OB Chapter 20

The nurse is caring for a pregnant client in the first trimester with a preexisting condition of rheumatic heart disease. The client reports mild shortness of breath with strenuous activity. When teaching the client, which statement(s) will the nurse include? Select all that apply. "Avoid cardiac medications in the first trimester." "Be sure to drink an adequate amount of fluids." "Be sure to receive an influenza vaccine." "Maintain bed rest to avoid cardiac exertion." "Perform moderate exercises as tolerated."

"Be sure to drink an adequate amount of fluids." "Be sure to receive an influenza vaccine." "Perform moderate exercises as tolerated." A woman with a preexisting cardiac valve disease is at an increased risk for heart failure during pregnancy, especially during certain periods of time of the client's pregnancy. The client should be advised to maintain hydration, avoid infection (by receiving the influenza vaccine), and perform moderate exercise as tolerated. The client with only mild cardiovascular disease may not require total bed rest and should be encouraged to maintain activity level as tolerated. The health care provider will advise the nurse regarding stopping or starting any cardiac medications during pregnancy.

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction? "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." "I need to be aware of my triggers and avoid them as much as possible." "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on." "It is fine for me to use my albuterol inhaler if I begin to feel tight."

"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." A pregnant woman with a history of asthma needs to be proactive, taking her inhalers and other asthma medications to prevent an acute asthma attack. She needs to understand that it is far more dangerous to not take the medications and have an asthma attack. She also needs to monitor her peak flow for decreases, be aware of triggers, and avoid them if possible. However, a pregnant woman should never begin allergy shots if she has not been taking them previously, due to the potential of an adverse reaction.

A pregnant client with a history of asthma since childhood presents for a prenatal visit. What statement by the client would the nurse prioritize? "I sometimes get a bit wheezy." "I sometimes get a feeling of euphoria." "Certain substances make me sneeze." "I have trouble getting comfortable in bed."

"I sometimes get a bit wheezy." Wheezing is a classic symptom of asthma. This statement should alert the nurse to the possibility that the woman's asthma is not being well-controlled and needs further evaluation and possible intervention. The other statements do not relate to the typical presentation of this disease in pregnancy.

A pregnant client with iron-deficiency anemia is prescribed an iron supplement. After teaching the woman about using the supplement, the nurse determines that more teaching is needed based on which client statement? "If I happen to miss a dose, I will take it as soon as I remember." "Taking the iron supplement with food will help with the side effects." "I will take the iron with milk instead of orange or grapefruit juice." "I will need to avoid coffee and tea when I take this supplement."

"I will take the iron with milk instead of orange or grapefruit juice." The pregnant client should take the iron supplement with vitamin C-containing fluids such as orange juice, which will promote absorption, rather than milk, which can inhibit iron absorption. Taking iron on an empty stomach improves its absorption, but many women cannot tolerate the gastrointestinal discomfort it causes. In such cases, the woman is advised to take it with meals. The woman also needs instruction about adverse effects, which are predominantly gastrointestinal and include gastric discomfort, nausea, vomiting, anorexia, diarrhea, metallic taste, and constipation. Taking the iron supplement with meals and increasing intake of fiber and fluids helps overcome the most common side effects. If the woman misses a dose, she should take a dose as soon as she remembers.

A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse? "You should talk to the doctor about that; the medications you're on can damage the fetus." "That's great. I've got a 4-year-old and a 2-year-old myself." "I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet." "Do you want to talk to a counselor who can help you weigh the pros and cons of having your own child rather than adopting?"

"I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet." Any woman with epilepsy needs to discuss medication management with her provider. The current research indicates the medications used for epileptic management are the major cause of birth defects for these clients. The nurse should be careful about mentioning that some epilepsy medications are teratogenic; some women may stop taking their medications in order to get pregnant. Suggesting adoption is inappropriate as the mother has given no indication she is interested in adoption; also, the mother needs to discuss this with the physician so that she can get accurate information about being on anti-seizure medications and being pregnant. The nurse should not share personal information as it does not assist this client in making a serious decision. The client should be referred to the health care provider to help the client make the best decision.

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or during the birth for the infant. Which statement by the mother indicates that further teaching is needed by the nurse? "My baby may be very large and I may need a cesarean birth to have him." "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born." "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day."

