Prenatal substance use
3 (Maternal alcohol use may result in FAS, marked by mild to moderate mental retardation, physical growth retardation, CNS disorders, and feeding difficulties. Because there is no definitive answer as to how much alcohol can be safely consumed by a pregnant woman, it is recommended that pregnant clients be taught to abstain from drinking alcohol during pregnancy. Smoking and other meds may affect the fetus)
A primigravid client asks the nurse if she can continue to have a glass of wine with dinner during her pregnancy. Which statement would be the nurses best response? 1. The effects of alcohol on a fetus during pregnancy are unknown 2. You should limit your consumption to beer and wine 3. You should abstain from drinking alcoholic beverages 4. You may have 1 drink of 2 oz of alcohol per day
c (Although medications can affect the fetus during all trimesters, the greatest risk of adverse effects from medications occurs in the first trimester)
In which trimester of pregnancy do medications have the most effect on the fetus? a Fourth trimester b Third trimester c First trimester d Second trimester
a,b,c,e (Rationale Smoking may cause decreased placental perfusion, resulting in a low birth weight. Mothers who smoke have an increased risk of preterm birth. The mother may develop placental abnormalities such as abruptio placentae or preterm rupture of membranes. Smoking does not cause hypotension; on the contrary, the nicotine in cigarettes is a vasoconstrictor and increases blood pressure.)
The nurse is providing education to a pregnant client who continues to smoke during pregnancy. Which complications will the nurse share with this client? (Select all that apply.) a Preterm rupture of membranes b Abruptio placentae c Prematurity d Hypotension e Low birth weight
c (For Category A drugs, controlled studies in humans have demonstrated no associated fetal risk. For category B drugs, animal studies show no risk but there are no controlled studies in humans, or animal studies indicate a risk but controlled human studies fail to demonstrate a risk. For category D drugs, evidence of human fetal risk exists, but the benefits of the drug may outweigh the risks. Category X drugs are known human teratogens whose benefits almost never justify their use in pregnancy.)
A drug in which evidence of human fetal risk exists, but the benefits of the drug may outweigh the risks, is classified as belonging to which drug category? a Category A b Category B c Category D d Category X
1 (Folic acid supplements are recommended to prevent neural tube defects and anemia in pregnancy. Deficiencies increase the risk of hemorrhage during birth as well as infection. The recommended dose is 400 mcg/day; while breastfeeding and during pregnancy, the recommended dosage is 400-800mcg/day. Blood glucose levels are not regulated by intake of folic acid. Vit C potentiates the absorption of iron and is also associated with blood clotting or collagen formation)
A client asks the nurse why taking folic acid is so important before and during pregnancy. The nurse should instruct the client that: 1. Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers 2. eating foods with moderate amounts of folic acid helps regulate blood glucose levels 3. folic acid consumption helps with the aborption of iron during pregnancy 4. folic acid is needed to promote blood clotting and collagen formation in the newborn
b
During prenatal care what is the most appropriate collaborative intervention for a known heroin user? (Christain Kotoucek) a) withdrawal completely during pregnancy to avoid fetal distress b) place on an alternative drug such as methadone c) join a support group such as NA and begin steps to recovery d) focus on guidance for nutritional requirements
1 (INfants of mothers who smoke are often low birth weight. Infants who are large for gestational age are associated with diabetic mothers. Preterm births are associated with smoking, but not with appropriate size for gestation. Growth retardation is associated with smoking but this does not affect the infants length.)
The nurse is teaching a group of prenatal clients about the effects of cigarette smoking on fetal development. Which characteristic is associated with babies born to mothers who smoked during pregnancy? 1. low birth weight 2. large for gestational age 3. preterm birth, but appropriate size for gestation 4. growth retardation in weight and length
4 (The long term prognosis for neonates with FAS is poor. Symptoms of withdrawal include tremors, sleeplessness, seizures, abdominal distension, hyperactivity, and inconsolable crying. Symptoms of withdrawal commonly occur within 6-12 hrs, or at the latest within the first 3 days of life. The neonate with FAS is usually growth deficient at birth. Most neonates with FAS are mild to severely handicapped. The facial deformities, such as short palpebral fissures, epicanthal folds, broad nasal bridge, flattened midface, and short upturned nose, are not easily corrected with plastic surgery.)
