Maternal 10
A nurse is aware that more teaching is necessary when a pregnant woman with gestational diabetes states A. "I will eat only three meals a day." B. "I will decrease my complex carbohydrates to 40% of my diet." C. "I can increase my fat intake slightly during the pregnancy." D. "I will not eat any sugary snacks until after the baby is born."
A. "I will eat only three meals a day." A pregnant woman with diabetes should divide her calorie intake among three meals and at least two snacks a day to keep her blood sugar levels consistent. Carbohydrate intake should be about 40% to 45%, fat intake can increase to 40%, and refined sugars should be eliminated from the diet
A pregnant woman can reduce her risk for toxoplasmosis by A. avoiding the handling of cat litter and soil and not handling or eating raw or uncooked meat B. practicing good genital hygiene. C. using safer sex methods, such as condoms, during intercourse. D. maintaining a nutritious diet during pregnancy
A. avoiding the handling of cat litter and soil and not handling or eating raw or uncooked meat Toxoplasmosis is a protozoal infection transmitted by handling or eating anything contaminated with infected cat feces or eating or handling raw or uncooked meat. Options b, c, and d are unrelated to the mode of transmission for toxoplasmosis. Toxoplasmosis is one of several infections that can cause severe congenital anomalies in the developing fetus. It is not sexually transmitted.
During the nursing assessment at a routine prenatal visit, the woman's blood pressure was significantly higher than at the last visit. Because of this finding, the nurse should A. check the urine for presence of protein B. check the pulse for significant decrease C. assess for pedal edema D. check the urine for presence of glucose
A. check the urine for presence of protein The two classic signs of preeclampsia are hypertension and proteinuria. Edema in the feet is common in most pregnancies. Edema with preeclampsia may continue up the legs to the hands and face.
A 5-month-pregnant woman has been diagnosed with iron-deficiency anemia. The nurse evaluates the patient teaching on diet to be effective when the woman selects which of the following meals to increase her iron intake? A. chicken with wild rice, steamed broccoli, sliced tomatoes, a green salad, and orange juice B. pinto beans with cornbread and milk C. broiled flounder, baked sweet potatoes, green beans, and iced tea D. refried beans with corn tortillas, Spanish rice, green salad, and coffee
A. chicken with wild rice, steamed broccoli, sliced tomatoes, a green salad, and orange juice Primary sources of iron are meat, fish, chicken, and green leafy vegetables. Foods rich in vitamin C will enhance the absorption of iron. Milk, tea, and coffee will decrease the absorption of iron.
Increased fetal surveillance should occur in the first trimester of a pregnant woman with preexisting diabetes mellitus to monitor for A. congenital anomalies B. signs of hypoxia C. evidence of placental failure D. signs of macrosomia
A. congenital anomalies There is an increased risk for congenital anomalies, so surveillance should begin early for women with preexisting diabetes. Testing should be done to identify possible neural tube defects, chromosomal abnormalities, and cardiac anomalies. The goal of increased surveillance in the last trimester is to monitor for signs of worsening intrauterine environment, such as signs of fetal hypoxia and evidence of placental failure.
Select all the signs and symptoms listed that may indicate hypovolemic shock. (Select all that apply.) A. fetal tachycardia B. maternal bradycardia C. decreased blood pressure D. cold and clammy skin E. increased urinary output
A. fetal tachycardia C. decreased blood pressure D. cold and clammy skin In hypovolemic shock (acute peripheral circulatory failure from loss of circulating blood), the body attempts to compensate for decreased blood volume and to maintain oxygenation of essential organs by increasing the rate and effort of the heart and lungs and by shunting blood from less essential organs, such as the skin and the extremities, to more essential organs such as the brain and the kidneys. This compensatory mechanism results in the following early signs and symptoms of hypovolemic shock: (1) fetal tachycardia (often the first sign of either maternal or fetal hypovolemia), (2) maternal tachycardia, weak peripheral pulses, (3) normal or slightly decreased blood pressure, (4) increased respiratory rate, (5) low oxygen saturation, and (6) cool, pale skin and mucous membranes
Which one(s) of the following women are at higher risk for an ectopic pregnancy? (Select all that apply.) A. history of pelvic infection B. had a tubal ligation 1 year ago C. history of hormonal implants for contraception 4 years ago D. conception was by assisted reproduction E. use of alcohol during the first 2 weeks of the pregnancy F. history of intrauterine contraceptive device G. had five therapeutic abortions
A. history of pelvic infection B. had a tubal ligation 1 year ago D. conception was by assisted reproduction F. history of intrauterine contraceptive device G. had five therapeutic abortions A common factor for the development of ectopic pregnancy in the fallopian tube is due to scarring of the fallopian tubes because of pelvic infection, inflammation, or surgery. A failed tubal ligation, even if performed many years ago, and a history of previous ectopic pregnancy also increase the risk for an ectopic pregnancy in the fallopian tube. Greater incidences of ectopic pregnancies occur in women who conceived with assisted reproduction, most likely related to the tubal factors that contributed to infertility. Contraception such as intrauterine contraceptive devices or low-dose progesterone agents is associated with increased risk of ectopic pregnancy. However, 40% or more of ectopic pregnancies occur in women with no identified risk factors.
