Chapter 28: Care of the High-Risk Mother, Newborn, and Family with Special Needs

A pregnant patient who has type 2 diabetes (NIDDM) may require insulin. Why is the insulin necessary? a. The growing baby will require more glucose. b. Oral hypoglycemic agents may be teratogenic. c. Increased hormone levels raise blood glucose. d. Oral hypoglycemics do not reach the fetus.

b. Oral hypoglycemic agents may be teratogenic. Oral hypoglycemics are discontinued because of teratogenic effects. p. 898

The nurse is assessing the newborn and discovers a yellowing of the skin. What is true for jaundice that appears at birth? a. Within normal limits b. Pathologic c. A result of iron deficiency d. Indicating possible hepatitis

b. Pathologic Jaundice observed at birth is considered an indicator of a pathologic condition, erythroblastosis fetalis. It is considered abnormal. p. 912

What is a prominent feature of postpartum depression? a. Failure to thrive b. Rejection of the infant c. Inability to care for the baby d. Problems with the baby's father

b. Rejection of the infant A prominent feature of PPD is rejection of the infant. p. 916

Compared to older infants of comparable weight, how much higher is the morbidity and mortality rate for preterm infants? a. 1 to 2 times b. 2 to 3 times c. 3 to 4 times d. 4 to 5 times

c. 3 to 4 times The morbidity and mortality rate for preterm infants is higher by 3 to 4 times that of an older infant of similar weight. p. 908

Cognitive impairment, facial abnormalities, and growth retardation are characteristics of which abnormality in a fetus? a. Fetal dependency b. Fetal immaturity c. Malnutrition dependency d. Fetal alcohol syndrome

d. Fetal alcohol syndrome Use of alcohol may result in multiple anomalies called fetal alcohol syndrome. The fetus may also be born with alcohol dependency and immaturity, but the characteristics noted are specific for fetal alcohol syndrome. p. 915, Table 28-4

Following an abruptio placentae, the patient suddenly becomes dyspneic, complains of chest pain, and begins to ooze blood from her IV insertion site. The nurse assesses these as indicators of _____________ ______________ _________________.

disseminated intravascular coagulation (DIC) DIC is characterized by dyspnea, chest pain, and uncontrolled bleeding. p. 887

What is the antidote for magnesium sulfate toxicity? a. Vitamin K b. Calcium gluconate c. Potassium sulfate d. Calcium carbonate

b. Calcium gluconate The antidote for magnesium sulfate toxicity is calcium gluconate. p. 892, Box 28-4

What symptom, no matter what stage of pregnancy, should be reported immediately? a. Backache b. Urinary frequency c. Vaginal bleeding d. Uterine tightening

c. Vaginal bleeding Women should be instructed to contact their physician if any bleeding occurs during pregnancy. p. 884

The nurse reports to the charge nurse that the 3-hour postpartum patient is bleeding excessively as she has saturated one peripad in less than ______ minutes.

15 The saturation of one peripad within 15 minutes is considered to be excessive bleeding. p. 888

The nurse explains that severe preeclampsia needs to be controlled because it can develop into another syndrome called _________________.

HELLP (Hypertension, Elevated Liver enzymes, and Low Platelets) Progressive preeclampsia can develop into HELLP syndrome. p. 893

The newborn infant has oxygenation problems and a lack of subcutaneous fat. What should the nurse determine as the gestational age of this infant? a. 20 to 37 completed weeks of pregnancy b. 38 to 41 completed weeks of pregnancy c. 14 to 36 completed weeks of pregnancy d. 42 or more completed weeks of pregnancy

a. 20 to 37 completed weeks of pregnancy The lungs of preterm infants have not fully developed; therefore, they have problems with oxygenation. Preterm infants also lack subcutaneous fat. The gestational age of the preterm is classified as 20 to 37 complete weeks of pregnancy. p. 908

