Chapter 11 - High Risk Perinatal Care Preexisting Conditions (Maternity) EAQ's

A pregnant patient with diabetes is prescribed aerobic exercise with resistance training, arm exercises, and a recumbent exercise bicycle. What does the nurse instruct the patient to ensure optimal benefit from the exercise? Select all that apply. 1 "Do the prescribed exercises after meals." 2 "Stop the exercises if you have uterine contractions." 3 "Perform aerobic exercises for 10 minutes every day." 4 "Increase exercise if there are signs of hypoglycemia." 5 "Check glucose levels before, during, and after exercise."

1 - "Do the prescribed exercises after meals." 2 - "Stop the exercises if you have uterine contractions." 5 - "Check glucose levels before, during, and after exercise." pg 250 - The nurse advises the patient to perform the prescribed exercises after meals, when the blood glucose level is rising. The exercise needs to be discontinued immediately if there are uterine contractions, because they may decrease uterine perfusion. The nurse asks the patient to measure glucose levels before, during, and after the exercise to monitor the effects of insulin. Aerobic exercises are performed for at least 30 minutes to achieve benefits. If there are signs of hypoglycemia, the patient is advised to consume a simple carbohydrate food.

Which interventions does the nurse implement while providing care for a pregnant patient with cystic fibrosis? Select all that apply. 1 Monitor the fetal movements. 2 Assess for pulmonary infection. 3 Encourage exposure to sunlight. 4 Assess the patient's weight daily. 5 Assess for vitamin A, D, E, or K deficiency.

1- Monitor the fetal movements. 2 - Assess for pulmonary infection. 4 - Assess the patient's weight daily. 5 - Assess for vitamin A, D, E, or K deficiency. pg 271 - The nurse assesses the patient's weight daily as a weight gain of 11 to 12 kg is recommended during pregnancy. If the patient does not gain an appropriate amount of weight, nasogastric tube feedings at night are prescribed. The patient is at an increased risk for pulmonary infections, so the nurse is alert for infections so that prompt treatment can be initiated. Fat-soluble vitamins (A, D, E, and K) are not absorbed adequately in the patient with cystic fibrosis. Therefore the nurse needs to monitor for any deficiency for prompt action. Fetal movement counts are recommended from 28 weeks of gestation to assess fetal well-being. Exposure to sunlight is recommended for patients with pruritus gravidarum—a skin disease—to decrease itching.

Which tests does the nurse evaluate to determine the health status of a patient with diabetes in the first few weeks of pregnancy? Select all that apply. 1 Nonstress fetal test 2 Thyroid function test 3 Urinalysis and culture 4 24-Hour urine collection 5 Glycosylated hemoglobin A1c

2 - Thyroid function test 3 - Urinalysis and culture 4 - 24-Hour urine collection 5 - Glycosylated hemoglobin A1c pg 248/249 - The nurse evaluates the urinalysis and culture reports to assess for urinary tract infections, because they are common in a diabetic pregnancy. A 24-hour urine collection is evaluated for total protein excretion and creatinine clearance. A thyroid function test helps detect any coexisting thyroid disease. Glycosylated hemoglobin A1c is measured to assess glycemic control over the past 4 months. A nonstress test is performed after 32 weeks' gestation to assess fetal well-being.

What is the rationale for the nurse asking a pregnant patient with heart disease to document the daily weight? 1 To monitor for heart failure 2 To monitor nutritional intake 3 To assess for fluid retention 4 To assess for any weight loss

3 - To assess for fluid retention pg 267 - A sudden weight gain in a patient with heart disease indicates water retention. Hence, the nurse advises the patient to check her weight daily. Nutritional intake is monitored by consuming the prescribed foods and supplements. Heart failure is indicated by dyspnea, frequent, moist cough, or palpitations. Weight loss is a concern for a patient who has elevated free thyroxine (T4) as a result of hyperthyroidism.

What does the nurse inform a breastfeeding patient who is taking propylthiouracil (Propacil) for hyperthyroidism? 1 "The medication is likely to decrease milk production." 2 "Stop breastfeeding the child, and start infant formula." 3 "It can adversely affect the neonate's thyroid function." 4 "Take the medication immediately after breastfeeding."

4 - "Take the medication immediately after breastfeeding." pg 261 - The nurse advises the patient to take the medication immediately after breastfeeding to allow a 3- to 4-hour period for the medication to absorb before nursing again. Milk production decreases if there is poor metabolic control, not because of antithyroid medications. It is not necessary to stop breastfeeding or provide infant formula, because there are no side effects of the medication in the infant. The medication also does not adversely affect the neonate's thyroid function.

What does the nurse teach a patient with phenylketonuria (PKU) about breastfeeding? 1 "You should breastfeed your child every 3 to 4 hours." 2 "Eat a phenylalanine-restricted diet for breastfeeding." 3 "Eat wheat products immediately after breastfeeding." 4 "You should bottle-feed, because it is not safe to breastfeed."

4 - "You should bottle-feed, because it is not safe to breastfeed." pg 262 - It is not advisable to breastfeed if the patient has PKU, because the milk will contain a high concentration of phenylalanine. The nurse instructs the patient to breastfeed every 3 to 4 hours for patients without PKU. Wheat products contain phenylalanine and are not recommended for patients with PKU. Eating a phenylalanine-restricted diet is effective before conception in order to lower the phenylalanine levels in the patient.

Thalassemia is a relatively common anemia in which what occurs? 1 Folate deficiency occurs. 2 There are inadequate levels of vitamin B12. 3 RBCs have a normal life span but are sickled in shape. 4 An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs).

4 - An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). pg 270 - Thalassemia is a hereditary disorder that involves the abnormal synthesis of the α or β chains of hemoglobin. An insufficient amount of hemoglobin is produced to fill the RBCs. This is the underlying description for sickle cell anemia. Folate deficiency is the most common cause of megaloblastic anemias during pregnancy. B12 deficiency must also be considered if the pregnant woman presents with anemia.

During a physical assessment of an at-risk patient, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. What are these most likely signs of? 1 Euglycemia 2 Pneumonia 3 Rheumatic fever 4 Cardiac decompensation

4 - Cardiac decompensation pg 266 - Symptoms of cardiac decompensation may appear abruptly or gradually. Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation. Rheumatic fever can cause heart problems, but it does not present with these symptoms, which indicate cardiac decompensation. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation.

