Chapter 11: High Risk Perinatal Care: Preexisting Conditions

Achieving and maintaining euglycemia comprise the primary goals of medical therapy for the pregnant woman with diabetes. These goals are achieved through a combination of diet, insulin, exercise, and blood glucose monitoring. The target blood glucose levels 1 hour after a meal should be: _________________

ANS: 130 to 140 mg/dL Target levels of blood glucose during pregnancy are lower than nonpregnant values. Accepted fasting levels are between 65 and 95 mg/dL, and 1-hour postmeal levels should be less than 130 to 140 mg/dL. Two-hour postmeal levels should be 120 mg/dL or less. PTS: 1 DIF: Cognitive Level: Application REF: 273 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

Marfan syndrome is an autosomal dominant genetic disorder that displays as weakness of the connective tissue, joint deformities, ocular dislocation, and weakness to the aortic wall and root. While providing care to a client with Marfan syndrome during labor, which intervention should the nurse complete first? a. Antibiotic prophylaxis b. b-Blockers c. Surgery d. Regional anesthesia

ANS: A Because of the potential for cardiac involvement during the third trimester and after birth, treatment with prophylactic antibiotics is highly recommended. b-Blockers and restricted activity are recommended as treatment modalities earlier in the pregnancy. Regional anesthesia is well tolerated by clients with Marfan syndrome; however, it is not essential to care. Adequate labor support may be all that is necessary if an epidural is not part of the womans birth plan. Surgery for cardiovascular changes such as mitral valve prolapse, aortic regurgitation, root dilation, or dissection may be necessary. Mortality rates may be as high as 50% in women who have severe cardiac disease. PTS: 1 DIF: Cognitive Level: Analysis REF: 287 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

As related to the care of the patient with anemia, the nurse should be aware that: a. It is the most common medical disorder of pregnancy. b. It can trigger reflex brachycardia. c. The most common form of anemia is caused by folate deficiency. d. Thalassemia is a European version of sickle cell anemia.

ANS: A Combined with any other complication, anemia can result in congestive heart failure. Reflex bradycardia is a slowing of the heart in response to the blood flow increases immediately after birth. The most common form of anemia is iron deficiency anemia. Both thalassemia and sickle cell hemoglobinopathy are hereditary but not directly related or confined to geographic areas. PTS: 1 DIF: Cognitive Level: Knowledge REF: 290 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

Congenital anomalies can occur with the use of antiepileptic drugs (AEDs), including (Select all that apply): a. Cleft lip. b. Congenital heart disease. c. Neural tube defects. d. Gastroschisis. e. Diaphragmatic hernia.

ANS: A, B, C Congenital anomalies that can occur with AEDs include cleft lip or palate, congenital heart disease, urogenital defects, and neural tube defects. Gastroschisis and diaphragmatic hernia are not associated with the use of AEDs. PTS: 1 DIF: Cognitive Level: Comprehension REF: 294 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

When the pregnant diabetic woman experiences hypoglycemia while hospitalized, the nurse should intervene by having the patient: a. Eat six saltine crackers. b. Drink 8 oz of orange juice with 2 tsp of sugar added. c. Drink 4 oz of orange juice followed by 8 oz of milk. d. Eat hard candy or commercial glucose wafers.

ANS: A Crackers provide carbohydrates in the form of polysaccharides. Orange juice and sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar. Milk is a disaccharide and orange juice is a monosaccharide. They will provide an increase in blood sugar but will not sustain the level. Hard candy or commercial glucose wafers provide only monosaccharides. PTS: 1 DIF: Cognitive Level: Application REF: 274 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states: a. I will need to increase my insulin dosage during the first 3 months of pregnancy. b. Insulin dosage will likely need to be increased during the second and third trimesters. c. Episodes of hypoglycemia are more likely to occur during the first 3 months. d. Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding.

