Chapter 20: nursing management of the pregnancy at risk

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

The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement?

Orange juice

The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement?

orange juice

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

restricted sodium intake

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

Which factor would contribute to a high-risk pregnancy?

type 1 diabetes

A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. Which of the following does the nurse anticipate in this woman's pregnancy?

Potential for greater than usual back pain

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%

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."

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 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."

After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching?

"I need to eat foods high in fiber."

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."

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 both are at risk for complications."

A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse?

"I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet."

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."

A pregnant woman determined to be at high risk for gestation diabetes is undergoing a 1 hours glucose challenge test. The nurse schedules the client for a 3-hours glucose tolerance test based on which result?

- 146 mg/dl rationale: any blood glucose level over 140 with a 1 hour glucose challenge test is considered abnormal and warrant follow up testing with a 3 hours glucose tolerance test.

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

- 24-28 WEEKS RATIONALE: A woman identified as high risk would undergo rescreening

A pregnant woman with diabetes is having a glycosylated hemoglobin (HbA1C) level drawn. Which result would require the nurse to revise the clients plan of care?

- 8.5% -rationale: a HbA1C level of more than 8% indicates poor control and the need for intervention.

Pregnant woman with chronic HTN comes to the clinic for evaluation. The last several blood pressure readings were gradually increasing. On today's visit her BP is 166/100 mm hg. The health care provider prescribes an antihypertensive agent.

- Methyldopa is the most commonly prescribed agent

COMPLICATIONS ASSOCIATED WITH SMOKING DURING PREGNANCY?

- Spontaneous abortion -maternal HTN -Abruptio placenta

Sign and symptoms of sickle cell crisis:

- fever -joint pain severe abdominal pain, muscle spasm

Foods high in IRON:

-Peanut butter -Rasins - broccoli - whole grains, green leafy vegetables

A pregnant client, postive for hepatitis B virus, her infant should be vaccinated with an initial HBV vaccine dose at which time?

-Within 12 hours of birth the second dose will be given at 1 month and 3rd at 6 months

A woman with diabetes is in labor. To promote optimal outcomes for the mother and neonate, the nurse monitors the client's blood glucose level closely ensuring that it is maintained below which level?

110mg/dl

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? A. blindness B. neonatal laryngeal papillomas C.deafness D. chicken pox

A R: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 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? A. hyperglycemia B. birth trauma C. hypoglycemia D. macrosomia

A R: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 diabetes is in labor. To reduce the likelihood of neonatal hypoglycemia, the nurse monitors the client's blood glucose level closely with the goal to maintain which level? A. below 110 mg/dL B. below 115 mg/dL C. below 105 mg/dL D. below 120 mg/dL

A R: For the laboring woman with diabetes, the blood glucose levels are monitored every 1 to 2 hours with the goal to maintain the levels below 110 mg/dL throughout the labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level.

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? A. Provide the client some milk to drink. B. Withhold her insulin, and notify the health care provider. C. Stay with her, and ask another nurse to bring her insulin. D. Recheck her blood sugar for accuracy.

A R: 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.

What criteria would the physician base his decision on to begin insulin therapy for a gestational diabetic mother?

A 2-hour postprandial glucose level cannot be kept below 120 mg/dL.

HbA1C levels

A glycosylated hemoglobin level of less than 7% indicates good control

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. A. Do not share food or drinks with young children, especially if they are in daycare. B. If you develop any flu-like symptoms, notify your physician immediately to be evaluated for CMV. C. Wash your hands thoroughly with soap and water after touching saliva or urine. D. If you have CMV, it is suggested that you not breast-feed your infant. E. If you contract CMV, your doctor will give you some oral medicine to treat it.

A,B,C R: 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.

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. A. Plan periods of rest into the workday. B. Receive pneumococcal and influenza vaccines. Continue taking the scheduled warfarin. C. Let the physician know if you become short of breath or have a nighttime cough. D. Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus.