A patient with a history of rheumatic heart disease is being admitted to the labor and delivery unit. To prevent further stress on the heart, what should the nurse anticipate to be ordered? a. Oxygen administration b. Administering large amount of IV fluids c. Positioning the patient on her back d. Encouraging activity between contractions

a. Oxygen administration Oxygen is administered to increase blood oxygen saturation and decrease the stress on the heart. IV fluid administration is kept to a minimum to prevent fluid overload. The patient would be positioned in a semi-Fowler position to improve circulation. The patient should be encouraged to rest between contractions to conserve energy. p. 902

A pregnant patient with tuberculosis asks the nurse how the disease will affect her pregnancy and her newborn. What statements by the nurse are most appropriate? (Select all that apply.) a. "You have nothing to worry about. You will be disease free before you deliver." b. "The tuberculosis can be transmitted to the fetus in rare occurrences." c. "Your newborn will be tested for tuberculosis after delivery." d. "There is no approved treatment for the infant if she tests positive for the disease." e. "You will not be able to hold your newborn until you have been cleared according to the health department guidelines."

b. "The tuberculosis can be transmitted to the fetus in rare occurrences." c. "Your newborn will be tested for tuberculosis after delivery." e. "You will not be able to hold your newborn until you have been cleared according to the health department guidelines." TB can be transmitted to a fetus in the womb. Newborns of infected mothers are skin tested for TB after birth and treated if the skin test is positive. Mothers who have TB are not allowed to have exposure to their newborn until they have been cleared according to the health department standards. p. 897

What percent of first-trimester pregnancies spontaneously abort? a. 5% to 10% b. 10% to 15% c. 20% to 25% d. 40% to 50%

b. 10% to 15% It is estimated that 10% to 15% of first-trimester pregnancies end in spontaneous abortion. p. 882

A neonate is born with weak muscle tone, froglike extremities, and ears that fold easily. From these observations, what gestational age should the nurse give this infant? a. Full term b. Small for gestational age c. Preterm d. Post-term

c. Preterm Preterm infant posture is froglike, the muscle tone is weak, and the ears are easily folded. p. 909

What test is used to identify the maternal level of Rh antibodies in the mother's blood? a. Indirect Coombs test b. Hemolytic test c. Rh antibody test d. Direct Coombs test

a. Indirect Coombs test The indirect Coombs test measures the maternal level of antibodies. p. 912

The nurse is assessing a "kick count" for a patient with gestational hypertension. What result should be a cause for concern? a. Less than three kicks per hour b. Less than five kicks per hour c. Less than seven kicks per hour d. Less than nine kicks per hour

a. Less than three kicks per hour A kick count of fewer than three per hour is considered serious and a cause for concern. p. 891

The patient who has taken the ovulation stimulant clomiphene (Clomid), and who has been determined to be pregnant, calls the clinic nurse to report that she is bleeding and has passed a small grapelike object. From this information the nurse suspects a _________ ____________.

hydatidiform mole Hydatidiform moles occur frequently in people who have taken Clomid. The physical changes are similar to a real pregnancy until bleeding occurs and some grapelike clusters are passed. p. 880

A woman who is 14 weeks pregnant calls the clinic nurse to report that after a brief bleeding episode a week ago, her uterus seems to have gotten smaller, but her periods have not begun. The nurse assesses the indicators for a _____________ abortion.

missed A missed abortion is initiated by a bleeding episode in which the fetus is not expelled. The uterus begins to shrink, but periods do not resume. p. 882

Why do alcohol and illegal drugs endanger the fetus? a. Both are absorbed into the bloodstream. b. Both affect the mother. c. Both cross the placental barrier. d. Both increase the heart rate of the fetus.

c. Both cross the placental barrier. Alcohol and illicit drugs cross the placental barrier and affect the fetus. p. 914

What should the nurse hope to identify by keeping a record of a patient's blood pressure during prenatal visits? a. Ketoacidosis b. Placenta previa c. Gestational diabetes d. Gestational hypertension

d. Gestational hypertension Blood pressure should be assessed routinely during pregnancy, because symptoms of gestational hypertension include hypertension. p. 889