ANS: A Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. Insulin dosage will likely need to be increased during the second and third trimesters, Episodes of hypoglycemia are more likely to occur during the first 3 months, and Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy. PTS: 1 DIF: Cognitive Level: Application REF: 269 OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

With one exception, the safest pregnancy is one in which the woman is drug and alcohol free. For women addicted to opioids, ________________________ treatment is the current standard of care during pregnancy. a. Methadone maintenance b. Detoxification c. Smoking cessation d. 4 Ps Plus

ANS: A Methadone maintenance treatment (MMT) is currently considered the standard of care for pregnant women who are dependent on heroin or other narcotics. Buprenorphine is another medication approved for opioid addiction treatment that is increasingly being used during pregnancy. Opioid replacement therapy has been shown to decrease opioid and other drug use, reduce criminal activity, improve individual functioning, and decrease rates of infections such as hepatitis B and C, HIV, and other sexually transmitted infections. Detoxification is the treatment used for alcohol addiction. Pregnant women requiring withdrawal from alcohol should be admitted for inpatient management. Women are more likely to stop smoking during pregnancy than at any other time in their lives. A smoking cessation program can assist in achieving this goal. The 4 Ps Plus is a screening tool designed specifically to identify pregnant women who need in-depth assessment related to substance abuse. PTS: 1 DIF: Cognitive Level: Application REF: 298 OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for: a. Macrosomia. b. Congenital anomalies of the central nervous system. c. Preterm birth. d. Low birth weight.

ANS: A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman. PTS: 1 DIF: Cognitive Level: Comprehension REF: 270 OBJ: Nursing Process: Planning, Implementation MSC: Client Needs: Physiologic Integrity

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that: a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. Hydramnios occurs approximately twice as often in diabetic pregnancies. c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies. d. Even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being.

ANS: A Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios occurs 10 times more often in diabetic pregnancies. Infections are more common and more serious in pregnant women with diabetes. Mild to moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being. PTS: 1 DIF: Cognitive Level: Comprehension REF: 270 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

Prophylaxis of subacute bacterial endocarditis is given before and after birth when a pregnant woman has: a. Valvular disease. b. Congestive heart disease. c. Arrhythmias. d. Postmyocardial infarction.

ANS: A Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve stenosis. Prophylaxis for intrapartum endocarditis is not indicated for congestive heart disease, arrhythmias, or after myocardial infarction. PTS: 1 DIF: Cognitive Level: Comprehension REF: 285 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a. Hypoglycemia b. Hypercalcemia c. Hypobilirubinemia d. Hypoinsulinemia

ANS: A The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, thus leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth and release large amounts of bilirubin into the neonates circulation, with resulting hyperbilirubinemia. Because fetal insulin production is accelerated during pregnancy, the neonate presents with hyperinsulinemia. PTS: 1 DIF: Cognitive Level: Comprehension REF: 272 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. These complications include: a. Atherosclerosis. b. Retinopathy. c. IUFD. d. Nephropathy. e. Autonomcs neuropathy.

ANS: A, B, D, E These structural changes are most likely to affect a variety of systems, including the heart, eyes, kidneys, and nerves. Intrauterine fetal death (stillbirth) remains a major complication of diabetes in pregnancy; however, this is a fetal complication. PTS: 1 DIF: Cognitive Level: Comprehension REF: 268 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action? a. Provide a low-protein diet. b. Offer the vaccine. c. Discuss the recommendation to bottle-feed her baby. d. Practice respiratory isolation.

ANS: B A person who has a history of high risk behaviors should be offered the hepatitis B vaccine. Care is supportive and includes bed rest and a high-protein, low-fat diet. The first trimester is too early to discuss feeding methods with a woman in the high risk category. Hepatitis B is transmitted through blood. PTS: 1 DIF: Cognitive Level: Application REF: 298 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

Concerning the use and abuse of legal drugs or substances, nurses should be aware that: a. Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health. b. Caucasian women are more likely to experience alcohol-related problems. c. Coffee is a stimulant that can interrupt body functions and has been related to birth defects. d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise, they would not have been prescribed.

ANS: B African-American and poor women are more likely to use illicit substances, particularly cocaine, whereas Caucasian and educated women are more likely to use alcohol. Cigarette smoking impairs fertility and is a cause of low birth weight. Caffeine consumption has not been related to birth defects. Psychotherapeutic drugs have some effect on the fetus, and that risk must be weighed against their benefit to the mother. PTS: 1 DIF: Cognitive Level: Knowledge REF: 297 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

While providing care in an obstetric setting, the nurse should understand that postpartum care of the woman with cardiac disease: a. Is the same as that for any pregnant woman. b. Includes rest, stool softeners, and monitoring of the effect of activity. c. Includes ambulating frequently, alternating with active range of motion. d. Includes limiting visits with the infant to once per day.