A,B,C R: 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 pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply. A. previous large for gestational age (LGA) infant B. hypertension C. maternal age less than 18 years D. obesity E. genitourinary tract abnormalities

A,B,D R: 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.

The nurse is caring for a pregnant client who indicates that she is fond of meat, works with children, and has a pet cat. Which instructions should the nurse give this client to prevent toxoplasmosis? Select all that apply. A. Eat meat cooked to 160° F (71° C). B. Avoid cleaning the cat's litter box. C. Avoid contact with children when they have a cold. D. Avoid outdoor activities such as gardening. E. Keep the cat outdoors at all times.

A,B,D R:To minimize risk of toxoplasmosis, the nurse should instruct the client to eat meat that has been cooked to an internal temperature of 160° F (71° C) throughout and to avoid cleaning the cat's litter box or performing activities such as gardening. Avoiding children with colds is unreasonable when working with children, and contact with children with colds is not a cause of toxoplasmosis. The cat should be kept indoors to prevent it from hunting and eating birds or rodents.

The nurse is educating a client with type 1 diabetes about the complications associated with diabetes and pregnancy. Which problems would the nurse include in her teaching? Select all that apply. A. Decreased birth weight B. Polyhydramnios C. Increased risk of spontaneous abortion D. Hypertension E. Cystic fibrosis

A,B,D R:Women with pregestational diabetes, which is type 1 diabetes, are at a higher risk of having an infant with complications during the pregnancy and at delivery. Spontaneous abortion is higher in women who have pregestational diabetes. Also, they run a higher risk of having a pregnancy with polyhydramnios, and of developing maternal hypertension. The birth weight of an infant born to a mother with diabetes is increased, not decreased. Cystic fibrosis is not associated with maternal diabetes.

A woman who immigrated here from a third world country presents to the clinic to find out if she is pregnant. Which signs and/or symptoms would the nurse assess as possible indicators that she might have an active case of tuberculosis as well? Select all that apply. A. anorexia B. hemoptysis C. weight gain D. night sweats E. fatigue

A,B,D,E R: Women emigrating from developing countries are at high risk for tuberculosis. Clinical manifestations include fatigue, fever or night sweats, nonproductive cough, weakness, slow weight loss, anemia, hemoptysis, and anorexia.

A nurse is caring for a client with cardiovascular disease who has just given birth. What nursing interventions should the nurse perform when caring for this client? Select all that apply. A. Assess for shortness of breath. B. Assess for edema and note any pitting. C. Monitor the client's hemoglobin and hematocrit. D. Auscultate heart sounds for abnormalities. E. Assess for a moist cough.

A,B,D,E R: The nurse should assess for possible fluid overload in a client with cardiovascular disease who has just given birth. Signs of fluid overload in the client who has just labored include cough, progressive dyspnea, edema, palpitations, and crackles in the lung bases. Hemoglobin and hematocrit levels are not affected by laboring of the client with cardiovascular disease.

A nurse is assessing a newborn and suspects that the mother may have abused alcohol during her pregnancy. The nurse suspect this based on which newborn findings? Select all that apply. A. small head circumference B. thin upper lip C. large inset eyes D. macrocephaly E. limb abnormality

A,B,E R: Characteristics of FASD include craniofacial dysmorphia (thin upper lip, small head circumference, and small eyes), IUGR, microcephaly, and congenital anomalies such as limb abnormalities and cardiac defects.

A nurse is conducting a class for a group of pregnant women about the risk of substance use during pregnancy. When discussing the effects of nicotine on a pregnancy, which complications would the nurse include? Select all that apply. A. premature rupture of membranes B. ectopic pregnancy C. macrosomia D. placenta previa E. spontaneous abortion

A,D,E R: Smoking increases the risk of spontaneous abortion, tubal ectopic pregnancy, preterm labor and birth, fetal growth restriction, stillbirth, premature rupture of membranes, low fetal iron stores, maternal hypertension, placenta previa, and abruptio placentae.