A woman is admitted with a diagnosis of missed abortion. After taking her blood pressure, the nurse notices petechiae on the woman's arm where the cuff was located. The nurse's next action should be to A. notify the health care provider B. massage the arm C. monitor her blood pressure closely D. determine her temperature
A. notify the health care provider Two major complications of missed abortion are infection and disseminated intravascular coagulation (DIC). DIC may be manifested by small areas of hemorrhaging. The health care provider needs to be notified.
A pregnant woman should be taught that the first sign of a threatened abortion is usually A. vaginal bleeding B. uterine cramping C. rupture of membranes D. backache
A. vaginal bleeding The first sign of threatened abortion is vaginal bleeding, which is rather common during early pregnancy. 25% of pregnant women experience bleeding in early pregnancy and up to 50% of these pregnancies end in spontaneous abortion. The vaginal bleeding may be followed by uterine cramping and backache.
A woman is admitted to the maternity unit with preeclampsia. She is started on magnesium sulfate IV, a urinary catheter is inserted, and she is put on bed rest. The nurse understands it is important to monitor urinary output hourly. It is important that the patient have an hourly output of at least A. 15 mL B. 30 mL C. 60 mL D. 100 mL
B. 30 mL Normal renal profusion should be an hourly output of at least 30 mL. Decreased urinary output indicates poor perfusion of the kidneys and may precede acute renal failure.
A woman in labor has a long history of uncontrolled hypertension. The hypertension has continued throughout the pregnancy and labor. The nurse is aware that the woman is at high risk for which complication? A. placenta previa B. abruptio placentae C. hypotonic contractions D. DIC
B. abruptio placentae Risk factors for abruptio placentae include maternal hypertension. Vasoconstriction is an effect of hypertension that can affect the endometrial arteries.
A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often A. orthopnea B. decreasing energy level C. moist, frequent cough and frothy sputum D. crackles at bases of lungs upon auscultation
B. decreasing energy level Decreasing energy level (fatigue) is an early finding of heart failure, and care must be taken to recognize it as a warning rather than a typical change of the third trimester. Options a, c, and d are manifestations that appear later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema. Cardiac decompensation is most likely to occur early in the third trimester, during childbirth, and during the first 48 hours following birth.
Which pregnancy hormones are responsible for creating insulin resistance in maternal cells? (Select all that apply.) A. FSH (follicle- stimulating hormone) B. estrogen C. progesterone D. HPL (human placental lactogen) E. LH (luteinizing hormone) F. testosterone
B. estrogen C. progesterone D. HPL (human placental lactogen) During the second half of pregnancy, when fetal growth accelerates, levels of placental hormones rise sharply. These hormones, particularly estrogen, progesterone, and human placental lactogen (hPL), create resistance to insulin in maternal cells. This resistance allows an abundant supply of glucose to be available for the fetus. However, the hormones have a diabetogenic effect in that they may leave the woman with insufficient insulin and episodes of hyperglycemia.
A 20-week-pregnant patient attending her first prenatal visit tells the nurse at the maternity clinic that she has had vaginal bleeding and excessive nausea and vomiting for the past 3 days. The nurse assesses her blood pressure at 142/95 mm Hg, pulse 86 bpm, respirations 16 breaths per minute. When the nurse helps the patient onto the examining table, the abdomen looks larger than normal for a 20-week pregnancy. The nurse is aware that these are signs of A. ectopic pregnancy B. hydatidiform mole C. hyperemesis gravidarum D. preeclampsia
B. hydatidiform mole Signs and symptoms of a hydatidiform mole pregnancy include a uterus that is larger than expected, vaginal bleeding, excessive nausea and vomiting, and early development of preeclampsia.