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

The maternal health nurse cares for a homeless pregnant woman who presented to the emergency room in precipitous labor. The woman has not had prenatal care. Upon delivery, her infant weighs 4.6 kg and notes the infant appears to be jittery. Which nursing action will the nurse perform first? Administer intramuscular (IM) vitamin K. Check the infant's axillary temperature. Administer glucose. Check the infant's blood glucose level.

Check the infant's blood glucose level. The infant larger than 4 kg is considered macrosomic (large birth weight), which may occur when the pregnant woman has pregestational or gestational diabetes. Babies born to mothers who have uncontrolled diabetes are at increased risk for hypoglycemia because the infant produces large amounts of insulin in order to compensate for the elevated serum glucose levels that may be present in the blood due to diabetes. An infant with macrosomia and a jittery appearance should have blood glucose levels checked immediately. Once the glucose level is determined, glucose may or may not need to be administered. Checking the infant's axillary temperature and administering IM vitamin K will occur after the assessment and stabilization of the infant's blood glucose level.

A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control? Plenty of rest Oral hypoglycemic agents Vitamin supplements Exercise

Exercise The three main facets to glycemic control for the woman with pregestational diabetes are diet, exercise, and insulin. An individual with type 1 diabetes uses insulin and not oral hypoglycemic agents. Vitamin supplements may assist with helping to keep the woman healthy but not necessarily through glycemic control. It will be important for the woman to get enough rest throughout the pregnancy but this will not assist with glycemic control.

A nurse is assessing a client in her seventh month of pregnancy who has an artificial valve prosthesis. The client is taking an oral anticoagulant to prevent the formation of clots at the valve site. Which of the following nursing interventions is most appropriate in this situation? Urge the client to discontinue the anticoagulant to prevent pregnancy complications. Observe the client for signs of petechiae and premature separation of the placenta. Put the client on bed rest. Instruct the client to avoid wearing constrictive knee-high stockings.

Observe the client for signs of petechiae and premature separation of the placenta. Subclinical bleeding from continuous anticoagulant therapy in the woman has the potential to cause placental dislodgement. Observe a woman who is taking an anticoagulant for signs of petechiae and signs of premature separation of the placenta during both pregnancy and labor. The nurse should not urge the client to discontinue the anticoagulant, as this is not within the nurse's scope of practice and, in any case, the client still needs the anticoagulant to prevent clots. Bed rest is prescribed for clients with a thrombus to prevent it from moving and becoming a pulmonary embolus. Avoiding the use of constrictive knee-high stockings is to prevent thrombus formation.

The nurse is teaching a pregnant woman about how to prevent contracting cytomegalovirus (CMV) during pregnancy. What tips would the nurse share with this client? Select all that apply. Wash your hands thoroughly with soap and water after touching saliva or urine. If you have CMV, it is suggested that you not breastfeed your infant. Do not share food or drinks with young children, especially if they are in day care. If you contract CMV, your practitioner will give you some oral medicine to treat it. If you develop any flu-like symptoms, notify your pratitioner immediately to be evaluated for CMV.

Wash your hands thoroughly with soap and water after touching saliva or urine. Do not share food or drinks with young children, especially if they are in day care. If you develop any flu-like symptoms, notify your pratitioner immediately to be evaluated for CMV. Cytomegalovirus (CMV) is a mild infection and women may not know they have contracted it. The problem arises when a pregnant woman contracts it during the first 20 weeks of gestation. Prevention is the key, so the nurse would reinforce handwashing, not eating or drinking from a container after a small child has done so, and notifying the physician if the client develops mild flu-like symptoms so she can be tested to rule out CMV.

A woman who is 8 months pregnant comes to the clinic with urinary frequency and pain on urination. The client is diagnosed with a urinary tract infection (UTI). Which medication would the nurse anticipate the physician will prescribe? amoxicillin tetracycline bactrim septra

amoxicillin Amoxicillin is a penicillin antibiotic and can be used in the pregnant woman to treat a UTI. Tetracycline should never be given to a pregnant woman, because it may cause retardation of bone growth and staining of the fetal teeth. The sulfonamides (bactrim and septra) can be used in early pregnancy but not near term, because they can interfere with protein binding of bilirubin, which then can lead to hyperbilirubinemia in the newborn.

The clinic nurse teaches a client with pregestational type 1 diabetes that maintaining a constant insulin level is very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use: an insulin pen. an insulin pump. an insulin drip. regular insulin twice a day.

an insulin pump. Because a pregnant client will have some periods of relative hyperglycemia and hypoglycemia no matter how carefully the client maintains diet and balances exercise levels, an effective method to keep serum glucose levels constant is to administer insulin with a continuous pump during pregnancy.