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 considered safe in the doses prescribed by her care provider.

The maternal health nurse is caring for a 32-year-old client with Marfan syndrome who presents to the outpatient clinic to discuss her desire to become pregnant. Which statement is true regarding this client's condition and pregnancy?

Pregnancy is often contraindicated.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? A. Hemoglobin of 13 or lower B. Heart rate of 84 C. Hematocrit of 32% or less D. Blood pressure of 100/68

C R:Iron-deficiency anemia is diagnosed in a pregnant woman if the hematocrit is less that 33% or the hemoglobin is less than 11 g/dL. Tachycardia, hypotension and tachypnea are all symptoms of iron-deficiency anemia but are not diagnostic criteria.

The nurse is preparing information for a client who has just been diagnosed with gestational diabetes. Which instruction should the nurse prioritize in this information?

Maintain a daily blood glucose log

What important instruction should the nurse give a pregnant client with tuberculosis?

Maintain adequate hydration.

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.

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

A nurse is assessing a client in her seventh month of pregnancy who has an artificial valve prosthesis. The client is taking an oral anticoagulant to prevent the formation of clots at the valve site. Which of the following nursing interventions is most appropriate in this situation?

Observe the client for signs of petechiae and premature separation of the placenta

The nurse is providing care to a neonate whose mother abuses heroin. Which finding would the nurse expect to assess? A. easy consolability B. sneezing C. vigorous sucking D. hypotonicity

B

What criteria would the physician base his decision on to begin insulin therapy for a gestational diabetic mother? A. Urine is 2+ for glucose and serum blood glucose is 120. B. A 2-hour postprandial glucose level cannot be kept below 120 mg/dL. C. Weight gain is over 30 pounds (13.6 kg) and blood sugars are fluctuating between 95 and 130 throughout the day. D. Client cannot keep fasting blood sugar lower than 90 mg/dL.

B R: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.

A woman with diabetes is in labor. To reduce the likelihood of neonatal hypoglycemia, the nurse monitors the client's blood glucose level closely with the goal to maintain which level? A. below 105 mg/dL B. below 110 mg/dL C. below 120 mg/dL D. below 115 mg/dL

B R: For the laboring woman with diabetes, the blood glucose levels are monitored every 1 to 2 hours with the goal to maintain the levels below 110 mg/dL throughout the labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level.

The nurse is teaching a pregnant woman with iron deficiency anemia about foods high in iron. Which foods if selected by the woman indicate a successful teaching program? Select all that apply. A. potatoes B. broccoli C. peanut butter D. corn E. yogurt F. raisins

B,C,F R:Foods high in iron include dried fruits such as raisins, whole grains, green leafy vegetables such as broccoli and spinach, peanut butter, and iron-fortified cereals. Potatoes and corn are high in carbohydrates. Yogurt is a good source of calcium.

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?

Be non-judgmental in your history gathering and offer her pregnancy resources to read and explore.

A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse?

Both parents have to carry the trait.

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. A. Since fortified cereals are a poor source of iron, eat eggs or pancakes for breakfast. B. Limit intake of dried fruits, eating only fresh fruit. C. Drink orange juice with the iron supplement. D. Cook food in an iron skillet, if possible. E. Increase intake of dried beans and green leafy vegetables.

C,D,E R: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.

During a routine prenatal check up, the nurse interviews a pregnant client to identify possible risk factors for developing gestational diabetes. Which factor would the nurse identify as increasing the woman's risk? Select all that apply. A. younger maternal age at pregnancy B. previous birth of small for gestational age baby C. maternal obesity with body mass index more than 35 D. client of African-American lineage E. previous history of spontaneous abortion

C,E R:The risk factors for gestational diabetes include previous history of spontaneous abortion, maternal obesity with body mass index (BMI) more than 35, and client of a high-risk ethnic group such as Native American, Hispanic, Asian. The other risk factors for gestational diabetes are previous history of stillbirth, birth of large for gestational age infant, and advancing maternal age.

