Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations
A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement? "A pregnant woman with a chronic condition can put herself at risk." "A pregnant woman with a chronic illness can put the fetus at risk." "A pregnant woman does not have to worry about contracting new illnesses during pregnancy." "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy."
"A pregnant woman does not have to worry about contracting new illnesses during pregnancy."
A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement? "A pregnant woman with a chronic condition can put herself at risk." "A pregnant woman with a chronic illness can put the fetus at risk." "A pregnant woman does not have to worry about contracting new illnesses during pregnancy." "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy."
"A pregnant woman does not have to worry about contracting new illnesses during pregnancy." Explanation: When a woman enters a pregnancy with a chronic illness, it can put both her and the fetus at risk. She needs to be cautious about developing a new illness during her pregnancy as well as having an accident during the pregnancy.
The nurse is assessing a pregnant client who has a long history of asthma treated with albuterol and montelukast. The client states, "I am trying not to use my asthma medications because I do not want my baby exposed to them." Which response should the nurse prioritize? "Actually, having uncontrolled asthma is much riskier for your baby than the medication." "In fact, most modern asthma medications are categorized as safe for use in pregnancy." "I am glad to hear that you are focused on ensuring your baby's health." "Your health care provider will likely agree with your decision."
"Actually, having uncontrolled asthma is much riskier for your baby than the medication."
A pregnant client is diagnosed with syphilis. Which response would demonstrate respect for the client and therapeutic communication? "Why didn't you use protection when having intercourse with your partner?" "I am sure it is frightening to you to be diagnosed with a disease that can affect your baby." "I noticed that you seem fidgety. Is there something wrong besides your STI?" "You should have thought about what diseases you could be exposed to. At least you are HIV negative."
"I am sure it is frightening to you to be diagnosed with a disease that can affect your baby." Explanation: The nurse needs to be supportive, empathic and accepting of the client, asking open-ended questions and acting calm and reassuring to her. By acknowledging her fears for her fetus, the nurse is demonstrating respect for her and conveying confidence that the client is trying to take care of her fetus.
A nurse is teaching a woman diagnosed with gestational diabetes about meal planning and nutrition. The nurse determines that additional teaching is needed based on which client statement? "I need to avoid any fat with my meals." "I should get most of my calories from good complex carbs." "Having a bedtime snack is good for me." "It's okay to eat small meals or snacks throughout the day."
"I need to avoid any fat with my meals."
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? "I need to be aware of my triggers and avoid them as much as possible." "It is fine for me to use my albuterol inhaler if I begin to feel tight." "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on."
"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring."
A pregnant client with a history of asthma since childhood presents for a prenatal visit. What statement by the client alerts the nurse to perform a further assessment? "I sometimes get a bit wheezy." "I have trouble getting comfortable in bed." "I sometimes get a feeling of euphoria." "Certain substances make me sneeze."
"I sometimes get a bit wheezy." Explanation: Wheezing is a classic symptom of asthma. This statement should alert the nurse to the possibility that the client's asthma is not well-controlled and needs further evaluation and possible intervention. The other statements do not relate to the typical presentation of this disease in pregnancy nor are they cause for concern.
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? "I don't have to worry about this because I had the problem fixed before I became pregnant." "I know I will be fine, but I worry about the fetus." "I understand that my fetus and I both are at risk for complications." "I know my baby will be fine, but I am worried about having a personal complication."
"I understand that my fetus and I both are at risk for complications."
The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or during the birth for the infant. Which statement by the mother indicates that further teaching is needed by the nurse? "My baby may be very large and I may need a cesarean birth to have him." "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day." "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born."
"If my blood sugars are elevated, my baby's lungs will mature faster, which is good."
A pregnant woman who has had cardiovascular disease for the last 3 years asks the nurse why this disorder makes her pregnancy an "at-risk" pregnancy. What is the nurse's best response? "The fact that you are receiving prenatal care will help." "Pregnancy taxes the circulatory system of every woman." "Don't worry. You have an excellent primary care provider." "Our facility has a lot of experience in dealing with this."