A nurse is teaching a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority? consumption of a low-fat diet administration of immunoglobulins constipation prevention avoidance of infection

avoidance of infection Prevention of crises, if possible, is the focus of treatment for the pregnant woman with sickle cell anemia. Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common-sense strategies that decrease the risk of a crisis. Fat intake does not need to be decreased and immunoglobulins are not normally administered. Constipation is not usually a result of sickle cell anemia.

A pregnant client with type I diabetes asks the nurse about how to best control her blood sugar while she is pregnant. The best reply would be for the woman to: begin oral hyperglycemic medications along with the insulin she is currently taking. check her blood sugars frequently and adjust insulin accordingly. limit weight gain to 15 pounds during the pregnancy. exercise for 1 to 2 hours each day to keep the blood glucose down.

check her blood sugars frequently and adjust insulin accordingly. The goal for a mother who has type I diabetes mellitus is to keep tight control over her blood sugars throughout the pregnancy. Therefore, she needs to test her blood sugar frequently during the day and make adjustments in the insulin doses she is receiving.

A 15-year-old adolescent arrives at the office with a report of flu symptoms, including nausea and vomiting and recent weight loss. A pregnancy test is done and is positive. The client begins crying and tells the nurse her mother will be furious with her. What can the nurse do to assist this adolescent at this point? Tell the adolescent that this is too big of a problem for her to make decisions about and she needs to listen to her mother. Recommend some adoption agencies for her to talk to in the near future. Support her by respecting her right to privacy and confidentiality. Contact the mother of the adolescent to be sure the child gets prenatal care.

Support her by respecting her right to privacy and confidentiality. The nurse needs to be an advocate for the adolescent and respect her privacy and confidentiality. It would be advisable for the nurse to encourage the adolescent to talk to her mother or some other support person for help. The nurse has no right to contact the adolescent's mother or to share any information with her. Also, the nurse should not mention adoption at this point to the adolescent. That would be a topic for later discussion.

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? 14% 12% 8% 6%

6% The upper normal level of HbA1C is 6% of total hemoglobin.

A 38-year-old client comes into the office for prenatal care, stating that she is about 12 weeks' pregnant with her first child. What action will the nurse take, considering the client's age and potential sensitivity to being labeled an "older" primipara? Ask about chronic illnesses that the health care provider should know about due to the client being older. Inquire about any family history of chromosomal abnormalities since older women are more likely to have infants with a chromosomal defect. Offer genetic counseling and an early amniocentesis to determine if termination is needed. Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore.

Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore. This client is pregnant for the first time later in life. The nurse must be supportive of this choice. Most women realize the increased risks for having giving birth after 35 years of age and do not need constant reminding of the potentially poor outcomes that can occur. The majority of pregnancies to women older than 35 years of age end with healthy newborns and mothers.

The nurse is caring for a pregnant client with pregestational diabetes. Which goal does the nurse identify as priority during the client's pregnancy? Encourage minimal weight gain. Maintain glycemic control. Ensure compliance of glucose monitoring. Monitor for associated complications.

Maintain glycemic control. The most important goal when caring for a pregnant client with pregestational diabetes is to maintain glycemic control. The scenario does not give enough information on the client's weight to determine if the client should gain only minimal weight during pregnancy. Ensuring compliance of glucose monitoring and monitoring for associated complications are appropriate nursing interventions; however, these do not take priority.

The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement? Fortified grains Dried beans Orange juice Dried apples

Orange juice Anemia is a condition in which the blood is deficient in red blood cells, from an underlying cause. The woman needs to take iron to manufacture enough red blood cells. Taking an iron supplement will help improve her iron levels, and taking iron with foods containing ascorbic acid, such as orange juice, improves the absorption of iron. Dried fruit (such as apples), fortified grains, and dried beans are additional food choices that are rich in iron and should be included in her daily diet.

The maternal health nurse is caring for a group of high-risk pregnant clients. Which client condition will the nurse identify as being the highest risk for pregnancy? Pulmonary hypertension Loud systolic murmur Repaired atrial septal defect Secondary hypertension

Pulmonary hypertension Pulmonary hypertension is considered the greatest risk to a pregnancy because of the hypoxia that is associated with the condition. The remaining conditions represent potential cardiac complications that may increase the client's risk in pregnancy; however, these do not present the greatest risk in pregnancy.

