NCMA 219- CHAPTER 20 Nursing care of a Family experiencing a Pregnancy Complication From a Pre-existing Or Newly acquired Illness

1. Cardiac Disease - Left-sided heart failure - Right-sided heart failure - Peripartum heart Disease

CARDIOVASCULAR DISORDERS AND PREGNANCY

CLASS III

CLASSIFICATION OF HEART DISEASE Markedly compromised. During less than ordinary activity, woman experiences excessive fatigue, palpitations, dyspnea, or anginal pain

CLASS IV

CLASSIFICATION OF HEART DISEASE Severely compromised. Woman is unable to carry out any physical activity without experiencing discomfort. Even at rest symptoms of cardiac insufficiency or anginal pain are present.

CLASS II

CLASSIFICATION OF HEART DISEASE Slightly compromised. Ordinary physical activity causes excessive fatigue, palpitation, and dyspnea or anginal pain.

CLASS 1

CLASSIFICATION OF HEART DISEASE Uncompromised. Ordinary physical activity causes no discomfort. No symptoms of cardiac insufficiency and no anginal pain

pulmonary valve stenosis and atrial and ventricular septal defects

Congenital heart defects that can result in right-sided heart failure.

high-risk pregnancy

Is one in which a concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the woman, the fetus, or both.

mitral stenosis, mitral insufficiency, and aortic coarctation

Left-sided heart failure occurs in conditions such as???

8 weeks

Pregnancy taxes the circulatory system of every woman, even without cardiac disease, because both the blood volume and cardiac output increase approximately 30% (perhaps as much as 50%). Half of this increase occurs by ____ weeks; it is maximized by mid pregnancy.

valve damage

The cardiovascular disorders that most commonly cause difficulty during pregnancy are ________ caused by rheumatic fever or Kawasaki disease and congenital anomalies such as atrial septal defect or uncorrected coarctation of the aorta.

28-32 weeks

The danger of pregnancy in a woman with cardiac disease occurs primarily because of the increase in circulatory volume. The most dangerous time for a woman is in weeks ______, just after the blood volume peaks. However, if heart disease is severe, symptoms can occur as early as the beginning of pregnancy

TRUE a woman with artificial but well-functioning heart valves can be expected to complete a pregnancy without difficulty as long as she has consistent prenatal and postpartum care. A woman with a pacemaker implant can also expect to complete pregnancy successfully. Even women who have had heart transplants can be expected to have successful pregnancies (Sibanda et al., 2007).

The estimation of whether a woman with cardiovascular disease can complete a pregnancy successfully or not depends on the type and extent of her disease. TRUE/FALSE a woman with artificial but well-functioning heart valves, can be expected to complete a pregnancy without difficulty as long as she has consistent prenatal and postpartum care.

1. class I or II 2. Class III 3. CLASS IV

To predict pregnancy outcome, heart disease is divided into four categories based on criteria established by the New York State Heart Association. 1. A woman with ______heart disease can expect to experience a normal pregnancy and birth. 2. Women with ______can complete a pregnancy by maintaining almost complete bed rest. 3. Women with ______heart disease are poor candidates for pregnancy because they are in cardiac failure even at rest and when they are not pregnant. They are usually advised to avoid pregnancy

Kawasaki disease or rheumatic fever

Women who had ___________ as a child may have both valvular and aortic artery constrictions that lead to true valve dysfunction and organic murmurs (Hibbard, Fajardo, & Briller, 2007).

before conception

a woman should visit her obstetrician or family physician ___________ _________ so the health care team can become familiar with her state of health when she is not pregnant and establish baseline evaluations of her heart function, such as with an echocardiogram (Hameed & Akhter, 2007).

The pregnancy of a woman who is DIABETIC

automatically termed one with greater than normal risk because it forces a fetus to grow in an environment in which hyperglycemia (increased serum glucose levels) becomes the rule.

Aortic dilatation

may occur from Marfan's syndrome and also be a concern (Chaffins, 2007).

Right-sided failure

occurs when the output of the right ventricle is less than the blood volume received by the right atrium from the vena cava. Back-pressure from this results in congestion of the systemic venous circulation and decreased cardiac output to the lungs.

Pulmonary edema

produces profound dyspnea as it interferes with oxygen-carbon dioxide exchange as the fluid coats the alveolar exchange space (Bashore & Granger, 2009).

"high risk"

rarely refers to just one causative factor helps in the planning of holistic and ultimately effective nursing care.

paroxysmal nocturnal dyspnea

suddenly waking at night short of breath. This occurs because heart action is more effective when she is at rest. With the more effective heart action, interstitial fluid returns to the circulation. This overburdens the circulation, causing increased left-side failure and increased pulmonary edema

Left-sided heart failure

the left ventricle cannot move the volume of blood forward that it has received by the left atrium from the pulmonary circulation. The heart becomes so overwhelmed it fails to function. The reason for the failure is most often at the level of the mitral valve.

Nursing care for the well, pregnant woman focuses on preventing illness by promoting an especially healthy lifestyle. When accidents and illness occurs despite these safeguards, nursing care focuses on:

• Preventing such disorders from affecting the health of the fetus • Helping a woman regain her health as quickly as possible so she can continue a healthy pregnancy and prepare herself psychologically and physically for labor and birth and the arrival of her newborn • Helping a woman learn more about her chronic illness so she can continue to safeguard her health during her childrearing years

Several National Health Goals are aimed at reducing complications of pregnancy that arise from existing or newly acquired disorders. These goals are:

• Reduce the rate of fetal deaths to 4.1 per 1000 live births from a baseline of 6.8 per 1000. • Reduce the rate of maternal deaths to 3.3 per 100,000 live births from a baseline of 7.1 per 100,000. • Reduce the rate of maternal illness and complications during pregnancy to 24 per 100 births from a baseline of 31.2 per 100

1. b) 20-40 years 2. b) Demyelination 3. c) Category C 4. c) Improvement due to increased corticosteroid levels 5. d) ACTH or corticosteroids

1. At what age does multiple sclerosis (MS) predominantly occur in women? a) 10-20 years b) 20-40 years c) 40-60 years d) 60-80 years 2. What is the characteristic feature of MS related to nerve fibers? a) Increased myelination b) Demyelination c) Increased coordination d) Reduced fatigue 3. Which drug category is interferon classified as during pregnancy? a) Category A b) Category B c) Category C d) Category D 4. How might pregnancy affect the long-term course of multiple sclerosis (MS)? a) Worsening of symptoms b) No effect c) Improvement due to increased corticosteroid levels d) Increase in fatigue 5. What treatment option is safe for women with MS during pregnancy? a) Cyclosporine b) Azathioprine c) Plasmapheresis d) ACTH or corticosteroids

1. c 2. b 3. c 4. b 5. b

1. At what pressure in the pulmonary vein does fluid begin to pass into the interstitial spaces, leading to pulmonary edema? a. 15 mm Hg b. 20 mm Hg c. 25 mm Hg d. 30 mm Hg 2. What is the result of pulmonary edema on oxygen-carbon dioxide exchange in the alveoli? a. Improved exchange b. Profound dyspnea c. Decreased respiratory rate d. Alveolar collapse 3. What may develop if pulmonary capillaries rupture under pressure in left-sided heart failure? a. Pulmonary hypertension b. Increased cardiac output c. Blood-speckled sputum d. Aortic stenosis 4. Why are women with pulmonary hypertension at high risk during pregnancy? a. Increased oxygen exchange b. Spontaneous miscarriage c. Improved cardiac output d. Aortic insufficiency 5. What symptoms may a woman experience due to the decreased oxygen saturation of the blood in left-sided heart failure? a. Increased energy b. Fatigue, weakness, and dizziness c. Orthopnea d. Pulmonary edema

1. Yes, as a rule, breastfeeding is generally acceptable. 2. Immediately 3. Only after approval from the physician or nurse-midwife 4. A stool softener 5. Plans for rest, assistance at home, and scheduling a return appointment for postpartum checkup for gynecologic health and cardiac status.

1. Can a woman with heart disease breastfeed without difficulty in the postpartum period? 2. When can Kegel exercises be initiated for perineal strengthening in the postpartum period? 3. When should postpartum exercises to improve abdominal tone be initiated, and under what condition? 4. What can be prescribed to prevent straining with bowel movements in the postpartum period for women with heart disease? 5. What important considerations should be addressed before discharge for a woman with heart disease in the postpartum period?

FETAL ASSESSMENT ANSWER 1. Maternal blood pressure becomes insufficient to provide an adequate supply of blood and nutrients to the placenta, resulting in low birth weights for infants. 2. Acidotic fetal environment, preterm labor, and exposure of the infant to hazards of immaturity and low birth weight. 3. To prevent supine hypotension syndrome and increased heart effort. 4. Carefully, ensuring she stops exercising before reaching the point of uterine/placental constriction. 5. To ensure a healthy pregnancy and baby without overburdening the heart and circulatory system.

1. How does cardiac failure in a pregnant woman affect fetal growth? 2. What potential complications may arise due to poor perfusion in a pregnant woman with cardiac disease? 3. Why is it recommended for women with cardiac disease to rest in the left lateral recumbent position? 4. How should a rest program be designed for a woman with cardiac disease during pregnancy? 5. Why might a woman with cardiac disease need closer supervision of nutrition during pregnancy?

1. It occurs rapidly within 5 minutes after birth, requiring the heart to make a rapid and major adjustment. 2. Decreased activity, possible anticoagulant and digoxin therapy, antiembolic stockings, ambulation, and prophylactic antibiotics. 3. To ensure the infant does not have a heart defect or was not harmed by any medication taken during pregnancy. 4. Acrocyanosis is normal, preventing misinterpretation as cardiac inadequacy. 5. They tend to increase blood pressure, necessitating increased heart action.

1. How does the adjustment of blood volume after birth differ from the gradual increase during pregnancy? 2. What interventions may be necessary for a woman in severe congestive heart failure after birth? 3. Why might a woman with heart disease be interested in close inspection of her baby immediately after birth? 4. What should be clarified regarding acrocyanosis in newborns to a woman with heart disease in the postpartum period? 5. Why should agents to encourage uterine involution, such as oxytocin, be used with caution in women with heart disease?

1. B 2. B 3. B 4. B 5. B

1. Is having a colostomy a contraindication to pregnancy? A. Yes B. No C. Only if it's a recent colostomy D. It depends on the type of colostomy 2. Is a previous liver transplant a contraindication to pregnancy? A. Yes B. No C. Only if the transplant was recent D. It depends on the type of transplant 3. What nursing diagnosis is associated with gastrointestinal disorder during pregnancy? A. Acute abdominal pain B. Imbalanced nutrition, less than body requirements C. Ectopic pregnancy D. Premature separation of the placenta 4. What is the desired outcome for the nursing diagnosis "Imbalanced nutrition, less than body requirements" during pregnancy? A. Client experiences weight loss B. Client gains 25 to 30 lb during pregnancy C. Client's hemoglobin is below 11 mg/dL D. Client's urine specific gravity is above 1.030 5. What is the recommended weight gain during pregnancy for the desired outcome mentioned in question 9? A. 10 to 15 lb B. 25 to 30 lb C. 40 to 45 lb D. No specific weight gain is recommended

1. b) 12-14 years 2. b) Chest compression interfering with respiration and heart action 3. b) Chest compression 4. c) Cesarean birth 5. a) Body brace

1. What age group typically first experiences the noticeable signs of scoliosis? a) 5-8 years b) 12-14 years c) 18-20 years d) 25-30 years 2. If scoliosis is left uncorrected, what complications may arise during pregnancy? a) Increased fertility b) Chest compression interfering with respiration and heart action c) Reduced blood flow to the limbs d) Enhanced flexibility of the spine 3. Why might spinal or epidural anesthesia be challenging for pain management during labor for a woman with a severely curved spine? a) Increased sensitivity to anesthesia b) Chest compression c) Lack of pain receptors d) Increased bone density 4. What intervention may be necessary for a woman with a highly distorted pelvis due to scoliosis during childbirth? a) Home birth b) Forceps delivery c) Cesarean birth d) Water birth 5. What may be worn by girls with scoliosis during their adolescent years to maintain an erect posture? a) Body brace b) Necklace c) Leg brace d) Arm sling

1. C 2. B 3. D 4. B 5. B

1. What are common minor gastrointestinal discomforts during pregnancy? A. Acute abdominal pain B. Protracted vomiting C. Nausea, heartburn, constipation D. Premature separation of the placenta 2. Why is acute abdominal pain during pregnancy a cause for concern? A. It is a normal pregnancy symptom B. It may indicate complications such as placental separation or ectopic pregnancy C. It is associated with minor gastrointestinal discomforts D. It is unrelated to the pregnancy 3. What are potential causes of abdominal pain during pregnancy unrelated to the pregnancy itself? A. Ectopic pregnancy B. Ulcerative colitis C. Hepatitis D. All of the above 4. How might complications like premature separation of the placenta or ectopic pregnancy manifest during pregnancy? A. Mild nausea B. Acute abdominal pain C. Heartburn D. Constipation 5. What is a possible gastrointestinal condition that may cause abdominal pain during pregnancy? A. Gestational diabetes B. Hiatal hernia C. Placental insufficiency D. Ectopic pregnancy

1. D 2. B 3. C 4. B 5. B

1. What are some conditions that can lead to left-sided heart failure? a. Mitral stenosis b. Aortic coarctation c. Mitral insufficiency d. All of the above 2. In left-sided heart failure, which ventricle is primarily affected? a. Right ventricle b. Left ventricle c. Both ventricles equally d. Atria 3. What is the role of the mitral valve in left-sided heart failure? a. Facilitating blood flow to the lungs b. Preventing back-pressure on the pulmonary circulation c. Pushing blood forward from the left atrium d. None of the above 4. How does pregnancy affect the mitral valve in the context of left-sided heart failure? a. Prolongs diastole b. Shortens diastole c. Decreases cardiac output d. None of the above 5. What is the consequence of the mitral valve's inability to push blood forward? a. Increased cardiac output b. Back-pressure on the pulmonary circulation c. Systemic blood pressure elevation d. Aortic coarctation

1. Thalassemias are autosomal recessively inherited blood disorders causing poor hemoglobin formation and severe anemia, prevalent in Mediterranean, African, and Asian populations. 2. Anemia in thalassemia is treated with measures like folic acid supplementation and blood transfusion. Iron supplementation is avoided during pregnancy to prevent iron overload from blood transfusions. 3. Malaria is caused by a protozoan infection transmitted by Anopheles mosquitoes. 4. Malaria causes red blood cells to stick to capillary surfaces, leading to vessel obstruction and potential complications such as end organ anoxia. 5. Malaria is most prevalent in Mediterranean, African, and Asian populations. Symptoms usually appear in childhood.

