Chapter 19: PrepU - Conditions Existing Before Conception

A pregnant client with deep vein thrombosis has been diagnosed as having systemic lupus erythematosus (SLE). The nurse would monitor the client closely for the development of which complication? 1- Increased placental weight 2- Post-term birth of infant 3- Fetal macrosomia 4- Fetal malnutrition

4

Charlene McCoy, who has several children already, reports for a first prenatal visit. She seems preoccupied and withdrawn, and she makes consistently negative remarks about the pregnancy. Reviewing her records, you note that she is receiving a serotonin reuptake inhibitor. What should you do? 1- Reassure her that ambivalence is normal 2- Refer her for drug and alcohol counseling 3- Give her printed material to read at home 4- Alert the RN or primary care provider

4

A nurse is client teaching with a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority? 1- avoidance of infection 2- constipation prevention 3- administration of immunoglobulins 4- consumption of a low-fat diet

1

A patient with type 2 diabetes mellitus is planning to become pregnant within the next several months. What should the nurse instruct the patient to support the 2020 National Health Goals of reducing the complications of pregnancy from diabetes? 1- Avoid episodes of hyperglycemia. 2- Reduce the current exercise regimen by half. 3- Limit the intake of carbohydrates and fats in the diet. 4- Reduce the use of insulin for blood glucose coverage.

1

A pregnant client has a history of asthma. After reveiwing the possible medications that may be prescribed during her pregnancy to control her asthma, the nurse determines additional teaching is needed when the client identifies which drug as being used? 1- misoprostol 2- budesonide 3- albuterol 4- salmeterol

1

A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse? 1- Both parents have to carry the trait. 2- There is a good chance the infant will inherit the disease from the mother. 3- The infant inherits the disease from the father. 4- If the mother goes into a crisis while pregnant, the baby will develop sickle cell anemia.

1

The nurse explains to a pregnant client that she will need to take iron during her pregnancy after being diagnosed with iron-deficiency anemia. The nurse suggests that absorption of the supplemental iron can be increased by taking it with which substance? 1- meals high in iron 2- milk 3- legumes 4- orange juice

4

A nurse is interviewing a couple at a preconception counseling session. The couple is of Greek heritage and are concerned about the possibility of their children being born with a genetic disorder. Based on the nurse's understanding of genetic disorders, the nurse would identify this couple as being at risk for which conditon? 1- β-thalassemia 2- α-thalassemia 3- sickle cell anemia 4- Tay-Sachs disease

1

A pregnant woman with a history of mitral stenosis is to be prescribed medication as treatment. Which of the following medication classes would the nurse expect the patient to begin taking? 1- anticoagulant 2- diuretic 3- antihypertensive 4- antineoplastic

1

A woman is pregnant and has asthma. Her primary care provider has told her to continue taking prednisone during pregnancy, but she is concerned the drug may be teratogenic. What advice would be best to give her regarding this? 1- Prednisone is considered safe in the doses prescribed by her care provider. 2- She should half her dose during the first 3 months of pregnancy. 3- She should omit the drug during pregnancy. 4- Prednisone is a teratogenic drug, but she may need it to control her asthma symptoms.

1

A woman who has sickle cell anemia asks the nurse if her infant will develop sickle cell disease. The nurse would base the answer on which information? 1- Sickle cell anemia is recessively inherited. 2- Sickle cell anemia has more than one polygenic inheritance pattern. 3- Sickle cell anemia is dominantly inherited. 4- Sickle cell anemia is not inherited; it occurs following a malaria infection.

1

A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize? 1- Decrease activity and rest more often. 2- Increase fluids and take more vitamins. 3- Bed rest and bathroom privileges only until birth. 4- Discuss induction of labor with the primary care provider.

1

A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client? 1- diet 2- long-acting insulin 3- oral hypoglycemic drugs 4- glucagon

1

A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response? 1- "Your primary care provider will order safe doses of your medication." 2- "It's OK to not use them if you would feel more comfortable." 3- "They won't cause any major defects." 4- "I'll let your primary care provider know how you feel about it."

1

A nurse is conducting a class on gestational diabetes for a group of pregnant women who are at risk for the condition. The nurse determines that additional teaching is needed when the class identifies which complication as affecting the neonate? 1- hyperglycemia 2- macrosomia 3- hypoglycemia 4- birth trauma

1

During the assessment of a laboring client, the nurse learns that the client has cardiovascular disease (CVD). Which assessment would be priority for the newborn? 1- respiratory function 2- heart rate 3- temperature 4- urine output

1

Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 124/86 mm Hg; week 20 - 138/90 mm Hg; week 24 - 140/92 mm Hg; and week 28 - 142/94 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure? 1- mild hypertensive 2- normotensive 3- prehypertensive 4- severe hypertensive

1

The nurse instructs a pregnant patient with sickle cell anemia on ways to prevent a crisis. Which patient statement indicates that teaching has been effective? 1- "I should drink eight glasses of water every day." 2- "I should take an iron supplement every day." 3- "I should make sure I stand for at least 4 hours every day." 4- "I should avoid sitting with my legs elevated during the day."