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

more women waiting until after age 30 years to get pregnant As more women wait until they are older than 30 years to have their first child, more also enter pregnancy with a pre-existing disorder.

The nurse is appraising the laboratory results of a pregnant client who is in her second trimester and notes the following: thyroid stimulating hormone (TSH) slightly elevated, glucose in the urine, complete blood count (CBC) low normal, and normal electrolytes. The nurse prioritizes further testing to rule out which condition? Hyperthyroidism Anemia Gestational diabetes Preeclampsia

Gestational diabetes Glycosuria, glucose in the urine, may occur normally during pregnancy; however, if it appears in the urine, the client should be sent for testing to rule out gestational diabetes. Preeclampsia, anemia, and hyperthyroidism are not related to glucose nor to renal function. A slightly elevated TSH would indicate possible hypothyroidism instead of hyperthyroidism. Anemia would be indicated by below normal hematocrit. If the client's CBC is low normal than the nurse should monitor future results to ensure the client's counts are not dropping. It would also be appropriate for the nurse to investigate possible dietary issues. Preeclampsia would be best monitored by the blood pressure readings.

A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. Which of the following does the nurse anticipate in this woman's pregnancy? potential for greater than usual back pain increased risk of fetal trauma cesarean birth increased risk of miscarriage

potential for greater than usual back pain urgical correction of scoliosis (lateral curvature of the spine) involves implanting stainless-steel rods on both sides of the vertebrae to strengthen and straighten the spine. Such rod implantations do not interfere with pregnancy; a woman may notice more than usual back pain, however, from increased tension on back muscles. If a woman's pelvis is distorted due to scoliosis, a cesarean birth may be scheduled to ensure a safe birth, but this is not required in this scenario. Vaginal birth, if permitted, requires the same management as for any woman. With the improved management of scoliosis, the high maternal and perinatal risks associated with the disorder reported in earlier literature no longer exist.

A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement? "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy." "A pregnant woman with a chronic illness can put the fetus at risk." "A pregnant woman with a chronic condition can put herself at risk." "A pregnant woman does not have to worry about contracting new illnesses during pregnancy."

"A pregnant woman does not have to worry about contracting new illnesses during pregnancy." When a woman enters a pregnancy with a chronic illness, it can put both her and the fetus at risk. She needs to be cautious about developing a new illness during her pregnancy as well as having an accident during the pregnancy.

The nurse is assessing a pregnant client who has a long history of asthma. She states, "I'm trying not to use my asthma medications because I certainly don't want my baby exposed to them." What is the nurse's best response? "Actually, having uncontrolled asthma is much riskier for your baby than the medication." "Your health care provider will likely agree with your decision." "I'm glad to hear that you're focused on ensuring your baby's health." "In fact, most modern asthma medications are categorized as safe for use in pregnancy."

"Actually, having uncontrolled asthma is much riskier for your baby than the medication." It is important for pregnant clients with asthma to keep taking their medications because the risks of exacerbations exceed the risks of the medications.

A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse? If the mother goes into a crisis while pregnant, the baby will develop sickle cell anemia. There is a good chance the infant will inherit the disease from the mother. Both parents have to carry the trait. The infant inherits the disease from the father.

Both parents have to carry the trait. Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. If one parent has the disease and the other is free of the disease and trait, the chances of the child inheriting the disease is zero. The infant will not develop the disease just because the mother has a crisis during the pregnancy.

The nurse is assessing a 35-year-old woman at 22 weeks' gestation who has had recent laboratory work. The nurse notes fasting blood glucose 146 mg/dl (8.10 mmol/L), hemoglobin 13 g/dl (130 g/L), and hematocrit 37% (0.37). Based on these results, which instruction should the nurse prioritize? Check blood sugar levels daily. Take daily iron supplements. the signs and symptoms of urinary tract infection Include iron-enriched foods in the diet.

Check blood sugar levels daily. An elevated blood glucose is concerning for diabetes. A fasting blood glucose level of greater than 140 mg/dl (7.77 mmol/L) or random level of greater than 200 mg/dl (11.10 mmol/L) is concerning; this must be followed up to ensure the client is not developing gestational diabetes. The hemoglobin and hematocrit are within normal limits for this client. The values should be hemoglobin greater than 11 g/dl (110 g/L) and hematocrit greater than 33% (0.33). Values lower than that are possible indications of anemia and would necessitate further evaluation. An individual with higher than normal blood glucose levels is at risk for developing urinary tract infection. This will usually happen after the glucose levels are elevated. Anemia can be treated by increasing the consumption of iron-enriched foods and taking a daily iron supplement.