What does the nurse tell a pregnant patient with diabetes who asks about dietary management during pregnancy? Select all that apply. 1 "Eat meals at the same time every day." 2 "You need a large carbohydrate snack at bedtime." 3 "If you skip a meal, you should have a large snack." 4 "You need to stay away from any aerobic exercise." 5 "Remember to have more whole grains in your diet."

1 - "Eat meals at the same time every day." 2 - "You need a large carbohydrate snack at bedtime." 5 - "Remember to have more whole grains in your diet." pg 250 - The nurse advises the diabetic pregnant patient to eat meals at the same time every day to prevent fluctuations in the glucose levels. The patient is asked to consume more whole grains, because they contain complex carbohydrates and fiber, which help regulate blood glucose levels. The nurse suggests a large carbohydrate snack at bedtime to help prevent hypoglycemia and starvation ketosis during the night. Skipping meals is not advised, because it may increase the risk for episodes of hypoglycemia. The patient may be prescribed aerobic exercise as a part of the treatment plan.

The nurse is informing the pregnant patient with a cardiac disorder about the dietary changes that are needed. What should the nurse include in the teaching? Select all that apply. 1 "Include potassium-rich foods in the diet." 2 "Increase your daily intake of dietary fiber." 3 "Take iron and folic acid supplements daily." 4 "Take the stool softener daily as prescribed." 5 "Cut intake of dark, green leafy vegetables."

1 - "Include potassium-rich foods in the diet." 2 - "Increase your daily intake of dietary fiber." 3 - "Take iron and folic acid supplements daily." 4 - "Take the stool softener daily as prescribed." pg 267 - The nurse instructs the patient to take iron and folic acid supplements to prevent anemia. Iron supplements may cause constipation. Therefore the nurse advises the patient to increase fiber and fluid intake. The nurse also advises the patient to take the prescribed stool softeners to prevent straining during defecation, because forced expiration causes blood to rush to the heart and overload the cardiac system. Patients with a cardiac history may be taking diuretics, which may cause loss of potassium. Therefore the nurse should teach the patient to include foods high in potassium in the diet. Dark, green leafy vegetables contain folate and are included in the patient's diet.

A patient who recently had a heart transplant with no evidence of rejection asks the nurse about the safety of conceiving a child. What is the best response by the nurse? 1 "You may conceive 1 year after the transplant." 2 "A heart transplant does not tolerate pregnancy." 3 "The newborn may have congenital heart disease." 4 "You may need to terminate pregnancy at any time."

1 - "You may conceive 1 year after the transplant." pg 266 - The nurse advises the patient to plan conception 1 year after the transplant to prevent acute rejection. The transplanted heart responds normally to pregnancy-related changes. Pregnancy may be terminated if there are signs of hypertension and an episode of rejection. There is no evidence to suggest that the newborn will have a congenital heart defect as a result of the patient having a history of a transplant.

Which information does the nurse include in preconception counseling for a patient with Marfan syndrome who also presents with an aortic root diameter of more than 6 cm? Select all that apply. 1 "You may not be able to deliver the child vaginally." 2 "It should be repaired before you become pregnant." 3 "There is an increased chance of maternal mortality." 4 "The newborn child may develop Marfan syndrome." 5 "You should not even try to become pregnant at all."

1 - "You may not be able to deliver the child vaginally." 2 - "It should be repaired before you become pregnant." 3 - "There is an increased chance of maternal mortality." 4 - "The newborn child may develop Marfan syndrome." pg 265 - The nurse advises the patient to have the aortic root repaired to prevent the risk for maternal mortality. The nurse also informs the patient that there is an increased risk for maternal mortality associated with this disorder. Therefore the patient will be able to make an informed decision about planning a pregnancy. The nurse needs to educate the patient about the fact that there is a 50% chance of the newborn developing Marfan syndrome. A vaginal birth is difficult for the patient because of an increased pressure in the aorta during labor. The nurse does not advise the patient to not attempt the pregnancy but informs about the risks associated with the pregnancy to help the patient make a well-informed decision.

What does the nurse include in the plan of care of a pregnant patient with Eisenmenger syndrome? Select all that apply. 1 Assess for signs of fluid overload. 2 Put on compression support hose. 3 Use the prescribed oxygen therapy. 4 Have the patient change positions slowly. 5 Advise the patient to perform light physical exercises.

1 - Assess for signs of fluid overload. 2 - Put on compression support hose. 3 - Use the prescribed oxygen therapy. 4 - Have the patient change positions slowly. pg 265 - Eisenmenger syndrome is a cardiac defect that causes right-to-left shunting at either the atrial or the ventricular level of the heart and is combined with elevated pulmonary vascular resistance. The nurse should decrease the risk for hypotension in a patient with this defect. This increases hypoxemia and pulmonary vascular resistance. One way to decrease the risk for hypotension is to have the patient change positions slowly. The nurse should assess for fluid volume overload, such as edema. This will decrease stress to the failing right side of the heart. Oxygen therapy is used to prevent hypoxia in the patient. Physical activity is strictly limited in this patient. Therefore the nurse does not instruct the patient about any physical exercises.

A pregnant woman is being examined by the nurse in the outpatient obstetric clinic. The nurse suspects systemic lupus erythematosus (SLE) after the examination reveals which symptoms? Select all that apply. 1 Fever 2 Hyperactivity 3 Hypotension 4 Muscle aches 5 Weight changes

1 - Fever 4 - Muscle aches 5 - Weight changes pg 275 - Common symptoms, including myalgias, fatigue, weight change, and fevers, occur in nearly all women with SLE at some time during the course of the disease. Fatigue, rather than hyperactivity, is a common sign of SLE. Hypotension is not a characteristic sign of SLE. Although a diagnosis of SLE is suspected based on clinical signs and symptoms, it is confirmed by laboratory testing that demonstrates the presence of circulating autoantibodies. As with other autoimmune diseases, SLE is characterized by a series of exacerbations (flares) and remissions (Chin and Branch, 2012).

Which obstetric or medical complications should the nurse be alert for while providing care to a pregnant patient with diabetes mellitus? Select all that apply. 1 Hydramnios 2 Preeclampsia 3 Hypoglycemia 4 Monilial vaginitis 5 Brachial plexus palsy

1 - Hydramnios 2 - Preeclampsia 3 - Hypoglycemia 4 - Monilial vaginitis pg 247 - A pregnant patient with diabetes mellitus is at risk for hypertension, which may result in preeclampsia. Hypoglycemia may occur because of an increase in insulin levels in the first trimester of pregnancy. Hydramnios may occur in the third trimester of pregnancy because of hyperglycemia. Monilial vaginitis is a vaginal infection that is seen in women with diabetes during pregnancy. This results from an alteration in the normal resistance of the body to infection. Brachial plexus palsy may be seen in the child born to a woman with diabetes as a result of a difficult vaginal birth.