1. What are thalassemias, and how do they impact hemoglobin formation and anemia? 2. How is anemia treated in individuals with thalassemia, and why is iron supplementation usually avoided during pregnancy? 3. What is the primary cause of malaria, and how is it transmitted to humans? Answer: Malaria is caused by a protozoan infection transmitted by Anopheles mosquitoes. 4. How does malaria affect red blood cells, and what complications can arise from the obstruction of capillaries? 5. In which populations is malaria most prevalent, and when do symptoms typically appear?

1. Classifications of diabetes predict pregnancy outcomes, including risks and complications. 2. Gestational diabetes mellitus typically occurs during the second half of pregnancy. 3. Gestational diabetes is diagnosed through glucose tolerance tests. 4. Monitoring women with diabetes during pregnancy involves various components, including blood sugar levels. 5.Insulin therapy during pregnancy is adjusted to maintain optimal blood sugar levels.

1. What are the classifications of diabetes mellitus, and how do they predict pregnancy outcomes? 2. What is gestational diabetes mellitus, and when does it typically occur during pregnancy? 3. How is gestational diabetes mellitus diagnosed? 4. What are the key components of monitoring a woman with diabetes during pregnancy? 5. How is insulin therapy adjusted during pregnancy for women with diabetes?

1. Long-term effects of diabetes mellitus include cardiovascular disease, kidney disease, and nerve damage. 2. Incidence of type 1 and type 2 diabetes during pregnancy varies. 3. Women with successful glucose and insulin regulation may experience challenges in controlling blood sugar during pregnancy. 4. Hormonal changes during pregnancy contribute to insulin resistance. 5.Ketoacidosis can occur if blood sugar levels become too high during pregnancy.

1. What are the long-term effects of diabetes mellitus? 2.Describe the incidence of type 1 and type 2 diabetes during pregnancy. 3. Why might a woman with successful glucose and insulin regulation before pregnancy experience less-than-optimal control during pregnancy? 4. What hormonal changes contribute to insulin resistance during pregnancy? 5. When might a woman become ketoacidotic during pregnancy?

1. Recommended values for fasting and postprandial blood glucose levels are determined for pregnant women. 2.Insulin pump therapy has specific purposes and restrictions. 3. Tests to assess placental function and fetal well-being are performed during pregnancy. 4. The timing of birth is a concern for women with diabetes during pregnancy. 5.Postpartum adjustment differs between women with gestational diabetes and preexisting diabetes.

1. What are the recommended values for fasting and postprandial blood glucose levels? 2. What is the purpose of insulin pump therapy, and what are its restrictions? 3. What tests are performed to assess placental function and fetal well-being? 4. When is the timing of birth a chief concern for women with diabetes during pregnancy? 5. How is the postpartum adjustment different for women who had gestational diabetes compared to preexisting diabetes?

1. b. Crohn's disease and Ulcerative colitis 2. d. 12-30 years 3. c. Autoimmune process 4. c. Terminal ileus 5. c. Chronic diarrhea, weight loss, occult blood in stool, nausea, and vomiting

1. What are the two main types of inflammatory bowel disease mentioned in the passage? a. Diabetes and Hypertension b. Crohn's disease and Ulcerative colitis c. Asthma and Bronchitis d. Migraine and Fibromyalgia 2. At what age range do Crohn's disease and ulcerative colitis commonly occur? a. 5-10 years b. 20-40 years c. 30-50 years d. 12-30 years 3. What is the suggested cause of Crohn's disease and ulcerative colitis? a. Bacterial infection b. Viral infection c. Autoimmune process d. Genetic mutation 4. Which part of the bowel is affected by inflammation in Crohn's disease? a. Duodenum b. Jejunum c. Terminal ileus d. Rectum 5.What symptoms might a woman with inflammatory bowel disease experience? a. Chronic cough and fever b. Joint pain and muscle stiffness c. Chronic diarrhea, weight loss, occult blood in stool, nausea, and vomiting d. Headache and dizziness

1. d 2. a (both jugular venous distention and increased portal circulation occur) 3. d 4. a 5. b

1. What causes right-sided heart failure? a. Pulmonary stenosis b. Decreased blood volume in the vena cava c. Output of the left ventricle d. Back-pressure from the right ventricle 2. What is the consequence of right-sided heart failure on the systemic venous circulation? a. Jugular venous distention b. Pulmonary edema c. Increased arterial blood pressure d. Aortic stenosis 3. Why does blood pressure decrease in the aorta during right-sided heart failure? a. Increased blood volume in the vena cava b. Decreased blood volume in the vena cava c. Pulmonary stenosis d. Back-pressure from the right ventricle 4. What occurs in the vena cava due to back-pressure from right-sided heart failure? a. Jugular venous distention b. Pulmonary edema c. Increased arterial blood pressure d. Aortic stenosis 5. What symptoms may a pregnant woman with liver enlargement due to right-sided heart failure experience? a. Increased energy b. Dyspnea and pain c. Elevated blood pressure d. Aortic dissection

1. C 2. B 3. B 4. C 5. D

1. What does GERD stand for? A. Gastric Esophageal Reflux Disease B. Gallbladder Epigastric Reflux Disease C. Gastroesophageal Reflux Disease D. Gallstone Esophagus Disorder 2. What is the primary symptom of GERD and hiatal hernia during pregnancy? A. Constipation B. Heartburn C. Vomiting D. Hematemesis 3. How are GERD and hiatal hernia usually diagnosed during pregnancy? A. Barium x-rays B. Endoscopy or ultrasound C. CT scan D. Blood tests 4. What is the recommended therapeutic management for GERD during pregnancy? A. Surgical intervention B. Linoleic acid supplements C. Proton pump inhibitors D. Weight loss programs 5. What should a woman be advised to do to help confine stomach secretions in GERD or hiatal hernia? A. Exercise regularly B. Sleep on the left side C. Wear tight clothing D. Sleep with her head elevated

1. c 2. d (a woman may be prescribed antihypertensives to control blood pressure, diuretics to reduce blood volume, and beta-blockers to improve ventricular filling (Hameed & Akhter, 2007). 3. c 4. b 5. c

1. What does the term "nonstress tests" refer to in the context of monitoring fetal health? a. Tests without maternal stress b. Tests measuring maternal blood pressure c. Tests measuring fetal heart rate in response to movement d. Tests measuring fetal lung development 2. What is the primary goal of prescribing diuretics in cases of aortic coarctation during pregnancy? a. Improve ventricular filling b. Control blood pressure c. Prevent thrombus formation d. Reduce blood volume 3. What is intrauterine growth restriction? a. Abnormal growth of the uterus b. Insufficient blood flow to the uterus c. Abnormal growth of the fetus d. Inability to conceive 4. What condition may result if a woman with mitral stenosis does not receive proper anticoagulation therapy during pregnancy? a. Pulmonary edema b. Thrombus formation c. Intrauterine growth restriction d. Aortic dissection 5. Why is the monitoring of fetal health crucial in the presence of mitral stenosis or aortic coarctation during pregnancy? a. To improve maternal cardiac output b. To prevent pulmonary edema c. To identify and manage potential complications d. To avoid anticoagulant therapy

1. B 2. C 3. B 4. C 5. D

1. What finding in the urine is typical for a woman with appendicitis? A. Elevated glucose levels B. Presence of ketones C. Blood in urine D. Low pH levels 2. What imaging technique is recommended to reveal the inflamed appendix? A. X-ray B. CT scan C. Ultrasound D. MRI 3. Why is a woman advised not to take food, liquid, or laxatives while waiting to be evaluated for possible appendicitis? A. To prevent weight gain B. To reduce peristalsis that could cause a ruptured appendix C. To alleviate pain D. To prepare for surgery 4. How is appendicitis managed in a woman near term (past 36 weeks) with a mature fetus? A. Laparoscopic removal of the inflamed appendix B. Conservative management with antibiotics C. Cesarean birth followed by appendix removal D. Natural childbirth with postpartum appendix removal 5. Why does the risk to both mother and fetus increase dramatically if the appendix ruptures before surgery? A. Risk of generalized peritonitis B. Spread of infection to the fetus C. Development of peritoneal adhesions D. All of the above

1. Oxygen administration and continuous hemodynamic monitoring, such as by a Swan-Ganz catheter. 2. It can make both labor and birth less taxing. 3. Low forceps or a vacuum extractor 4. The measures are aimed at achieving the ultimate goals of a healthy newborn and a mother able to care for her new baby. 5. An increase of 20% to 40%, released from the blood that supplied the placenta.

1. What interventions may be necessary for women with extreme heart disease during labor? 2. Why is an epidural considered the anesthetic of choice during labor for women with heart disease? 3. For women with heart disease, what might be used for birth if they have received an epidural anesthetic? 4. What is emphasized to a woman disappointed by the use of medical interventions during birth? 5. What critical changes occur in a woman's blood volume immediately after the delivery of the placenta?

1. B 2. C 3. B 4. D 5. B

1. What is appendicitis? A. Inflammation of the gallbladder B. Inflammation of the appendix C. Inflammation of the stomach lining D. Inflammation of the kidneys 2. What is the incidence of appendicitis in young adults, including pregnant women? A. 1 in 500 to 1000 pregnancies B. 1 in 1000 to 1500 pregnancies C. 1 in 1500 to 2000 pregnancies D. 1 in 2000 to 2500 pregnancies 3. How does appendicitis pain differ from the pain caused by an overstretched round ligament during pregnancy? A. Appendicitis pain is constant and intense B. Round ligament pain fades instantly C. Appendicitis pain is diffuse and sharp D. Round ligament pain occurs only during movement 4. Where is the localized pain typically felt in a nonpregnant woman with appendicitis? A. Upper left quadrant B. Lower left quadrant C. Upper right quadrant D. Lower right quadrant at McBurney's point 5. Why is the complete blood count (CBC) result not as helpful in pregnant women with appendicitis? A. Pregnant women have a decreased white blood cell count B. Pregnant women have an elevated white blood cell count normally C. Appendicitis doesn't affect white blood cell count D. CBC is not used for appendicitis diagnosis

1. Asthma is marked by reversible airflow obstruction, airway hyperreactivity, and airway inflammation. It may be potentially associated with an increased risk of perinatal complications, such as preterm birth or fetal growth restriction if a major attack occurs during pregnancy. 2. Symptoms are triggered by inhaled allergens like pollen or cigarette smoke. An immediate release of bioactive mediators such as histamine and leukotrienes occurs, leading to bronchial smooth muscle constriction, mucosal inflammation, and bronchial swelling. 3. Asthma symptoms may improve during pregnancy due to high circulating levels of corticosteroids. A woman should check with her physician or nurse-midwife about the safety of her routine medications before pregnancy to ensure they can be continued safely during pregnancy and breastfeeding. 4. Beclomethasone (Beclovent, Vancenase) and budesonide (Pulmicort, Rhinocort) are commonly used

1. What is asthma, and what complications may it be potentially associated with during pregnancy? 2. What triggers asthma symptoms, and what happens in the airways when an asthma attack is triggered by an inhaled allergen? 3. Why might asthma symptoms improve during pregnancy, and what should a woman with asthma do before pregnancy regarding her medications? 4. Name two inhaled corticosteroids commonly used by pregnant women with persistent asthma, and why might parenteral administration of hydrocortisone be needed during labor? 5. Which beta-adrenergic agonists are safe to take during pregnancy, and what precaution should be taken close to term with these medications?

1. Diabetes mellitus is a group of metabolic disorders characterized by high blood sugar levels. 2. Diabetes mellitus affects approximately 2-10% of pregnancies. 3. Before 1921, women with type 1 diabetes faced challenges due to lack of insulin therapy. 4. New problems with the rise of type 2 diabetes in young adults include metabolic syndrome, cardiovascular disease, kidney disease, and premature death. 5. Women with diabetes might not be good candidates for oral contraceptives due to the risk of blood vessel complications.

1. What is diabetes mellitus? 2. What percentage of pregnancies does diabetes mellitus affect? 3. What were the challenges for women with type 1 diabetes before 1921? 4. Name the four new problems that have developed with the increase in type 2 diabetes in young adults. 5. Why might women with diabetes not be good candidates for oral contraceptives?

1. C 2. D 3. B 4. C 5. B

1. What is the approximate duration of newborn symptoms in infants born to women with SLE? A. 1 month B. 3 months C. 6 months D. 9 months 2. What might be necessary if congenital heart block occurs in a newborn of a woman with SLE? A. Blood transfusion B. Intravenous antibiotics C. Dialysis D. Newborn pacemaker 3. What is a potential outcome for a woman with SLE during the postpartum period when corticosteroid levels fall to normal? A. No change in symptoms B. Acute exacerbation of symptoms C. Resolution of symptoms D. Reduced risk of thrombi formation 4. What might necessitate screening for autoantibodies in newborns born to women with SLE? A. Increased risk of infection B. Greater-than-usual incidence of spontaneous miscarriage C. Neonatal heart block D. Risk of bleeding at birth 5. What is the primary purpose of intravenous hydrocortisone administration during labor for women with SLE? A. Pain relief B. Stress management C. Prevention of premature separation of the placenta D. Reduction of neonatal heart block

1. c) 1 in 1000 2. c) Breast 3. a) Women's preference for delayed pregnancies 4. d) All of the above 5. b) Throughout pregnancy

1. What is the approximate occurrence of cancer in pregnancies? a) 1 in 100 b) 1 in 500 c) 1 in 1000 d) 1 in 2000 2. Which malignancies are most commonly observed during pregnancy? a) Pancreatic b) Lung c) Breast d) Colorectal 3. Why is the incidence of malignancy during pregnancy, especially breast cancer, increasing? a) Women's preference for delayed pregnancies b) Increased exposure to environmental toxins c) Advancements in medical imaging d) Changes in immunologic mechanisms 4. In the first trimester, what difficult decisions do women and their partners face when cancer is diagnosed? a) Whether to delay treatment b) Whether to end the pregnancy c) Whether to choose chemotherapy or radiation treatment d) All of the above 5. When can women generally receive chemotherapy without adverse fetal effects? a) Only in the first trimester b) Throughout pregnancy c) Only in the second trimester d) Only in the third trimester

1. b 2. b 3. a 4. b 5. b (a right-to-left atrial or ventricular septal defect with an accompanying pulmonary stenosis (Davidson & Graham, 2007).