A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize? Decrease activity and rest more often. Discuss induction of labor with the health care provider. Increase fluids and take more vitamins. Bed rest and bathroom privileges only until birth.

Decrease activity and rest more often. If the client is developing symptoms associated with her heart condition, the first intervention is to monitor activity levels, decrease activity, and treat the symptoms. At 32 weeks' gestation, the suggestion to induce labor is not appropriate, and without knowledge of the type of heart condition one would not recommend an increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity.

The maternal health nurse is caring for a pregnant client with a history of epilepsy. The client's antiepileptic drug (AED) levels have been in the non-therapeutic range the last two times the labs were drawn. Which factor does the nurse associate with this finding? The action of many medications varies in pregnancy. Drug metabolism changes during pregnancy. Pregnant clients have high rates of noncompliance with maintenance medications. Most maintenance medications cannot be given in pregnancy.

Drug metabolism changes during pregnancy. Drug metabolism changes during pregnancy which may alter the therapeutic AED levels in the pregnant client. Some AEDs cannot be given in pregnancy due to risk of harm to the fetus; however, there are some that may be given. Pregnant clients do not have high rates of noncompliance and the action of medications does not change in pregnancy.

A nurse caring for a pregnant woman with a pre-existing heart problem realizes the importance of doing which of the following at the very beginning of the pregnancy to help diagnose a complication? Help the woman to establish a daily routine. Establish baseline vital signs. Instruct the client to discontinue her exercise program of walking daily. Advise the client to make plans to quit her job.

Establish baseline vital signs. It is important to establish baseline vital signs to later identify a complication related to a pre-existing condition.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? Heart rate of 84 beats/min Blood pressure of 100/68 mm Hg Hemoglobin of 13 g/dl (130 g/L) or lower Hematocrit of 32% or less

Hematocrit of 32% or less Iron-deficiency anemia is diagnosed in a pregnant woman if the hematocrit is less that 33% or the hemoglobin is less than 11 g/dl (110 g/L). Tachycardia, hypotension, and tachypnea are all symptoms of iron-deficiency anemia but are not diagnostic criteria

An infant is born to a mother with gestational diabetes. Which long-term maternal complication is associated with this diagnosis? Increased risk of development of type 2 diabetes Weight gain that is not lost after the pregnancy Heart disease Development of long-term hypertension

Increased risk of development of type 2 diabetes A mother who had gestational diabetes is at a 30% to 50% higher risk of developing type 2 diabetes mellitus than the general population. Long-term hypertension and heart disease are not associated with gestational diabetes, nor is weight gain following pregnancy. There is no data that validates long-term weight gain as a complication of gestational diabetes.

The nurse is leading a discussion with a group of pregnant women who have diabetes. The nurse should point out which situation can potentially occur during their pregnancy? Polyhydramnios Hypotension of pregnancy Postterm birth Small-for-gestational-age (SGA) infant

Polyhydramnios Polyhydramnios is an increase, or excess, in amniotic fluid and is a pregnancy-related complication associated with diabetes. An infant who is small-for-gestational-age is not associated with a mother who had diabetes prior to pregnancy. Other pregnancy-related complications associated with pregestational diabetes mellitus include hypertensive disorders, preterm birth, and shoulder dystocia.

A 17-year-old primigravida with type 1 diabetes is at 37 weeks' gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next? Scheduling the woman for induction of labor today. Preparing for amniocentesis and fetal lung maturity assessment Scheduling a cesarean delivery at 39 weeks. Allowing her to continue without plans for delivery.

Preparing for amniocentesis and fetal lung maturity assessment If the infant has macrosomia, is large for gestation age, and the mother has had poor blood-sugar control, the provider will want further information on the fetus and readiness for delivery before making any decisions on delivery. After determining the readiness of the fetus, then plans for delivery can be determined and scheduled.

A nurse working at the local health district clinic assists numerous adolescents who become pregnant. Which factor will the nurse tell the teens is crucial for a positive pregnancy outcome? Acceptance by peers Support network Involvement of the father Cultural sensitivity

Support network One crucial part of management of teenage adolescent pregnancy includes helping the teens to develop an adequate support network. The network may include parents, teachers, friends and the father of the baby, in addition to resources needed to provide care for the infant and self. Cultural sensitivity, involvement of the father, and acceptance by peers are important to the teenager who is pregnant, but they are not considered crucial for a positive pregnancy and outcome for the mother and fetus.