"Pregnancy taxes the circulatory system of every woman." Explanation: Pregnancy taxes the circulatory system of every woman because both the blood volume and cardiac output increase by approximately 30% to 50%. Half of these increases occur by 8 weeks; they are maximized by mid-pregnancy.
A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer? "She already has AIDS. That's what being HIV positive means." "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." "HIV is transmitted at birth; having a cesarean birth prevented transmission." "HIV antibodies do not cross the placenta; this means the baby will develop AIDS."
"The antibodies may be those transferred across the placenta; the baby may not develop AIDS."
A pregnant single mom living alone tells the nurse she is considering getting a cat for her 2-year-old daughter. Which is the best response by the nurse? "The exposure to the cat litter may cause you to need a C-section." "This will cut down on the jealousy for your two-year-old when the baby comes." "If you don't think caring for a cat is too much work, that would be great." "You should wait until after you give birth to obtain the cat for your daughter."
"You should wait until after you give birth to obtain the cat for your daughter."
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? "Your primary care provider will order safe doses of your medication." "It's OK to not use them if you would feel more comfortable." "They won't cause any major defects." "I'll let your primary care provider know how you feel about it."
"Your primary care provider will order safe doses of your medication."
A nurse is caring for a 33-year-old primigravida client who is obese and near the end of their second trimester. The client has a history of prepregnancy obesity, hypertension, and smoking. Complete the following sentence(s) by choosing from the lists of options. The client is at highest risk for developing.......................( gestational diabetes/ectopic pregnancy /gestational trophoblastic disease/ spontaneous abortion). The nurse provides discharge teaching to reduce the risks of developing this condition. Teaching should include ...........(change in lifestyle limit smoking /limit exercise during pregnancy refrain from having intercourse during pregnancy)
1. gestational diabetes 2. change in lifestyle
A nurse in the hospital is caring for a client at 37 weeks' gestation who experienced premature rupture of the membranes (PROM) more than 24 hours prior to coming to the hospital. The client presents with a fever of 100.4°F (38°C). Complete the following sentence(s) by choosing from the lists of options. Due to the client's PROM more than 24 hours prior to arriving to the hospital, the nurse determines the client is at risk for contracting (...chlamydia/ trichomoniasis/ bacterial vaginosis / group B streptococcus ) and should plan to implement ...(administer intravenous antibiotics/ administer metronidazole/ recommend including probiotics in their diet request fluconazole for external use) to prevent complications.
1.group B streptococcus 2.administer intravenous antibiotics Group B streptococcus infection is a bacterial infection that can be transmitted to the fetus during labor. This can have cause serious complications to the newborn, including respiratory distress and sepsis. Group B streptococcus infection can be transmitted to the fetus during labor. The client is at risk for contracting group B streptococcus due to premature rupture of membranes (PROM) more than 24 hours prior to arriving at the hospital. The nurse will plan to administer intravenous antibiotics to the client prior to birth of the fetus. Chlamydia, trichomoniasis, and bacterial vaginosis are sexually transmitted infections (STIs). Unlike group B streptococcus infection, these infections are not transmitted to the fetus during labor. As STIs, the client is not at risk for contracting these infections because of PROM. Metronidazole is an anti-infective that is used to treat bacterial vaginosis, not group B streptococcus. Probiotics are used to maintain natural flora in the gastrointestinal (GI) system, not to treat group B streptococcus. Fluconazole is used to treat vaginal candidiasis, not group B streptococcus infections.
A woman at 26 weeks' gestation is undergoing screening for diabetes with a 1-hour oral glucose challenge test. On the client's return visit, the nurse anticipates the need to schedule a 3-hour glucose challenge test based on which result of the previous test? 100 mg/dl (5.55 mmol/L) 114 mg/dL (6.33 mmol/L) 130 mg/dL (7.21 mmol/L) 146 mg/dL (8.10 mmol/L)
146 mg/dL (8.10 mmol/L) Explanation: For a 1-hour glucose challenge test, a 75-g oral glucose load is given, without regard to the timing or content of the last meal. Blood glucose is measured 1 hour later; a level above 140 mg/dl (7.77 mmol/L)is abnormal. If the result is abnormal, a 3-hour glucose tolerance test is done.