ANS: B Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluid. Care of the woman with cardiac disease in the postpartum period is tailored to the womans functional capacity. The woman will be on bed rest to conserve energy and reduce the strain on the heart. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated. PTS: 1 DIF: Cognitive Level: Comprehension REF: 290 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than about her recent diagnosis of diabetes. Several nursing diagnoses are applicable to assist in planning adequate care. The most appropriate diagnosis at this time is: a. Risk for injury to the fetus related to birth trauma. b. Noncompliance related to lack of understanding of diabetes and pregnancy and requirements of the treatment plan. c. Deficient knowledge related to insulin administration. d. Risk for injury to the mother related to hypoglycemia or hyperglycemia.

ANS: B Before a treatment plan is developed or goals for the outcome of care are outlined, this client must come to an understanding of diabetes and the potential effects on her pregnancy. She appears to have greater concern for changes to her social life than adoption of a new self-care regimen. Risk for injury to the fetus related to either placental insufficiency or birth trauma may come much later in the pregnancy. At this time the client is having difficulty acknowledging the adjustments that she needs to make to her lifestyle to care for herself during pregnancy. The client may not yet be on insulin. Insulin requirements increase with gestation. The importance of glycemic control must be part of health teaching for this client. However, she has not yet acknowledged that changes to her lifestyle need to be made, and she may not participate in the plan of care until understanding takes place. PTS: 1 DIF: Cognitive Level: Analysis REF: 269 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity

Nurses caring for antepartum women with cardiac conditions should be aware that: a. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor. b. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms. c. Women with class III cardiac disease should have 8 to 10 hours of sleep every day and limit housework, shopping, and exercise. d. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term.

ANS: B Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32, when homodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less than ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can carry on limited normal activities with discretion, although they still need a good amount of sleep. PTS: 1 DIF: Cognitive Level: Comprehension REF: 284 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by: a. Eating six small equal meals per day. b. Reducing carbohydrates in her diet. c. Eating her meals and snacks on a fixed schedule. d. Increasing her consumption of protein.

ANS: C Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. It is more important to have a fixed meal schedule than equal division of food intake. Approximately 45% of the food eaten should be in the form of carbohydrates. PTS: 1 DIF: Cognitive Level: Comprehension REF: 274 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

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

ANS: B 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 271 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

The use of methamphetamine (meth) has been described as a significant drug problem in the United States. In order to provide adequate nursing care to this client population the nurse must be cognizant that methamphetamine: a. Is similar to opiates. b. Is a stimulant with vasoconstrictive characteristics. c. Should not be discontinued during pregnancy. d. Is associated with a low rate of relapse.

ANS: B Methamphetamines are stimulants with vasoconstrictive characteristics similar to cocaine and are used similarly. As is the case with cocaine users, methamphetamine users are urged to immediately stop all use during pregnancy. Unfortunately, because methamphetamine users are extremely psychologically addicted, the rate of relapse is very high. PTS: 1 DIF: Cognitive Level: Comprehension REF: 299 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding? a. Hyperthyroidism b. Phenylketonuria (PKU) c. Hypothyroidism d. Thyroid storm

ANS: B PKU is a cause of mental retardation in infants; mothers with PKU pass on phenylalanine. A woman with hyperthyroidism or hypothyroidism would have no particular reason not to breastfeed. A thyroid storm is a complication of hyperthyroidism. PTS: 1 DIF: Cognitive Level: Comprehension REF: 283 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with: a. Frequent episodes of maternal hypoglycemia. b. Congenital anomalies in the fetus. c. Polyhydramnios. d. Hyperemesis gravidarum.

ANS: B Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically it is seen in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia. PTS: 1 DIF: Cognitive Level: Comprehension REF: 270 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. What nursing diagnosis is most appropriate for the woman at this time? a. Deficient fluid volume b. Imbalanced nutrition: less than body requirements c. Imbalanced nutrition: more than body requirements d. Disturbed sleep pattern

ANS: B This clients clinical cues include weight loss, which would support the nursing diagnosis of Imbalanced nutrition: less than body requirements. No clinical signs or symptoms support the nursing diagnosis of Deficient fluid volume. This client reports weight loss, not weight gain. Imbalanced nutrition: more than body requirements is not an appropriate nursing diagnosis. Although the client reports nervousness, based on the clients other clinical symptoms the most appropriate nursing diagnosis would be Imbalanced nutrition: less than body requirements. PTS: 1 DIF: Cognitive Level: Analysis REF: 282 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

In terms of the incidence and classification of diabetes, maternity nurses should know that: a. Type 1 diabetes is most common. b. Type 2 diabetes often goes undiagnosed. c. Gestational diabetes mellitus (GDM) means that the woman will be receiving insulin treatment until 6 weeks after birth. d. Type 1 diabetes may become type 2 during pregnancy.