A male neonate born at 36 weeks is admitted to the neonatal intensive care nursery with a diagnosis of FAS (probable). The mother visits the nursery soon after the neonate is admitted. Which instructions should the nurse expect to include when developing the teaching plan for the mother about FAS? 1. withdrawal symptoms usually do not occur until 7 days postpartum 2. Large for gestational age size is common with this condition 3. facial deformities associated with FAS can be corrected by plastic surgery 4. symptoms of withdrawal include tremors, sleeplessness, and seizures
4 (changes seen in the facial features of newborns with FAS remain that way. These include epicanthal folds, whorls, irregular hair, cleft lip or palate, small teeth, and lack of philtrum. Newborns with FAS are usually difficult to calm and frequently cry for long periods of time. Parents do need assistance with caring for themselves and their infants, particularly with continued alcohol use. A supportive family or support systems are essential. The problems seen with this newborn do not go away and remain with the infant throughout life and are compounded when the child begins to develop mentally)
A newborn is diagnosed with FAS. The nurse is teaching the mother what to expect when she goes home with her baby. the nurse determines the mother needs further instruction when she makes which statement? 1. The way my babys face looks now will stay that way 2. My baby may be irritable as a newborn 3. I may need some help coping with my newborn 4. My baby will be fine soon after we are home
2 (a quiet environment with decreased stimuli is best for a drug exposed neonate. The drug exposed neonate has limited ability to deal with stress and cope with stimuli. Assessing the VS and BP every hour would disturb the neonates rest periods and cause increased physical and psychological demands. Placement in a well lighted environment and increasing eye contact can be overwhelming for the neonate and increase the stress level)
A nurse is reviewing a clients maternal prenatal record and notes that the mother used narcotics during her pregnancy. A primary nursing intervention when caring for a drug exposed neonate is to : 1. assess VS including BP every hour 2. minimize environmental stimuli 3. place the infant in a well lighted area 4. increase eye contact with the caregiver
3 4 2 1 (It is crucial to confirm that the client was taking her husbands opiates and benzodiazepines and that her symptoms are due to the sudden withdrawal from these meds. It is also important to know if she has been using other substances (such as alcohol) that may cause other withdrawal symptoms. Even before calling for prescriptions, the nurse can initiate withdrawal precautions for client safety)
A young client is being admitted to the psychiatric unit after her OB's staff suspected she was experiencing postpartum psychosis. Her husband said she was doing fine for 2 weeks after the birth of the baby, except for pain from the C section and trouble sleeping. These symptoms subsided over the next 4 weeks. Three days ago, however, the client started having anxiety, irritability, vomiting, diarrhea, and delirium resulting in her inability to care for the baby. The husband says I saw that my bottles of alprazolam and oxycodone were empty even though I have not been taking them. What should the nurse do in order of priority from first to last? Use all options 1. Call the HCP for prescriptions for appropriate treatment for opiate and benzodiazepine withdrawal 2. Immediately place the client on withdrawal precautions 3. Confirm with the client that she has in fact been using her husbands medication 4. assess the client for prior and current use of any other subsances
b (Rationale Benzodiazepine withdrawal can result in significant complications and requires continuous supervision in a hospital. Neonatal benzodiazepine withdrawal can result in the same consequences for the infant if maternal use remains unaddressed. Reporting the client to law enforcement violates her confidentiality and is likely to result in nondisclosure, noncompliance, and undesirable outcomes in the future. Child welfare referrals should be made with the client's co-operation from the standpoint of providing assistance. Discontinuing the prescription does not address illicit use, and recommending the client cut down is inadequate to address the scope of the problem.)
During an initial prenatal visit, the client discloses she has been taking valium, a benzodiazepine, daily for several years. She has a prescription but also uses her friend's prescription or buys it illegally, adding to the prescribed dose. Which action does the nurse anticipate from the healthcare provider when these findings are reported? a Contacting the client's pharmacy for discontinuation of the valium prescription b Admission to the hospital for medically supervised withdrawal c Reporting the illegal drug use to law enforcement and a child welfare agency d Recommending that the client cut down her valium use
1 (a neonate undergoing cocaine withdrawal is irritable, often restless, difficult to console, and often in need of increased activity. It is commonly helpful to swaddle the neonate tightly with a blanket, offer a pacifier, and cuddle and rock the neonate. Offering extra nourishment is not advised because overfeeding tends to increase GI problems such as vomiting, regurgitation, and diarrhea. Environmental stimuli such as bright lights and loud noises should be kept at a minimum to decrease agitation. Minimizing touching the infant to only when they cry will not aid the bonding process between Mom and baby. Frequent holding and touching is permissible.)
When teaching a primiparous client who used cocaine during pregnancy how to comfort her fussy neonate, the nurse can advise the mother to: 1. tightly swaddle the neonate 2. feed the neonate extra high calorie formula 3. keep the neonate in a brightly lit environment 4. touch the baby on when it is crying
3 (CNS disorders are common in neonates with FAS. Speech and language disorders and hyperactivity are common manifestations of CNS dysfunction. Mild to severe mental retardation and feeding problems are common. Delayed growth and development is expected. These neonates feed poorly and commonly have persistent vomiting until age 6-7 months. These neonates do not have a 70% mortality rate, and there is no treatment for FAS)
Which characteristic should the nurse teach the mother about her neonate diagnosed with FAS? 1. Neonates are commonly listless and lethargic 2. The IQ scores are usually average 3. Hyperactivity and speech disorders are common 4. The mortality rate is 70%