A pregnant woman visits a clinic visit during her 21st week of pregnancy. The nurse identifies edema, hypertension, and proteinuria. What condition does the nurse suspect? a. Allergy b. Protein deficiency c. Circulatory problem d. Gestational hypertension

d. Gestational hypertension Gestational hypertension (GH), formerly referred to as pregnancy-induced hypertension (PIH), is a disease encountered during pregnancy or early in the puerperium, characterized by increasing hypertension, proteinuria, and generalized edema. These signs generally appear after the 20th week of pregnancy. p. 889

What complication of delivery should the nurse expect with the birth of multiple fetuses? a. An ectopic tendency b. Difficulty with breastfeeding c. A vaginal delivery d. Loss of uterine tone

d. Loss of uterine tone Delivery of multiple fetuses is often complicated by loss of uterine tone. Oftentimes multiple fetuses are delivered by cesarean. An ectopic tendency would present before delivery. While it can be difficult to breastfeed multiple infants, this does not relate to the delivery. p. 879

A patient with hyperemesis gravidarum asks the nurse what would have happened if she had not come to the hospital. What result is the best response by the nurse? a. A large for gestational age infant b. Anorexia nervosa c. Preterm delivery d. Maternal or fetal death

d. Maternal or fetal death If untreated, hyperemesis gravidarum can result in maternal or fetal death. p. 879

A patient presents with symptoms of abruptio placentae. To facilitate uterine-placental perfusion, in what position would the nurse place the patient? a. Prone position b. Trendelenburg position c. Supine position d. Modified side-lying position

d. Modified side-lying position A modified side-lying position facilitates uterine-placental perfusion. p. 886

How should twins who share a placenta and come from one fertilized ovum be identified? a. Dizygotic b. Trizygotic c. Genetically different d. Monozygotic

d. Monozygotic Monozygotic twins, also known as identical twins, originate from one fertilized ovum and share a placenta. Monozygotic twins carry the same genetic code. Dizygotic twins are the result of two separate ova being fertilized at the same time. p. 879

A primigravida is Rh negative and her husband is Rh positive. She is concerned about the health of the fetus. The nurse explains that there is little danger to the fetus if it is Rh positive; however, the mother would become sensitized during delivery. If this were the case, the mother would produce what in subsequent pregnancies? a. Rh-negative blood cells b. Rh-positive blood cells c. Rh-negative antibodies d. Rh-positive antibodies

d. Rh-positive antibodies If the mother is exposed to the Rh antigen, Rh-positive antibodies will be produced after delivery of an Rh-positive baby. If the baby is Rh negative, no antibodies will be produced. p. 912

A 14-year-old pregnant adolescent arrives at the hospital in early labor. The nurse should recognize that the adolescent is at a greater risk for which problem? a. Calcium deficit b. Cephalopelvic disproportion c. Bleeding tendency d. Low hemoglobin levels

b. Cephalopelvic disproportion There are several physiological concerns for pregnant adolescents, including cephalopelvic disproportion. p. 903

When discussing toxoplasmosis infection during pregnancy, what should the nurse caution the patient to avoid? a. Contact with an infected person b. Emptying cat litter boxes bare-handed c. Having unprotected sex d. Eating excessive amounts of shellfish

b. Emptying cat litter boxes bare-handed A pregnant woman should wear gloves whenever having contact with cat feces as this is a possible source of toxoplasmosis infection. p. 895, Box 28-5

A patient is admitted to the hospital with hyperemesis gravidarum. The patient is malnourished and severely dehydrated. The care plan should be altered to include which interventions? a. Hyperalimentation b. IV fluids and electrolyte replacement c. Hormone replacement therapy d. Vitamin supplements

b. IV fluids and electrolyte replacement Medical treatment is aimed at meeting fluid and electrolyte replacement. p. 878

A nursery nurse is implementing phototherapy for a jaundiced infant. What is the purpose of the phototherapy? a. It is initiated when the bilirubin level reaches 5 mg/dL. b. It converts bilirubin to a water-soluble form to be excreted in the urine. c. It changes bilirubin to a bile salt to be excreted through the bowel. d. It requires eye patches to remain in place 24 hours a day.