ANS: B Type 2 diabetes often goes undiagnosed because hyperglycemia develops gradually and often is not severe. Type 2 diabetes, sometimes called adult onset diabetes, is the most common. GDM refers to any degree of glucose intolerance first recognized during pregnancy. Insulin may or may not be needed. People do not go back and forth between types 1 and 2 diabetes. PTS: 1 DIF: Cognitive Level: Knowledge REF: 268 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age. Identify all disorders that fall into the category of collagen vascular disease. a. Multiple sclerosis b. Systemic lupus erythematosus c. Antiphospholipid syndrome d. Rheumatoid arthritis e. Myasthenia gravis

ANS: B, C, D, E Multiple sclerosis is not an autoimmune disorder. This patchy demyelinization of the spinal cord may be a viral disorder. Autoimmune disorders (collagen vascular disease) make up a large group of conditions that disrupt the function of the immune system of the body. They include those listed, as well as systemic sclerosis. PTS: 1 DIF: Cognitive Level: Comprehension REF: 296 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance COMPLETION

The nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc: a. Is now done for all pregnant women, not just those with or likely to have diabetes. b. Is a snapshot of glucose control at the moment. c. Would be considered evidence of good diabetes control with a result of 5% to 6%. d. Is done on the patients urine, not her blood.

ANS: C A score of 5% to 6% indicates good control. This is an extra test for diabetic women, not one done for all pregnant women. This test defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are done on the blood. PTS: 1 DIF: Cognitive Level: Comprehension REF: 273 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

Nursing intervention for the pregnant diabetic patient is based on the knowledge that the need for insulin: a. Increases throughout pregnancy and the postpartum period. b. Decreases throughout pregnancy and the postpartum period. c. Varies depending on the stage of gestation. d. Should not change because the fetus produces its own insulin.

ANS: C Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. Insulin needs increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. The insulin needs change throughout the different stages of pregnancy. PTS: 1 DIF: Cognitive Level: Comprehension REF: 269 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

Which heart condition is not a contraindication for pregnancy? a. Peripartum cardiomyopathy b. Eisenmenger syndrome c. Heart transplant d. All of these contraindicate pregnancy.

ANS: C Pregnancy is contraindicated for peripartum cardiomyopathy and Eisenmenger syndrome. Women who have had heart transplants are successfully having babies. However, conception should be postponed for at least 1 year after transplantation. PTS: 1 DIF: Cognitive Level: Comprehension REF: 287 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should understand that: a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar. c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. Maternal insulin requirements steadily decline during pregnancy.

ANS: C Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own insulin around the tenth week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). Maternal insulin requirements may double or quadruple by the end of pregnancy. PTS: 1 DIF: Cognitive Level: Comprehension REF: 270 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

Which factor is known to increase the risk of gestational diabetes mellitus? a. Underweight before pregnancy b. Maternal age younger than 25 years c. Previous birth of large infant d. Previous diagnosis of type 2 diabetes mellitus

ANS: C Previous birth of a large infant suggests gestational diabetes mellitus. Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 years generally is not at risk for gestational diabetes mellitus. The person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy. PTS: 1 DIF: Cognitive Level: Comprehension REF: 279 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A woman with asthma is experiencing a postpartum hemorrhage. Which drug would not be used to treat her bleeding because it may exacerbate her asthma? a. Pitocin b. Nonsteroidal antiinflammatory drugs (NSAIDs) c. Hemabate d. Fentanyl

ANS: C Prostaglandin derivatives should not be used to treat women with asthma, because they may exacerbate symptoms. Pitocin would be the drug of choice to treat this womans bleeding because it would not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding. PTS: 1 DIF: Cognitive Level: Analysis REF: 292 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

_____ use/abuse during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications. a. Alcohol b. Caffeine c. Tobacco d. Chocolate

ANS: C Smoking in pregnancy is known to cause a decrease in placental perfusion and has serious health risks, including bleeding complications, low birth weight, prematurity, miscarriage, stillbirth, and sudden infant death syndrome. Prenatal alcohol exposure is the single greatest preventable cause of mental retardation. Alcohol use during pregnancy can cause high blood pressure, miscarriage, premature birth, stillbirth, and anemia. Caffeine and chocolate may safely be consumed in small quantities during pregnancy. PTS: 1 DIF: Cognitive Level: Knowledge REF: 298 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The most common neurologic disorder accompanying pregnancy is: a. Eclampsia. b. Bells palsy. c. Epilepsy. d. Multiple sclerosis.