1

The nursing instructor is pointing out the various complcations which can occur during pregnancy in women with diabetes mellitus. The instructor determines the session is successful after the students correctly choose which complication that can occur if the diabetes is not kept under control? 1- hydramnios 2- placenta previa 3- cerebral vascular accident 4- hypotension

1

Which of the following statements regarding weight and pregnancy is correct? 1- An underweight woman should increase her caloric intake by 500 to 1000 calories a day. 2- Obesity usually occurs from hypothyroidism. 3- Dieting during pregnancy to reduce weight is recommended only for morbidly obese women. 4- Women who are underweight coming into pregnancy should gain the same amount of weight as women with a normal BMI.

1

A pregnant woman diagnosed with cardiac disease 4 years ago is told that her pregnancy is a high-risk pregnancy. The nurse then explains that the danger occurs primarily because of the increase in circulatory volume. The nurse informs the client that the most dangerous time for her is when? 1- in weeks 8 to 12 2- in weeks 28 to 32 3- in weeks 12 to 20 4- in weeks 20 to 28

2

After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which foods as being good sources of iron in her diet? Select all that apply. 1- dried fruits 2- peanut butter 3- meats 4- milk 5- white bread

1,2,3

A nursing instructor is teaching students about high-risk pregnancies. Some circumstances that may cause a pregnancy to be labeled as high-risk include which of the following? (Select all that apply.) 1- lack of support people 2- genetic inheritance 3- good coping mechanisms 4- past history of pregnancy complications 5- high socioeconomic status 6- poverty

1,2,4, 6

A 22-year-old homeless woman arrives at a walk-in clinic seeking pregnancy confirmation. The nurse notes on assessment a 12-week gestational uterus, a blood pressure of 110/70 mm Hg, and a BMI of 17.5. The client admits to using cocaine a few times. She has been pregnant before and indicates she "loses them early." What characteristics place the client in the high-risk pregnancy category? Select all that apply. 1- BMI 17.5 2- blood pressure 110/70 mm Hg 3- prenatal history 4- homelessness 5- age 6- prenatal care

1,3,4,6

A nurse is caring for a pregnant client with sickle cell anemia. What should the nursing care for the client include? Select all that apply. 1- Teach the client meticulous handwashing. 2- Assess serum electrolyte levels of the client at each visit. 3- Instruct the client to consume protein-rich food. 4- Assess hydration status of the client at each visit. 5- Urge the client to drink 8 to 10 glasses of fluid daily.

1,4,5

When evaluating fetal well-being, what is the maximum score on a biophysical profile?

10

A G4P3 client with a history of controlled asthma is upset her initial prenatal appointment is taking too long, making her late for another appointment. What is the nurse's best response when the client insists she knows how to handle her asthma and needs to leave? 1- Remind her to continue taking asthma medications, to monitor peak flow daily, and to monitor the baby's kicks in the second and third trimesters. 2- Acknowledge her need to leave but ask her to demonstrate the use of inhaler and peak flow meter before she goes; remind her to take regular medications. 3- Schedule an appointment for her to return to discuss her asthma management. 4- Note in the chart that the woman was not counseled about her asthma.

2

A nurse is caring for a pregnant client. The initial interview reveals that the client is accustomed to drinking coffee at regular intervals. For which increased risk should the nurse make the client aware? 1- heart disease 2- anemia 3- rickets 4- scurvy

2

A nurse is conducting a class for a group of couples about subfertility. When describing the causes of subfertility, which cause would the nurse include as being most common? 1- pelvic inflammatory disease 2- anovulation 3- excessive exercise 4- excess body weight

2

A nurse is presenting a program to a church group about intimate partner violence. During the presentation, a member of the audience asks the nurse to explain what "intergenerational transmission of violence" means because that phrase is used in the media. Which response by the nurse would be most appropriate? 1- "People who are violent are that way because of the various neurochemical imbalances in their brains." 2- "People who grow up in violent home situations tend to be involved in violence situations as adults." 3- "Recent research has identified a gene that is responsible for transmission of a risk for violent behavior that is passed on from generation to generation." 4- "Intimate partner violence seems to skip every other generation when it is traced in families."