1. What is the cause of extreme dyspnea and pain in a pregnant woman with liver enlargement in right-sided heart failure? a. Enlarged spleen b. Enlarged uterus c. Pulmonary stenosis d. Aortic regurgitation 2. What condition can result from distention of abdominal vessels in right-sided heart failure? a. Pulmonary edema b. Ascites c. Jugular venous distention d. Increased cardiac output 3. Where does fluid move in the presence of peripheral edema in right-sided heart failure? a. Peritoneal cavity b. Pulmonary circulation c. Vena cava d. Systemic circulation 4. What congenital anomaly is mentioned as a cause of right-sided heart failure in women of reproductive age? a. Aortic dissection b. Eisenmenger syndrome c. Pulmonary edema d. Aortic regurgitation 5. What characterizes Eisenmenger syndrome in the context of right-sided heart failure? a. Left-to-right ventricular septal defect b. Pulmonary stenosis c. Increased cardiac output to the lungs d. Aortic regurgitation

1. b) Autoimmune disorder 2. c) Anticholinesterase drugs 3. c) Plasmapheresis 4. d) It diminishes acetylcholine effects 5. b) Antibody transfer

1. What is the cause of myasthenia gravis? a) Bacterial infection b) Autoimmune disorder c) Genetic mutation d) Viral infection 2. Which class of drugs is commonly used to treat myasthenia gravis during pregnancy? a) Antibiotics b) Antifungals c) Anticholinesterase drugs d) Antivirals 3. What treatment option for myasthenia gravis should be carried out gradually during pregnancy to reduce the risk of complications? a) Surgery b) Radiation therapy c) Plasmapheresis d) Chemotherapy 4. Why should magnesium sulfate be avoided in a woman with myasthenia gravis during pregnancy? a) It induces labor b) It increases acetylcholine effects c) It causes hypotension d) It diminishes acetylcholine effects 5. How may an infant born to a woman with myasthenia gravis demonstrate disease symptoms at birth? a) Genetic mutation b) Antibody transfer c) Viral infection d) Bacterial infection

1. b 2. a 3. c 4. b 5. c

1. What is the chief complication of SLE that may occur for the first time during pregnancy? A. Arthritis B. Acute nephritis with glomerular destruction C. Respiratory distress D. Neurological symptoms 2. What symptoms are indicative of associated nephritis in a woman with SLE during pregnancy? A. Hypertension, hematuria, and decreased urine output B. Headache and blurred vision C. Joint pain and swelling D. Fever and fatigue 3. Why is frequent monitoring of serum creatinine levels necessary for pregnant women with SLE? A. To assess liver function B. To evaluate lung function C. To assess kidney function D. To monitor blood glucose levels 4. Why are women with SLE asked to decrease salicylate use about 2 weeks before their anticipated birth? A. To prevent joint damage B. To reduce the possibility of bleeding in the newborn C. To minimize hypertension D. To alleviate skin rashes 5. What may be necessary to guard against hemorrhage at birth for a fetus seriously threatened due to SLE complications? A. Blood transfusion B. Intravenous antibiotics C. Dialysis or plasmapheresis D. Neonatal heart surgery

1. C 2. C 3. B 4. A 5. C

1. What is the common age group for pancreatitis occurrence during pregnancy? A. Elderly women B. Infants C. Young adults D. Adolescents 2. How is pancreatitis diagnosed during pregnancy? A. Elevated blood glucose levels B. Ultrasound C. Increased serum amylase D. Decreased white blood cell count 3. What are the primary therapeutic measures for treating pancreatitis during pregnancy? A. Oral intake to stimulate peristalsis B. Nasogastric suction, bowel rest, analgesia, and intravenous hydration C. Antibiotic therapy D. Surgical removal of the pancreas 4. What does STI stand for in the context of hepatitis B and C? A. Sexually Transmitted Infection B. Systemic Tuberculosis Infection C. Severe Thyroid Infection D. Streptococcal Tonsillitis Infection 5. How is hepatitis A primarily spread? A. Exposure to contaminated blood B. Sexual contact C. Fecal-oral contact D. Airborne transmission

1. b 2. b (Although the cause is unknown, it is apparently because of the effect of the pregnancy on the circulatory system.) 3. b 4. c 5. c

1. What is the condition that can originate in pregnancy, characterized by myocardial failure with a mortality rate as high as 50%? a. Aortic dissection b. Peripartal cardiomyopathy c. Pulmonary edema d. Atrial fibrillation 2. What is the primary cause of peripartal cardiomyopathy? a. Hypertension b. Undetected heart disease c. African American ethnicity d. Previous pregnancies 3. What are common signs of myocardial failure in a woman with peripartal cardiomyopathy? a. Increased heart rate b. Shortness of breath, chest pain, and edema c. Hypertension and bradycardia d. Elevated blood sugar levels 4. What happens to the size of the heart in peripartal cardiomyopathy? a. Decreases b. Remains the same c. Increases (cardiomegaly) d. Becomes irregular 5. What is the recommended action for a woman with cardiomegaly in peripartal cardiomyopathy? a. Increase physical activity b. Maintain current activity levels c. Sharply reduce physical activity d. Start vigorous exercise

1. Autosomal dominant inheritance; may cause spontaneous miscarriage or postpartum hemorrhage in women. 2. Menorrhagia (heavy menstrual bleeding) and frequent episodes of epistaxis (nosebleeds) 3. Diagnosis through prolonged bleeding time; Intervention may include the replacement of factor VIII-related antigen (VIII-R) and factor VIII coagulation activity (VIII-C) through infusion of cryoprecipitate or fresh-frozen plasma. 4. Female carriers may have a reduced level of factor IX, and complications such as hemorrhage during labor or spontaneous miscarriage can occur. 5. Restoration through infusion of factor IX concentrate or fresh-frozen plasma; Important to prevent serious complications like hemorrhage during pregnancy.

1. What is the inheritance pattern of von Willebrand disease, and how does it affect women during pregnancy? 2. What are the common symptoms of von Willebrand disease in affected women before pregnancy? 3. How is von Willebrand disease diagnosed during pregnancy, and what intervention may be necessary before labor to prevent excessive bleeding? 4. In the context of hemophilia B, why do female carriers of the disorder need to be identified before pregnancy? 5. How can factor IX levels be restored in carriers of hemophilia B during pregnancy, and why is it important to address this issue?

1. c) Hypoxia 2. c) To ensure the lowest possible medication dosage 3. d) Category D 4. b) To control seizures 5. a) Ultrasound

1. What is the potential risk for a fetus during pregnancy if a woman with a seizure disorder experiences severe seizures? a) Congenital anomalies b) Hypertension c) Hypoxia d) Diabetes 2. Why is it important for women with recurrent seizures to meet with their healthcare providers before pregnancy? a) To discuss unrelated health issues b) To monitor blood pressure c) To ensure the lowest possible medication dosage d) To undergo unnecessary tests 3. Which drug category poses a risk of congenital anomalies during pregnancy for women with recurrent seizures? a) Category A b) Category B c) Category C d) Category D 4. What is the primary goal for women taking antiseizure medications during pregnancy? a) To prevent nausea b) To control seizures c) To avoid any medication d) To induce labor 5. How can the potential risk of neural tube disorders in infants born to women taking phenytoin be ruled out? a) Ultrasound b) MRI scan c) X-ray d) CT scan

1. c 2. c 3. b 4. b 5. c

1. What is the primary age group affected by systemic lupus erythematosus (SLE)? A. Children B. Elderly individuals C. Women of childbearing age D. Adolescents 2. What is the most distinctive skin change associated with SLE? A. Eczema-like rash B. Psoriasis C. Butterfly-shaped rash on the face D. Hives 3. What organs are most commonly affected by the widespread degeneration of connective tissue in SLE? A. Lungs and liver B. Heart, kidneys, blood vessels, spleen, skin, and retroperitoneal tissue C. Gastrointestinal tract D. Muscles and joints 4. What is the primary reason for the increased tendency for thrombi to form in many women with SLE? A. Elevated cholesterol levels B. Antiphospholipid antibodies C. Excessive platelet count D. Decreased blood viscosity 5. How may corticosteroid use during pregnancy affect symptoms in women with SLE? A. Aggravate symptoms B. Have no effect on symptoms C. Improve symptoms D. Induce thrombocytopenia

1. COPD is primarily associated with long-term cigarette smoking. Its association with pregnancy has increased as more women delay childbirth until age 35 to 40. 2. Women with COPD may need additional rest due to fatigue, and continuous supplemental oxygen is required to address oxygen deficiency. 3. Cystic fibrosis is a recessively inherited disease characterized by generalized dysfunction of exocrine glands, leading to thickened mucous secretions. 4. Men with cystic fibrosis may be sterile due to thickened semen. Women may face fertility issues as sperm struggle to migrate through viscid cervical mucus. 5. Artificial insemination or in vitro fertilization may be necessary to overcome conception challenges related to obstructed cervical mucus or impaired fallopian tubal transport.

1. What is the primary cause of COPD, and why has its association with pregnancy increased in recent times? 2. Why might women with COPD need additional rest during pregnancy, and what is the role of continuous supplemental oxygen? 3. What is the genetic basis of cystic fibrosis, and how does it affect the function of exocrine glands? 4. Why may men with cystic fibrosis be sterile, and what fertility concerns exist for women with the disorder? 5. What reproductive technologies might be necessary for conception in women with cystic fibrosis, and why?

1. B 2. B 3. A 4. A 5. C

1. What is the primary cause of juvenile rheumatoid arthritis? A. Bacterial infection B. Autoimmune response C. Genetic factors D. Environmental toxins 2. What is the main pathology involved in juvenile rheumatoid arthritis? A. Bone deformation B. Synovial membrane destruction C. Cartilage overgrowth D. Nerve compression 3. What symptoms are associated with juvenile rheumatoid arthritis? A. Joint pain and loss of mobility B. Fever and sore throat C. Headache and fatigue D. Respiratory difficulties 4. Why do women with juvenile rheumatoid arthritis take corticosteroids and NSAIDs? A. To prevent joint damage during pregnancy B. To induce labor contractions C. To treat bacterial infections D. To promote bone growth 5. What precaution is recommended for women taking oral aspirin therapy during pregnancy? A. Increase intake of salicylates B. Continue regular dosage throughout pregnancy C. Decrease intake of salicylates before term D. Discontinue aspirin therapy during pregnancy

1. The primary nursing diagnosis is "Pain related to rheumatic disorder during pregnancy." The desired outcome is for the client to state she is moderately comfortable and able to maintain her usual level of daily activity. 2. Juvenile rheumatoid arthritis is a disease of connective tissue with joint inflammation. The disease pathology involves synovial membrane destruction, leading to inflammation, joint swelling, erythema, and painful motion. Over time, granulation tissue formation can result in permanent joint disfigurement. 3. They take these medications to prevent joint pain and loss of mobility. A precaution is to decrease the intake of salicylates approximately 2 weeks before term to avoid increased bleeding at birth or prolonged pregnancy. 4. Symptoms may improve during pregnancy due to increased circulating corticosteroids. Symptoms may recur postpartum when corticosteroid levels fall to prepregnancy levels.

1. What is the primary nursing diagnosis related to rheumatic disorders during pregnancy, and what is the desired outcome? 2. What is juvenile rheumatoid arthritis, and how might the disease pathology lead to permanent joint disfigurement? 3. Why do women with juvenile rheumatoid arthritis frequently take corticosteroids and NSAIDs during pregnancy, and what precaution is necessary with salicylates? 4. How may symptoms of juvenile rheumatoid arthritis change during pregnancy, and why might arthritis symptoms recur postpartum? 5. What is the potential impact of low-dose methotrexate (pregnancy risk category X) on pregnancy, and what should women do before continuing this drug during pregnancy?

1. The primary problem for women with diabetes during pregnancy is maintaining optimal blood sugar levels. 2. Insufficient insulin during pregnancy can lead to increased blood sugar levels. 3. Glycosuria, the presence of glucose in the urine, typically occurs during pregnancy. 4. Dehydration in diabetic pregnant women can lead to serious consequences. 5. Elevated blood sugar levels can lead to ketoacidosis and an imbalance in blood pH.

1. What is the primary problem for women with diabetes mellitus during pregnancy? 2. What happens when a woman's insulin level is insufficient during pregnancy? 3. What is glycosuria, and when does it typically occur during pregnancy? 4. What are the consequences of dehydration in a woman with diabetes during pregnancy? 5.How do elevated blood sugar levels affect the blood pH, and what condition develops?

1. a 2. b 3. b 4. c 5. c

1. What is the purpose of extremely close monitoring after epidural anesthesia for women with uncorrected Eisenmenger syndrome? a. To minimize the risk of hypotension b. To improve ventricular filling c. To increase arterial blood pressure d. To prevent thrombus formation 2. What is the primary risk associated with epidural anesthesia in women with uncorrected Eisenmenger syndrome? a. Jugular venous distention b. Hypotension c. Pulmonary edema d. Aortic dissection 3. What effect does epidural anesthesia have on the risk of hypotension in women with uncorrected Eisenmenger syndrome? a. Decreases the risk b. Increases the risk c. No effect on the risk d. Causes pulmonary edema 4. Why might a woman be returned to heparin therapy during the last month of pregnancy? a. To control blood pressure b. To improve ventricular filling c. To avoid fetal coagulation disorder d. To prevent teratogenic effects 5. What is the primary goal of monitoring fetal health in pregnant women with uncorrected Eisenmenger syndrome? a. Improve maternal cardiac output b. Ensure fetal growth c. Identify and manage potential complications d. Avoid anticoagulant therapy

FETAL ASSESSMENT ANSWER: 1. They contain an iron supplement to prevent anemia, which could burden the heart by requiring increased blood circulation. 2. Due to expanded blood volume, and it may be necessary to strengthen cardiac output as pregnancy advances. 3. Yes, it is safe. It may be given to slow the fetal heart if fetal tachycardia is present. 4. Arrhythmia agents 5. It is not well studied, but it appears to be safe for use during pregnancy.

1. What is the purpose of prenatal vitamins for a woman with cardiac disease during pregnancy? 2. Why may a woman with cardiac disease need to increase her maintenance dose of cardiac medication during pregnancy? 3. Is digoxin safe for a pregnant woman, and for what purpose might it be administered during pregnancy? 4. Which category of drugs, such as adenosine, beta-blockers, and ACE inhibitors, are considered safe for use during pregnancy in women with heart disease? 5. Why is nitroglycerin considered a category C drug during pregnancy?

1. c 2. c 3. c 4. a 5. a

1. What is the result of elevating the chest in severe pulmonary edema? a. Increased cardiac output b. Decreased pulmonary edema c. Interstitial fluid returns to the circulation d. Aortic insufficiency 2. What occurs during paroxysmal nocturnal dyspnea in left-sided heart failure? a. Fluid settling in the lungs b. Effective heart action during rest c. Sudden awakening short of breath at night d. Pulmonary capillary rupture 3. Why does increased heart action during rest lead to more severe left-sided heart failure? a. Decreased cardiac output b. Interstitial fluid returns to the circulation c. Increased pulmonary edema d. Aortic coarctation 4. What happens when the fall in blood pressure is registered with the renal-angiotensin system in left-sided heart failure? a. Sodium and water retention b. Increased peripheral circulation c. Improved oxygen-carbon dioxide exchange d. Mitral valve regurgitation 5. Why may the placenta not receive adequate blood in left-sided heart failure? a. decreased peripheral circulation b. Pulmonary hypertension c. Decreased blood pressure d. Retention of sodium and water

1. c 2. c 3. c 4. c 5.d

1. What is the role of low-molecular-weight heparin in peripartal cardiomyopathy management? a. Increase heart rate b. Decrease cardiomegaly c. Decrease the risk of thromboembolism d. Improve myocardial contractility 2. What condition may recur in additional pregnancies if cardiomegaly persists in peripartal cardiomyopathy? a. Pulmonary edema b. Atrial fibrillation c. Peripartal cardiomyopathy d. Hypertension 3. What is the potential consequence of peripartal cardiomyopathy if it progresses to a severe stage? a. Increased cardiac output b. Coronary artery disease c. Heart transplant need d. Mitral valve regurgitation 4. What does immunosuppressive therapy aim to achieve in peripartal cardiomyopathy? a. Decrease heart rate b. Improve fetal growth c. Improve symptoms d. Increase blood pressure 5. What is the primary reason for the high mortality rate in peripartal cardiomyopathy? a. Undetected heart disease b. African American ethnicity c. Danger of thromboembolism d. Unknown cause

1. Increased amniotic fluid in diabetic women is significant and requires monitoring. 2. Preexisting kidney disease in pregnant women with diabetes poses additional risks. 3. Poorly controlled diabetes increases the risk of pregnancy-induced hypertension and infection. 4. Infants of women with poorly controlled diabetes tend to be large. 5. There is an increased risk of congenital anomalies in infants of women with uncontrolled diabetes.