ANS: C The effects of pregnancy on epilepsy are unpredictable. Eclampsia sometimes may be confused with epilepsy, which is the most common neurologic disorder accompanying pregnancy. Bells palsy is a form of facial paralysis. Multiple sclerosis is a patchy demyelinization of the spinal cord that does not affect the normal course of pregnancy or birth. PTS: 1 DIF: Cognitive Level: Knowledge REF: 294 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

In caring for a pregnant woman with sickle cell anemia, the nurse is aware that signs and symptoms of sickle cell crisis include: a. Anemia. b. Endometritis. c. Fever and pain. d. Urinary tract infection.

ANS: C Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints, and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered by dehydration, hypoxia, or acidosis. Women with sickle cell anemia are not iron deficient. Therefore, routine iron supplementation, even that found in prenatal vitamins, should be avoided in order to prevent iron overload. Women with sickle cell trait usually are at greater risk for postpartum endometritis (uterine wall infection); however, this is not likely to occur in pregnancy and is not a sign of crisis. These women are at an increased risk for UTIs; however, this is not an indication of sickle cell crisis. PTS: 1 DIF: Cognitive Level: Comprehension REF: 291 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)? a. 75 mg/dL before lunch. This is low; better eat now. b. 115 mg/dL 1 hour after lunch. This is a little high; maybe eat a little less next time. c. 115 mg/dL 2 hours after lunch; This is too high; it is time for insulin. d. 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.

ANS: D 60 mg/dL after waking from a nap is too low. During hours of sleep glucose levels should not be less than 70 mg/dL. Snacks before sleeping can be helpful. The premeal acceptable range is 65 to 95 mg/dL. The readings 1 hour after a meal should be less than 140 mg/dL. Two hours after eating, the readings should be less than 120 mg/dL. PTS: 1 DIF: Cognitive Level: Application REF: 277 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

Since the gene for cystic fibrosis was identified in 1989, data can be collected for the purposes of genetic counseling for couples regarding carrier status. According to statistics, how often does cystic fibrosis occur in Caucasian live births? a. 1 in 100 b. 1 in 1200 c. 1 in 2500 d. 1 in 3000

ANS: D Cystic fibrosis occurs in about 1 in 3000 Caucasian live births. PTS: 1 DIF: Cognitive Level: Comprehension REF: 293 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

What form of heart disease in women of childbearing years usually has a benign effect on pregnancy? a. Cardiomyopathy b. Rheumatic heart disease c. Congenital heart disease d. Mitral valve prolapse

ANS: D 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 produce pulmonary hypertension or endocarditis during pregnancy. PTS: 1 DIF: Cognitive Level: Knowledge REF: 284 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

Glucose metabolism is profoundly affected during pregnancy because: a. Pancreatic function in the islets of Langerhans is affected by pregnancy. b. The pregnant woman uses glucose at a more rapid rate than the nonpregnant woman. c. The pregnant woman increases her dietary intake significantly. d. Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.

ANS: D Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin also is broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glucose requirements differ because of the growing fetus. The pregnant woman should increase her intake by 200 calories a day. PTS: 1 DIF: Cognitive Level: Comprehension REF: 279 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation, which include: a. A regular heart rate and hypertension. b. An increased urinary output, tachycardia, and dry cough. c. Shortness of breath, bradycardia, and hypertension. d. Dyspnea; crackles; and an irregular, weak pulse.

ANS: D Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, rapid pulse; rapid respirations; a moist, frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nail beds. A regular heart rate and hypertension are not generally associated with cardiac decompensation. Tachycardia would indicate cardiac decompensation, but increased urinary output and a dry cough would not. Shortness of breath would indicate cardiac decompensation, but bradycardia and hypertension would not. PTS: 1 DIF: Cognitive Level: Comprehension REF: 288 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of: a. Euglycemia. b. Rheumatic fever. c. Pneumonia. d. Cardiac decompensation.

ANS: D 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 manifest 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. PTS: 1 DIF: Cognitive Level: Analysis REF: 288 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: a. Mothers age. b. Number of years since diabetes was diagnosed. c. Amount of insulin required prenatally. d. Degree of glycemic control during pregnancy.

ANS: D Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. PTS: 1 DIF: Cognitive Level: Comprehension REF: 273 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance