Maternal-Newborn ch 19 conditions existing before conception

A woman with a history of systemic lupus erythematosus comes to the clinic for evaluation. The woman tells the nurse that she and her partner would like to have a baby but that they are afraid her lupus will be a problem. Which response would be most appropriate for the nurse to make? "It's probably not a good idea for you to get pregnant since you have lupus." "Be sure that your lupus is stable or in remission for 6 months before getting pregnant." "Your lupus will not have any effect on your pregnancy whatsoever." "If you get pregnant, we'll have to add quite a few medications to your normal treatment plan.

"Be sure that your lupus is stable or in remission for 6 months before getting pregnant."

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 be aware of my triggers and avoid them as much as possible." "It is fine for me to use my albuterol inhaler if I begin to feel tight." "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on."

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

When evaluating fetal well-being, what is the maximum score on a biophysical profile?

10

A nurse should instruct a client who has a very low sperm count to make which lifestyle modification? Have intercourse every other day. Have intercourse only once a month. Abstain from intercourse for 8 days at a time. Abstain from intercourse for 15 days at a time.

Abstain from intercourse for 8 days at a time

Charlene McCoy, who has several children already, reports for a first prenatal visit. She seems preoccupied and withdrawn, and she makes consistently negative remarks about the pregnancy. Reviewing her records, you note that she is receiving a serotonin reuptake inhibitor. What should you do? Reassure her that ambivalence is normal Refer her for drug and alcohol counseling Give her printed material to read at home Alert the RN or primary care provider

Alert the RN or primary care provider

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. Increase fluids and take more vitamins. Bed rest and bathroom privileges only until birth. Discuss induction of labor with the primary care provider.

Decrease activity and rest more often.

Which response is most appropriate for a client with diabetes who wants to breast-feed but is concerned about the effects of breastfeeding on her health? Diabetic clients who breast-feed have a hard time controlling their insulin needs Diabetic clients shouldn't breast-feed because of potential complications Diabetic clients shouldn't breast-feed; insulin requirements are doubled Diabetic clients may breast-feed; insulin requirements may decrease from breast-feeding

Diabetic clients may breast-feed; insulin requirements may decrease from breast-feeding

A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? antihypertensive drugs diuretic drugs I.V. fluids antibiotics

I.V. fluids

A nursing instructor is teaching students about caring for a pregnant patient with a pre-existing disease. Which of the following does the instructor suggest has added to an increased incidence of pregnant women with a pre-existing disease? Women seeking out earlier prenatal care More women waiting until after age 30 years to get pregnant Better tests to diagnose diseases Better assessment skills by physicians

More women waiting until after age 30 years to get pregnant

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 Urge the client to discontinue the anticoagulant to prevent pregnancy complications Put the client on bed rest Instruct the client to avoid wearing constrictive knee-high stockings

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

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

assessing for cardiac decompensation

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. She should half her dose during the first 3 months of pregnancy. She should omit the drug during pregnancy. Prednisone is a teratogenic drug, but she may need it to control her asthma symptoms.

Prednisone is considered safe in the doses prescribed by her care provider.

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. Sickle cell anemia has more than one polygenic inheritance pattern. Sickle cell anemia is dominantly inherited. Sickle cell anemia is not inherited; it occurs following a malaria infection.

Sickle cell anemia is recessively inherited.

The client is 32 weeks pregnant and has been referred for biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective? The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. The BPP is a blood test to detect placental problems. The BPP is a screening for neural tube defects. The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response? "Your primary care provider will order safe doses of your medication." "It's OK to not use them if you would feel more comfortable." "They won't cause any major defects." "I'll let your primary care provider know how you feel about it."

Your primary care provider will order safe doses of your medication."

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which schedule would be most appropriate? monthly visits until 32 weeks, then bi-monthly visits bi-monthly visits until 28 weeks, then weekly visits monthly visits until 20 weeks, then bi-monthly visits bi-monthly visits until 36 weeks, then weekly visits

bi-monthly visits until 28 weeks, then weekly visits

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 long-acting insulin oral hypoglycemic drugs glucagon

diet

A client at 36 weeks' gestation who is 2 years post bariatric surgery would be expected to have a weight gain that is: less than other pregnant clients at the same gestational age. more than other pregnant clients at the same gestational age. the same as other pregnant clients at that gestational age determined by the client's BMI and gestational age.

less than other pregnant clients at the same gestational age.

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? hypoglycemia low birth weight hyperglycemia high birth weight

low birth weight

A nursing instructor is teaching students about high-risk pregnancies. Some circumstances that may cause a pregnancy to be labeled as high-risk include which of the following? (Select all that apply.) poverty lack of support people genetic inheritance good coping mechanisms past history of pregnancy complications high socioeconomic status

poverty lack of support people genetic inheritance past history of pregnancy complications

During the assessment of a laboring client, the nurse learns that the client has cardiovascular disease (CVD). Which assessment would be priority for the newborn? respiratory function heart rate temperature urine output

respiratory function

The nurse is caring for a pregnant client who is in her 30th week of gestation and has congenital heart disease. Which finding should the nurse recognize as a symptom of cardiac decompensation with this client? swelling of the face dry, rasping cough slow, labored respiration elevated temperature

swelling of the face

Which factor would contribute to a high-risk pregnancy? blood type O positive first pregnancy at age 33 history of allergy to honey bee pollen type 1 diabetes

type 1 diabetes

A couple is seeking guidance for their inability to conceive a child after trying for 15 months. They are morbidly obese but state they have friends with the same weight problem who have had no difficulty conceiving. What education can the nurse provide this couple to increase their chances of success? "If you have been trying for this long without success, something must be wrong. So we will need to run a series of tests to see what that is." "Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering." "Being this overweight is unhealthy for you and for any child that you may bring into the world. Before you consider conceiving, you should lose weight." "Weight has no bearing on the ability to conceive. Something else must be going on with your reproductive organs."

"Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering."

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful? "I'll basically follow the same diet that I was following before I became pregnant." "Because I need extra protein, I'll have to increase my intake of milk and meat." "Pregnancy affects insulin production, so I'll need to make adjustments in my diet." "I'll adjust my diet and insulin based on the results of my urine tests for glucose."

"Pregnancy affects insulin production, so I'll need to make adjustments in my diet."

A nursing student is preparing an oral presentation about autosomal recessive inheritance. What must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? Both parents must be heterozygous carriers. One parent must have the disease. The mother must be a carrier. The father must be affected by the disease.

Both parents must be heterozygous carriers.

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: limit weight gain to 15 pounds during the pregnancy. check her blood sugars frequently and adjust insulin accordingly. exercise for 1 to 2 hours each day to keep the blood glucose down. begin oral hyperglycemic medications along with the insulin she is currently taking.

check her blood sugars frequently and adjust insulin accordingly.

The nurse is teaching a pregnant woman with iron-deficiency anemia about her prescribed iron supplement. The nurse determines that the teaching was successful when the client states that she will take the supplement with: citrus juice. coffee. tea. fiber-rich foods.

citrus 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 I class II class III class IV

class III

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 maintaining a high fluid intake beginning a low-impact aerobics program discontinuing her prepregnancy anticoagulant

obtaining enough rest

A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests? semen analysis, ovulation monitoring, and tubal patency assessment semen analysis, urinalysis, and ovulation monitoring serologic test for syphilis, semen analysis, and tubal patency assessment pelvic sonogram, ovulation monitoring, and semen analysis

semen analysis, ovulation monitoring, and tubal patency assessment

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

dyspnea, crackles, and irregular weak pulse

Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 124/86 mm Hg; week 20 - 138/90 mm Hg; week 24 - 140/92 mm Hg; and week 28 - 142/94 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure? mild hypertensive normotensive prehypertensive severe hypertensive

mild hypertensive

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? 45 mg/dL 85 mg/dL 120 mg/dL 136 mg/dL

85 mg/dL

After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching? "I should take my iron with milk." "I should avoid drinking orange juice." "I need to eat foods high in fiber." "I'll call the primary care provider if my stool is black and tarry."

"I need to eat foods high in fiber"

A pregnant woman with cardiac disease tells the nurse that she wants to have a healthy baby and likes babies who have some extra weight. What would be the nurse's best response to this patient? "You may want to supply more cells with nutrients." "Too much weight gain could overburden your heart and circulatory system." "It should not be a problem to gain a few extra pounds." "As long as you take your prenatal vitamins, you should not have a problem."

"Too much weight gain could overburden your heart and circulatory system."

Which of the following statements regarding weight and pregnancy is correct? An underweight woman should increase her caloric intake by 500 to 1000 calories a day. Obesity usually occurs from hypothyroidism. Dieting during pregnancy to reduce weight is recommended only for morbidly obese women. Women who are underweight coming into pregnancy should gain the same amount of weight as women with a normal BMI.

An underweight woman should increase her caloric intake by 500 to 1000 calories a day.

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 constipation prevention administration of immunoglobulins consumption of a low-fat diet

avoidance of infection

A nursing student is learning how to differentiate autosomal-dominant from autosomal-recessive disorders. The student correctly identifies the causes of autosomal-recessive disorders as which of the following? (Select all that apply.) structural biochemical enzymatic environmental cancerous

biochemical enzymatic

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? Dried apples Fortified grains Dried beans Orange juice

orange juice

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? "You should talk to the doctor about that; the medications you're on can damage the fetus." "Do you want to talk to a counselor who can help you weigh the pros and cons of having your own child rather than adopting?" "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." "That's great. I've got a 4-year-old and a 2-year-old myself."

"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 G4P3 client with a history of controlled asthma is upset her initial prenatal appointment is taking too long, making her late for another appointment. What is the nurse's best response when the client insists she knows how to handle her asthma and needs to leave? Remind her to continue taking asthma medications, to monitor peak flow daily, and to monitor the baby's kicks in the second and third trimesters. Acknowledge her need to leave but ask her to demonstrate the use of inhaler and peak flow meter before she goes; remind her to take regular medications. Schedule an appointment for her to return to discuss her asthma management. Note in the chart that the woman was not counseled about her asthma.

Acknowledge her need to leave but ask her to demonstrate the use of inhaler and peak flow meter before she goes; remind her to take regular medications.

A nursing instructor is teaching about causes of infertility and identifies a need for further instruction when a student states which of the following? "A genetic abnormality may cause infertility." "An absence of ovulation may cause infertility." "Diet does not play a role in infertility." "Exercise can influence infertility."

"Diet does not play a role in infertility."

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? meals high in iron milk legumes orange juice

orange juice

A nurse is interviewing a couple at a preconception counseling session. The couple is of Greek heritage and are concerned about the possibility of their children being born with a genetic disorder. Based on the nurse's understanding of genetic disorders, the nurse would identify this couple as being at risk for which conditon? β-thalassemia α-thalassemia sickle cell anemia Tay-Sachs disease

β-thalassemia

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. There is a good chance the infant will inherit the disease from the mother. The infant inherits the disease from the father. If the mother goes into a crisis while pregnant, the baby will develop sickle cell anemia.

Both parents have to carry the trait

A pregnant client with deep vein thrombosis has been diagnosed as having systemic lupus erythematosus (SLE). The nurse would monitor the client closely for the development of which complication? Increased placental weight Post-term birth of infant Fetal macrosomia Fetal malnutrition

Fetal malnutrition