1. What is the significance of increased amniotic fluid in diabetic women during pregnancy? 2. What risks are associated with preexisting kidney disease in pregnant women with diabetes? 3. How does poorly controlled diabetes affect the risk of pregnancy-induced hypertension and infection? 4. Why do infants of women with poorly controlled diabetes tend to be large? 5.What is the risk of congenital anomalies in infants of women with uncontrolled diabetes?

1. B 2. D 3. C 4. B 5. A

1. What laboratory parameter is used to assess the client's anemia status in the nursing diagnosis? A. Blood glucose level B. Hemoglobin level C. White blood cell count D. Platelet count 2. What condition may necessitate dialysis or plasmapheresis during pregnancy to guard against hemorrhage at birth? A. Ectopic pregnancy B. Premature separation of the placenta C. Ulcerative colitis D. A fetus seriously threatened due to SLE complications 3. What is the primary nursing intervention for a client with imbalanced nutrition during pregnancy? A. Administering pain medication B. Providing emotional support C. Monitoring weight gain and laboratory values D. Inducing labor 4. Why might intravenous hydrocortisone be administered during labor for a woman with SLE? A. To induce labor contractions B. To help the woman adjust to stress during labor C. To prevent premature separation of the placenta D. To reduce abdominal pain 5. What is a potential complication for infants born to women with SLE? A. Neonatal heart block B. Gestational diabetes C. Sepsis D. Cleft palate

1. Folic acid supplementation is used to combat anemia in individuals with thalassemia, along with possible blood transfusions. 2. Iron supplementation is avoided during pregnancy in thalassemia to prevent iron overload, especially when blood transfusions are involved. 3. Malaria is transmitted to humans through the bite of infected Anopheles mosquitoes. 4. Complications of malaria-related capillary obstruction include end organ anoxia, thrombocytopenia, anemia, and renal failure. 5. Populations in Mediterranean, African, and Asian regions are at higher risk. Newly immigrated women may be susceptible due to potential exposure in endemic areas.

1. What measures are taken to combat anemia in individuals with thalassemia, aside from blood transfusions? 2. Why is iron supplementation usually avoided during pregnancy in women with thalassemia? 3. How is malaria transmitted to humans, and what are the primary vectors responsible? 4. What complications can arise from the obstruction of capillaries due to malaria? 5. What populations are at a higher risk of malaria, and why may newly immigrated women be susceptible to the infection?

1. c 2. b 3. c 4. c 5. b

1. What medications might be needed to maintain heart action in women with peripartal cardiomyopathy? a. Antibiotics b. Antihypertensives c. Diuretic, arrhythmia agent, and digitalis d. Anticoagulants 2. What therapy may be administered to decrease the risk of thromboembolism in peripartal cardiomyopathy? a. Digitalis therapy b. Low-molecular-weight heparin c. Immunosuppressive therapy d. Arrhythmia agent 3. What is generally suggested if cardiomegaly persists past the postpartum period in peripartal cardiomyopathy? a. Continue with normal activities b. Attempt further pregnancies c. Avoid any further pregnancies d. Use oral contraceptives 4. Why are oral contraceptives contraindicated in women with peripartal cardiomyopathy? a. They cause hypertension b. They increase heart rate c. They create a risk of thromboembolism d. They worsen cardiomegaly 5. What may be needed following pregnancy if peripartal cardiomyopathy progresses, and the heart function deteriorates? a. Beta-blockers b. Heart transplant c. Coronary artery bypass surgery d. Valve replacement surgery

1, c) Depression 2, b) Adolescence and young adulthood 3, c) Four times as commonly 4, c) To address distorted perceptions or depression 5. b) Antidepressants, especially serotonin-reuptake inhibitors

1. What mental illness is most commonly seen in pregnant women? a) Schizophrenia b) Bipolar disorder c) Depression d) Anxiety disorders 2. When does schizophrenia tend to have its highest incidence in pregnant women? a) Childhood b) Adolescence and young adulthood c) Middle age d) Elderly age 3. How much more commonly does depression occur in women compared to men during pregnancy? a) Twice as commonly b) Three times as commonly c) Four times as commonly d) Five times as commonly 4. Why is it important for a pregnant woman with a psychiatric disorder to be cared for by both a psychiatric care team and a prenatal care group? a) To exacerbate the mental illness b) To ensure fetal harm from medication c) To address distorted perceptions or depression d) To promote stress during pregnancy 5. Which medications used for mood disorders should be evaluated for possible fetal harm during pregnancy? a) Antipsychotics b) Antidepressants, especially serotonin-reuptake inhibitors c) Anxiolytics d) Stimulants

1. B 2. A 3. A 4. D 5. A

1. What mode of transmission is common for hepatitis B and C? A. Fecal-oral contact B. Sexual contact C. Airborne transmission D. Ingestion of contaminated water 2. How is maternal/fetal transmission prevented in hepatitis B cases? A. Immune globulin administration B. Hepatitis A vaccine C. Intravenous hydration D. Surgical removal of the gallbladder 3. What are common symptoms of hepatitis in pregnant women? A. Dark yellow urine and light-colored stools B. Nausea and vomiting C. Jaundice as an early symptom D. Enlargement of the liver 4. What is the risk of contracting hepatitis B infection in pregnancy? A. 1 in 100 pregnancies B. 1 in 500 pregnancies C. 1 in 1000 pregnancies D. 1 in 2000 pregnancies 5. What care measures are recommended for the newborn of a mother with hepatitis B infection? A. Wash well to remove maternal blood and administer hepatitis B vaccine B. Immediate breastfeeding to enhance immunity C. Administer immune globulin for prophylaxis D. No specific care is required

1. Rising uterus compresses the diaphragm, reducing thoracic cavity size, and available lung space. It poses a risk if the mother's oxygen-carbon dioxide exchange is altered or insufficient oxygen is received by the mother or fetus. 2. Nursing Diagnosis: Risk for ineffective breathing pattern related to respiratory changes during pregnancy. Outcome Evaluation: Respiratory rate is 16 to 20 per minute, PO2 is above 80 mm Hg, PCO2 is below 40 mm Hg, and fetal heart rate is 120 to 160 beats per minute with good variability. 3. Estrogen stimulation causes nasal congestion during pregnancy, making the common cold more severe. Aspirin should be avoided due to possible interference with blood clotting in both mother and fetus and the risk of prolonged pregnancy at term. 4. Common colds are caused by a virus, making antibiotic therapy unnecessary. Women should check with their health care provider before taking over-the-cou

1. What physiological changes in pregnancy can worsen any respiratory condition, and how does it pose a risk to the fetus? 2. What nursing diagnosis is associated with respiratory changes during pregnancy, and what outcomes are evaluated for effective breathing patterns? 3. Why is acute nasopharyngitis (common cold) more severe during pregnancy, and why should aspirin be avoided as a remedy? 4. Why is antibiotic therapy unnecessary for common colds during pregnancy, and what should women check before taking over-the-counter medications for a cold? 5. What virus causes influenza, and how can pregnant women be safely immunized against influenza?

1. The dilation of ureters due to the effect of progesterone leading to urine stasis, and the minimal glucosuria allowing increased bacterial growth. 2. They can progress to pyelonephritis, which is associated with preterm labor and premature rupture of membranes. 3. Women with known vesicoureteral reflux (backflow of urine into the ureters); they tend to develop UTIs or pyelonephritis more often. 4. Escherichia coli; Ascends from an ascending infection. 5. Streptococcus B infection of the genital tract is associated with pneumonia in newborns.

1. What physiological changes in pregnant women make them more susceptible to urinary tract infections (UTIs)? 2. Why are asymptomatic urinary tract infections (UTIs) in pregnant women considered potentially dangerous? 3. Which group of pregnant women is more prone to developing UTIs or pyelonephritis, and why? 4. What is the most common causative organism for urinary tract infections (UTIs) in pregnant women, and from where does the infection typically ascend? 5. Why is it important to obtain vaginal cultures if the infectious organism causing UTI is determined to be Streptococcus B?

1. c. Obstruction and fistula formation with peritonitis 2. b. To ensure proper fetal development 3. b. Total parenteral nutrition 4. a. Yes 5. b. To avoid interference with bilirubin binding sites and neonatal jaundice

1. What potential complications can arise in both Crohn's disease and ulcerative colitis? a. Respiratory failure b. Kidney stones c. Obstruction and fistula formation with peritonitis d. Heart attack 2. Why is careful monitoring of weight gain important during pregnancy for women with inflammatory bowel disease? a. To prevent stretch marks b. To ensure proper fetal development c. To avoid gestational diabetes d. To control hypertension 3. What is the suggested therapy for inflammatory bowel disease during pregnancy to provide rest for the gastrointestinal tract? a. High-fiber diet b. Total parenteral nutrition c. Regular exercise d. Fasting 4. Can Sulfasalazine (Azulfidine) be continued during pregnancy without causing fetal injury? a. Yes b. No c. Only in the first trimester d. It depends on the severity of the disease 5. Why is the dosage of sulfasalazine reduced close to birth? a. To prevent gastrointestinal bleeding b. To avoid interference with bilirubin binding sites and neonatal jaundice c. To prevent allergic reactions in the newborn d. To reduce the risk of preterm labor

1. C 2. B 3. C 4. A 5. C

1. What potential risks are associated with high doses of salicylates during pregnancy? A. Joint damage B. Premature labor C. Increased bleeding at birth D. Respiratory distress in the infant 2. Why might a woman be advised to decrease her intake of salicylates approximately 2 weeks before term? A. To prevent joint damage B. To avoid prolonged pregnancy C. To reduce the risk of respiratory distress in the infant D. To enhance prostaglandin synthesis 3. What advice is given to women taking low-dose methotrexate (pregnancy risk category X) before becoming pregnant? A. Continue the medication during pregnancy B. Discontinue the medication during pregnancy C. Consult a health care practitioner about continuing the medication D. Switch to corticosteroids during pregnancy 4. Why may symptoms of juvenile rheumatoid arthritis improve during pregnancy? A. Increased circulating levels of corticosteroids B. Decreased immune response C. Genetic modifications D. Enhanced joint lubrication 5. What is the individualized determination required for women regarding breastfeeding in the postpartum period? A. Based on the severity of joint damage B. Depending on the infant's weight C. Associated with maternal corticosteroid levels D. Guided by the woman's preference and medication taken

1. d) Separate ingestion from iron, calcium, or soy products by about 4 hours 2. d) Hyperemesis gravidarum 3. b) Increased by 20-30% 4. d) Antibiotics 5. b) Risk for maternal and fetal injury

1. What precaution should women taking levothyroxine for hypothyroidism follow to ensure proper medication absorption? a) Take it with iron-containing medications b) Take it with calcium-containing medications c) Take it with soy products d) Separate ingestion from iron, calcium, or soy products by about 4 hours 2. What condition may be associated with hypothyroidism during pregnancy, leading to increased nausea and vomiting? a) Anovulation b) Gestational diabetes c) Placental abruption d) Hyperemesis gravidarum 3. How should the dose of levothyroxine be adjusted during pregnancy for women with hypothyroidism? a) Decreased by 20-30% b) Increased by 20-30% c) Kept the same as pre-pregnancy level d) Discontinued during pregnancy 4. What should women with hypothyroidism avoid taking simultaneously with thyroxine to prevent absorption issues? a) Iron-containing medications b) Calcium-containing medications c) Soy products d) Antibiotics 5. What nursing diagnosis is associated with a woman with pre-existing thyroid disorder during pregnancy? a) Risk for ineffective tissue perfusion b) Risk for maternal and fetal injury c) Risk for impaired parenting d) Risk for falls and fractures

1. Prevention includes wearing protective clothing, using insect repellent, sleeping under mosquito nets, and avoiding travel to endemic areas during pregnancy. Malaria can be transmitted to the fetus through mother-to-fetus transmission. 2. The incubation period is 12 to 14 days. Symptoms include elevated liver function tests, fever, malaise, and headache. 3. Chloroquine is safe to administer during all trimesters of pregnancy and is the drug of choice for treating malaria. 4. Quinine, malarone, or tetracyclines should not be used during pregnancy or with breastfeeding women. 5. Antimalarial therapy may reduce the incidence of low birth weight and preterm birth.

1. What precautions can be taken to prevent malaria during pregnancy, and how can it be transmitted to the fetus? 2. What is the incubation period for the most common type of malaria, and what symptoms may manifest? 3. Which antimalarial drug is considered safe during all trimesters of pregnancy and is the drug of choice? 4. Which antimalarial drugs should not be used during pregnancy or breastfeeding? 5. How may antimalarial therapy contribute to reducing the incidence of adverse pregnancy outcomes?

1. Preventative measures include wearing protective clothing, using insect repellent, sleeping under mosquito nets, and avoiding travel to malaria-endemic areas during pregnancy. 2. Chloroquine is considered safe during all trimesters of pregnancy and is the drug of choice for treating malaria. 3. These antimalarial drugs should be avoided due to potential risks to the fetus or breastfeeding infant. 4. Antimalarial therapy may reduce the incidence of low birth weight and preterm birth in pregnant women with malaria. 5. Pregnant women should take precautions such as using insect repellent, wearing protective clothing, sleeping under mosquito nets, and avoiding travel to malaria-endemic areas if possible.

1. What preventative measures can be recommended to pregnant women to reduce the risk of malaria? 2. Which antimalarial drug is considered safe during all trimesters of pregnancy and is the drug of choice for treatment? 3. Why should quinine, malarone, or tetracyclines be avoided during pregnancy or breastfeeding? 4. How does antimalarial therapy contribute to reducing adverse pregnancy outcomes? 5. What precautions should pregnant women take if they reside in or travel to malaria-endemic areas?

1. b 2. c 3. b 4. d 5. b (If these complications result in impaired blood flow to the uterus, poor placental perfusion, intrauterine growth restriction, and fetal mortality can occur.)