The nurse is admitting a 37-week-pregnant woman with severe preeclampsia. When choosing a room for her, the nurse would put her in the A. first room near the elevator B. last room at the end of the hall, close to the nurses' station C. room next to the nursery D. room across from the visitors' lounge
B. last room at the end of the hall, close to the nurses' station The mother needs to be closely monitored. However, she also needs an area that is away from external stimuli and is quiet. All the other rooms would have visitors and noise associated with them.
Rh factor incompatibility can occur only in which one of the following situations? A. mother is Rh-positive, father is Rh-negative B. mother is Rh-negative, father is Rh-positive C. mother is Rh-negative, father is Rh-negative D. mother is Rh-positive, father is Rh-positive
B. mother is Rh-negative, father is Rh-positive Rh incompatibility during pregnancy is possible only when the mother is Rh-negative and the fetus is Rh-positive. For the fetus to be Rh-positive, the father must be Rh-positive. Rh-negative blood is an autosomal recessive trait and a person must inherit the same gene from both parents.
An 8-month-pregnant woman with gestational diabetes has been admitted to the antepartal unit of the hospital for fetal surveillance. The woman's blood sugar at 2 PM was 70 mg/dL. The nurse should A. record this reassuring blood sugar reading B. offer the woman 4 ounces of apple juice C. administer the appropriate amount of regular insulin needed for this blood sugar level according to the sliding scale ordered D. reassess the blood sugar reading in 30 minutes
B. offer the woman 4 ounces of apple juice Blood glucose levels should be maintained between 70 and 120 mg/dL; thus this woman is hypoglycemic. Hypoglycemia should be treated at once to prevent damage to the brain. The woman should take 15 g of carbohydrate, which is about ½ cup of fruit juice.
Although the cause of preeclampsia is not understood, there are several factors known to increase a woman's risk. Select all the following that are risk factors for preeclampsia. (Select all that apply.) A. underweight B. prepregnancy diabetes C. first baby D. women between the ages of 20 to 30 E. African American F. multifetal pregnancy G. family history
B. prepregnancy diabetes C. first baby E. African American F. multifetal pregnancy G. family history Many factors are known to increase the risk of preeclampsia: (1) first pregnancy, (2) men who fathered preeclamptic pregnancies are more likely to father further preeclamptic pregnancies, (3) age >35 years, (4) African-American descent, (5) history of thrombophilia such as hyperhomocysteinemia (elevated levels of homocysteine which increase the risk of developing clots, heart attack, and stroke), Factor V Leiden; or Protein C and Protein S deficiencies, (6) in vitro fertilization, (7) family or personal history of preeclampsia, (8) chronic hypertension or preexisting vascular or renal disease, (9) obesity, (10) diabetes mellitus, (11) metabolic syndrome, (12) antiphospholipid syndrome, (13) Systemic Lupus Erythematosus, and (14) multifetal pregnancy.
A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment will be evaluated as successful if A. blood pressure is reduced to prepregnant baseline B. seizures do not occur C. deep tendon reflexes become hypotonic D. diuresis reduces fluid retention
B. seizures do not occur Magnesium sulfate is a CNS depressant given primarily to prevent seizures. A temporary decrease in blood pressure can occur, but is not the purpose for giving the medication. Hypotonia is a sign of an excessive serum level of magnesium, as is depression of respiratory activity. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not a priority outcome of magnesium sulfate administration.
A woman has just been admitted to the maternity unit with a diagnosis of incomplete abortion. The physician has written the following orders: (1) NPO(2) Type and crossmatch for two units of blood. (3) Start intravenous line and run Ringer's lactate at 150 mL/hour. (4) Administer Pitocin, 10 units intramuscular. (5) Acetaminophen and codeine (Tylenol with Codeine #3), every 3 to 4 hours as needed for pain. (6) Bed rest with bathroom privileges. Which order should the nurse carry out first for this patient? A. inform her of the NPO and bed rest order B. start the IV and draw blood to send for the type and crossmatch C. administer the pain medication D. take time to listen to the patient about her feelings concerning the abortion
B. start the IV and draw blood to send for the type and crossmatch Initial treatment of an incomplete abortion should focus on stabilizing the woman cardiovascularly. She may have lost blood or is at high risk for blood loss, so it is important to have her typed and crossmatched for replacement blood. The IV will help with fluid replacement. The pitocin will help with uterine contractions to expel the products of conception. Options A, C, and D are also important but the IV takes priority.