2

A pregnant client in her 20th week of gestation, having systemic lupus erythematosus (SLE), is admitted to the healthcare unit for management of the exacerbation of SLE. Which of the following would be most appropriate to treat the client's condition? 1- Hydroxyurea 2- Corticosteriods 3- Beta2 agonists 4- Prostaglandin E

2

A pregnant client with type I diabetes asks the nurse about how to best control her blood sugar while she is pregnant. The best reply would be for the woman to: 1- limit weight gain to 15 pounds during the pregnancy. 2- check her blood sugars frequently and adjust insulin accordingly. 3- exercise for 1 to 2 hours each day to keep the blood glucose down. 4- begin oral hyperglycemic medications along with the insulin she is currently taking.

2

A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? 1- antihypertensive drugs 2- diuretic drugs 3- I.V. fluids 4- antibiotics

3

A woman with a history of systemic lupus erythematosus comes to the clinic for evaluation. The woman tells the nurse that she and her partner would like to have a baby but that they are afraid her lupus will be a problem. Which response would be most appropriate for the nurse to make? 1- "It's probably not a good idea for you to get pregnant since you have lupus." 2- "Be sure that your lupus is stable or in remission for 6 months before getting pregnant." 3- "Your lupus will not have any effect on your pregnancy whatsoever." 4- "If you get pregnant, we'll have to add quite a few medications to your normal treatment plan.

2

A woman's obstetrician prescribes vitamin K supplements for a client who is on antiepileptic medications beginning at 36 weeks' gestation. The mother asks the nurse why she is taking this medication. The nurse's best response would be: 1- vitamin K helps in keeping the placenta healthy. 2- antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn. 3- administration of vitamin K aids in lung maturity of the fetus. 4- The antiepileptic medications can cause the mother's platelets to drop.

2

An expectant mother in week 30 of her pregnancy reports to the nurse that she has been doing her kick counts several times a day and the fetus has been kicking at a rate of about 10 to 12 times per hour, on average. What is most likely indicated by this finding? 1- The fetus is not receiving enough nutrients. 2- The fetus is healthy. 3- The mother has been too active. 4- The mother is not performing the counts correctly.

2

During a prenatal visit, the physician determines that the fetal heart beat is too fast. What drug would the nurse expect the physician to order for the mother to treat the fetal tachycardia? 1- adenosine 2- digoxin 3- lisinopril 4- nitroglycerine

2

In women with cardiac failure, the maternal blood pressure becomes insufficient to provide an adequate supply of blood to the placenta. The infant will likely experience some undesired effects, including which of the following? 1- hypoglycemia 2- low birth weight 3- hyperglycemia 4- high birth weight

2

The nurse is caring for a client after experiencing a placental abruption. Which finding is the priority to report to the health care provider? 1- hematocrit of 36% 2- 45 ml urine output in 2 hours 3- hemoglobin of 13 g/dl 4- platelet count of 150,000 mm3

2

The nurse is caring for a client who is at 37 weeks' gestation and has a biophysical profile of 9. Which nursing action is best? 1- Notify the health care provider immediately. 2- Schedule a health care provider appointment for one week. 3- Tell the client to report to the hospital for a nonstress test. 4- Prepare all records as the client will be admitted for a cesarean section.

2

The nurse is caring for a diabetic, postpartum client who has developed an infection.The nurse is aware that infections in diabetic clients tend to be more severe and can quickly lead to complications. Which complication should the nurse assess this client for? 1- Anemia 2- Ketoacidosis 3- Respiratory acidosis 4- Respiratory alkalosis

2

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or at delivery for her baby. Which statement by the mother indicates that further teaching is needed by the nurse? 1- "My baby may be very large and I may need a cesarean section to have him." 2- "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." 3- "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day." 4- "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born."

2

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which schedule would be most appropriate? 1- monthly visits until 32 weeks, then bi-monthly visits 2- bi-monthly visits until 28 weeks, then weekly visits 3- monthly visits until 20 weeks, then bi-monthly visits 4- bi-monthly visits until 36 weeks, then weekly visits

2

A woman at 38 weeks' gestation with a history of heroin use disorder has given birth to a newborn several hours ago. Upon assessment, the nurse determines that the newborn is experiencing withdrawal based on which findings? Select all that apply. 1- flaccid extremities 2- high-pitched shrill cry 3- almost constant sneezing 4- nasal stuffiness 5- poor sucking reflex

2,3,4,5

A pregnant woman of Jewish descent comes to the clinic for counseling and tells the nurse that she is worried her baby may be born with a genetic disorder. Which disease does the nurse identify to be a risk for this client's baby based on the family's ancestry? 1- sickle cell anemia 2- b-thalassemia 3- Tay-Sachs 4- Down syndrome

3

The nurse is planning to instruct a patient who is 12 weeks pregnant on interventions to stop smoking. What should the nurse include in these instructions? Select all that apply. 1- Purchase nicotine chewing gum. 2- Follow a smoking cessation plan. 3- Ask a friend to help with smoking cessation actions. 4- Apply a nicotine patch when the cravings become severe. 5- Ask the physician if a smoking cessation medication can be used.