Which condition does the nurse expect to find in the medical record of a pregnant patient with diabetes mellitus? 1 Hypoglycemia 2 Cyanosis of lips 3 Increasing fatigue 4 Generalized edema

1 - Hypoglycemia pg 246 - In the first trimester of pregnancy, there is an increase in insulin production and a decrease in hepatic glucose production because of the rising levels of estrogen and progesterone. This lowers the glucose levels and makes the pregnant patient prone to hypoglycemia. Cyanosis of lips, increasing fatigue, and generalized edema are signs of cardiac decompensation in a pregnant patient with preexisting cardiac disease. It occurs because the heart is unable to maintain sufficient cardiac output because of pregnancy.

Which conditions are common in infants born to mothers with diabetes mellitus? Select all that apply. 1 Hypoglycemia 2 Marfan syndrome 3 Cephalhematoma 4 Shoulder dystocia 5 Brachial plexus palsy

1 - Hypoglycemia 3 - Cephalhematoma 4 - Shoulder dystocia 5 - Brachial plexus palsy pg 258 - Brachial plexus palsy and cephalhematoma may occur in the child as a result of a difficult vaginal birth. The brachial plexus is a group of nerves that originate from the spinal cord. They can be damaged because of a difficult birth. A cephalhematoma is a hemorrhage of blood between the skull and the periosteum. Shoulder dystocia is a risk associated with diabetic pregnancy because the infants born to women with diabetes tend to have a disproportionate increase in shoulder, trunk, and chest size. Hypoglycemia is a risk if the patient does not control her blood glucose during the last half of pregnancy. Marfan syndrome is a cardiac disease and is not seen in infants with diabetic mothers.

When providing preconception counseling, what instructions does the nurse give to a patient with diabetes mellitus? Select all that apply. 1 Inform the patient about the potential risks. 2 Explain the need for frequent obstetrical visits. 3 Instruct the patient about the expenses involved. 4 Advise the patient to use effective contraception. 5 Advise the patient against trying to conceive a child.

1 - Inform the patient about the potential risks. 2 - Explain the need for frequent obstetrical visits. 3 - Instruct the patient about the expenses involved. 4 - Advise the patient to use effective contraception. pg 246 - The nurse should inform the patient about the potential risks of pregnancy as a result of diabetes mellitus. This helps the patient make an informed decision about becoming pregnant. The nurse also provides information about the financial implications of a diabetic pregnancy so that the patient is able to plan accordingly. When a patient with diabetes becomes pregnant, the patient will need to see the obstetrician more frequently than a patient without diabetes. This is done to assess the health of the patient and the fetus. Therefore the nurse informs the patient about this in advance. The use of contraception is advised to help the patient plan effectively for the pregnancy. The nurse does not advise against conceiving but explains the complications to help the patient make a decision.

The nurse is teaching a woman with gestational diabetes the technique to inject insulin. What should the nurse include in the teaching session? Select all that apply. 1 Inject insulin slowly. 2 Aspirate before injecting. 3 Clean injection site with alcohol. 4 After injection, cover site with sterile gauze. 5 Insert the needle at a 45- to 90-degree angle.

1 - Inject insulin slowly. 4 - After injection, cover site with sterile gauze. 5 - Insert the needle at a 45- to 90-degree angle. pg 251 - Insulin should be injected with the short needle inserted at a 45- to 90-degree angle, depending on fatty tissue. Insulin is injected slowly to allow tissue expansion and minimize pressure, which can cause insulin leakage. After injection, the site should be covered with sterile gauze. Gentle pressure should be applied to prevent bleeding. Aspirating when injecting into subcutaneous tissue is not necessary. The injection site should be clean, but using alcohol is not necessary.

Which dietary supplements does the primary health care provider prescribe for a pregnant patient who takes anticonvulsant medications? Select all that apply. 1 Iron 2 Vitamin K 3 Folic acid 4 Vitamin D 5 Vitamin B12

1 - Iron 3 - Folic acid 4 - Vitamin D pg 269/273 - Iron supplements are are prescribed for all pregnant patients to prevent anemia. Pregnant women should take folic acid supplements of 4 mg daily to decrease the risk for neural tube defects in the infant for a patient who takes anticonvulsant medications. Vitamin D supplements are prescribed daily, because anticonvulsant medications can interfere with production of the active form of vitamin D. Vitamin K deficiency is not seen in patients who take anticonvulsant medications; it is seen in infants exposed in utero to phenobarbital, phenytoin, and primidone. Vitamin B12 supplements are needed if there is a vitamin B12 deficiency in a pregnant patient.

Which condition is a fetus at risk for if the mother has poor glycemic control later in pregnancy? 1 Macrosomia 2 Hydramnios 3 Ketoacidosis 4 Preeclampsia

1 - Macrosomia pg 247 - Poor glycemic control later in pregnancy increases the risk for fetal macrosomia, or an infant with a birth weight of more than 4000 to 4500 g, or greater than the 90th percentile. Hydramnios may occur in the third trimester of pregnancy because of hyperglycemia. Ketoacidosis occurs during the second and third trimesters if the maternal metabolism is stressed by illness or infection. Preeclampsia is seen in women with nephropathy and hypertension in addition to diabetes.

The nurse is caring for a woman with mitral stenosis who is in the active stage. What action should the nurse take to promote cardiac function? 1 Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. 2 Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling. 3 Encourage the woman to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function. 4 Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics.

1 - Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. pg 267 - The side-lying position with the head and shoulders elevated helps to facilitate hemodynamics during labor. A vaginal delivery is the preferred method of delivery for a woman with cardiac disease as it sustains hemodynamics better than a cesarean section. The use of supportive care, medication, and narcotics or epidural regional analgesia is not contraindicated with a woman with heart disease. The use of the Valsalva maneuver during pushing in the second stage should be avoided because it reduces diastolic ventricular filling and obstructs left ventricular outflow.