A 32-week-pregnant woman calls the prenatal clinic complaining of bleeding without pain or contractions. The nurse should A. tell her to rest for a couple of hours and call back if it does not stop B. tell her to go to the hospital to be evaluated C. make her an appointment for the next morning D. have her assess fetal movement for 30 minutes
B. tell her to go to the hospital to be evaluated Signs of placenta previa are painless bleeding after 20 weeks of gestation. Active bleeding can occur; therefore she needs to be evaluated.
A woman with a preexisting cardiac disease who is 7 months pregnant has been treated with restriction of activities and sodium intake. During a clinic visit, the woman complains of increased shortness of breath and fatigue. The nurse is aware that the next line of treatment for this woman may be A. anticoagulant therapy with warfarin (Coumadin) B. complete bed rest C. diuretic therapy D. hospitalization
C. diuretic therapy Diuretics may be needed when congestive heart failure is uncontrolled by restriction of activity and sodium intake.
When doing a chart review of a patient with preeclampsia, the nurse noted that the patient was assessed with +3 edema. This indicates A. minimal edema of the lower extremities B. marked edema of lower extremities C. edema of lower extremities, face, hands, and sacral area D. generalized massive edema that includes ascites
C. edema of lower extremities, face, hands, and sacral area The +3 assessment of edema indicates edema of the lower extremities, face, hands, and sacral area. Option a indicates a +1 grade, option b indicates a +2 grade, and option d indicates a +4 grade.
A woman has come to the clinic for a preconception visit. It is important to teach this woman to increase her intake of which vitamin prior to conception? A. vitamin c B. vitamin b12 C. folic acid D. niacin
C. folic acid There is an association between folic acid deficiency and neural tube defects. Therefore it is recommended that all women of childbearing age take 400 mcg of folic acid (pregnancy amounts) daily to reduce this risk.
During pregnancy a woman has an indirect Coombs test done. The nurse can teach her that this test will show A. her Rh factor B. her previous exposure to certain viral infections C. her previous exposure to Rh-positive blood D. her blood type
C. her previous exposure to Rh-positive blood Rh-negative women should have an indirect Coombs test to determine whether they are sensitized (have developed antibodies) as a result of previous exposure to Rh-positive blood.
During labor, a woman suddenly complains of increasing pain, and the electronic monitor shows no uterine activity. The abdomen is boardlike and tender and the fetal heart shows late decelerations. The nurse should A. turn the mother to her side and continue to monitor the fetal heart rate B. assess the mother's blood pressure, temperature, pulse, and respirations C. notify the health care provider D. anticipate that the woman has moved into the second stage of labor
C. notify the health care provider With abruptio placentae, the uterus may become exceedingly firm and tender. Because of decreased blood flow, the fetus will show signs of hypoxia. An immediate cesarean birth may be necessary; therefore the health care provider should be notified.
A woman with gestational diabetes is at 36 weeks' gestation. On the regular antepartal visit, the woman tells the nurse, "I am so excited. My blood sugars have gone down and I have been able to decrease the amount of insulin I need by about half." The nurse should be aware that this is an indication of a A. diabetic in good glycemic control B. fetal problem that needs further investigation C. placental problem that needs further investigation D. maternal pancreas that is increasing its insulin production
C. placental problem that needs further investigation Insulin needs should increase markedly during the second and third trimesters when placental hormones reach their peak. The placental hormones initiate maternal resistance to the effects of insulin. If insulin needs decrease, it is a sign that the placental production of the hormones has decreased and the placenta may be failing.