1. What secondary problem can occur in the presence of mitral stenosis due to difficulty in blood leaving the left atrium? a. Hypertension b. Thrombus formation c. Aortic dissection d. Aneurysm 2. Why might a woman with mitral stenosis be prescribed an anticoagulant? a. To control blood pressure b. To improve ventricular filling c. To prevent thrombus formation d. To reduce blood volume 3. What can occur in cases of coarctation of the aorta due to high blood pressure pushing blood past the constriction? a. Pulmonary edema b. Aortic dissection c. Mitral valve regurgitation d. Bradycardia 4. Which medications might be prescribed to a woman with coarctation of the aorta to control blood pressure? a. Anticoagulants b. Diuretics c. Beta-blockers d. antihypertensive 5. What complications can arise if impaired blood flow to the uterus occurs due to mitral stenosis or aortic coarctation? a. Pulmonary edema b. Intrauterine growth restriction c. Aortic dissection d. Thrombus formation

1. c 2. d 3. a 4. c 5. d

1. What stimulates the respiratory center to increase respiratory rate as a response to decreased oxygen saturation? a. Increased cardiac output b. Alveolar collapse c. Chemoreceptors d. Aortic coarctation 2. How does the respiratory rate change in women with left-sided heart failure as the dysfunction of the alveoli progresses? a. Decreases with rest b. Remains constant c. Increases only during exertion d. Increases with rest 3. Why does a woman experience paroxysmal nocturnal dyspnea in left-sided heart failure? a. Effective heart action during rest b. Fluid settling in the lungs c. Decreased cardiac output d. Pulmonary hypertension 4. What is orthopnea in the context of left-sided heart failure? a. Inability to sleep b. Sleeping in a specific position c. Inability to breathe in any position except elevated d. Rapid heart rate during sleep 5. How does orthopnea help in left-sided heart failure? a. Facilitates blood flow to the lungs b. Allows for fluid settling in the lungs c. Increases pulmonary hypertension d. Frees space for gas exchange

1. b 2. b 3. b 4. a 5. c

1. When should a woman undergo serial ultrasound and nonstress tests to monitor fetal health? a. Weeks 20 to 22 b. Weeks 30 to 32 c. Weeks 10 to 12 d. Weeks 40 to 42 2.What medical procedure can be performed during pregnancy to loosen mitral valve adhesions? a. Coronary artery bypass surgery b. Balloon valve angioplasty c. Aortic valve replacement d. Ventricular septal defect repair 3. What is the drug of choice for anticoagulation during early pregnancy, especially if mitral stenosis is present? a. Warfarin b. Heparin c. Coumadin d. Beta-blockers 4. Why is heparin preferred over warfarin during early pregnancy? a. Warfarin has teratogenic effects b. Heparin has a stronger anticoagulant effect c. Warfarin does not cross the placenta d. Heparin improves ventricular filling 5. When can warfarin be used during pregnancy if anticoagulation is required? a. Anytime during pregnancy b. Only during the first trimester c. After week 12 d. After week 30

1. c) Enlargement (hypertrophy) 2. b) Maternal and fetal injury 3. c) Hyperthyroidism 4. b) Synthroid (levothyroxine) 5. c) Heat intolerance

1. Which of the following is a normal effect of pregnancy on the thyroid gland? a) Decreased vascularity b) Hypotrophy c) Enlargement (hypertrophy) d) Reduced blood flow 2. What is the potential risk associated with pre-existing thyroid disorders during pregnancy? a) Reduced fertility b) Maternal and fetal injury c) Increased blood flow d) Improved immune function 3. Which condition is more likely to cause heart failure during pregnancy if undiagnosed? a) Hypothyroidism b) Scoliosis c) Hyperthyroidism d) Osteoporosis 4. What medication is commonly prescribed to women with hypothyroidism during pregnancy? a) Methimazole b) Synthroid (levothyroxine) c) PTU (propylthiouracil) d) Corticosteroids 5. What symptom is associated with hyperthyroidism (Graves' disease)? a) Weight gain b) Bradycardia c) Heat intolerance d) Dry skin (myxedema)

1. d) The fetus is directly exposed 2. a) Increased risk of thrombus formation 3. b) It disrupts the pregnancy 4. b) Availability of a vaccine against HPV 5. b) Melanoma

1. Why does radiation therapy pose a risk to the fetus throughout pregnancy? a) It induces early labor b) It affects the fetal nervous system c) It increases the risk of fetal anomalies d) The fetus is directly exposed 2. What risk is associated with surgery to remove a tumor during pregnancy? a) Increased risk of thrombus formation b) Fetal metastasis c) Fetal anemia d) Decreased coagulation process 3. Why does cervical conization for cervical cancer pose a high fetal risk? a) It induces early labor b) It disrupts the pregnancy c) It increases the risk of fetal anomalies d) It leads to fetal metastasis 4. Why is cervical cancer incidence expected to decrease in the future? a) Advancements in surgical techniques b) Availability of a vaccine against HPV c) Improved prenatal care d) Decreased maternal age 5.Which type of cancer appears capable of spreading to the fetus? a) Breast cancer b) Melanoma c) Ovarian cancer d) Leukemia

1. B 2. B 3. C 4. C 5. C

1. Why is direct endoscopy or ultrasound preferred over barium x-rays for diagnosing GERD or hiatal hernia during pregnancy? A. Barium x-rays are harmful to the fetus B. Direct endoscopy provides better visualization C. Ultrasound is more cost-effective D. Barium x-rays are less accurate 2. What is the typical age group associated with cholecystitis and cholelithiasis? A. Teenagers B. Women older than 40 years C. Young adults D. Men older than 60 years 3. What type of diet is recommended for women with cholecystitis and cholelithiasis during pregnancy? A. High-fat diet B. Fat-free diet C. Low-fat diet D. High-protein diet 4. What medical therapy is suggested to lower fat intake for cholecystitis and cholelithiasis during pregnancy? A. Linoleic acid supplements B. Proton pump inhibitors C. Low-fat diet D. High-fat diet 5. Under what circumstances is surgery for gallbladder removal considered during pregnancy for cholecystitis? A. Always B. If the woman prefers it C. If symptoms cannot be controlled by conservative management D. Only in the third trimester

1. To ensure the well-being of both the mother and the baby. 2. Ineffective pumping of the heart, requiring compensation through an increased heart rate. 3. Side-lying position. 4. To ease the work of breathing 5. Fatigue may indicate an inability of the heart to meet the increased demands during labor.

1. Why is it essential to monitor fetal heart rate and uterine contractions in all women with heart disease during labor? 2. What does a rapidly increasing pulse rate during labor (e.g., "100 beats per minute) indicate? 3. What position should a woman be advised to assume to reduce the possibility of supine hypotension syndrome during labor? 4. Why might a woman with pulmonary edema need her chest and head elevated (semi-Fowler's position) during labor? 5. Why is fatigue considered a symptom of heart decompensation during labor?

1. d 2. d 3. d 4. d 5. b

1. Why might a woman be switched from warfarin to heparin during the last month of pregnancy? a. To control blood pressure b. To improve ventricular filling c. To prevent teratogenic effects d. To avoid fetal coagulation disorder 2. What is the primary reason for using heparin during the last month of pregnancy? a. To prevent thrombus formation b. To reduce blood volume c. To improve fetal growth d. To avoid teratogenic effects 3. What effect does heparin have on the fetus during pregnancy? a. Crosses the placenta and enters the fetus b. Improves fetal cardiac output c. Causes intrauterine growth restriction d. Does not cross the placenta 4. What is the purpose of balloon valve angioplasty in the context of mitral stenosis? a. To reduce blood volume b. To prevent thrombus formation c. To improve ventricular filling d. To loosen mitral valve adhesions 5. What is the risk associated with sodium warfarin (Coumadin) during pregnancy? a. Aortic dissection b. Teratogenic effects c. Bradycardia d. Intrauterine growth restriction

1. b) To counteract decreased vitamin K levels in newborns 2. c) Continue taking it 3. b) To ensure adequate fetal oxygenation 4. b) Risk is higher than average 5. a) These are normal newborn characteristics

1. Why might women taking phenytoin be prescribed vitamin K during labor or the last 4 weeks of gestation? a) To prevent seizures b) To counteract decreased vitamin K levels in newborns c) To induce labor d) To reduce blood pressure 2. During labor, what should a woman with recurrent seizures do regarding her medication? a) Stop taking it b) Take a higher dose c) Continue taking it d) Switch to a different medication 3. Why is administering oxygen by mask recommended during a tonic-clonic seizure in pregnancy? a) To prevent seizures b) To ensure adequate fetal oxygenation c) To induce labor d) To reduce blood pressure 4. What is the potential concern for a woman with recurrent seizures regarding her child's risk for seizures? a) Risk is lower than average b) Risk is higher than average c) Risk is equal to average d) No risk at all 5. What should healthcare providers educate a woman with recurrent seizures about her newborn's sudden jerking movements? a) These are normal newborn characteristics b) These indicate seizures c) These require immediate medical attention d) These are a sign of a genetic disorder

1. d 2. b 3. b 4. b 5. c

1. Why might women with uncorrected Eisenmenger syndrome be advised not to become pregnant? a. Increased risk of pulmonary stenosis b. Decreased risk of right-sided heart failure c. Risk of fetal growth restriction d. Risk of maternal complications 2. What is recommended for women with uncorrected Eisenmenger syndrome if they become pregnant? a. Home care b. Hospitalization for the last part of pregnancy c. Avoiding oxygen administration d. No need for fetal growth monitoring 3. Why do pregnant women with uncorrected Eisenmenger syndrome need oxygen administration and arterial blood gas assessments? a. To minimize diaphragmatic pressure b. To ensure fetal growth c. To monitor pulmonary pressure d. To prevent pulmonary edema 4. What may be needed during labor for women with uncorrected Eisenmenger syndrome? a. Increased oxygen administration b. Pulmonary artery catheter c. Aortic valve replacement d. Beta-blockers 5. Why is a pulmonary artery catheter inserted during labor for women with uncorrected Eisenmenger syndrome? a. To improve ventricular filling b. To monitor systemic blood pressure c. To monitor pulmonary pressure d. To prevent thrombus formation

1. Penicillin is not known to be a fetal teratogen, and it offers protection against bacterial endocarditis. 2. Ampicillin, amoxicillin (Amoxil), or clindamycin (Cleocin) to protect against bacterial endocarditis. 3. Concerns about the general rule of avoiding medicine during pregnancy, but exceptions exist. 4. Infections can increase body temperature, leading to increased energy expenditure and cardiac output, which may be too extreme for a woman with heart disease. 5. Alert health care personnel to consider early antibiotic therapy.

1. Why should a woman with a history of rheumatic fever continue taking penicillin prophylactically during pregnancy? 2. What antibiotics might be prescribed close to the anticipated day of birth for women with heart disease? 3. Why is it challenging to encourage women with heart disease to take necessary medicine during pregnancy? 4. Why should a woman with heart disease avoid infections during pregnancy? 5. What action should a woman with heart disease take at the first indication of an upper respiratory tract infection or urinary tract infection?

1. d) Fetal thyroid may incorporate the drug 2. b) Methimazole 3. b) Goiter 4. c) Thyroid activity 5. c) It requires general anesthesia

1. Why should the nuclear medicine imaging study involving the radioactive uptake of 131I subtype not be used during pregnancy? a) It induces labor b) It can lead to congenital anomalies c) It's ineffective in diagnosing hyperthyroidism d) Fetal thyroid may incorporate the drug 2. What is the preferred drug for pregnant women with hyperthyroidism due to its lower placental transfer? a) PTU (propylthiouracil) b) Methimazole c) Synthroid (levothyroxine) d) Corticosteroids 3. What complication may arise in infants born to mothers with unregulated hyperthyroidism during pregnancy? a) Hypothyroidism b) Goiter c) Hypertension d) Congenital heart defects 4. What should be regulated for women with hyperthyroidism during pregnancy to prevent fetal complications? a) Blood pressure b) Blood glucose levels c) Thyroid activity d) Hemoglobin levels 5. Why might surgical treatment to reduce the functioning of the maternal thyroid gland be avoided during pregnancy? a) It induces labor b) It causes hyperthyroidism c) It requires general anesthesia d) It interferes with fetal development

1. Historical advice was due to the high-risk status during pregnancy. Today, with conscientious prenatal care, women with chronic renal disease can have healthy pregnancies and children. 2. Due to the diseased kidneys not producing erythropoietin; Synthetic erythropoietin is safe to take during pregnancy and aids in red cell formation. 3. Pregnancy increases the glomerular filtration rate, leading to a lower serum creatinine level; Women with kidney disease may be concerned as their normal level may already be elevated, and further decrease may lead to kidney failure. 4. Increased glomerular permeability during pregnancy affects values; Proteinuria and blood pressure must be compared to a woman's individualized prepregnancy level to be meaningful. 5. To manage renal disease; Animal studies show an increased incidence of cleft palate, but this is not observed in humans.

1. Why were females with chronic renal disease historically advised against having children, and how has this perspective changed today? 2. Why might women with chronic renal disease develop severe anemia during pregnancy, and what is the role of synthetic erythropoietin in managing this condition? 3. How does pregnancy affect a woman's serum creatinine level, and why might a serum creatinine level below normal during pregnancy be concerning for some women with kidney disease? 4. Why is it challenging to interpret kidney function during pregnancy based on nonpregnant values, and what must be considered when assessing proteinuria and blood pressure in pregnant women with renal disease? 5. Why is the use of corticosteroids, such as oral prednisone, continued throughout pregnancy in many women with renal disease, and what potential side effect has been observed in animal studies?

11. SARS spreads by close person-to-person contact via droplet transmission. The incubation period is 2 to 10 days. 2. Decreased lymphocyte and platelet counts are common. Vigorous therapy with intravenous antibiotics is recommended, and respiratory support may be needed. 13. SARS during pregnancy is associated with high incidences of spontaneous miscarriage, preterm birth, and intrauterine growth restriction. There is no evidence of perinatal SARS infection among infants born to these mothers.

11. How does SARS spread, and what is the incubation period for the disease? 12. What laboratory findings are common in SARS, and what therapy is recommended, including potential respiratory support? 13. What complications are associated with SARS during pregnancy, and what evidence is there regarding perinatal SARS infection among infants born to affected mothers?

11. Diagnosis through laboratory studies revealing marked thrombocytopenia; Platelet count may be as low as 20,000/mm3. 12. Platelet transfusion or plasmapheresis; Oral prednisone is also effective. 13. Decreased platelet count can lead to increased bleeding at birth, and the antiplatelet factor can cross the placenta, causing platelet destruction in the newborn. 14. The newborn may be born with the illness, leading to platelet destruction.

11. How is ITP diagnosed, and what laboratory findings are associated with the condition? 12. What interventions can be administered to temporarily increase the platelet count in women with ITP during pregnancy? 13. Why is it important to identify women with ITP during pregnancy? 14. How might ITP affect the newborn if not identified and managed during pregnancy? 15. What is the recommended care for a child born with ITP? Answer: Refer to Chapter 44 for care of the child with ITP.