What are maternal and neonatal risks associated with gestational diabetes mellitus? 1 Maternal preeclampsia and fetal macrosomia 2 Maternal placenta previa and fetal prematurity 3 Maternal hyperemesis and neonatal low birth weight 4 Maternal premature rupture of membranes and neonatal sepsis

1 - Maternal preeclampsia and fetal macrosomia pg 247 - Women with gestational diabetes have twice the risk of developing hypertensive disorders such as preeclampsia, and the baby usually has macrosomia. Premature rupture of membranes and neonatal sepsis are not risks associated with gestational diabetes. Hyperemesis is not seen with gestational diabetes, nor is there an association with low birth weight of the infant. Placental previa and subsequent prematurity of the neonate are not risks associated with gestational diabetes.

The nurse is reviewing the medical record of a pregnant patient with diabetes mellitus and notices the patient has poor glycemic control throughout the early weeks of pregnancy. What does the nurse infer that the patient may be at risk for? 1 Miscarriage 2 Ketoacidosis 3 Polyhydramnios 4 Fetal macrosomia

1 - Miscarriage pg 247 - Metabolic changes in the early weeks of pregnancy change the insulin and glucose levels in the body. This may result in poor glycemic control and may increase the chance of miscarriage. Polyhydramnios may occur in the third trimester of pregnancy because of hyperglycemia. There is an increased chance of fetal macrosomia if there is poor glycemic control in the later weeks of pregnancy. Ketoacidosis occurs during the second and third trimesters if the maternal metabolism is stressed by illness or infection.

Which action does the nurse take to determine whether the carbohydrate intake is inadequate in a pregnant patient with diabetes? 1 Monitor for urine ketones. 2 Evaluate the nonstress test results. 3 Determine the degree of glycosuria. 4 Schedule a baseline fetal sonogram.

1 - Monitor for urine ketones. pg 253 - If a patient with diabetes does not take in enough carbohydrates, the body resorts to breaking down fats for energy. The by-product of fat metabolism is ketones. Therefore the nurse monitors the urine for ketones. The amount of ketones in the urine helps detect inadequate carbohydrate intake. Nonstress tests will help assess the well-being of the fetus. Glycosuria does not accurately reflect the blood glucose levels because of a lowered renal threshold for glucose during pregnancy. The nurse obtains a baseline sonogram to assess gestational age in the first trimester.

What does the nurse include in the plan of care of a patient with a cardiac disorder during the postpartum period? Select all that apply. 1 Monitor oxygen saturation levels. 2 Place the newborn at the bedside. 3 Put the patient on a full liquid diet. 4 Teach the patient how to breastfeed. 5 Have the patient talk to the newborn.

1 - Monitor oxygen saturation levels. 2 - Place the newborn at the bedside. 4 - Teach the patient how to breastfeed. 5 - Have the patient talk to the newborn. pg 268/270 - The nurse monitors oxygen saturation levels in the patient to assess for adequate oxygenation. The nurse places the infant at the bedside so that the patient can touch the infant without expending energy. This also helps establish an emotional bond. The nurse assists the patient in breastfeeding by positioning the infant correctly for feeding. The nurse encourages the patient to talk to the newborn to involve the mother in the infant's care and help the patient feel vitally important. A fluid diet is not prescribed, because it does not ensure adequate nutrition for the infant.

Which nursing interventions are included in the plan of care of a pregnant patient with mitral stenosis? Select all that apply. 1 Restrict dietary sodium. 2 Teach passive exercises. 3 Assess respiratory status. 4 Assess the echocardiogram. 5 Place the patient on bed rest.

1 - Restrict dietary sodium. 3 - Assess respiratory status. 4 - Assess the echocardiogram. 5 - Place the patient on bed rest. pg 264 - Dietary sodium is restricted in a pregnant patient with mitral stenosis to decrease preload. The patient is placed on bed rest to prevent tachycardia. The nurse evaluates echocardiogram reports to assess the atrial and ventricular size and heart valve function. The nurse should auscultate the patient's lung sounds to assess for fluid overload. The nurse does not teach any physical exercise, because activity needs to be limited to prevent tachycardia.

Which conditions does the nurse ask the pregnant patient with a cardiac disorder to report immediately? Select all that apply. 1 Shortness of breath 2 Palpitations and pain 3 Urinary tract infection 4 Onset of constipation 5 Orthostatic hypotension

1 - Shortness of breath 2 - Palpitations and pain 3 - Urinary tract infection pg 262/264 - If a patient with a cardiac disorder acquires infection, the patient's condition worsens because infection can increase the heart rate, and organisms can spread to the heart structure. Therefore the nurse instructs the patient to report signs of a urinary tract infection immediately. The patient should report palpitations, pain, and shortness of breath because they could also be signs of heart failure. The patient need not report constipation, because it can be prevented by increasing fluids and fiber in the patient's diet. Hypotension is usually seen in pregnant patients with diabetes, and it is treated by consuming simple carbohydrate foods.

Hypothyroidism occurs in two to three pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for what? Select all that apply. 1 Stillbirth 2 Miscarriage 3 Macrosomia 4 Placental abruption 5 Gestational hypertension

1 - Stillbirth 2 - Miscarriage 4 - Placental abruption 5 - Gestational hypertension pg 260 - Hypothyroidism is often associated with both infertility and an increased risk for miscarriage. These outcomes can be improved with early diagnosis and treatment. Pregnant women with hypothyroidism are more likely to experience both preeclampsia and gestational hypertension. Placental abruption and stillbirth are risks associated with hypothyroidism. Placental abruption and stillbirth are risks associated with hypothyroidism. Infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm.

The nurse is developing the plan of care for a pregnant patient with an underlying history of cardiovascular disease. Which conditions would this patient be at risk for? Select all that apply. 1 Stillbirth 2 Miscarriage 3 Hypoglycemia 4 Atrial septal defect 5 Intrauterine growth restriction

1 - Stillbirth 2 - Miscarriage 5 - Intrauterine growth restriction pg 262 - Stillbirth and miscarriage may occur because of cardiovascular problems in pregnancy. Intrauterine growth restriction results in a pregnant patient with cardiovascular disease because of low oxygen pressure. Hypoglycemia is seen in a pregnant patient with diabetes because a decrease in glucose levels. An atrial septal defect is a congenital birth defect that is not related to underlying maternal cardiac disease.