Signs of a threatened abortion are noted in a woman at 8 weeks of gestation. Which one of the following actions is an appropriate management approach for this type of abortion? A. prepare the woman for a dilation and curettage (D&C) B. place the woman on bed rest for at least 1 week and reevaluate C. prepare the woman for an ultrasound to determine the integrity of the gestational sac D. comfort the woman by telling her that if she loses this baby, she can try to get pregnant again in about 1 month
C. prepare the woman for an ultrasound to determine the integrity of the gestational sac It is important to determine whether the gestational sac is intact. A D&C is not considered until signs of progress to inevitable abortion are noted or the contents expelled are incomplete. Bed rest is not recommended for this woman, just a decrease in activities. Telling the woman she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy. If the pregnancy is lost, she should be guided through the grieving process.
A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. The primary goal of her treatment at this time would be to A. rest the gastrointestinal tract by restricting all oral intake for 48 hours B. reduce emotional stress by encouraging the woman to discuss her feelings C. reverse fluid, electrolyte, and acid-base imbalances that are present D. restore the woman's ability to take and retain oral fluid and foods
C. reverse fluid, electrolyte, and acid-base imbalances that are present Fluid, electrolyte, and acid-base imbalances present the greatest immediate danger to the well-being of the maternal-fetal unit. Options a, b, and d are all components of treatment but do not represent immediate care for patients with hyperemesis gravidarum.
A woman has just had a spontaneous abortion. She asks the nurse, "Why did this happen?" The nurse is aware that the most common cause of spontaneous abortion is A. improper maternal nutrition B. caffeine use in the early pregnancy C. severe congenital abnormalities D. improper implantation
C. severe congenital abnormalities Chromosomal abnormalities account for about 50% to 60% of early spontaneous abortions. Other possible causes are various types of infections and maternal disorders.
A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this patient should know that A. oral hypoglycemic agents are the preferred choice to control an elevated blood sugar level B. dietary modifications and insulin are both required for adequate treatment C. glucose levels are monitored by testing urine four times a day and at bedtime D. dietary management involves distributing nutrient requirements over three meals and two or three snacks
D. dietary management involves distributing nutrient requirements over three meals and two or three snacks Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Insulin is the preferred medication to use, if needed, because it does not cross the placenta. Oral hypoglycemic agents can be harmful to the fetus and are less effective than insulin in achieving tight glucose control. In some women, gestational diabetes can be controlled with dietary modifications alone. Blood, not the urine glucose level, is monitored several times a day. Urine is tested for ketone content; results should be negative.
Which one of the following new pregnant patients should the nurse monitor more closely for signs of gestational diabetes mellitus? A. gravida 2 with a body mass index of 22 B. gravida 1 who is 24 years old C. gravida 3 whose previous children weighed 6 lb, 4 oz and 7 lb, 5 oz at birth D. gravida 2 who is pregnant with triplets
D. gravida 2 who is pregnant with triplets A woman with a multifetal pregnancy is at risk for developing gestational diabetes. Greatly increased circulating HPL (human placental lactogen) levels as a result of extra placental tissue require a greater maternal insulin production. Women with a body mass index greater than 25, older than the age of 25, or have given birth to infants weighing more than 4000 g are also at risk.
When teaching a diabetic pregnant woman to give herself insulin injections, the nurse should emphasize that A. a meal should be eaten before insulin injections B. the angle of the subcutaneous injection should be 45 degrees C. once the needle is injected, the woman should aspirate before injecting the medication D. the medication should be injected slowly
D. the medication should be injected slowly Insulin should be injected slowly (over 2 to 4 seconds) to allow tissue expansion and minimize pressure, which can cause insulin leakage. A meal should be eaten within 30 minutes after insulin is injected. The angle of the injection should be 90 degrees unless the woman is very thin. It is not necessary to aspirate when injecting into subcutaneous tissues.
The acronym for hemolysis, elevated liver enzyme levels, and low platelets that describes a life-threatening occurrence during pregnancy is
HELLP
When a pregnant woman progresses from preeclampsia to generalized seizures that cannot be attributed to other causes, it is called
eclampsia
The loss of the pregnancy before the fetus is viable or capable of living outside the uterus is termed a(n)
abortion
When the membranes rupture and the cervix dilates, an abortion is usually
inevitable
A condition in which hypertension develops during the last half of pregnancy in a woman who previously had normal blood pressure is called
preeclampsia
In an HIV-positive pregnancy, multiple antiviral drugs will be given, with the primary drug being
zidovudine (also known as ZDV)