A pregnant client with type 1 diabetes is in labor. The client's blood glucose levels are being monitored every hour and she has a prescription for an infusion of regular insulin as needed based on the client's blood glucose levels. Her levels are as follows: 1300: 105 mg/dL (5.83 mmol/L) 1400: 100 mg/dL (5.55 mmol/L) 1500: 120 mg/dL (6.66 mmol/L) 1600: 106 mg/dl (5.88 mmol/L) Based on the recorded blood glucose levels, at which time would the nurse likely administer the regular insulin infusion? 1300 1400 1500 1600
1500 Explanation: For the laboring woman with diabetes, intravenous (IV) saline or lactated Ringer's is given, and blood glucose levels are monitored every 1 to 2 hours. Glucose levels are maintained below 110 mg/dL (6.11 mmol/L) throughout labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level. The insulin infusion would be given at 1500, based on the blood glucose level being higher than 110 mg/dL (6.11 mmol/L).
A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? 8% 14% 6% 12%
6% Explanation: The upper normal level of HbA1C is 6% of total hemoglobin.
A pregnant woman with diabetes is having her hemoglobin (glycosylated) level evaluated. The nurse determines that the woman's glucose is under control and continues the woman's plan of care based on which result? 8.5% 8.0% 6.5% 7.5%
6.5%
A pregnant woman with diabetes is having her hemoglobin (glycosylated) level evaluated. The nurse determines that the woman's glucose is under control and continues the woman's plan of care based on which result? 8.5% 8.0% 6.5% 7.5%
6.5% Explanation: A hemoglobin (glycosylated) level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. A glycosylated hemoglobin level less than 7% indicates that the plan is working and should be continued.
A pregnant woman with diabetes is having a glycosylated hemoglobin (HgbA1C) level drawn. Which result would require the nurse to revise the client's plan of care? 5.5% 6.0% 7% 8.5%
8.5%
A client is 33 weeks' pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled? 45 mg/dl 85 mg/dl 120 mg/dl 136 mg/dl
85 mg/dl Explanation: Recommended fasting blood glucose levels in pregnant clients with diabetes are 60 to 95 mg/dl. A fasting blood glucose level of 45 g/dl is low and may result in symptoms of hypoglycemia. A blood glucose level below 120 mg/dl is recommended for 2-hour postprandial values. A blood glucose level above 136 mg/dl in a pregnant client indicates hyperglycemia.
What criteria would the practitioner base a decision on to begin insulin therapy for a mother with gestational diabetes? Client cannot keep fasting blood sugar lower than 90 mg/dl. Urine is 2+ for glucose and serum blood glucose is 120. A 2-hour postprandial glucose level cannot be kept below 120 mg/dl. Weight gain is over 30 pounds (13.6 kg) and blood sugars are fluctuating between 95 and 130 throughout the day.
A 2-hour postprandial glucose level cannot be kept below 120 mg/dl.
At 24 weeks' gestation, a client's 1-hour glucose tolerance test is elevated. The nurse explains that, based on this finding, the client will need to take which action? A 3-hour glucose tolerance test for follow-up Daily insulin injections for gestational diabetes Monthly hemoglobin A1C levels to rule out diabetes Daily fingersticks for a fasting blood glucose level
A 3-hour glucose tolerance test for follow-up Explanation: The 1-hour glucose tolerance test is a screening procedure. If the results are elevated, the client needs a 3-hour glucose tolerance test, which is diagnostic of gestational diabetes. Since this is only a screening test, no treatment for gestational diabetes, such as finger-sticks or insulin, is implemented until the 3-hour glucose tolerance test result determines if the client has gestational diabetes. An HgbA1C level does not rule out diabetes; it monitors average blood glucose level over an extended period of time.
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? 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. 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. Schedule an appointment for her to return to discuss her asthma management. Note in the chart that the woman was not counseled about her asthma.