Which nursing interventions does the nurse implement when assessing a patient with gestational diabetes? Select all that apply. 1 Tells the patient to follow a diabetic diet 2 Explains the importance of exercising daily 3 Demonstrates how to monitor blood glucose levels 4 Tells the patient to not take any oral hypoglycemics 5 Explains the effects of diabetes on the pregnancy and fetus

1 - Tells the patient to follow a diabetic diet 3 - Demonstrates how to monitor blood glucose levels 5 - Explains the effects of diabetes on the pregnancy and fetus pg 257 - The nurse tells the patient to follow a diabetic diet to promote self-management and compliance with the treatment. The nurse demonstrates how to monitor blood glucose levels to establish the patient's ability to perform the procedure. The nurse explains the effects of diabetes on the pregnancy and the fetus to promote the patient's compliance with the treatment plan. The nurse instructs the patient to take oral hypoglycemic medications as prescribed to control blood glucose levels. The nurse does not encourage the patient to exercise unless prescribed by the primary health care provider.

The prenatal medical record for a pregnant patient with diabetes states that amniotic fluid phosphatidylglycerol is greater than 3%. What does this indicate? 1 The fetal lung maturation is normal. 2 The mother may develop hydramnios. 3 There is a chance of fetal macrosomia. 4 The mother is at risk for hypoglycemia.

1 - The fetal lung maturation is normal. pg 254 - Fetal lung maturation is predicted by the presence by amniotic fluid phosphatidylglycerol. If it is greater than 3%, the fetal lung maturation is normal. The risk for hypoglycemia can be confirmed by evaluating blood glucose levels. The risk for fetal macrosomia is increased if there is poor glycemic control in pregnancy. If hyperglycemia occurs, the patient is at risk for hydramnios.

Adequate insulin is the primary factor in the maintenance of euglycemia during pregnancy. Insulin requirements during pregnancy change dramatically as the pregnancy progresses. For the patient with pregestational diabetes that is accustomed to one injection per day of intermediate-acting insulin, multiple daily injections of mixed type insulin is a new experience. You are working as a nurse in a busy OB/GYN practice and have been assigned the task of instructing a patient on the procedure for mixing NPH (intermediate-acting) and regular (short-acting) insulin. In which order should the insulin be mixed? 1. Check insulin bottles for type and expiration. 2. Wipe off rubber stopper with alcohol. 3. Wash hands thoroughly and gather supplies. 4. Inject air equal to the NPH dose into the NPH vial. Remove needle. 5. Gently rotate insulin vial to mix. 6. Draw into the syringe the amount of air equal to the total dose. 7. Invert regular insulin bottle and withdraw the dose. 8. Without adding more air to NPH vial, carefully withdraw the dose. 9. Inject air equal to regular insulin dose into the vial.

1. - Gently rotate insulin vial to mix. 2. - Wash hands thoroughly and gather supplies. 3. - Check insulin bottles for type and expiration. 4. - Wipe off rubber stopper with alcohol. 5. - Draw into the syringe the amount of air equal to the total dose. 6. - Inject air equal to the NPH dose into the NPH vial. Remove needle. 7. - Inject air equal to regular insulin dose into the vial. 8. - Invert regular insulin bottle and withdraw the dose. 9. - Without adding more air to NPH vial, carefully withdraw the dose. pg 251 - Aseptic technique is always the number one priority when preparing medications. To promote medication safety, the insulin bottle must be checked for the expiration date and type of insulin. It is important to gently rotate the insulin (never shake the bottle) in order to maintain the integrity of the medication. These are multidose vials, and the rubber stopper should always be cleansed with alcohol. The nurse must calculate the combined dose in units and draw that exact amount of air into the empty syringe. Air is then injected into the NPH vial in order for it to be withdrawn later. The remainder of the air is injected into the regular insulin vial, which is then inverted and the correct amount of units are withdrawn. The NPH vial is ready to go and that dose is withdrawn last.

Arrange the steps in the order in which diabetic ketoacidosis (DKA) develops in a pregnant patient. 1. The fatty acids are mobilized from fat stores and enter the circulation. 2. The hepatic glucose production increases because of some infection. 3. Osmotic diuresis results with volume depletion and cellular dehydration. 4. The stress hormones that cause impaired insulin action are secreted. 5. The extra glucose and ketone bodies are released into the circulation. 6. The buffering system is unable to compensate and acidosis develops.

1. - The hepatic glucose production increases because of some infection. 2. - The stress hormones that cause impaired insulin action are secreted. 3. - The fatty acids are mobilized from fat stores and enter the circulation. 4. - The extra glucose and ketone bodies are released into the circulation. 5. - The buffering system is unable to compensate and acidosis develops. 6.. - Osmotic diuresis results with volume depletion and cellular dehydration. pg 247 - A stress factor, such as infection, increases the hepatic glucose production and decreases peripheral glucose use. Therefore the stress hormones are released, which act to impair insulin action. Fatty acids are mobilized from fat stores to enter the circulation. As they are oxidized, ketone bodies are released into the peripheral circulation. The patient's buffering system is unable to compensate, which causes DKA to develop. The excessive blood glucose and ketone bodies result in osmotic diuresis, which then cause loss of fluid and electrolytes, volume depletion, and cellular dehydration. Because the body's buffering system cannot compensate, this results in a diagnosis of diabetic ketoacidosis.

What instruction does the nurse give to a pregnant patient who takes iron supplements and is also prescribed levothyroxine (Synthroid) (T4)? 1 "Perform your aerobic exercises after taking levothyroxine (T4)." 2 "Take iron supplements and levothyroxine (T4) at different times." 3 "Discontinue the iron supplements in case of nausea or vomiting." 4 "Lower the levothyroxine (T4) dosage as the pregnancy progresses."

2 - "Take iron supplements and levothyroxine (T4) at different times." pg 261 - The nurse advises the patient to take the supplements and T4 at different times, because the iron supplements decrease the absorption of T4. The T4 dosage is increased as the pregnancy progresses because of increased estrogen levels. Iron supplements are not discontinued, because discontinuing the supplements may increase chances of anemia. Instead, iron is administered parenterally if the patient is unable to take iron supplements orally. Aerobic exercises do not affect the drug action of T4. Aerobic exercises are prescribed for patients with diabetes

How does the nurse advise the patient who has given birth to an infant with microcephaly in the past and is now planning for the next child? 1 "There is a higher chance of having a preterm birth." 2 "You should be screened for phenylketonuria (PKU)." 3 "You must go for genetic counseling before conception." 4 "There may be a miscarriage in your second pregnancy."

2 - "You should be screened for phenylketonuria (PKU)." pg 261 - If a patient has given birth to an infant with microcephaly in the past, there is a possibility that the patient has phenylketonuria (PKU). PKU results from a deficiency in the enzyme phenylalanine hydrolase. Preterm birth is a possibility in pregnant women with untreated hypothyroidism. PKU affects brain development and function in the child; it does not cause miscarriage. Genetic counseling is more important for patients who have hereditary disorders, which can be passed on to the child.

