Conditions Existing Before Conception
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 Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. NOT 2 Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. 3 Oral hypoglycemic drugs are usually not given during pregnancy and would not be the first option. 4 Glucagon raises blood glucose and is used to treat hypoglycemic reactions
A nurse is teaching 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 Prevention of crises, if possible, is the focus of treatment for the pregnant woman with sickle cell anemia. Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common-sense strategies that decrease the risk of a crisis. NOT 3.4. Fat intake does not need to be decreased and immunoglobulins are not normally administered. 2 Constipation is not usually a result of sickle cell anemia
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 Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. If one parent has the disease and the other is free of the disease and trait, the chance of the child inheriting the disease is zero. If the woman has the disease and her partner has the trait, there is a 50% chance that the child will be born with the disease. If both parents have the disease, then all of their children also will have the disease
A nurse studying high-risk pregnancies correctly identifies which of the following as causes for such a label? Select all that apply. 1 concurrent disorder 2 pregnancy-related complication 3 history of multiple pregnancies 4 external factor that jeopardizes both the health of the woman and fetus 5 external factor that jeopardizes the health of the woman or the fetus
1.2.4.5. A high-risk pregnancy is one in which a concurrent condition, pregnancy-related complication, or external factor jeopardizes the health of the woman, fetus, or both.
An expectant mother in week 30 of her pregnancy reports to the nurse that she has been doing her fetal movement (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 A healthy fetus moves with a degree of consistency, at about 10 times per hour. NOT 1 In contrast, a fetus who is not receiving enough nutrients because of poor maternal nutrition or placental insufficiency has greatly decreased movements. 3 Activity in the mother would not explain the decreased movement in the fetus. 4 There is no indication in this scenario that the client is performing the counts incorrectly
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 The goal for a mother who has type I diabetes mellitus is to keep tight control over her blood sugars throughout the pregnancy. Therefore, she needs to test her blood sugar frequently during the day and make adjustments in the insulin doses she is receiving.
The nurse educator is teaching new nurses on risk factors for intimate partner violence to watch for when caring for pregnant clients. Which risk factors will the nurse include in the teaching? Select all that apply. 1 advanced maternal age 2 uncertainty of the baby's father 3 unwanted pregnancy 4 unemployed mother 5 neither parent attended college
2.3.4. Risk factors for intimate partner violence during pregnancy include doubts about paternity, an unwanted pregnancy, either or both parents being unemployed, young age during pregnancy, and having less than a high school education. Other risk factors include heavy drinking by the partner, history of abuse, cohabitation, jealousy, change in woman's shape, stress of becoming a father, previous isolation from family, and financial hardships.
A pregnant woman who has been taking penicillin prophylactically because she had rheumatic fever as a child tells the nurse that she wants to stop taking it now that she is pregnant. Which of the following is the best response by the nurse? 1 "You should stop this drug immediately because it could damage the fetus." 2 "Perhaps you could take only half the dose to prevent harm to the fetus." 3 "You should continue taking this drug because penicillin is not known to be a fetal teratogen." 4 "You should never take any medication while pregnant because drugs could cause damage to the fetus."
3 A woman taking penicillin prophylactically because she had rheumatic fever as a child and wants to prevent a recurrence should continue this drug during pregnancy. Penicillin is not known to be a teratogen
A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse? 1 "You should talk to the doctor about that; the medications you're on can damage the fetus." 2 "Do you want to talk to a counselor who can help you weigh the pros and cons of having your own child rather than adopting?" 3 "I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet." 4 "That's great. I've got a 4-year-old and a 2-year-old myself."
3 Any woman with epilepsy needs to discuss medication management with her provider. The current research indicates the medications used for epileptic management are the major cause of birth defects for these clients. NOT 1 The nurse should be careful about mentioning that some epilepsy medications are teratogenic; some women may stop taking their medications in order to get pregnant. 2 Suggesting adoption is inappropriate as the mother has given no indication she is interested in adoption; also, the mother needs to discuss this with the physician so that she can get accurate information about being on anti-seizure medications and being pregnant. 4 The nurse should not share personal information as it does not assist this client in making a serious decision. The client should be referred to the health care provider to help the client make the best decision
The client is 32 weeks' pregnant and has been referred for a 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 A biophysical profile uses a combination of factors to determine fetal well-being based upon five fetal biophysical variables. An NST is done to measure FHR acceleration. Then an ultrasound is done to measure breathing, body movements, tone, and amniotic fluid volume. Each variable receives a score from 0 to 2 for a maximum score of 10. A score of 6 or less indicates altered fetal well-being and indicates a need for further assessment. NOT 1 A needle is not involved with the BPP. 2.3. The BPP does not detect placental problems, and the BPP is not a screening for neural tube defects
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 health care provider.