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.
A pregnant client is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. Which sign would indicate a positive test result? An indurated wheal under 10 mm in diameter appears in 6 to 12 hours. An indurated wheal over 10 mm in diameter appears in 48 to 72 hours. A flat, circumscribed area under 10 mm in diameter appears in 6 to 12 hours. A flat circumscribed area over 10 mm in diameter appears in 48 to 72 hours.
An indurated wheal over 10 mm in diameter appears in 48 to 72 hours.
A woman with class II heart disease is experiencing an uneventful pregnancy and is now prescribed bed rest at 36 weeks' gestation by her health care provider. The nurse should point out that this is best accomplished with which position? Lie flat on her back. Stay in high Fowler position. Lie in a semi-recumbent position. Use pillows and wedges to stay in a fully recumbent position.
Lie in a semi-recumbent position.
A 38-year-old client comes into the office for prenatal care, stating that she is about 12 weeks' pregnant with her first child. What action will the nurse take, considering the client's age and potential sensitivity to being labeled an "older" primipara? Inquire about any family history of chromosomal abnormalities since older women are more likely to have infants with a chromosomal defect. Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore. Offer genetic counseling and an early amniocentesis to determine if termination is needed. Ask about chronic illnesses that the health care provider should know about due to the client being older.
Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore.
After conducting a refresher class on possible congenital infections with a group of perinatal nurses, the nurse recognizes the class was successful when the group identifies which congenital viral infection as the most common? CMV HIV HPV RSV
CMV Explanation: Cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. Human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus (HSV) are other potential viruses
Between her regularly scheduled visits, a woman in her first trimester of pregnancy who is taking iron supplements for anemia calls the nurse at her obstetrician's office reporting constipation. She reports that she has never had this problem before and asks for some advice about how to get relief. What is the best advice the nurse can give her? Stop taking iron supplements for a few days, exercise more, drink more fluids, eat high-fiber, low-iron foods until the constipation is relieved, then resume the iron supplement. Continue taking iron supplements but increase fluids and high-fiber foods; exercise more. Increase the iron supplements, fluid intake, and consumption of high-fiber foods; exercise more. Take the iron supplement every other day, increase fluid intake and consumption of high-fiber foods; exercise more.
Continue taking iron supplements but increase fluids and high-fiber foods; exercise more.
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? Decrease activity and rest more often. Increase fluids and take more vitamins. Bed rest and bathroom privileges only until birth. Discuss induction of labor with the health care provider.
Decrease activity and rest more often.
A 20-year-old pregnant client is positive for hemoglobin S. The nurse explains to the client that she will need perform which actions during her pregnancy? Select all that apply. Drink lots of fluids. Eat high-protein meals. Be on bed rest. Avoid conditions of low oxygen tension, such as high altitudes.
Drink lots of fluids. Avoid conditions of low oxygen tension, such as high altitudes.
The nurse is doing meal planning with a pregnant woman with iron-deficiency anemia. What dietary recommendations would the nurse make to enhance the woman's intake of iron? Select all that apply. Drink orange juice with the iron supplement. Increase intake of dried beans and green leafy vegetables. Cook food in an iron skillet, if possible. Limit intake of dried fruits, eating only fresh fruit. Since fortified cereals are a poor source of iron, eat eggs or pancakes for breakfast.
Drink orange juice with the iron supplement. Increase intake of dried beans and green leafy vegetables. Cook food in an iron skillet, if possible.
The nurse encourages a woman with gestational diabetes to maintain an active exercise period during pregnancy. Prior to this exercise period, the nurse would advise her to take which action? Inject a bolus of insulin. Eat a high-carbohydrate snack. Eat a sustaining-carbohydrate snack. Add a bolus of long-acting insulin.
Eat a sustaining-carbohydrate snack.