A pregnant woman in her first trimester with a history of epilepsy is transported to the hospital via ambulance after suffering a seizure in a restaurant. Which health care provider orders should the nurse expect to be included in the plan of care? Select all that apply. 1 Valproate (Depakote) 2 Abdominal ultrasounds 3 Carbamazepine (Tegretol) 4 Serum lab levels of medications 5 Prenatal vitamins with vitamin D

2 - Abdominal ultrasounds 4 - Serum lab levels of medications 5 - Prenatal vitamins with vitamin D pg 273/274 - Checking lab levels of medications, performing abdominal ultrasounds to assess fetal growth, and taking prenatal vitamins with vitamin D are all expected interventions for a pregnant woman diagnosed with epilepsy. Carbamazepine (Tegretol) and valproate (Depakote) should be avoided if possible during pregnancy, especially during the first trimester, because their use is associated with neural tube defects in the fetus.

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. What should she be told is most often the earliest sign of decompensation? 1 Orthopnea 2 Decreasing energy levels 3 Moist frequent cough and frothy sputum 4 Crackles (rales) at the bases of the lungs on auscultation

2 - Decreasing energy levels pg 266 - Decreasing energy level (fatigue) is an early finding of heart failure. Care must be taken to recognize it as a warning rather than a typical change of the third trimester. Cardiac decompensation is most likely to occur early in the third trimester, during childbirth, and during the first 48 hours following birth. Orthopnea, a moist, frequent cough, and crackles and rales appear later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema.

When a pregnant woman with diabetes experiences hypoglycemia while hospitalized, what should the nurse have the woman do? 1 Eat a candy bar. 2 Eat six saltine crackers or drink 8 oz of milk. 3 Drink 4 oz of orange juice followed by 8 oz of milk. 4 Drink 8 oz of orange juice with 2 teaspoons of sugar added.

2 - Eat six saltine crackers or drink 8 oz of milk. pg 250 - Crackers provide carbohydrates in the form of polysaccharides. A candy bar provides only monosaccharides. Milk is a disaccharide and orange juice is a monosaccharide. This will provide an increase in blood sugar but will not sustain it to normal levels. Orange juice and sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar.

Which test does the nurse evaluate to understand the cause of fatigue, shortness of breath, and dyspnea in a pregnant patient? 1 Nonstress test 2 Electrocardiography 3 24-Hour urine collection 4 Glycosylated hemoglobin

2 - Electrocardiography pg 264 - Fatigue, shortness of breath, and dyspnea in a pregnant patient indicate primary pulmonary hypertension (PPH). Therefore the nurse needs to evaluate electrocardiography results, which diagnose the condition. The 24-hour urine collection is used to evaluate total protein excretion and creatinine clearance in a pregnant patient with diabetes. The nonstress test is used to assess fetal well-being in a pregnant patient with diabetes. The glycosylated hemoglobin test is used to assess glycemic control in a pregnant patient with diabetes.

Which instruction should the nurse include when teaching a pregnant woman with class II heart disease? 1 Advise her to gain at least 30 pounds. 2 Instruct her to avoid strenuous activity. 3 Inform her of the need to limit fluid intake. 4 Explain the importance of a diet high in calcium.

2 - Instruct her to avoid strenuous activity. pg 262 - Activity may need to be limited so that cardiac demand does not exceed cardiac capacity. Weight gain should be kept to a minimum with heart disease. Fluid intake is necessary to prevent fluid deficits. Fluid intake should not be limited during pregnancy. She may also be put on a diuretic. Iron and folic acid intake is important to prevent anemia.

What are the metabolic changes associated with pregnancy? Select all that apply. 1 Maternal insulin requirements increase during the first trimester. 2 Maternal production of insulin increases during the first trimester. 3 There is enough glucose for the fetus during the second trimester. 4 Fasting blood glucose levels will decrease during the first trimester. 5 The patient's tolerance to glucose increases in the second trimester.

2 - Maternal production of insulin increases during the first trimester. 3 - There is enough glucose for the fetus during the second trimester. 4 - Fasting blood glucose levels will decrease during the first trimester. pg 245/246 - In the first trimester, an increase in estrogen and progesterone production stimulates the beta cells in the pancreas to increase insulin production. The beta cells also increase peripheral use of glucose and, in turn, decrease the overall blood glucose levels. This reduces fasting glucose levels by approximately 10%. During the second and third trimesters, hormonal changes increase insulin resistance and ensure an abundant supply of glucose for the fetus. The body develops insulin resistance as a glucose-sparing mechanism. In the second trimester, hormonal changes decrease tolerance to glucose. Maternal insulin requirements increase from 18 to 24 weeks of gestation, not in the first trimester.

The nurse notices that a pregnant patient shows signs of fatigue and lethargy and has glossitis and rough skin. Which condition does the nurse likely suspect? 1 Thalassemia 2 Megaloblastic anemia 3 Iron deficiency anemia 4 Sickle cell hemoglobinopathy

2 - Megaloblastic anemia pg 269 - Signs of fatigue, lethargy, glossitis, and skin roughness indicate megaloblastic anemia. This is caused by a folic acid deficiency. Thalassemia is indicated by severe anemia and congestive heart failure in a pregnant patient. Fatigue indicates iron deficiency anemia, but glossitis and skin roughness are not present. Anemia, repeated infections, shortness of breath, fatigue, and jaundice are seen in a patient with sickle cell hemoglobinopathy.

Which medication is administered to a pregnant patient to treat hyperthyroidism? 1 Isotretinoin (Accutane) 2 Methimazole (Tapazole) 3 Levothyroxine (Synthroid) 4 Sodium iodide 131I (Hicon)

2 - Methimazole (Tapazole) pg 260 - Methimazole (Tapazole) is administered to a pregnant patient to control symptoms of hyperthyroidism, improve weight gain, and reduce tachycardia. Isotretinoin (Accutane) is prescribed for cystic acne. It is not prescribed during pregnancy, because it is highly teratogenic. Levothyroxine (Synthroid) is used to treat hypothyroidism in pregnant patients who do not have a functioning thyroid tissue. Sodium iodide 131I (Hicon) is radioactive iodine. It is not used to treat hyperthyroidism in pregnant patients, because it may destroy the fetal thyroid.