11. Pregnancy does not appear to shorten the life span of women with cystic fibrosis. However, it is considered a strain on the respiratory system. 12. Pancrelipase may interfere with iron absorption, putting women with cystic fibrosis at a greater risk for iron-deficiency anemia during pregnancy. 13. Individuals with cystic fibrosis have a higher incidence of developing diabetes mellitus. Prenatal monitoring involves close surveillance of serum glucose levels to detect gestational diabetes. 14. Chest physiotherapy is challenging late in pregnancy due to exhaustion. Modifications may include more frequent and shorter sessions in modified positions. 15. Fetal health is monitored through ultrasound and nonstress tests to identify intrauterine growth restriction.

11. How might pregnancy impact the life span of women with cystic fibrosis, and why is pregnancy considered a strain on the respiratory system? 12. Why is iron supplementation commonly prescribed for women with cystic fibrosis during pregnancy? 13. What health complication do individuals with cystic fibrosis have a higher incidence of, and how does this impact prenatal monitoring? 14. Why does chest physiotherapy become challenging late in pregnancy, and what modifications may be necessary? 15. How is fetal health monitored during pregnancy in women with cystic fibrosis?

11. Infants may experience a greater-than-usual incidence of spontaneous miscarriage, preterm birth, a lupus-like rash, anemia, thrombocytopenia, and neonatal heart block. They may be small for gestational age due to decreased blood flow to the placenta. 12. Newborn symptoms last about 6 months and then fade. If congenital heart block occurs, a newborn pacemaker may be necessary. 13. Screening for the exact type of autoantibodies present may be helpful in predicting which newborns are susceptible to congenital heart block. 14. The nursing diagnosis indicates potential or actual pain related to disease pathology. Achieving a pain-free outcome may be challenging due to the nature of these illnesses. 15. Corticosteroid levels fall to prepregnancy levels during the postpartum period, and symptoms of rheumatoid arthritis may recur. Monitoring these levels is crucial to manage symptom exacerbation.

11. What complications may arise in infants born to women with SLE, and why are infants at risk of being small for gestational age? 12. How long do symptoms in newborns born to women with SLE typically last, and what intervention might be necessary if congenital heart block occurs? 13. Why might a screening for the exact type of autoantibodies present in women with SLE be helpful during pregnancy? 14. In the context of rheumatic disorders during pregnancy, what is the significance of the nursing diagnosis "Pain related to rheumatic disorder," and why might achieving a pain-free outcome be challenging? 15. What is the potential impact of corticosteroid levels on symptoms of rheumatoid arthritis during the postpartum period, and why is it crucial for healthcare providers to monitor these levels?

11. Voiding frequently, wiping front to back, wearing cotton underwear, and voiding immediately after sexual intercourse. 12. To flush out the infection from the urinary tract; Specify a specific amount to drink every day (up to 3 to 4 L per 24 hours). 13. By assuming a knee-chest position for 15 minutes morning and evening. 14. The chances of developing another UTI late in pregnancy are high when urinary stasis tends to be greater. 15. Remind the woman to take the medication by posting a chart and keeping medicine out of sight and reach to establish the habit of "childproofing."

11. What preventive measures can all pregnant women be reminded of to reduce the risk of urinary tract infections (UTIs)? 12. Why is it crucial for a pregnant woman with a UTI to increase fluid intake, and how should health care providers advise her regarding this? 13. How can a pregnant woman promote urine drainage and reduce pressure on the ureters? 14. Why might a woman with one urinary tract infection during pregnancy be kept on prophylactic antibiotics throughout the remainder of her pregnancy? 15. How can health care providers address potential issues with medication compliance in pregnant women with urinary tract infections?

11. Isoniazid (INH) and ethambutol hydrochloride (Myambutol) are considered the drugs of choice for tuberculosis and can be given during pregnancy. 12. INH may result in a peripheral neuritis if a woman does not take supplemental pyridoxine (vitamin B6). 13. To ensure that tuberculosis pockets are not broken down. Recent inactive tuberculosis may become active during pregnancy or the postpartum period if not careful, leading to potential complications. 14. Tuberculosis is usually spread to the fetus after birth. If a woman has a recent history of tuberculosis and is planning to breastfeed, she should have three negative sputum cultures before holding or caring for her infant, and breastfeeding may be possible. 15. Women with well-managed asthma may experience an improvement in symptoms during pregnancy due to the high circulating levels of corticosteroids. Corticosteroids play a role in managing asthma and may contri

11. Which drugs are considered the drugs of choice for tuberculosis and can be given during pregnancy? 12. What potential effects might INH have, and what precaution should be taken to avoid a peripheral neuritis? 13. Why should a woman with a history of tuberculosis be especially careful about maintaining an adequate level of calcium during pregnancy? 14. How is tuberculosis usually spread to the fetus, and what precautionary measures should be taken if a woman has a recent history of tuberculosis and is planning to breastfeed? Answer: Tuberculosis is usually spread to the fetus after birth. If a woman has a recent history of tuberculosis and is planning to breastfeed, she should have three negative sputum cultures before holding or caring for her infant, and breastfeeding may be possible. 15. Why might women with well-managed asthma experience an improvement in symptoms during pregnancy, and what is the role of corticosteroids in this context?

11. Increased glomerular permeability during pregnancy may lead to trace amounts of glucose and protein in the urine, making individualized comparisons necessary for meaningful assessment. 12. Corticosteroids are continued throughout pregnancy for renal disease management; Animal studies show an increased incidence of cleft palate, which is not observed in humans. 13. General health, time since transplant, serum creatinine level, presence of proteinuria or hypertension, signs of graft rejection, and medications taken to reduce graft rejection. 14. Risk of preterm labor, possibly due to progesterone removal; Progesterone may be administered intramuscularly before dialysis to prevent preterm labor. 15. It causes less drastic fluid shifts; Administered on an ambulatory basis throughout pregnancy.

11. Why might proteinuria and blood pressure assessments during pregnancy need to be compared to individualized prepregnancy levels in women with renal disease? 12. What role do corticosteroids play in the management of renal disease during pregnancy, and what side effect has been observed in animal studies? 13. What criteria are evaluated to determine if a woman with a kidney transplant can safely carry a pregnancy to term? 14. What risk is associated with dialysis in pregnant women, and how can this risk be mitigated? 15. Why is continuous ambulatory peritoneal dialysis preferred over hemodialysis in pregnant women, and how is it administered throughout pregnancy?

16. The shape of the lung changes during pregnancy due to pressure on the diaphragm from below. Waiting 1 to 2 years after the infection becomes inactive is recommended before attempting to conceive to reduce the risk of recent inactive tuberculosis becoming active during pregnancy or postpartum, especially if lung shape changes. 17. Severe acute respiratory syndrome (SARS) during pregnancy is associated with high incidences of spontaneous miscarriage, preterm birth, and intrauterine growth restriction. The incubation period for SARS is 2 to 10 days. 18. Oseltamivir (Tamiflu) is used cautiously during pregnancy as its long-term effects are not fully known. It falls under pregnancy category C. 19. The rising uterus compresses the diaphragm, reducing the size of the thoracic cavity and available lung space, potentially worsening respiratory conditions. Any respiratory disorder can pose serious hazards to the fetus if

16. How might the shape of the lung change during pregnancy, and why is waiting 1 to 2 years after the infection becomes inactive recommended for women with a history of tuberculosis before attempting to conceive? 17. What potential complications are associated with severe acute respiratory syndrome (SARS) during pregnancy, and what is the incubation period for SARS? 18. Why is oseltamivir (Tamiflu) used cautiously during pregnancy, and what category does it fall under? 19. How does the rising uterus during pregnancy contribute to the worsening of respiratory conditions, and what are the potential hazards to the fetus in this context? 20. Why is it important for women with chronic renal disease to maintain an adequate level of platelets during pregnancy, and how might this affect the newborn? Answer: Women with chronic renal disease may need to maintain an adequate level of platelets during pregnancy to prevent increased bleeding at birth. The antiplatelet factor can cross the placenta, causing platelet destruction in the newborn or allowing the newborn to be born with the illness.

16. Pyelonephritis is an extension of a urinary tract infection; it typically occurs as an infection that originated in or spread to the kidney. 17. Treatment with intravenous antibiotics during hospitalization; Maintenance with oral nitrofurantoin (Macrodantin) for the remainder of the pregnancy. 18. It is not recommended because a newborn can develop scurvy in the immediate neonatal period from withdrawal. 19. Intravenous pyelogram or ultrasound to detect urinary tract abnormalities and prevent future infections. 20. Remind them to continue taking prophylactic antibiotics and consider establishing a reminder system, as compliance tends to decrease when clinical evidence of sickness diminishes.

16. What is pyelonephritis, and how does it usually occur in pregnant women? 17. What is the recommended treatment for pyelonephritis in pregnant women, and what drug may be prescribed for maintenance after the acute episode? 18. Why is acidifying urine with ascorbic acid (vitamin C) not usually recommended during pregnancy? 19. After birth, what diagnostic procedures may be scheduled for a woman who developed more than one urinary tract infection during pregnancy? 20. What advice can be given to pregnant women regarding medication compliance for prophylactic antibiotics, especially as they approach the end of pregnancy?

16. Women with cystic fibrosis may need to plan how to conserve energy for infant care in the immediate postpartum period to avoid exhaustion. 17. Women with cystic fibrosis are advised not to breastfeed as their milk is high in sodium, potentially placing the infant at risk for hypernatremia. 18. Breastfeeding could be more tiring for the mother with cystic fibrosis. 19. The milk of nursing mothers with cystic fibrosis is high in sodium. 20. Women with severe COPD may be advised to avoid pregnancy due to the significant challenges they face in their nonpregnant state, which can be exacerbated during pregnancy.

16. What modifications might be needed to conserve energy for infant care in the immediate postpartum period for women with cystic fibrosis? 17. Why are women with cystic fibrosis usually advised not to breastfeed, and what potential risk does their milk pose to the infant? 18. How might breastfeeding impact the mother with cystic fibrosis? 19. What is the typical sodium content in the milk of nursing mothers with cystic fibrosis? 20. Why might women with severe COPD be advised to avoid pregnancy, and what challenges can arise in their nonpregnant state?

16. Decreasing salicylate intake before term is advised to reduce the possibility of increased bleeding at birth or prolonged pregnancy. High salicylate use may lead to increased bleeding in the newborn and prolonged pregnancy. 17. Both conditions may present with increased blood pressure, but nephritis symptoms in SLE involve hematuria, whereas pregnancy-induced hypertension does not. 18. Increased corticosteroid levels during pregnancy may lessen symptoms of SLE. The increased risk for preterm birth is associated with decreased blood flow to the placenta. 19. Women with cystic fibrosis are at greater risk for iron-deficiency anemia, so iron supplementation is recommended. They also need close monitoring of serum glucose levels for the development of gestational diabetes. 20. Women with cystic fibrosis are usually advised not to breastfeed due to the high sodium content in their milk, potentially placing the infant

16. Why might a woman with juvenile rheumatoid arthritis be advised to decrease her intake of salicylates about 2 weeks before term, and what risks are associated with high salicylate use during pregnancy? 17. In the case of systemic lupus erythematosus (SLE), why is it challenging to differentiate symptoms of associated nephritis from those of pregnancy-induced hypertension, and what distinguishes the two conditions? 18. How might corticosteroid levels during pregnancy affect symptoms of systemic lupus erythematosus (SLE), and why is there an increased risk for preterm birth in women with SLE? 19. What precautions are recommended for women with cystic fibrosis during pregnancy, especially concerning iron supplementation and glucose monitoring? 20. What is the rationale behind advising women with cystic fibrosis against breastfeeding, and what potential risk does their milk pose to the infant?

16. Low potassium diet is needed to avoid potassium buildup; A nutrition consultation is necessary to address the potential nutritional concerns. 17. They may be aware of the risk to their own life and the life of the child, and they may need extra support and information to monitor the well-being of the fetus. 18. Oral prednisone (a corticosteroid); Animal studies have shown an increased incidence of cleft palate, which is not observed in humans. 19. They may need extra time for bonding as they may have been too concerned during pregnancy to initiate this process. Healthcare providers can facilitate this by allowing additional time and support. 20. Misinterpretation of kidney function; It may lead to unnecessary concerns or interventions if not compared appropriately.

16. Why might women with severe renal disease require a nutrition consultation during pregnancy, and what could be the potential consequence of a low potassium diet? 17. What emotional challenges might pregnant women with renal disease face, and why might they need extra support and information during pregnancy? 18. What medication is typically continued throughout pregnancy in women with renal disease, and what has been observed in animal studies regarding its use during pregnancy? 19. Why might pregnant women with severe renal disease need extra time with their infant at birth, and how can healthcare providers support this need? 20. What might be a potential consequence of not comparing proteinuria and blood pressure levels during pregnancy to individualized prepregnancy levels in women with renal disease?

6. Manifested by frequency and pain on urination; Pyelonephritis may involve lumbar pain, nausea, vomiting, malaise, and elevated temperature. 7. Greater compression and urinary stasis on the right ureter due to the uterus being pushed that way by the large bulk of the intestine on the left side. 8. Over 100,000 organisms per milliliter of urine. 9. Recommended antibiotics include amoxicillin, ampicillin, and cephalosporins; Sulfonamides are contraindicated near term due to the risk of hyperbilirubinemia in the newborn. 10. Nursing Diagnosis: Risk for infection related to stasis of urine with pregnancy; Outcome Evaluation: Oral temperature below 100.4°F and a clean-catch urine specimen with a bacteria count below 100,000 colonies per milliliter.

6. How is a urinary tract infection (UTI) typically manifested, and what additional symptoms may occur with pyelonephritis? 7. Why is there a higher incidence of urinary tract infections on the right side during pregnancy? 8. What level of organisms in a urine culture is diagnostic of a urinary tract infection (UTI)? 9. What are the recommended antibiotics for treating urinary tract infections (UTIs) during pregnancy, and why are some antibiotics contraindicated near term? 10. What nursing diagnosis is associated with a woman experiencing urinary stasis during pregnancy, and what is the related outcome evaluation?

6. Cromolyn sodium (Intal) is commonly used. It falls under pregnancy category B. 7. Leukotriene receptor antagonists are montelukast sodium (Singulair) or zafirlukast (Accolate). Both are pregnancy category B and may be continued during pregnancy. 8. Tuberculosis is caused by Mycobacterium tuberculosis. The body responds with macrophages and T lymphocytes surrounding the invading bacillus, leading to fibrosis, calcification, and scar tissue formation, confining the organisms. 9. Women in high-risk areas should undergo skin testing (PPD test). A positive reaction does not necessarily mean active disease but indicates exposure to tuberculosis and antibodies in the system. 10. Symptoms include chronic cough, weight loss, hemoptysis, night sweats, low-grade fever, and chronic fatigue. A woman with a recent history of tuberculosis should wait 1 to 2 years after the infection becomes inactive before attempting to conceive

6. Name a mast cell stabilizer commonly used to prevent asthma symptoms, and what pregnancy category does it fall under? 7. What are leukotriene receptor antagonists, and name two examples that are safe to be continued during pregnancy? 8. What disease is Tuberculosis caused by, and how does the body respond to Mycobacterium tuberculosis invasion? 9. What assessment should women in high-risk areas undergo during pregnancy, and what caution is given regarding a positive reaction to a Mantoux test? 10. Name symptoms of tuberculosis, and what should be done if a woman has a recent history of tuberculosis and is planning to conceive?

