Ch 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations

A nurse is talking to a newly pregnant woman who had a mitral valve replacement in the past. Which statement by the client reveals an understanding about the preexisting condition? A) "I understand that my fetus and I both are at risk for complications." B) "I know my baby will be fine, but I am worried about having a personal complication." C) "I know I will be fine, but I worry about the fetus." D) "I don't have to worry about this because I had the problem fixed before I became pregnant."

A) "I understand that my fetus and I both are at risk for complications." When a woman enters pregnancy with a preexisting condition, both she and her fetus can be at risk of developing complications.

A woman with cardiac disease has come to the office for prenatal counseling. According to the functional classification system developed by the Criteria Committee of the New York Heart Association, the woman would be cautioned against pregnancy based on which category? A) class IV B) class III C) class I D) class II

A) class IV A woman with class IV disease should avoid pregnancy. These individuals can be symptomatic at rest or with any physical activity resulting in inability to carry on any physical activity without discomfort. Symptoms or heart failure or the anginal syndrome may be present even at rest. The pregnancy may put too much stress on the woman's body increasing her risk of serious complications or even death.

A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer? A) "HIV antibodies do not cross the placenta; this means the baby will develop AIDS." B) "HIV is transmitted at birth; having a cesarean birth prevented transmission." C) "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." D) "She already has AIDS. That's what being HIV positive means."

C) "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." Infants born of HIV-positive women test positive for HIV antibodies at birth because these have crossed the placenta. An accurate disease status cannot be determined until the antibodies fade at about 18 months. Testing positive for HIV antibodies does not mean the infant has AIDS. Having a cesarean birth does decrease the risk of transmitting the virus to the infant at birth; it does not prevent the transmission of the disease. HIV antibodies do cross the placenta, which is why babies born of HIV positive mothers are HIV positive.

The nurse is assessing a woman with class III heart disease who is in for a prenatal visit. What would be the first recognizable sign that this client is in heart failure? A) elevated blood pressure B) audible wheezes C) persistent rales in the bases of the lungs D) low blood pressure

C) persistent rales in the bases of the lungs The earliest warning sign of cardiac decompensation is persistent rales in the bases of the lungs.

When educating a client about pregestational diabetes on how to control blood sugar, the nurse knows there are three main facets to glycemic control. In addition to diet and exercise, which is a main facet? A) insulin B) folic acid C) niacin D) glucose tablets

A) insulin The three main facets to glycemic control for the woman with pregestational diabetes are diet, exercise, and insulin. Folic acid does not impact glycemic control. Glucose tablets are not a facet of glycemic control.

A pregnant client with sickle cell anemia is at an increased risk for having a sickle cell crisis during pregnancy. Aggressive management for a client experiencing a sickle cell crisis with severe pain includes which measure? A) diuretic drugs B) antihypertensive drugs C) I.V. fluids D) aceteminophen for pain

C) I.V. fluids A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and I.V. fluids. Antihypertensive drugs usually aren't necessary. Diuretics would not be used unless fluid overload resulted. The client usually needs a stronger analgesic than acetaminophen to control the pain of a crisis.

A woman at 26 weeks' gestation is undergoing screening for diabetes with a 1-hour oral glucose challenge test. On the client's return visit, the nurse anticipates the need to schedule a 3-hour glucose challenge test based on which result of the previous test? A) 130 mg/dL B) 146 mg/dL C) 100 mg/dL D) 114 mg/dL

B) 146 mg/dL For a 1-hour glucose challenge test, a 75-g oral glucose load is given, without regard to the timing or content of the last meal. Blood glucose is measured 1 hour later; a level above 140 mg/dL is abnormal. If the result is abnormal, a 3-hour glucose tolerance test is done.

A pregnant woman with diabetes is having her glycosylated hemoglobin level evaluated. The nurse determines that the woman's glucose is under control and continues the woman's plan of care based on which result? A) 8.5% B) 8.0% C) 6.5% D) 7.5%

C) 6.5% A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. A glycosylated hemoglobin level of more than 8.0% indicates poor blood glucose control and the need for intervention, necessitating a revision in the woman's plan of care.

A pregnant client is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. Which sign would indicate a positive test result? A) A flat, circumscribed area under 10 mm in diameter appears in 6 to 12 hours. B) A flat, circumscribed area over 10 mm in diameter appears in 48 to 72 hours. C) An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. D) An indurated wheal under 10 mm in diameter appears in 6 to 12 hours.

C) An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. A positive PPD result would be an indurated wheal over 10 mm in diameter that appears in 48 to 72 hours. The area must be a raised wheal, not a flat, circumscribed area.

A 40-year-old woman comes to the clinic reporting having missed her period for two months. A pregnancy test is positive. What is she and her fetus at increased risk for? A) postterm birth B) placental abnormalities C) type 2 diabetes mellitus D) type 1 diabetes mellitus

B) placental abnormalities A woman older than 35 years is more likely to conceive a child with chromosomal abnormalities, such as Down syndrome. She is also at higher risk for spontaneous abortion (miscarriage), preeclampsia-eclampsia, gestational diabetes, preterm birth, bleeding and placental abnormalities, and other intrapartum complications.