The nurse is appraising the laboratory results of a pregnant client who is in her second trimester and notes the following: thyroid stimulating hormone (TSH) slightly elevated, glucose in the urine, complete blood count (CBC) low normal, and normal electrolytes. The nurse prioritizes further testing to rule out which condition? Preeclampsia Anemia Hyperthyroidism Gestational diabetes
Gestational diabetes
A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize? antihypertensive drugs diuretic drugs IV fluids antibiotics
IV fluids Explanation: A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and IV fluids. Antihypertensive drugs usually aren't necessary. Diuretics would not be used unless fluid overload resulted. The client would be given antibiotics only if there were evidence of an infection
The nurse is assessing a mother who just delivered a 7 lb (3136 g) baby via cesarean delivery. Which assessment finding should the nurse prioritize if the mother has a history of controlled atrial fibrillation? Nausea and vomiting Jugular distention Abdominal cramps Urinary retention
Jugular distention
What important instruction should the nurse give a pregnant client with tuberculosis? Maintain adequate hydration. Avoid direct sunlight. Avoid red meat. Wear light, cotton clothes.
Maintain adequate hydration. Explanation: The nurse should instruct the pregnant client with tuberculosis to maintain adequate hydration as a health-promoting activity. The client need not avoid direct sunlight or red meat, or wear light clothes; these have no impact on the client's condition.
A pregnant woman diagnosed with diabetes should be instructed to perform which action? Discontinue insulin injections until 15 weeks gestation. Ingest a smaller amount of food prior to sleep to prevent nocturnal hyperglycemia. Notify the primary care provider if unable to eat because of nausea and vomiting. Prepare foods with increased carbohydrates to provide needed calories.
Notify the primary care provider if unable to eat because of nausea and vomiting.
The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement? Dried apples Fortified grains Dried beans Orange juice
Orange juice
The nurse is caring for a 2-day-old newborn whose mother was diagnosed with cytomegalovirus during the first trimester. On which health care provider prescription should the nurse place the priority? Perform a hearing screen test. Obtain a urine specimen. Monitor growth and development. Assess pulse rate.
Perform a hearing screen test. Explanation: Symptoms of CMV in the fetus and newborn, known as CMV inclusion disease, include hepatomegaly, thrombocytopenia, IUGR, jaundice, microcephaly, hearing loss, chorioretinitis, and intellectual disability. A hearing screen would be priority over monitoring growth and development because that will have to be done over an extended period of time. Urine and pulse are not important with this diagnosis
The nurse is leading a discussion with a group of pregnant women who have diabetes. The nurse should point out which situation can potentially occur during their pregnancy? Small-for-gestational-age (SGA) infant Polyhydramnios Postterm birth Hypotension of pregnancy
Polyhydramnios Explanation: Polyhydramnios is an increase, or excess, in amniotic fluid and is a pregnancy-related complication associated with diabetes. An infant who is small-for-gestational-age is not associated with a mother who had diabetes prior to pregnancy. Other pregnancy-related complications associated with pregestational diabetes mellitus include hypertensive disorders, preterm birth, and shoulder dystocia.
The maternal health nurse is caring for a group of high-risk pregnant clients. Which client condition will the nurse identify as being the highest risk for pregnancy? Secondary hypertension Repaired atrial septal defect Pulmonary hypertension Loud systolic murmur
Pulmonary hypertension Explanation: Pulmonary hypertension is considered the greatest risk to a pregnancy because of the hypoxia that is associated with the condition. The remaining conditions represent potential cardiac complications that may increase the client's risk in pregnancy; however, these do not present the greatest risk in pregnancy.
A nurse is providing education to a woman at 28 weeks' gestation who has tested positive for gestational diabetes mellitus (GDM). What would be important for the nurse to include in the client teaching? She is at increased risk for type 2 diabetes mellitus after her baby is born. Her baby is at increased risk for neonatal diabetes mellitus. Her baby is at increased risk for type 1 diabetes mellitus. She is at increased risk for type 1 diabetes mellitus after her baby is born.
She is at increased risk for type 2 diabetes mellitus after her baby is born.
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? Sickle cell anemia is recessively inherited. Sickle cell anemia has more than one polygenic inheritance pattern. Sickle cell anemia is dominantly inherited. Sickle cell anemia is not inherited; it occurs following a malaria infection.