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 nurse is assessing a 35-year-old woman at 22 weeks' gestation who has had recent laboratory work. The nurse notes fasting blood glucose 146 mg/dl (8.10 mmol/L), hemoglobin 13 g/dl (130 g/L), and hematocrit 37% (0.37). Based on these results, which instruction should the nurse prioritize?

Check blood sugar levels daily.

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.

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? A. warfarin B. digoxin C. aspirin D. heparin

D R: 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.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? A. Blood pressure of 100/68 B. Heart rate of 84 C.Hemoglobin of 13 or lower D. Hematocrit of 32% or less

D R: Iron-deficiency anemia is diagnosed in a pregnant woman if the hematocrit is less that 33% or the hemoglobin is less than 11 g/dL. Tachycardia, hypotension and tachypnea are all symptoms of iron-deficiency anemia but are not diagnostic criteria.

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

D R: 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.

A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize?

Decrease activity and rest more often.

A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control?

Exercise

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 Vitamin K in the last weeks of pregnancy

The nurse is educating a client with type 1 diabetes about the complications associated with diabetes and pregnancy. Which problems would the nurse include in her teaching? Select all that apply.

Increased risk of spontaneous abortion Polyhydramnios Hypertension

The nurse is assessing a mother who just delivered a 7 lb (3136 g) baby via cesarean delivery. Which assessment finding should the nurse prioritize if the mother has a history of controlled atrial fibrillation?

Jugular distention

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 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.

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.

A nurse working at the local health district clinic assists numerous adolescents who become pregnant. Which factor will the nurse point out to each teen is crucial for a positive pregnancy outcome?

Support network

A client in her 20th week of gestation develops HELLP syndrome. Which of the following should the nurse consider as features of HELLP syndrome? Select all that apply. a) Elevated liver enzymes) Low platelet count) Hemolysise)

a) Elevated liver enzymesc) Low platelet count) Hemolysis Rationale:The HELLP syndrome is a syndrome involving hemolysis (microangiopathic hemolytic anemia), elevated liver enzymes, and a low platelet count. Hyperthermia and leukocytosis are not features of HELLP syndrome.

A woman who is 8 months' pregnant comes to the clinic with urinary frequency and pain on urination. The client is diagnosed with a urinary tract infection (UTI). Which medication would the nurse anticipate the physician will prescribe?

amoxicillin

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 pump.

A pregnant woman with a history of mitral stenosis is to be prescribed medication as treatment. Which of the following medication classes would the nurse expect the patient to begin taking?

anticoagulant

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.

A nurse is client teaching with 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 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 client with type I diabetes asks the nurse about how to best control her blood sugar while she is pregnant. The best reply would be for the woman to:

check her blood sugars frequently and adjust insulin accordingly.

A nurse studying high-risk pregnancies correctly identifies which of the following as causes for such a label? (Select all that apply.)

concurrent disorder pregnancy-related complication external factor that jeopardizes both the health of the woman and fetus external factor that jeopardizes the health of the woman or the fetus

A nurse is conducting a class for pregnant women with diabetes. Which factor would the nurse emphasize as being most important in helping to reduce the maternal/fetal/neonatal complications associated with pregnancy and diabetes?

degree of glycemic control achieved during the pregnancy

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?

diet

During a prenatal visit, the physician determines that the fetal heart beat is too fast. What drug would the nurse expect the physician to order for the mother to treat the fetal tachycardia?

digoxin

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 G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control?

exercise

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?

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

In women with cardiac failure, the maternal blood pressure becomes insufficient to provide an adequate supply of blood to the placenta. The infant will likely experience some undesired effects, including which of the following?

low birth weight

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

low-birth-weight

A pregnant client has developed iron-deficiency anemia and has been prescribed 200 mg of elemental iron per day. The nurse should encourage the client to take this medication with which substance?

orange juice

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