Chapter 16 PrepU 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 need to drink plenty of fluids to prevent constipation."

The nurse instructs a pregnant client with sickle cell anemia on ways to prevent a crisis. Which client statement indicates that teaching has been effective?

"I should drink eight glasses of water every day."

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.

"Try to avoid extreme temperatures." "Try to avoid large crowds." "Inspect your legs daily for the development of ulcers."

In which age range are women most vulnerable for intimate partner violence?

16-24 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?

85 mg/dl. Normal fasting blood sugar is 70-100

Which initial interview technique would be least effective in gathering information from a suspected abuse victim? You Selected:

Ask the client to strip down and show you where she has been hurt.

A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize?

IV fluids

The nurse is caring for a pregnant client with pregestational diabetes. Which goal does the nurse identify as priority during the client's pregnancy?

Maintain glycemic control.

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?

Orange juice

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 III

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman?

Hematocrit of 32% or less

The nurse is teaching a pregnant client with type 2 diabetes about diet during pregnancy. Which client statement indicates that the nurse's teaching was successful?

Pregnancy affects insulin production, so I will need to make adjustments in my diet.

A client who is 36 weeks pregnant has been taking phenytoin for a seizure disorder. Which supplement should the nurse anticipate being prescribed for this client?

vitamin k

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?

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

A client with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The client explains that she has been "eating for two" so the baby is healthy. How should the nurse respond to the client?

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

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?

24 to 28 weeks

The nurse is assessing a pregnant client who has a history of heart disease. The nurse will prioritize assessments focusing on the heart during which time frame?

28-32 weeks

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 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 develop any flu-like symptoms, notify your practitioner immediately to be evaluated for CMV.

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:

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

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 The insertion site of the insulin pump should be changed every 24 to 48 hours, not every 12 hours.

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?

dyspnea, crackles, and irregular weak pulse

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?

prednisone

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

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?

Observe the client taking her inhaler.

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 begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring."

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.

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.

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 little wheezy

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.

The maternal health nurse is caring for a pregnant client with iron-deficiency anemia who reports "extreme fatigue and shortness of breath" during a prenatal checkup at the outpatient clinic. The nurse prepares to educate the client regarding proper nutrition for this condition. Which dietary choice(s) will the nurse suggest? Select all that apply.

beef stew with potatoes and milk fortified dried cereal with milk and orange juice dark leafy green salad with sunflower seeds and water red beans and rice with cranberry juice

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?

folic acid deficiency anemia

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?

Check the infant's blood glucose level.

Which factor would contribute to a high-risk pregnancy?

type 1 diabetes

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."

A client 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 client's concern?

Asthma medication may reduce labor contractions and should be reduced.

A client with type 2 diabetes mellitus is planning to become pregnant within the next several months. What should the nurse instruct the client to support the 2020 National Health Goals of reducing the complications of pregnancy from diabetes?

Avoid episodes of hyperglycemia.

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.

A pregnant client is diagnosed with syphilis. Which response 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.

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 understand that my fetus and I are both are at risk for complications.

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?

Preparing for amniocentesis and fetal lung maturity assessment

A woman with known cardiac disease is in labor. In what position would the nurse place the client?

Semi-recumbent with a pillow under one hip

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 partner answers questions for the pregnant client.

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 clinic nurse teaches a client with pregestational type 1 diabetes that maintaining a constant insulin level is very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use:

insulin pump

A woman with epilepsy who is taking phenytoin sodium has just learned that she is pregnant. When planning this woman's care, which intervention would the nurse most likely include?

teaching about vitamin K during the last 4 weeks of pregnancy

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."

A nurse is teaching a prenatal client with class III heart failure the signs and symptoms which should be reported to the health care provider. The nurse determines the teaching has been effective when the client states which statement?

"I will call the clinic when I have a cough at night."

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?

1500

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?

8.5% A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. Therefore, the nurse would need to revise the plan of care.

A 38-year-old client comes into the office for prenatal care, stating that she is about 12 weeks' pregnant with her first child. What action will the nurse take, considering the client's age and potential sensitivity to being labeled an "older" primipara?

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

A client 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 client?

During weeks 28 and 32, blood volume peaks, and heart function can be affected.

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or during the birth for the infant. Which statement by the mother indicates that further teaching is needed by the nurse?

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

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?

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

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?

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.

A pregnant client has tested positive for HIV using an enzyme-linked immunoassay (ELISA) test. When talking with the client about the results, she asks, "So what happens next?" Which response by the nurse would be appropriate as the next step?

You will need to have another test to confirm the diagnosis.

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

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 abnormalities

Which medication would you expect to see prescribed for a pregnant woman with an artificial heart valve shortly before or during labor?

penicillin

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