Sickle cell anemia is recessively inherited.
A 15-year-old adolescent arrives at the office with a report of flu symptoms, including nausea and vomiting and recent weight loss. A pregnancy test is done and is positive. The client begins crying and tells the nurse her mother will be furious with her. What can the nurse do to assist this adolescent at this point? Support her by respecting her right to privacy and confidentiality. Contact the mother of the adolescent to be sure the child gets prenatal care. Tell the adolescent that this is too big of a problem for her to make decisions about and she needs to listen to her mother. Recommend some adoption agencies for her to talk to in the near future.
Support her by respecting her right to privacy and confidentiality.
Which factor would contribute to a high-risk pregnancy? blood type O positive first pregnancy at age 33 history of allergy to honey bee pollen type 1 diabetes
Which factor would contribute to a high-risk pregnancy? blood type O positive first pregnancy at age 33 history of allergy to honey bee pollen type 1 diabetes
The clinic nurse teaches a client with pregestational type 1 diabetes that maintaining a constant insulin level is very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use: regular insulin twice a day. an insulin pen. an insulin drip. an insulin pump.
an insulin pump. Explanation: Because a pregnant client will have some periods of relative hyperglycemia and hypoglycemia no matter how carefully the client maintains diet and balances exercise levels, an effective method to keep serum glucose levels constant is to administer insulin with a continuous pump during pregnancy.
A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum? limiting sodium intake inspecting the extremities for edema ensuring that the client consumes a high fiber diet assessing for cardiac decompensation
assessing for cardiac decompensation Explanation: The nurse should assess the client with heart disease for cardiac decompensation, which is most common from 28 to 32 weeks' gestation and in the first 48 hours postpartum. Limiting sodium intake, inspecting the extremities for edema, and ensuring that the client consumes a high-fiber diet are interventions during pregnancy not in the first 48 hours postpartum.
A pregnant woman in her 39th week of pregnancy presents to the clinic with a vaginal infection. She tests positive for chlamydia. What would this disease make her infant at risk for? deafness blindness neonatal laryngeal papillomas chickenpox
blindness
Human papillomavirus (HPV) can cause condylomata acuminata that can develop in clusters on the vulva, within the vagina, on the cervix, or around the anus. What is their risk? neonatal auricular papillomas block a vaginal birth heavy bleeding during vaginal birth neonatal hemorrhage
block a vaginal birth Genital warts have a tendency to increase in size during pregnancy. These warts may grow large enough to block a vaginal birth. The pregnant woman can pass HPV to her fetus during the birth process. In rare instances, neonatal HPV infection can result in life-threatening laryngeal papillomas. HPV infection transmitted to the infant may not appear for as long as 10 years after birth.
A new young mother has tested positive for HIV. When discussing the situation with the client, the nurse should advise the mother that she should avoid which activity? breastfeeding future pregnancies cesarean birth handling the infant with open sores
breastfeeding Explanation: Breastfeeding is a major contributing factor for mother-to-child transmission of HIV. Cesarean birth before the onset of labor and/or rupture of membranes can greatly reduce the chance of transmitting the infection to the infant. Future pregnancies should be discussed and decided on an individual basis. Proper treatment of any open wounds and education should be provided to the mother to ensure she reduces the chance of transmitting HIV to her infant
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: limit weight gain to 15 pounds during the pregnancy. check her blood sugars frequently and adjust insulin accordingly. exercise for 1 to 2 hours each day to keep the blood glucose down. begin oral hyperglycemic medications along with the insulin she is currently taking.
check her blood sugars frequently and adjust insulin accordingly.