6. Acetaminophen (Tylenol) is recommended for controlling fever. Oseltamivir (TamiFlu), a category C oral antiviral drug, should be used cautiously until its long-term effects are known. 7. Some studies have shown a link between influenza during pregnancy and schizophrenia in children. Treatment includes an antipyretic such as acetaminophen to control fever. 8. Pathogens include S. pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae. Antibiotic therapy is aimed at the bacterial or viral invasion of lung tissue. 9. Oxygen deficit in severe pneumonia may lead to preterm labor. During labor, oxygen should be administered to ensure adequate oxygen resources for the fetus during contractions. 10. Severe acute respiratory syndrome (SARS) has these symptoms, and a coronavirus has been identified as the responsible pathogen.

6. What antipyretic is recommended for controlling fever in influenza, and what caution should be exercised with the oral antiviral drug oseltamivir? 7. What potential link has been observed between influenza during pregnancy and children's health, and what treatment is recommended for influenza during pregnancy? 8. What is the pathogen responsible for pneumonia, and what is the therapy involving antibiotics aimed at? 9. Why might pneumonia in late pregnancy lead to preterm labor, and what intervention is necessary during labor if pneumonia is present? 10. What infectious disease has symptoms such as persistent fever, chills, muscle aches, dry cough, and dyspnea, and what pathogen has been identified as responsible for this illness?

6. General health, time since transplant (preferably >2 years), serum creatinine level, presence of proteinuria or hypertension, signs of graft rejection, and medications taken to reduce graft rejection. 7. Dialysis aids kidney function; Risk of preterm labor, possibly due to progesterone removal. Progesterone may be administered intramuscularly before dialysis to prevent this. 8. Peritoneal dialysis causes less drastic fluid shifts; It can be administered on an ambulatory basis (continuous ambulatory peritoneal dialysis) throughout pregnancy. 9. Low potassium diet to avoid potassium buildup; Emotional support is needed due to awareness of the vital role of kidneys, the risk of kidney failure, and the potential impact on the life of both the fetus and the woman. 10. It aids in red cell formation, addressing the severe anemia that may develop during pregnancy.

6. What criteria should be evaluated to determine if a woman with a kidney transplant can carry a pregnancy to term? 7. Why may women with severe renal disease require dialysis during pregnancy, and what risk is associated with this procedure? 8. Why is peri-toneal dialysis preferred over hemodialysis in pregnant women, and how is it administered throughout pregnancy? 9. What is the potential nutritional concern for pregnant women with renal disease, and why might they need emotional support during pregnancy? 10. How can synthetic erythropoietin benefit pregnant women with chronic renal disease?

6. To detect whether a male fetus has hemophilia; Recommended when there is a family history of hemophilia. 7. These procedures could result in extensive fetal blood loss. 8. ITP is a decreased number of platelets; Manifests with petechiae, ecchymoses, and frequent nosebleeds in pregnant women 9. Assumed to be an autoimmune illness; Symptoms usually occur shortly after a viral invasion such as an upper respiratory infection. 10. Typically runs a 1- to 3-month limited course; Confused with pregnancy-induced hypertension with HELLP syndrome.

6. What is the purpose of percutaneous umbilical blood sampling in the context of hemophilia, and when is it recommended? 7. Why are internal fetal heart rate monitoring and fetal scalp blood sampling contraindicated in a fetus with a coagulation disorder? 8. What is idiopathic thrombocytopenic purpura (ITP), and how does it manifest in pregnant women? 9. What is the assumed cause of idiopathic thrombocytopenic purpura (ITP), and when do symptoms usually occur? 10. What is the typical duration of the limited course of ITP, and how might it be confused with another serious pregnancy complication?

6. Chronic respiratory infection, lung overinflation, and difficulty digesting fat and protein are common symptoms. Poor pulmonary function increases the risk of preterm labor and perinatal death during pregnancy. 7. Cystic fibrosis in the fetus can be identified by chorionic villi sampling or amniocentesis, with screening typically performed during pregnancy or immediately after birth. 8. Pancrelipase, bronchodilators, and antibiotics may be prescribed. Chest physiotherapy is essential to reduce the buildup of lung secretions. 9. Pancrelipase is a pregnancy risk category C drug, and caution is advised due to unknown teratogenic effects. However, it does not appear to affect the fetus. 10. Individuals with cystic fibrosis excrete a higher level of sodium in perspiration. Careful monitoring during labor is crucial to prevent dehydration.

6. What symptoms are typical for individuals with cystic fibrosis, and how might poor pulmonary function impact pregnancy? 7. How can cystic fibrosis in the fetus be identified during pregnancy, and when is screening typically performed? 8. What therapeutic measures are commonly prescribed for individuals with cystic fibrosis during pregnancy, and why is chest physiotherapy important? 9. Why is caution advised for taking pancrelipase during pregnancy, and what category of drug is it? 10. How do individuals with cystic fibrosis excrete sodium differently, and why is careful monitoring necessary during labor?

6. Women with SLE may be at risk due to widespread degeneration of connective tissue. Manifestations include heart, kidney, blood vessel, spleen, skin, and retroperitoneal tissue involvement. 7. The characteristic skin change is a butterfly-shaped rash on the face. Blood vessel obstruction can be life-threatening to the woman if blood flow to vital organs becomes compromised and life-threatening to the fetus if blood flow to the placenta is obstructed. 8. Increased circulating corticosteroids during pregnancy may lessen symptoms. Nephritis symptoms in pregnancy may lead to increased blood pressure, hematuria, decreased urine output, proteinuria, and edema in the woman. The fetus is seriously threatened if these symptoms occur. 9. Frequent monitoring is necessary to assess kidney function. An elevated creatinine level over 1.5 mg/dL, along with proteinuria and a decreased creatinine clearance, indicates a serious thre

6. Why might women with systemic lupus erythematosus (SLE) be at risk during pregnancy, and what are some manifestations of SLE in vital organs? 7. What is the characteristic skin change associated with SLE, and what complications may arise due to blood vessel obstruction? 8. How might corticosteroids taken during pregnancy affect symptoms of SLE, and what complications may arise for the fetus with nephritis during pregnancy? 9. Why is frequent monitoring of serum creatinine levels necessary for women with SLE during pregnancy, and what does an elevated creatinine level indicate for the fetus? 10. What precautions are recommended for women with SLE concerning salicylate use before birth, and what intervention may be administered during labor?

1. Pica is the craving and eating of substances such as ice or starch; it develops due to the body recognizing the need for increased nutrients. 2. Women should take prenatal vitamins containing an iron supplement of 60 mg elemental iron as prophylactic therapy, eat a diet high in iron and vitamins, and, if eligible, enroll in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). 3. 120 to 200 mg elemental iron/day; commonly ferrous sulfate or ferrous gluconate. 4. Iron is best absorbed from an acid medium; women can take iron supplements with orange juice or a vitamin C supplement containing ascorbic acid. 5. Reticulocyte counts should rise from a normal range (0.5% to 1.5%) to 3% to 4% by 2 weeks' time.

A WOMAN WITH IRON-DEFICIENCY 1. What is pica, and why do some women with iron-deficiency anemia develop this craving? 2. How can iron-deficiency anemia be prevented during pregnancy? 3. What is the recommended therapeutic range of medication for women with iron-deficiency anemia, and what forms are commonly prescribed? 4. Why is iron best absorbed from an acid medium, and what recommendations can be given to women taking iron supplements? 5. What change in reticulocyte counts should be observed in women with iron-deficiency anemia when prescribed iron supplements?

1. Constipation or gastric irritation; increasing roughage in the diet and taking pills with food can help reduce these symptoms. 2. To prevent them from worrying about internal bleeding. 3. Intramuscular or intravenous iron dextran. 4. Hematologic disorders. 5. When hemoglobin concentration is less than 11 g/dL in the first or third trimester or less than 10.5 g/dL in the second trimester.

A WOMAN WITH IRON-DEFICIENCY ANEMIA 1. What are common side effects of oral iron supplements, and how can these symptoms be reduced? 2. Why should women be cautioned about stools turning black when taking ferrous sulfate for iron-deficiency anemia? 3. In cases of severe iron-deficiency anemia with difficulty in oral therapy, what alternative forms of iron can be prescribed? 4. What hematologic disorder during pregnancy involves either blood formation or coagulation disorders? 5. When is true anemia considered present during pregnancy based on hemoglobin concentration?

1. Pseudo-anemia is the normal blood volume expansion ahead of red cell count; true anemia is present when hemoglobin concentration is less than 11 g/dL in the first or third trimester or less than 10.5 g/dL in the second trimester. 2. 15% to 25% of pregnancies; causes include a diet low in iron, heavy menstrual periods, or unwise weight-reducing programs. 3. Confirmed by a corresponding low serum iron level and an increased iron-binding capacity. 4. Microcytic (small red blood cell), hypochromic (less hemoglobin), hematocrit and hemoglobin reduced (#33% and #12 mg/dL, respectively), low serum transferrin, transferrin saturation under 5%, serum iron under 30 g/dL, mean corpuscular hemoglobin concentration under 30, and increased iron-binding capacity ("400 g/dL). 5. Low birth weight and preterm birth.

A WOMAN WITH IRON-DEFICIENCY ANEMIA 1. What is pseudo-anemia of early pregnancy, and when is true anemia present during pregnancy? 2. What percentage of pregnancies does iron-deficiency anemia complicate, and what are common causes of iron deficiency in pregnant women? 3. How is iron deficiency confirmed when the hemoglobin level is below 12 mg/dL during pregnancy? 4. Describe the characteristic features of iron-deficiency anemia in terms of red blood cell characteristics and laboratory values. 5. What complications are iron-deficiency anemia mildly associated with during pregnancy?

1. 15% to 25% of pregnancies. 2. Diet low in iron, heavy menstrual periods, or unwise weight-reducing programs. 3. Confirmed by a corresponding low serum iron level and an increased iron-binding capacity when hemoglobin is below 12 mg/dL. 4. Mildly associated with low birth weight and preterm birth. 5. Pica is the craving and eating of substances such as ice or starch; it develops due to the body recognizing the need for increased nutrients.

A WOMAN WITH IRON-DEFICIENCY ANEMIA 1. What percentage of pregnancies does iron-deficiency anemia complicate? 2. What are common causes of iron deficiency in pregnant women? 3. How is iron deficiency confirmed during pregnancy? 4. What complications are iron-deficiency anemia associated with during pregnancy? 5. What is pica, and why might women with iron-deficiency anemia develop this craving?

1. Lower abdomen; usually avoided during pregnancy due to the presence of the uterus. 2. Regulated by frequent partial thromboplastin time (PTT) determinations. 3. To reduce the possibility of hemorrhage at birth. 4. Avoidance of routine episiotomy or epidural anesthesia unless at least 4 hours have passed since the last heparin dose; to prevent hemorrhage. 5. Either heparin or sodium warfarin (Coumadin); Coumadin should be used cautiously with breastfeeding due to its potential effects on blood coagulation.

A WOMAN WITH VENOUS THROMBOEMBOLIC DISEASE 1. What site is generally recommended for rotating sites for subcutaneous heparin administration, and why is it usually avoided during pregnancy? 2. How is heparin dosage regulated in pregnant women with thrombosis? 3. Why should women taking heparin during pregnancy avoid additional injections once labor begins? 4. What precautions should be taken for women taking heparin during labor, and why are they not candidates for routine episiotomy or epidural anesthesia? 5. What medications can be prescribed after birth for women not breastfeeding, and why should Coumadin be used cautiously with breastfeeding?

1. Chest pain, sudden onset of dyspnea, cough with hemoptysis, tachycardia or missed beats, severe dizziness, or fainting from lowered blood pressure. 2. It is an immediate emergency requiring prompt intervention. 3. By adopting common-sense measures such as avoiding constrictive stockings, not crossing legs, and avoiding prolonged standing. 4. Bed rest and intravenous heparin for 24 to 48 hours, followed by subcutaneous heparin for the duration of the pregnancy. 5. To regulate heparin dosage and monitor coagulation status during labor.

A WOMAN WITH VENOUS THROMBOEMBOLIC DISEASE 1. What symptoms may indicate pulmonary embolism as an immediate emergency? 2. Why is recognition of pulmonary embolism crucial during pregnancy? 3. How can the risk of venous thromboembolic disease be reduced during pregnancy? 4. What is the typical treatment for a woman diagnosed with a thrombus during pregnancy? 5. Why are PTT determinations continued during labor for women on heparin therapy?

1. 140/90 mm Hg or above. 2. Arteriosclerosis or renal disease. 3. Fetal well-being can be compromised by poor placental perfusion. 4. Prescription of beta-blockers and ACE inhibitors. 5. To reduce blood pressure by peripheral dilation to a safe level without compromising placental circulation.

A Woman With Chronic Hypertensive Vascular Disease 1. What blood pressure level is considered elevated in women with chronic hypertensive vascular disease entering pregnancy? 2. What conditions are chronic hypertensive diseases usually associated with in pregnant women? 3. Why is chronic hypertension during pregnancy considered a concern for both the woman and the fetus? 4. What is the primary management strategy for chronic hypertensive vascular disease during pregnancy? 5. What is the purpose of prescribing beta-blockers and ACE inhibitors for women with chronic hypertensive disease during pregnancy?

1. Compromised placental circulation. 2. Yes. 3. It is prescribed to help reduce blood pressure. 4. It is usually associated with arteriosclerosis or renal disease, which are more prevalent in older individuals. 5. To maintain blood pressure at a safe level without compromising placental perfusion.

A Woman With Chronic Hypertensive Vascular Disease 1. What is the potential risk of reducing blood pressure below a certain threshold during pregnancy in women with chronic hypertensive disease? 2. Can Methyldopa (Aldomet) be considered a typical drug prescribed for women with chronic hypertensive vascular disease during pregnancy? 3. What is the role of Methyldopa (Aldomet) in the management of chronic hypertensive vascular disease during pregnancy? 4. Why is chronic hypertensive vascular disease often considered a problem of older pregnant women? 5. What is the goal in prescribing medications for chronic hypertensive vascular disease during pregnancy?

1. Fear that the increased blood volume gained during pregnancy would overwhelm the artificial valve. 2. Safely, with the use of oral anticoagulants and specific precautions. 3. Increased risk of congenital anomalies in infants. 4. To reduce the risk of congenital anomalies associated with sodium warfarin (Coumadin) use. 5. Heparin does not cross the placenta and does not interfere with fetal development or coagulation.

