Chapter 20 PrepU

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

Correct response: 24 to 28 weeks Explanation: A woman identified as high risk for gestational diabetes would undergo rescreening between 24 and 28 weeks; however, some health care providers can choose to conduct this screening earlier.

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

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

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.

Correct response: She is at increased risk for type 2 diabetes mellitus after her baby is born. Explanation: The woman who develops GDM is at increased risk for developing type 2 diabetes mellitus after pregnancy.

A 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. Assess for shortness of breath. Assess for a moist cough. Assess for edema and note any pitting. Auscultate heart sounds for abnormalities. Monitor the client's hemoglobin and hematocrit.

Assess for shortness of breath. Assess for a moist cough. Assess for edema and note any pitting. Auscultate heart sounds for abnormalities. Explanation: 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 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 under 10 mm in diameter appears in 6 to 12 hours. An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. A flat, circumscribed area under 10 mm in diameter appears in 6 to 12 hours. A flat circumscribed area over 10 mm in diameter appears in 48 to 72 hours.

Correct response: An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. Explanation: 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.

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? limiting sodium intake inspecting the extremities for edema ensuring that the client consumes a high fiber diet assessing for cardiac decompensation

Correct response: assessing for cardiac decompensation Explanation: The nurse should assess the client with heart disease for cardiac decompensation, which is most common from 28 to 32 weeks' 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.

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."

Correct response: "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." Explanation: Elevated blood sugars delay the maturation of fetal lungs, not increase maturation time, resulting in potential respiratory distress in newborns born to diabetic mothers. Doing "kick counts", as the fetal movement monitoring is often called, is standard practice, as is the possibility of an amniocentesis to determine lung maturity during the third trimester. Health care personnel should also prepare the mother for the potential of a cesarean section delivery if the infant is too large.

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? "She already has AIDS. That's what being HIV positive means." "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." "HIV is transmitted at birth; having a cesarean birth prevented transmission." "HIV antibodies do not cross the placenta; this means the baby will develop AIDS."

Correct response: "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." Explanation: 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 is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize? regular heart rate and hypertension increased urinary output, tachycardia, and dry cough shortness of breath, bradycardia, and hypertension dyspnea, crackles, and irregular weak pulse

Correct response: dyspnea, crackles, and irregular weak pulse Explanation: The nurse should be alert for signs of cardiac decompensation due to congestive heart failure, which include crackles in the lungs from fluid, difficulty breathing, and weak pulse from heart exhaustion. The heart rate would not be regular, and a cough would not be dry. The heart rate would increase rather than decrease.

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client? monoamine oxidase inhibitors (MAOIs) methadone therapy restricted sodium intake ginger therapy

Correct response: restricted sodium intake Explanation: The client with peripartum cardiomyopathy should be prescribed a 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 a substance use disorder during pregnancy. Complementary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum, not peripartum cardiomyopathy.