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? class I class II class III class IV
class III Explanation: The nurse should classify the client's condition as belonging to class III of NYHA. In class III of NYHA classification, the client will be symptomatic with ordinary activity, and her condition is markedly compromised. The client is asymptomatic with all kinds of activity and is in uncompromised state in class I. The client is symptomatic with increased activity and is in slight compromised state in class II. The client is symptomatic when resting and is incapacitated in class IV
When providing nutritional counseling to a pregnant woman with diabetes, the nurse would urge the client to obtain most of her calories from which source? complex carbohydrates protein unsaturated fats saturated fats
complex carbohydrates Explanation: The pregnant woman with diabetes is encouraged to eat three meals a day plus three snacks, with 40% of calories derived from good-quality complex carbohydrates, 35% of calories from protein sources, and 35% of calories from unsaturated fats. The intake of saturated fats should be limited during pregnancy, just as they should be for any person to reduce the risk of heart disease.
A nurse is interviewing a pregnant woman who has come to the clinic for her first prenatal visit. During the interview, the client tells the nurse that she works in a day care center with 2- and 3-year olds. Based on the client's history, the nurse would be alert for the development of which condition? cytomegalovirus chlamydia gonorrhea toxoplasmosis
cytomegalovirus
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? diet long-acting insulin oral hypoglycemic drugs glucagon
diet Explanation: Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are usually not given during pregnancy and would not be the first option. Glucagon raises blood glucose and is used to treat hypoglycemic reactions
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? regular heart rate and hypertension increased urinary output, tachycardia, and dry cough shortness of breath, bradycardia, and hypertension dyspnea, crackles, and irregular weak pulse
dyspnea, crackles, and irregular weak pulse
A nurse is admitting a pregnant woman with sickle cell anemia to the emergency department. Which findings would lead the nurse to suspect the client is in crisis? Select all that apply. fever joint pain increased skin turgor pallor fatigue
fever joint pain fatigue
The nurse is preparing a postpartum nursing care plan for a single HIV-positive primigravida client. The nurse should prioritize in the plan how to acquire which resource? breast pump diapers car seat formula
formula
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. flaccid extremities high-pitched shrill cry almost constant sneezing nasal stuffiness poor sucking reflex
high-pitched shrill cry almost constant sneezing nasal stuffiness poor sucking reflex
The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of having a heroin use disorder. The nurse would be alert for which finding when assessing the neonate? low, feeble cry hypertonicity easy consolability vigorous sucking
hypertonicity Explanation: Newborns of mothers with heroin or other opioid use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.
Cytomegalovirus infection can result in different congenital anomalies. It can also be transmitted via different routes. When discussing this infection with a pregnant woman, the nurse integrates understanding that permanent fetal disability can occur with which type of transmission of CMV? in utero transmission during birth transmission after birth transmission with any transmission
in utero transmission
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? in weeks 8 to 12 in weeks 28 to 32 in weeks 12 to 20 in weeks 20 to 28
in weeks 28 to 32 Explanation: The danger of pregnancy in a woman with cardiac disease occurs primarily because of the increase in circulatory volume. The most dangerous time for a woman is in weeks 28 to 32, just after the blood volume peaks
A nursing instructor is teaching students about anemia during pregnancy. Which type of anemia does the instructor teach students is most prevalent during pregnancy? sickle-cell anemia pernicious anemia iron-deficiency anemia folic acid anemia
iron-deficiency anemia Explanation: Iron-deficiency anemia is the most common type in pregnancy. Many woman enter pregnancy with a low iron count because of poor diet, heavy menstrual periods, unwise weight-loss programs, or a combination of these.
A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client? sexual development of the client whether sex was consensual options for birth control in the future knowledge of child development
knowledge of child development
Which change in insulin is most likely to occur in a woman during pregnancy? enhanced secretion from normal not released because of pressure on the pancreas unavailable because it is used by the fetus less effective than normal
less effective than normal
he infant born to a woman with untreated tuberculosis (TB) is more likely to have which conditions? Select all that apply. low Apgar score overweight perinatal death postnatal TB underweight
low Apgar score perinatal death postnatal TB underweight
A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply. maternal age less than 18 years genitourinary tract abnormalities obesity hypertension previous large-for-gestational-age (LGA) infant
obesity hypertension previous large-for-gestational-age (LGA) infant
A woman with an artificial mitral valve develops heart failure at the 20th week of pregnancy. Which measure would the nurse stress with her during the remainder of the pregnancy? obtaining enough rest maintaining a high fluid intake beginning a low-impact aerobics program discontinuing her prepregnancy anticoagulant
obtaining enough rest Explanation: As the blood volume doubles during pregnancy, heart failure can occur. The pregnant woman needs to obtain adequate rest to prevent overworking the heart. Fluid may need to be restricted.