A Woman With Chronic Hypertensive Vascular Disease 1. Why were women with heart valve prostheses once advised against becoming pregnant? 2. How is pregnancy managed in women with a valve prosthesis today? 3. What potential problem is associated with the use of oral anticoagulants during pregnancy for women with valve prostheses? 4. Why are women usually placed on low-molecular-weight heparin therapy before becoming pregnant? 5. How does heparin therapy affect fetal development and coagulation?

1. Folic acid is necessary for the normal formation of red blood cells in the mother and prevents neural tube defects in the fetus. Complications of folic acid-deficiency anemia can include megaloblastic anemia, elevated mean corpuscular volume, and potential contributions to early miscarriage or premature placental separation. 2. It is most often observed in multiple pregnancies due to increased fetal demand, in women with a secondary hemolytic illness, those taking hydantoin, using oral contraceptives, or having had gastric bypass surgery for morbid obesity. 3. Megaloblastic anemia presents with enlarged red blood cells, in contrast to the smaller cells seen in iron-deficiency anemia. 4. It often becomes most apparent during the second trimester, and fetal effects can include early miscarriage or premature separation of the placenta. 5. A supplement of 400 μg folic acid daily is recommended for women expecting t

A Woman With Folic Acid-Deficiency Anemia 1. What is the role of folic acid in pregnancy, and what complications can arise from folic acid-deficiency anemia? 2. In which population is folic acid-deficiency anemia most commonly observed, and what factors contribute to its occurrence? 3. What is the characteristic red blood cell morphology in megaloblastic anemia, and how does it differ from iron-deficiency anemia? 4. During which trimester of pregnancy does folic acid-deficiency anemia often become most apparent, and what fetal effects can occur if there is a deficiency? 5. What is the recommended daily supplement of folic acid for women expecting to become pregnant, and how does it change during pregnancy?

1. Fetal effects of deficiency occur in the first few weeks of fetal development; folacin-rich foods include green leafy vegetables, oranges, and dried beans. 2. Generally, over-the-counter multivitamin preparations do not contain adequate folic acid for pregnancy, and specific prenatal vitamins are recommended. 3. Healthcare providers should ask whether a woman is taking her prescribed vitamin and be aware that some women may use over-the-counter types unknowingly. 4. Women who develop folic acid-deficiency anemia are prescribed even higher or therapeutic levels of folic acid. 5. Women might choose over-the-counter, less expensive vitamins to save money; healthcare providers should be aware of this possibility and educate women about the importance of prescribed vitamins for pregnancy.

A Woman With Folic Acid-Deficiency Anemia 1. Why is it essential for women to begin folic acid supplementation before pregnancy, and what foods are rich in folacin? 2.What is the role of over-the-counter multivitamin preparations in providing adequate folic acid for pregnancy? 3. How can healthcare providers ensure that women are taking the prescribed folic acid supplement during prenatal visits? 4. What daily folic acid supplement is prescribed for women who develop folic acid-deficiency anemia during pregnancy? 5. Why might women choose over-the-counter, less expensive vitamins instead of filling a prescribed vitamin, and what should healthcare providers be aware of?

1. Dehydration increases blood viscosity, leading to cell clumping and vessel blockage. Fluid intake is monitored during pregnancy to prevent dehydration and subsequent sickle cell crisis. 2. In sickle cell anemia, oxygen transport is compromised due to irregularly shaped red blood cells. This can result in fatigue and poor exercise tolerance. 3. The primary threat is compromised placental circulation, leading to low birth weight and fetal death. Manifestations include reduced intrauterine growth and increased blood flow velocity through the uterus and placenta. 4. Folic acid is essential for building new red blood cells. Monitoring a woman's diet ensures sufficient folic acid intake, as it may be necessary to build new red blood cells. 5. Exchange transfusions replace sickled cells with non-sickled cells, helping to prevent sickle cell crisis. Additionally, they remove increased bilirubin and restore hemoglobin leve

A Woman With Sickle Cell Anemia 1. How does dehydration contribute to sickle cell crisis in individuals with sickle cell anemia, and why is fluid intake monitored closely during pregnancy? 2. Why might a woman with sickle cell anemia experience increased fatigue and exercise intolerance during pregnancy? 3. What is the primary threat to fetal health during pregnancy in women with sickle cell anemia, and how can it manifest? 4. What role does folic acid play in the management of sickle cell anemia during pregnancy, and why is it important for building new red blood cells? 5. Explain the significance of exchange transfusions in preventing sickle cell crisis during pregnancy.

1. Blockage to placental circulation can compromise the fetus, leading to low birth weight and fetal death. Fetal health is monitored through ultrasound examinations at 16 to 24 weeks and weekly nonstress or ultrasound examinations starting at about 30 weeks. 2. Periodic exchange transfusions throughout pregnancy can replace sickled cells with non-sickled cells. These transfusions also help remove increased bilirubin and restore hemoglobin levels. 3. Women with sickle cell disease are not given iron supplements during pregnancy because sickled cells cannot incorporate iron in the same manner as non-sickled cells, leading to excessive iron buildup. 4. A woman with sickle cell anemia should be well-hydrated during labor. If operative birth is necessary, she generally receives epidural anesthesia, as general anesthesia poses a risk of hypoxia. 5. Sickle cell disease is recessively inherited. If one parent has the diseas

A Woman With Sickle Cell Anemia 1. What are the potential complications to fetal health in pregnant women with sickle cell anemia, and how can they be monitored? 2. What therapeutic interventions can be used to prevent sickle cell crisis during pregnancy? 3. Why is iron supplementation generally not given to pregnant women with sickle cell disease? 4. What precautions should be taken during labor for a woman with sickle cell anemia? 5. How is the inheritance pattern of sickle cell disease determined, and what are the chances of a child inheriting the disease based on the parents' status?

1. Sickle cell anemia is caused by an abnormal amino acid in the beta chain of hemoglobin. Heterozygous individuals (trait) have sickle cell trait (HbAS), and homozygous individuals (disease) have sickle cell disease (HbSS). 2. The majority of red blood cells in sickle cell anemia are irregular or sickle-shaped. Their irregular shape hinders their ability to carry as much hemoglobin as normal cells. Clumping occurs when oxygen tension is reduced, leading to vessel blockage and reduced blood flow to organs. 3. Approximately 1 in every 10 African Americans has the sickle cell trait. The disease is no longer confined to one ethnic group due to increasing interracial marriages. 4. Sickle cell trait does not appear to influence the course of pregnancy. However, women with the homozygous disease may face increased risks of prematurity, miscarriage, and perinatal mortality. 5. Pregnant women with sickle cell anemia are more

A Woman With Sickle Cell Anemia 1. What causes sickle cell anemia, and how does it differ in individuals who are heterozygous (trait) or homozygous (disease)? 2. Describe the characteristic shape of red blood cells in sickle cell anemia and the consequences of their irregular shape. 3. What percentage of African Americans has the sickle cell trait, and how has interracial marriages affected the prevalence of sickle cell disease? 4. How might sickle cell trait influence pregnancy, and what increased risks may be associated with women having the homozygous disease? 5. Why is a clean-catch urine sample collected periodically during pregnancy for women with sickle cell anemia?

1. Women with sickle cell anemia are more susceptible to bacteriuria. A clean-catch urine sample is collected periodically during pregnancy to detect developing bacteriuria while the woman is still asymptomatic. 2. Standing for long periods increases pressure on leg veins, leading to pooling of blood and potential red cell destruction. This can exacerbate complications of sickle cell anemia during pregnancy. 3. Encouraging venous return includes avoiding long periods of standing, sitting with legs elevated, or lying on the side in a modified Sims' position. 4. Electrophoresis testing of red blood cells obtained during fetal life or at birth can reveal the presence of sickle cell disease. Screening is routine in some settings. 5. Iron supplementation is not recommended because sickled cells cannot incorporate iron effectively. Women may need a folic acid supplement to support new cell production without excessive ir

A Woman With Sickle Cell Anemia 1. Why might a woman with sickle cell anemia be more susceptible to bacteriuria during pregnancy, and how is it detected? 2. How does standing for long periods during the day contribute to the complications of sickle cell anemia during pregnancy? 3. What measures can be taken to encourage venous return from the lower extremities in pregnant women with sickle cell anemia? Answer: Encouraging venous return includes avoiding long periods of standing, sitting with legs elevated, or lying on the side in a modified Sims' position. 4. Describe the screening methods used to determine if a child has inherited sickle cell disease at birth. 5. Why is iron supplementation generally not recommended for pregnant women with sickle cell disease, and what alternative supplement might be prescribed?

1. Stasis of blood in the lower extremities from uterine pressure and hypercoagulability (elevated estrogen). 2. Stasis, vessel damage, and hypercoagulation. 3. Increased age is another risk factor for thrombosis formation. 4. Diagnosed by a woman's history and Doppler ultrasonography; measures include avoiding constrictive knee-high stockings, not sitting with legs crossed, and avoiding prolonged standing in one position. 5. Bed rest and intravenous heparin for 24 to 48 hours; followed by subcutaneous heparin every 12 or 24 hours for the duration of the pregnancy.

A Woman With Venous Thromboembolic Disease 1. What factors contribute to the increased incidence of venous thromboembolic disease during pregnancy? 2. What is the triad of effects that sets the stage for thrombus formation in the lower extremities during pregnancy? 3. Why does the likelihood of deep vein thrombosis (DVT) leading to pulmonary emboli increase for women aged 30 years or older during pregnancy? 4. How is a thrombus diagnosed during pregnancy, and what common-sense measures can reduce the risk of thrombus formation? 5. What treatment is administered if a thrombus occurs during pregnancy, and for how long?

1. Women with antiphospholipid antibodies (aPLA) 2. Aspirin or subcutaneous heparin, continued postpartum, to reduce the possibility of DVT. 3. It may help reduce the formation of additional antibodies 4. It can increase blood coagulation and the possibility of thrombi formation. 5. Pulmonary embolism

A Woman With Venous Thromboembolic Disease 1. What group of women is identified as more susceptible to thrombi formation, spontaneous miscarriage, fetal death, and hypertension of pregnancy? 2. What is the suggested prophylactic program for women identified as aPLA positive during pregnancy? 3. How does the administration of a corticosteroid help women with antiphospholipid antibodies during pregnancy? 4. Why should women with antiphospholipid antibodies avoid starting an oral contraceptive after pregnancy? 5. What is the chief danger of thrombophlebitis during pregnancy?

1. Signs of petechiae and signs of premature separation of the placenta. 2. Placental dislodgement. 3. Women with valve prostheses can now complete pregnancy safely. 4. To detect and address any signs of complications, such as placental dislodgement. 5. Increased risk of congenital anomalies.

A Woman With an Artificial Valve Prosthesis 1. What should be observed in a woman taking an anticoagulant during pregnancy and labor? 2. What is the potential risk associated with subclinical bleeding from anticoagulants in the mother during pregnancy? 3. How has the approach to pregnancy changed for women with valve prostheses over time? 4. Why is it important for healthcare providers to carefully monitor women with valve prostheses during pregnancy? 5. What is the potential impact of sodium warfarin on fetal development?

1 week after the first missed menstrual period

A woman should begin prenatal care as soon as she suspects she is pregnant so that her general condition and circulatory system can be monitored (Mooney, 2007).

1. The enlarged uterus presses on the diaphragm, causing left axis deviation. 2. It displaces the heart laterally, impacting the accuracy of certain assessments. 3. As part of a comprehensive physical examination. 4. Both procedures are safe and will not harm the fetus. 5. At specific points in pregnancy as determined by the healthcare provider.

ASESSEMENT OF A WOMAN WITH CARDIAC DISEASE 1. Why may an ECG become less accurate late in pregnancy? 2. What does an enlarged uterus during late pregnancy affect in the cardiac assessment? 3. How can jugular venous distention be assessed in a pregnant woman? 4. What reassurance can be provided to a pregnant woman about the safety of ECG and echocardiography for her fetus? 5. When might periodic cardiac assessments such as ECG or echocardiogram be necessary during pregnancy?

- cough - tachycardia - poor fetal heart tone (FHT) variability from poor tissue perfusion - edema from poor venous return - fatigue increased respiratory rate - decreased amniotic fluid from intrauterine growth restriction

ASSESSING A PREGNANT WOMAN WITH CARDIAC DISEASE

answer: 1. Conducting a thorough health history. 2. To document her pre-pregnancy cardiac status and assess symptoms such as shortness of breath and cyanosis. 3. Coughing may be an early sign of pulmonary edema from heart failure. 4. The edema of pregnancy-induced hypertension or heart failure is serious and requires specific management. 5. After week 20 of pregnancy.

ASSESSMENT OF A WOMAN WITH CARDIAC DISEASE 1. What is the initial step in assessing a pregnant woman with cardiovascular disease? 2. Why is it important to inquire about a pregnant woman's level of exercise performance? 3. Why should women with cardiac disease always report coughing during pregnancy? 4. Why is it crucial to differentiate between normal pregnancy edema and edema associated with hypertension or heart failure? 5. When does edema of pregnancy-induced hypertension typically begin?

ANSWER 1. Irregular pulse, rapid or difficult respirations, and possibly chest pain on exertion. 2. At the first prenatal visit. 3. For the most accurate comparison and assessment of changes. 4. Assessments for nail bed filling, jugular venous distention, and liver size. 5. It helps in evaluating the extent of right-sided heart failure.

ASSESSMENT OF A WOMAN WITH CARDIAC DISEASE 1. What symptoms might indicate that edema is a sign of heart failure in a pregnant woman? 2. When should baseline blood pressure, pulse rate, and respiratory rate be recorded for a pregnant woman with cardiac disease? 3. Why is it important to take blood pressure, pulse rate, and respiratory rate in the same position at each health visit? 4. What additional assessments are helpful for cardiac status in pregnant women? 5. What is the significance of assessing liver size in a pregnant woman with right-sided heart failure?

ANSWER 1. The enlarged uterus presses the liver upward, making palpation difficult and likely inaccurate. 2. Electrocardiogram (ECG), chest radiograph, or echocardiogram. 3. It measures cardiac electrical discharge and is considered safe for the fetus. 4. Echocardiography 5. Yes, it is safe if the woman's abdomen is covered by a lead apron during exposure.

ASSESSMENT OF A WOMAN WITH CARDIAC DISEASE 1. Why does liver assessment become challenging late in pregnancy? 2. What diagnostic procedures may be needed for additional cardiac status assessment during pregnancy? 3. How does an ECG measure cardiac activity, and is it safe for the fetus? 4. What imaging technique uses ultrasound for cardiac assessment in pregnant women? 5. Is chest radiography considered safe during pregnancy, and what precautions should be taken?

chest and head elevated (orthopnea). * Elevating her chest allows fluid to settle to the bottom of her lungs and frees space for gas exchange.

As pulmonary edema becomes severe, a woman cannot sleep in any position except with her ________.