b. It converts bilirubin to a water-soluble form to be excreted in the urine. Phototherapy converts the bilirubin into a water-soluble form to be excreted by the kidneys. It is initiated when the bilirubin level reaches 12 to 15 mg/dL. The eye patches are worn during therapy, but removed for feeding, bathing, and socialization. p. 913

What is a major complication of gestational diabetes that affects the infant? a. Lack of nutrition b. Dehydration c. Hypoglycemia d. Hyperglycemia

c. Hypoglycemia A result of gestational diabetes is neonatal hypoglycemia. p. 898

An infant born to a diabetic mother should be closely monitored for the presence of what condition? a. Hyperglycemia b. Hypercalcemia c. Hypoglycemia d. Cardiac abnormalities

c. Hypoglycemia The infant of a diabetic mother will frequently exhibit hypoglycemia, hypocalcemia, perinatal asphyxia, congenital abnormalities, and respiratory difficulties. p. 912

Why is the fetus dependent on the mother for glucose control? a. The insulin requirements are higher. b. Insulin is destroyed by the placenta. c. Insulin does not cross the placenta. d. Insulin is absorbed by the fetus.

c. Insulin does not cross the placenta. Insulin will not cross the placenta, but high glucose levels do. Therefore, it is imperative that the mother control glucose levels. p. 901

What is the usual treatment for severe postpartum depression? a. Improved nutrition b. Vitamin therapy c. Pharmacologic interventions d. Support group therapy

c. Pharmacologic interventions Support therapy is not enough for major PPD. Pharmacologic interventions are needed in most instances. p. 916

A patient in her second trimester of pregnancy arrives at the hospital complaining of bright red, painless vaginal bleeding. What condition should the nurse immediately suspect? a. Abruptio placentae b. Hemorrhage c. Placenta previa d. Placentitis

c. Placenta previa Placenta previa is a serious condition that consists of bright red painless vaginal bleeding occurring after 20 weeks of pregnancy. The major symptoms of abruptio placentae are severe abdominal pain and uterine rigidity. p. 884

The nurse assures a patient who has become sensitized to the Rh antigen that she can be protected for future pregnancies by receiving what injection? a. Iron b. Vitamin B12 c. RhoGAM d. Type O blood

c. RhoGAM RhoGAM prevents the development of naturally occurring maternal antibodies. p. 913

A patient is admitted to the hospital with signs of an ectopic pregnancy. What should the plan of care include for the patient? a. Long-term bed rest b. Episodes of extreme hypertension c. Surgery to remove the embryo/fetus d. Treatment for dehydration

c. Surgery to remove the embryo/fetus An ectopic implantation occurs somewhere outside the uterus and either resolves itself in a spontaneous abortion or requires surgical intervention. p. 881

What is the cause of gestational hypertension? a. Too much salt b. A toxin c. Unknown d. Diabetes

c. Unknown The cause of gestational hypertension is unknown. p. 889

When should the gestational age of the infant be determined? a. Within 5 to 10 minutes of delivery b. Within 1 to 2 hours of delivery c. Within 2 to 8 hours of delivery d. Within 12 to 24 hours of delivery

c. Within 2 to 8 hours of delivery The gestational age tests are done within 2 to 8 hours of delivery. p. 908

A pregnant woman comes to the hospital 3 weeks before her estimated date of birth (EDB) complaining of severe pain and a rigid abdomen. What should the nurse immediately suspect as the cause of the pain? a. Placenta previa b. Appendicitis c. Ectopic pregnancy d. Abruptio placentae

d. Abruptio placentae The major symptoms of abruptio placentae are severe pain and a rigid abdomen. Placenta previa consists of painless bleeding. Appendicitis is not usually accompanied by a rigid abdomen. Symptoms of an ectopic pregnancy would usually occur in the first trimester. p. 885

What should be specifically monitored in a patient who is hospitalized with gestational hypertension? a. Blood sugar b. Temperature c. Level of consciousness d. Deep tendon reflexes

d. Deep tendon reflexes If the patient is hospitalized for gestational hypertension, deep tendon reflexes are monitored. The blood sugar, temperature, and LOC will also be monitored, but they are not the priority in the hypertensive patient. p. 890