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? meals high in iron milk legumes orange juice
orange juice
A woman with no previous history of heart disease begins to have symptoms of myocardial failure a few weeks before the birth of her first child. Findings include shortness of breath, chest pain, and edema, with her heart also showing enlargement. The nurse suspects which condition? mitral stenosis left-sided heart failure pulmonary valve stenosis peripartum cardiomyopathy
peripartum cardiomyopathy Explanation: Peripartum cardiomyopathy can occur in pregnancy without any previous history of heart disease. Symptoms include shortness of breath, chest pain, and edema; also, the heart begins to enlarge. Treatment is with a diuretic, an antiarrhythmic agent, digitalis, low weight heparin, and bed rest.
A 40-year-old woman comes to the clinic reporting having missed her period for two months. A pregnancy test is positive. What is she and her fetus at increased risk for? type 2 diabetes mellitus type 1 diabetes mellitus placental abnormalities postterm birth
placental abnormalities
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? respiratory function heart rate temperature urine output
respiratory function Explanation: The nurse should identify respiratory distress syndrome as a major risk that can be faced by the offspring of a client with cardiovascular disease. While the other assessments are important, they are not priority
A nurse is caring for a newborn with fetal alcohol spectrum disorder. What characteristic of the fetal alcohol spectrum disorder should the nurse assess for in the newborn? small head circumference decreased blood glucose level poor breathing pattern wide eyes
small head circumference
Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 130/86 mm Hg; week 20 - 138/88 mm Hg; week 24 - 136/82 mm Hg; and week 28 - 138/88 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure? elevated stage 1 stage 2 hypertensive crisis
stage 1 Stage 1: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg; Stage 2: Systolic at least 140 mm Hg or diastolic at least 90 mm Hg; Hypertensive crisis: Systolic over 180 mm Hg and/or diastolic over 120 mm Hg (Alexander, 2019; Bakris, 2019).
What is the role of the nurse during the preconception counseling of a pregnant client with chronic hypertension? stressing the avoidance of dairy products stressing the positive benefits of a healthy lifestyle stressing the increased use of Vitamin D supplements stressing regular walks and exercise
stressing the positive benefits of a healthy lifestyle Explanation: The nurse should stress the positive benefits of a healthy lifestyle during the preconception counseling of a client with chronic hypertension. The client need not avoid dairy products or increase intake of vitamin D supplements. It may not be advisable for a client with chronic hypertension to exercise without consultation.
A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth? the viral load amniocentesis results at 34 weeks' gestation the mother's age prophylactic antiretroviral therapy (ART) to the infant at birth
the viral load
A pregnant woman in her second trimester comes to the prenatal clinic for a routine visit. She reports that she has a new kitten. The nurse would have the woman evaluated for which infection? cytomegalovirus parvovirus B19 toxoplasmosis herpes simplex virus
toxoplasmosis Explanation: Toxoplasmosis is transferred by hand to mouth after touching cat feces while changing the litter box or through gardening in contaminated soil. Cytomegalovirus is transmitted via sexual contract, blood transfusions, kissing, and contact with children in daycare centers. Parvovirus B19 is a common self-limiting benign childhood virus that causes fifth disease. A pregnant woman may transmit the virus transplacentally to her fetus if she is exposed to an infected child. Herpesvirus infection occurs by direct contact of the skin or mucous membranes with an active lesion through kissing, sexual contact, or routine skin-to-skin contact.
A pregnant woman at 36 weeks' gestation comes to the care center for a follow-up visit. The woman is to be screened for group B streptococcus (GBS) infection. When describing this screening to the woman, the nurse would explain that a specimen will be taken from which area(s)? Select all that apply. throat nasal cavity vagina rectum conjunctiva
vagina rectum