A pregnant woman with a history of mitral valve stenosis is to be prescribed medication as treatment. Which medication class would the nurse expect the client to be prescribed? vasodilator anticoagulant angiotensin receptor blockers inotropic

anticoagulant In mitral valve stenosis, it is difficult for blood to leave the left atrium. A secondary problem of thrombus formation may develop as a result of noncirculating blood. A woman may need to be prescribed an anticoagulant to prevent this complication. Vasodilators are used for peripartum cardiomyopathy. Inotropics are used for heart failure. Angiotensin receptor blockers are used for congestive heart failure.

The maternal health nurse is caring for a pregnant client with iron-deficiency anemia who reports "extreme fatigue and shortness of breath" during a prenatal checkup at the outpatient clinic. The nurse prepares to educate the client regarding proper nutrition for this condition. Which dietary choice(s) will the nurse suggest? Select all that apply. beef stew with potatoes and milk dark leafy green salad with sunflower seeds and water fortified dried cereal with milk and orange juice red beans and rice with cranberry juice oatmeal with banana and tea

beef stew with potatoes and milk dark leafy green salad with sunflower seeds and water fortified dried cereal with milk and orange juice red beans and rice with cranberry juice The nurse should provide the client guidance on proper nutrition to help with the treatment of the client's disease. Nutrition should focus on foods high in iron, such as animal protein, dried beans, fortified grains and cereals, dried fruits, and any food cooked in cast iron cookware. The nurse should instruct the client that vitamin C enhances iron absorption. Therefore, the client should try to eat foods high in vitamin C along with iron-rich foods. Beef stew is animal protein that is high in iron. Fortified cereal is high in folate and fiber. Additionally, eating fortified food with orange juice increases its absorption. Dark leafy greens contain a large amount of folic acid, which is beneficial in the treatment of iron deficiency anemia. Red beans contain a large amount of iron and cranberry juice contains vitamin C, which aids in the iron absorption.

A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client? long-acting insulin glucagon oral hypoglycemic drugs diet

diet Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are usually not given during pregnancy and would not be the first option. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.

A pregnant woman diagnosed with cardiac disease 4 years ago is told that her pregnancy is a high-risk pregnancy. The nurse then explains that the danger occurs primarily because of the increase in circulatory volume. The nurse informs the client that the most dangerous time for her is when? in weeks 12 to 20 in weeks 20 to 28 in weeks 8 to 12 in weeks 28 to 32

in weeks 28 to 32 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 28 to 32, just after the blood volume peaks.

The nurse reviews the medication therapy regimen of a pregnant woman with chronic hypertension. Which medication would the nurse most likely expect to find? carvedilol metoprolol labetalol atenolol

labetalol Although beta-blockers and calcium channel blockers may be prescribed to reduce blood pressure by peripheral dilation to a safe level, it should not be reduced below the threshold that allows for good placenta circulation. Labetalol and nifedipine are typical drugs that may be prescribed.

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

restricted sodium intake The client with peripartum cardiomyopathy should be prescribed a restricted sodium intake to control the blood pressure. Monoamine oxidase inhibitors are given to treat depression in pregnancy, not peripartum cardiomyopathy. Methadone is a drug given for the treatment of a substance use disorder during pregnancy. Complementary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum, not peripartum cardiomyopathy.

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

type 1 diabetes A woman with a history of diabetes has an increased risk for perinatal complications, including hypertension, preeclampsia, and neonatal hypoglycemia. The age of 33 without other risk factors does not increase risk, nor does type O-positive blood or environmental allergens.

A pregnant woman at 36 weeks' gestation comes to the care center for a follow-up visit. The woman is to be screened for group B streptococcus (GBS) infection. When describing this screening to the woman, the nurse would explain that a specimen will be taken from which area(s)? Select all that apply. rectum conjunctiva vagina throat nasal cavity

vagina rectum According to Centers for Disease Control and Prevention guidelines, all pregnant women should be screened for GBS at 35 to 37 weeks' gestation and treated. Vaginal and rectal specimens are cultured for the presence of the bacterium. Specimens from the throat, nasal cavity, or conjunctiva are not used.