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn.

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? can be used as long as they control serum glucose levels. can be taken until the degeneration of the placenta occurs. are usually suggested primarily for women who develop gestational diabetes. have been shown to be effective and safe in recent short term studies.

have been shown to be effective and safe in recent short term studies.

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

Eat a sustaining-carbohydrate snack.

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? "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." "If you get pregnant, you are likely to face many complications."

"Because of improved management, more women with cardiac problems can complete pregnancies successfully."

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 hasten the development of the fetus in utero." "Elevated blood glucose levels in the first trimester have been linked to congenital anomalies."

"Elevated blood glucose levels in the first trimester have been linked to congenital anomalies."

A pregnant client is diagnosed with syphilis. Which response would demonstrate respect for the client and therapeutic communication? "Why didn't you use protection when having intercourse with your partner?" "I am sure it is frightening to you to be diagnosed with a disease that can affect your baby." "I noticed that you seem fidgety. Is there something wrong besides your STI?" "You should have thought about what diseases you could be exposed to. At least you are HIV negative."

"I am sure it is frightening to you to be diagnosed with a disease that can affect your baby."

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? "I need to be aware of my triggers and avoid them as much as possible." "It is fine for me to use my albuterol inhaler if I begin to feel tight." "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."

A pregnant client with iron-deficiency anemia is prescribed an iron supplement. After teaching the woman about using the supplement, the nurse determines that more teaching is needed based on which client statement? "Taking the iron supplement with food will help with the side effects." "I will need to avoid coffee and tea when I take this supplement." "I will take the iron with milk instead of orange or grapefruit juice." "If I happen to miss a dose, I will take it as soon as I remember."

"I will take the iron with milk instead of orange or grapefruit juice."

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or at delivery for her baby. Which statement by the mother indicates that further teaching is needed by the nurse? "My baby may be very large and I may need a cesarean section to have him." "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day." "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born."

"If my blood sugars are elevated, my baby's lungs will mature faster, which is good."

A pregnant client with type 1 diabetes is in labor. The client's blood glucose levels are being monitored every hour and she has a prescription for an infusion of regular insulin as needed based on the client's blood glucose levels. Her levels are as follows: 1300: 105 mg/dL (5.83 mmol/L) 1400: 100 mg/dL (5.55 mmol/L) 1500: 120 mg/dL (6.66 mmol/L) 1600: 106 mg/dl (5.88 mmol/L) Based on the recorded blood glucose levels, at which time would the nurse likely administer the regular insulin infusion? 1300 1400 1500 1600

1500

In which age range are women most vulnerable for intimate partner violence? 16 to 24 years 25 to 34 years 35 to 44 years 45 years and older

16 to 24 years

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

85 mg/dl

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

A 3-hour glucose tolerance test for follow-up

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. The woman should increase her maintenance medications during labor. Adequate analgesia decreases the woman's risk for exacerbation during labor. The woman should receive her regularly scheduled bronchodilators during labor. Labor will exacerbate the woman's symptoms. 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.

Which initial interview technique would be least effective in gathering information from a suspected abuse victim? Ask open-ended, nonjudgmental questions of the client. 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 the client to strip down and show you where she has been hurt.

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 medication is teratogenic and should not be taken. Asthma improves during pregnancy so higher doses are not needed. Asthma medication may reduce labor contractions and should be reduced. Asthma medication is ineffective during pregnancy and should be stopped.

Asthma medication may reduce labor contractions and should be reduced.

The maternal health nurse is caring for a pregnant client with preexisting heart disease. Which concept will the nurse identify as priority? Balancing weight gain Restricting sodium intake Supplementing potassium intake Restricting exercise

Balancing weight gain

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? Inquire about any family history of chromosomal abnormalities since older women are more likely to have infants with a chromosomal defect. Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore. Offer genetic counseling and an early amniocentesis to determine if termination is needed. Ask the mother if she has any chronic illnesses that the doctor needs to know about due to her being older.

Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore.

A patient in the second trimester of pregnancy is diagnosed with cervical cancer. For which treatment should the nurse instruct the patient as causing the least harm to the developing fetus? Chemotherapy Chelation therapy Radiation therapy Anticoagulant therapy

Chemotherapy

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? 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. 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.

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 C during active labor Vitamin K in the last weeks of pregnancy Vitamin E in the second and third trimesters

High-dose folic acid before pregnancy Vitamin K in the last weeks of pregnancy

A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? antihypertensive drugs diuretic drugs IV fluids antibiotics

IV fluids

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. It is recommended that she wait 6 months after seizures are under control before getting pregnant. 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.

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. 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. Instruct the client on the need for weekly intravenous fluid therapy. Emphasize the importance of maintaining the medication regimen established before pregnancy.

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.

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

Pulmonary hypertension

A nurse is providing education to a woman at 28 weeks' gestation who has tested positive for gestational diabetes mellitus (GDM). What would be important for the nurse to include in the client teaching? She is at increased risk for type 2 diabetes mellitus after her baby is born. Her baby is at increased risk for neonatal diabetes mellitus. Her baby is at increased risk for type 1 diabetes mellitus. She is at increased risk for type 1 diabetes mellitus after her baby is born.

She is at increased risk for type 2 diabetes mellitus after her baby is born.

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.

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? Support her by respecting her right to privacy and confidentiality. Contact the mother of the adolescent to be sure the child gets prenatal care. 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. Recommend some adoption agencies for her to talk to in the near future.

Support her by respecting her right to privacy and confidentiality.

During a prenatal examination the nurse observes bruises on the client's arms and a black eye. When asked about the bruises, the client states, "It was an accident. My spouse just had a bad day at work, and I was late getting dinner prepared. But my spouse is being so kind now; my spouse brought me flowers yesterday. My spouse is looking for a new job, so it will not happen again." This client is in which phase of the cycle of violence? The honeymoon phase The resolution and reorganization phase The tension-building phase The acute explosion or incident phase

The honeymoon phase

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 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 The client asks questions of the nurse about her pregnancy.

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

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 D Vitamin E Vitamin K

Vitamin K

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

an insulin pump.

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? congenital anomalies incompetent cervix placenta previa placental abruption (abruptio placentae)

congenital anomalies

The nurse is caring for a pregnant woman with diabetes mellitus. Which potential fetal complications should the nurse monitor the client for as she presents for her scheduled visits? Select all that apply. congenital malformations macrosomia fetus with juvenile diabetes smaller than gestational age baby respiratory disorder

congenital malformations macrosomia respiratory disorder

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 chlamydia gonorrhea toxoplasmosis

cytomegalovirus

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

less effective than normal

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

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

Which factor would contribute to a high-risk pregnancy? blood type O positive first pregnancy at age 33 history of allergy to honey bee pollen type 1 diabetes

type 1 diabetes