Which form of heart disease in women of childbearing years usually has a benign effect on pregnancy? 1 Cardiomyopathy 2 Mitral valve prolapse 3 Rheumatic heart disease 4 Congenital heart disease

2 - Mitral valve prolapse pg 263 - Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy.

Which interventions does the nurse implement to ease the labor process of a pregnant patient with heart disease? Select all that apply. 1 Use stirrups to facilitate an easy labor. 2 Monitor the patient's oxygen saturation. 3 Maintain a peaceful, calm environment. 4 Place the patient in a side-lying position. 5 Provide the patient with a relaxing back rub.

2 - Monitor the patient's oxygen saturation. 3 - Maintain a peaceful, calm environment. 4 - Place the patient in a side-lying position. 5 - Provide the patient with a relaxing back rub. pg 267 - The nurse places the patient in a side-lying position to facilitate uterine perfusion. The nurse monitors the patient's oxygen saturation to assess for adequate oxygenation. The nurse maintains a calm environment to minimize the patient's anxiety. The nurse also provides a back massage to comfort the patient. Stirrups are not used because they may cause compression of the popliteal veins or increase in blood volume in the chest.

Which clinical finding in a pregnant patient will indicate proper fetal brain development? 1 Hemoglobin A1c levels greater than 6 2 Normal maternal thyroxine (T4) levels 3 3% amniotic fluid phosphatidylglycerol 4 Fasting glucose levels less than 95 mg/dL

2 - Normal maternal thyroxine (T4) levels pg 261 - Proper fetal brain development depends on normal maternal T4 levels early in pregnancy. Mild maternal hypothyroidism during the first trimester can cause neuropsychological damage in the infant. Hemoglobin A1c levels greater than 6 indicate long-term elevated glucose levels in the patient. A 3% amniotic fluid phosphatidylglycerol indicates proper lung maturation in the fetus. Fasting glucose levels less than 95 mg/dL indicate proper glycemic control in the pregnant patient.

Which is the ideal treatment for severe unmanageable hyperthyroidism in a patient who is pregnant? 1 Radioactive iodine 2 Subtotal thyroidectomy 3 Methimazole (Tapazole) 4 Propylthiouracil (Propacil)

2 - Subtotal thyroidectomy pg 261 - A subtotal thyroidectomy is prescribed for a pregnant patient with severe hyperthyroidism if the drug therapy proves toxic. Oral methimazole and propylthiouracils are prescribed for hyperthyroidism but may be ineffective in severe cases. Radioactive iodine is not used to treat hyperthyroidism in pregnant patients, because it may destroy the fetus's thyroid gland.

Diabetes in pregnancy puts the fetus at risk in several ways. What should nurses be aware of? 1 At birth, the neonate of a diabetic mother is no longer at any greater risk. 2 The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. 3 With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. 4 Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring.

2 - The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. pg 247 - Congenital malformations account for 30% to 50% of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.

A patient with gestational diabetes tells the nurse, "I'm extremely worried that my child will be diabetic, too." Which actions does the nurse take to alleviate the patient's anxiety? Select all that apply. 1 Evaluate the test results to assess fetal growth. 2 Use therapeutic communication with the patient. 3 Listen to the feelings and concerns of the patient. 4 Provide factual information of risks to the patient. 5 Ask the patient to share any fears with the nurse.

2 - Use therapeutic communication with the patient. 3 - Listen to the feelings and concerns of the patient. 4 - Provide factual information of risks to the patient. 5 - Ask the patient to share any fears with the nurse. pg 259 - The nurse listens to the patient's feelings and concerns to assess for any misconception or misinformation that can be causing anxiety. The nurse provides factual information about any risks to the patient to correct any misconceptions. Using therapeutic communication will develop an open relationship that also helps promote trust. The nurse encourages the patient to share concerns with the nursing staff to promote collaboration in the care process. Evaluating test reports for fetal growth will help assess fetal well-being, although it does not help alleviate the patient's fears.

What instruction should the nurse give to a pregnant patient with hyperthyroidism who often gets fatigued and weak as a result of nervousness and hyperactivity? 1 "Ensure that you wear warm clothes." 2 "Perform aerobic exercises every day." 3 "Become involved in reading or a craft." 4 "Avoid going out in the cold or at night."

3 - "Become involved in reading or a craft." pg 261 - The nurse advises the patient to engage in quiet activities, such as reading or crafting, to prevent fatigue and weakness. Extreme cold temperature should be avoided, and warm clothing is suggested if the patient has cold intolerance because of hypothyroidism. The patient is hypersensitive to heat and gets easily fatigued; therefore aerobic exercises are not advised.

What does the nurse recommend to a pregnant patient with diabetes who works long, irregular hours? 1 "Quit working for a while." 2 "Eat a snack hourly when at work." 3 "Keep fruits or fruit juice available." 4 "Try taking naps when you are free."

3 - "Keep fruits or fruit juice available." pg 253 - If the patient has to be away from home for long hours, the nurse advises the patient to carry fruits or fruit juices. They contain simple carbohydrates that help control blood glucose levels. The nurse should not advise the patient to quit working, because it may not be feasible for the patient. Instead, the nurse should encourage the patient to follow a consistent daily schedule. Taking naps when free ensures rest, but it does not help keep glucose levels in check. Eating a snack every hour is not advised, because it may fluctuate blood glucose levels. Instead, three meals and two or three snacks are advised.

The nurse is teaching a pregnant patient with diabetes mellitus about ways to prevent infant morbidity. What is the most important aspect to include? 1 "You must avoid exercise after meals." 2 "Fetal growth needs to be checked monthly." 3 "Your blood glucose levels must be in control." 4 "You need to adhere to a strict ketogenic diet."

3 - "Your blood glucose levels must be in control." pg 247 - A strict control of glucose levels in a mother with diabetes prevents infant morbidity. This is because an increase in the glucose levels will not provide the adequate insulin required for fetal growth. If the health care provider prescribes exercise, it is performed after meals, because the blood glucose level rises at this time. Fetal growth and well-being is assessed twice weekly after 32 weeks of gestation. A ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that is used to treat epilepsy in children. A ketogenic diet is not suggested for a pregnant patient because it may result in ketoacidosis.

Which is the most important intervention that the nurse implements for a pregnant patient with uncorrected tetralogy of Fallot in the late third trimester of pregnancy? 1 Monitor respiratory function. 2 Monitor heart valve function. 3 Apply pressure support hose. 4 Assess pedal and radial pulses.