4 A client on an SSRI or SRI (serotonin reuptake inhibitor) might be in current treatment for a psychiatric disorder. The medication may also be one that is not safe during pregnancy. The RN and the health care provider need to be alerted to seek more information from the client. NOT 1 Reassurance is good practice, but not enough in this case. 2 You do not have enough information to refer her for drug and alcohol counseling. 3 She is under the care of another provider for her mental disorder, so do not confuse her with more material to read.
Which response is most appropriate for a client with diabetes who wants to breastfeed but is concerned about the effects of breastfeeding on her health? 1 Diabetic clients who breastfeed have a hard time controlling their insulin needs. 2 Diabetic clients shouldn't breastfeed because of potential complications. 3 Diabetic clients shouldn't breastfeed; insulin requirements are doubled. 4 Diabetic clients may breastfeed; insulin requirements may decrease from breastfeeding
4 Breastfeeding has an antidiabetic effect. Insulin needs are decreased because carbohydrates are used in milk production. Breastfeeding clients are at a higher risk for hypoglycemia in the first postpartum days after birth because glucose levels are lower. Diabetic clients should be encouraged to breastfeed.
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 should be alert for signs of cardiac decompensation due to congestive heart failure, which include crackles in the lungs from fluid, difficulty breathing, and weak pulse from heart exhaustion. NOT 1.2. The heart rate would not be regular, and a cough would not be dry. 3 The heart rate would increase rather than decrease
Tay-Sachs disease (TSD)
A fatal genetic disorder in which harmful quantities of a fatty substance buildup in tissues and nerve cells in the brain Marked by progressive physical degeneration, mental retardation, and early death
Postprandial values
Postprandial means after a meal; therefore, PPG concentrations refer to plasma glucose concentrations after eating A blood glucose level below 120 mg/dl is recommended for 2-hour postprandial values.
A nurse informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night's sleep. The nurse further instructs the client that which position for this rest is best?
The pregnant woman should rest in the left lateral recumbent position to prevent supine hypotension syndrome and increased heart effort
A woman with known cardiac disease from childhood presents at the obstetrician's office 6 weeks' pregnant. What recommendations would the nurse make to the client to address the known cardiac problems for this pregnancy? Select all that apply. 1 Plan periods of rest into the workday. 2 Continue taking the scheduled warfarin. 3 Receive pneumococcal and influenza vaccines. 4 Let the physician know if you become short of breath or have a nighttime cough. 5 Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus.
Women with known heart conditions need to be closely followed by both the obstetrician and a cardiologist. 1.3.4. Recommendations would include rest periods, reduction of stress, getting immunizations, and monitoring for heart failure as demonstrated by a nighttime cough and shortness of breath. NOT 5 Consuming more sodium in the diet is not recommended due of the potential of developing hypertension. 2 Warfarin is contraindicated during pregnancy since it crosses the placental barrier and can cause spontaneous abortion (miscarriage), stillbirth or preterm birth.
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? a 45 mg/dl b 85 mg/dl c 120 mg/dl d 136 mg/dl
b. Recommended fasting blood glucose levels in pregnant clients with diabetes are 60 to 95 mg/dl. NOT a. A fasting blood glucose level of 45 g/dl is low and may result in symptoms of hypoglycemia. c. A blood glucose level below 120 mg/dl is recommended for 2-hour postprandial values. d. A blood glucose level above 136 mg/dl in a pregnant client indicates hyperglycemia
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 Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. NOT 2.3. If one parent has the disease and the other is free of the disease and trait, the chances of the child inheriting the disease is zero. 4 The infant will not develop the disease just because the mother has a crisis during the pregnancy.