2,3,5

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction? 1- "I need to be aware of my triggers and avoid them as much as possible." 2- "It is fine for me to use my albuterol inhaler if I begin to feel tight." 3- "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." 4- "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on."

3

A nurse is talking to a newly pregnant woman who had a mitral valve replacement in the past. Which statement by the client reveals an understanding about the preexisting condition? 1- "I don't have to worry about this because I had the problem fixed before I became pregnant." 2- "I know I will be fine, but I worry about the fetus." 3- "I understand that my fetus and I both are at risk for complications." 4- "I know my baby will be fine, but I am worried about having a personal complication."

3

A nursing instructor is teaching about causes of infertility and identifies a need for further instruction when a student states which of the following? 1- "A genetic abnormality may cause infertility." 2- "An absence of ovulation may cause infertility." 3- "Diet does not play a role in infertility." 4- "Exercise can influence infertility."

3

A pregnant client with a history of heart disease has been admitted to a health care center reporting breathlessness. The client also reports shortness of breath and easy fatigue when doing ordinary activity. The client's condition is markedly compromised. The nurse would document the client's condition using the New York Heart Association (NYHA) classification system as which class? 1- class I 2- class II 3- class III 4- class IV

3

A 17-year-old primigravida with type 1 diabetes is at 37 weeks gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next? 1- Scheduling the woman for induction of labor today. 2- Allowing her to continue without plans for delivery. 3- Scheduling a cesarean delivery at 39 weeks. 4- Preparing for amniocentesis and fetal lung maturity assessment

4

A nurse is caring for a 45-year-old pregnant client with a cardiac disorder who has been instructed by her primary care provider to follow class I functional activity recommendations. The nurse correctly instructs the client to follow which limitations? 1- "You will need to be on bedrest for the remainder of your pregnancy." 2- "It is important for you to rest after any physical activity in order to prevent any cardiac complications." 3- "It will be beneficial if you plan rest periods throughout your day." 4- "You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or shortness of breath."

4

A woman with type 2 diabetes is considering becoming pregnant and asks the nurse whether she will be able to continue taking her current oral hypoglycemics. The nurse's response will point out which factor? 1- can be used as long as they control serum glucose levels. 2- can be taken until the degeneration of the placenta occurs. 3- are usually suggested primarily for women who develop gestational diabetes. 4- have been shown to be effective and safe in recent short term studies.

4

The client is 32 weeks pregnant and has been referred for biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective? 1- The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. 2- The BPP is a blood test to detect placental problems. 3- The BPP is a screening for neural tube defects. 4- The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

4

The nurse is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize? 1- regular heart rate and hypertension 2- increased urinary output, tachycardia, and dry cough 3- shortness of breath, bradycardia, and hypertension 4- dyspnea, crackles, and irregular weak pulse

4

The nurse is caring for a pregnant client admitted for abdominal trauma following an assault. The nurse will monitor the client for which potential complications? Select all that apply. 1- Miscarriage 2- Placental abruption 3- Uterine rupture 4- Gestational hypertension 5- Preterm labor

4

Which factor would contribute to a high-risk pregnancy? 1- blood type O positive 2- first pregnancy at age 33 3- history of allergy to honey bee pollen 4- type 1 diabetes

4

Which response is most appropriate for a client with diabetes who wants to breast-feed but is concerned about the effects of breastfeeding on her health? 1- Diabetic clients who breast-feed have a hard time controlling their insulin needs 2- Diabetic clients shouldn't breast-feed because of potential complications 3- Diabetic clients shouldn't breast-feed; insulin requirements are doubled 4- Diabetic clients may breast-feed; insulin requirements may decrease from breast-feeding

4

Your patient is very conscious of the weight she gained during her pregnancy. She has decided to breastfeed her baby and asks you how many calories a day extra she should be eating so that she and her baby are healthy. She states she does not want to gain any extra weight from over-eating. What would be your best response? 1- "You are eating for two now. Besides, you are breastfeeding and you will lose your pregnancy weight very quickly." 2- "You need to keep eating just like when you were pregnant. That gives you about 300 kcal extra every day." 3- "You have a nice slender body type. Just eat what you want and you will do fine." 4- "You should be eating an extra 200 kcal over what you were eating while you were pregnant."

4