3 - Apply pressure support hose. pg 263 - If a patient with uncorrected tetralogy of Fallot becomes pregnant, there is a reduction in blood flow through the pulmonary circulation, which increases hypoxemia. This can lead to syncope or death. Hence, the nursing priority is the maintenance of venous return in the patient, because venous return is reduced by the large pregnant uterus. The best way to do this is to have the patient wear compression support hose. Respiratory function is monitored in pregnant patients with cystic fibrosis, because there is a problem with respiratory function. The heart valve function is assessed in pregnant patients with mitral stenosis. Although it is important to assess peripheral pulses in any patient, it does not relate to the tetralogy of Fallot defect.

What intervention does the nurse include while providing care for a pregnant patient with primary pulmonary hypertension (PPH)? 1 Assess the heart valve function. 2 Administer parenteral analgesia. 3 Assess the patient's blood pressure. 4 Place the patient in the supine position.

3 - Assess the patient's blood pressure. pg 264 - Primary pulmonary hypertension is the condition where the blood vessels in the lungs constrict, increasing the pulmonary artery pressure. PPH may impair the blood flow to the lungs, which can be precipitated by hypotension. Therefore, to prevent complications of PPH, the nurse should monitor the patient's blood pressure. Heart valve function is assessed in patients with mitral stenosis to assess for potential risks. During labor, epidural analgesia is administered to the patient to prevent blood loss, because it can result in hypotension. The nurse avoids the supine position to prevent supine hypotension in the patient.

During pregnancy, alcohol withdrawal may be treated using what? 1 Aminophylline 2 Corticosteroids 3 Benzodiazepines 4 Disulfiram (Antabuse)

3 - Benzodiazepines pg 278 - Symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. Disulfiram is contraindicated in pregnancy because it is teratogenic. Corticosteroids are not used to treat alcohol withdrawal. Aminophylline is not used to treat alcohol withdrawal.

From 4% to 8% of pregnant women have asthma, making it one of the most common preexisting conditions of pregnancy. When does severity of symptoms usually peak? 1 In the first trimester 2 Immediately postpartum 3 Between 17 to 24 weeks of gestation 4 During the last 4 weeks of pregnancy

3 - Between 17 to 24 weeks of gestation pg 271 - The period between 17 and 24 weeks of pregnancy is associated with the greatest severity of symptoms. Women often have few symptoms of asthma during the first trimester. During the last 4 weeks of pregnancy symptoms often subside. Often issues have resolved by the time the woman gives birth.

Which condition does the nurse suspect in a pregnant patient if there is weight loss and the patient's pulse rate is greater than 100 beats/min? 1 Macrosomia 2 Phenylketonuria 3 Hyperthyroidism 4 Atrial septal defect

3 - Hyperthyroidism pg 260 - Weight loss and a pulse rate greater than 100 beats/min may indicate hyperthyroidism in a pregnant patient. Fatigue and dyspnea in a patient may indicate atrial septal defect. However, these symptoms are also seen in normal pregnancy. Macrosomia is a condition in which an infant's birth weight is more than 4000 to 4500 g. Hypopigmentation of hair, eyes, and skin indicates phenylketonuria.

Which condition should the nurse be alert for after administering terbutaline (Brethine) to a pregnant patient with diabetes mellitus? 1 Infection 2 Dyspnea 3 Ketoacidosis 4 Hypoglycemia

3 - Ketoacidosis pg 247 - Terbutaline (Brethine) is a beta-mimetic drug administered for tocolysis to stop preterm labor. It may lead to hyperglycemia and cause ketoacidosis in the pregnant patient. Dyspnea on exertion may be seen in a pregnant patient with acquired cardiac disease. Infection in pregnant women happens because of an alteration in the normal resistance of the body to infection. Hypoglycemia occurs if there is an increase in the insulin levels.

What is the most important instruction to include in a teaching plan for a woman in early pregnancy who has class I heart disease? 1 She must report any nausea or vomiting. 2 She may experience mild fatigue in early pregnancy. 3 She must report any chest discomfort or productive cough. 4 She should plan to increase her daily exercise gradually throughout pregnancy.

3 - She must report any chest discomfort or productive cough. pg 267 - Angina or a productive cough may signal congestive heart failure or pulmonary edema. Nausea and vomiting are expected in early pregnancy. Mild fatigue is expected in early pregnancy. Depending on the severity of the heart disease, she may need to limit physical activity.

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes mellitus (GDM). What does the nurse caring for this woman understand? 1 Glucose levels are monitored by testing urine 4 times a day and at bedtime. 2 Dietary modifications and insulin are both required for adequate treatment. 3 Oral hypoglycemic agents should not be used if the woman is reluctant to give herself insulin. 4 Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

4 - Dietary management involves distributing nutrient requirements over three meals and two or three snacks. pg 250 - Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Oral hypoglycemic agents can be used as an alternative to insulin in women with GDM who require medication in addition to diet for blood glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative.

Which medication does the primary health care provider ask the nurse to administer in a vaginal delivery to a patient who has a history of a myocardial infarction (MI)? 1 Oxytocin 2 Diuretics 3 Anticoagulant 4 Epidural analgesia

4 - Epidural analgesia pg 264 - Epidural analgesia is administered during labor to a patient with MI to prevent pain, which can result in tachycardia and increased cardiac demands. Oxytocin is administered to a patient after birth to prevent hemorrhage. Diuretics are administered to prevent fluid retention in a pregnant patient with a heart disease. Anticoagulant therapy is administered for recurrent venous thrombosis in pregnancy.

Which medication is ideal for the treatment of systemic lupus erythematosus (SLE) in a pregnant patient? 1 Aspirin (Ecotrin) 2 Azathioprine (Imuran) 3 Prednisone (Deltasone) 4 Hydroxychloroquine (Plaquenil)

4 - Hydroxychloroquine (Plaquenil) pg 275 - Hydroxychloroquine (Plaquenil) reduces SLE disease activity in a pregnant patient without any adverse effects on the fetus. Aspirin (Ecotrin) is not recommended during pregnancy, because it has an increased risk for premature closure of the fetal ductus arteriosus. Azathioprine (Imuran) is discontinued before conception, because it is fetotoxic. Prednisone (Deltasone) is prescribed to treat SLE during pregnancy, but it increases the risk for bone demineralization, gestational diabetes, preeclampsia, premature rupture of membranes (PROM), and intrauterine growth restriction (IUGR).