The nurse instructs a pregnant client with sickle cell anemia on ways to prevent a crisis. Which client 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 fluid status of a pregnant client with sickle cell anemia is important because dehydration can precipitate a crisis. The client should drink at least eight glasses of fluid each day to prevent dehydration. NOT 2 Clients with sickle cell anemia should not take an iron supplement because the sickled cells cannot incorporate iron in the same way as nonsickled cells. 3 Standing for long periods of time can cause red cell destruction in the client with sickle cell anemia. 4 The client should sit with the legs elevated to encourage venous return of blood from the lower extremities
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? 1 Nausea and vomiting 2 Jugular distention 3 Abdominal cramps 4 Urinary retention
2 A woman who has a cardiac condition is at increased risk in the postpartum period. The most important nursing action is to monitor for signs of cardiac decompensation. The nurse should monitor for and report jugular distention, clubbing, and slow capillary refill time. If an irregular pulse is noted, compare it to the apical pulse. NOT 3 The abdominal cramps may be related to the uterus involution. 1.4. The nausea and vomiting and urinary retention may be related to the surgical procedure and not necessarily the cardiac issue
A nursing instructor is teaching students about caring for a pregnant client with a pre-existing disease. Which of the following does the instructor suggest has added to an increased incidence of pregnant women with a pre-existing disease? 1 women seeking out earlier prenatal care 2 more women waiting until after age 30 years to get pregnant 3 better tests to diagnose diseases 4 better assessment skills by physicians
2 As more women wait until they are older than 30 years to have their first child, more also enter pregnancy with a pre-existing disorder
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 Cardiac failure can affect fetal growth at the point at which maternal blood pressure becomes insufficient to provide an adequate supply of blood and nutrients to the placenta. For this reason, the infant may tend to have a low birth weight, be preterm, and respond poorly to labor
The nurse is caring for a postpartum client with diabetes who has developed an infection. The nurse is aware that infections in clients with diabetes 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 Clients with diabetes who become pregnant tend to become sicker and develop illnesses more quickly than pregnant clients without diabetes. Severe infections in diabetes can lead to diabetic ketoacidosis. NOT 1.3.4. Anemia, respiratory acidosis, and respiratory alkalosis aren't generally associated with infections in diabetic clients
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 corticosteroids 3 beta2 agonists 4 prostaglandin E
2 Corticosteroid therapy is the treatment of choice for pregnant clients with SLE. SLE is an autoimmune disorder where there is deposition of immune complexes in the capillaries and in visceral structure. Corticosteroid therapy in pregnant clients with SLE has a favorable outcome. NOT Hydroxyurea, beta2 agonists and prostaglandin E are not used in the treatment of pregnant clients with SLE. 1 Hydroxyurea is a drug used in the treatment of sickle cell anemia. 3 Beta2 agonists are drugs given to asthmatic clients. 4 Prostaglandin E is a drug used for the induction of labor
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? 1 "My baby may be very large and I may need a cesarean birth 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 Elevated blood sugars delay the maturation of fetal lungs, not increase maturation time, resulting in potential respiratory distress in newborns born to mothers with diabetes. NOT 3.4. Doing fetal movement (kick) counts is standard practice, as is the possibility of an amniocentesis to determine lung maturity during the third trimester. 1 Health care personnel should also prepare the mother for the potential of a cesarean birth if the infant is too large.
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 For the woman with chronic hypertension, prenatal visits typically occur every 2 weeks until 28 weeks' gestation and then weekly to allow for frequent maternal and fetal surveillance.
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 The time at which the nurse comes in contact with the woman in her childbearing life cycle will determine the focus of the assessment. If the woman is considering pregnancy, it is recommended that she postpone conception until the disease has been stable or in remission for 6 months. Active disease at time of conception and history of renal disease increase the likelihood of a poor pregnancy outcome (Cunningham et al., 2018). In particular, if pregnancy is planned during periods of inactive or stable disease, the result is often giving birth to healthy full-term babies without increased risks of pregnancy complications. Nonetheless, pregnancies with most autoimmune diseases are still classified as high risk because of the potential for major complications. Preconception counseling should include the medical and obstetric risks of spontaneous abortion (miscarriage), stillbirth, fetal death, fetal growth restriction, preeclampsia, preterm labor, and neonatal death and the need for more frequent visits for monitoring the condition. Treatment of SLE in pregnancy is generally limited to NSAIDs (e.g., ibuprofen), prednisone, and an antimalarial agent, hydroxychloroquine. During pregnancy in the woman with SLE, the goal is to keep drug therapy to a minimum
The nurse is teaching a pregnant client with type 2 diabetes about diet during pregnancy. Which client statement indicates that the nurse's teaching was successful? 1 "I'll basically follow the same diet that I was following before I became pregnant." 2 "Because I need extra protein, I will have to increase my intake of milk and meat." 3 "Pregnancy affects insulin production, so I will need to make adjustments in my diet." 4 "I will adjust my diet and insulin based on the results of my urine tests for glucose."
3 In pregnancy, placental hormones cause insulin resistance at a level that tends to parallel growth of the fetoplacental unit. Nutritional management focuses on maintaining balanced glucose levels. Thus, the client will probably need to make adjustments in the diet. NOT Protein needs increase during pregnancy, but this is unrelated to diabetes. Blood glucose monitoring results typically guide therapy.
A nurse is about to give a client with type 2 diabetes insulin before breakfast on her first day postpartum. Which answer best describes insulin requirements immediately postpartum? 1 lower than during her pregnancy 2 higher than during her pregnancy 3 lower than before she became pregnant 4 higher than before she became pregnant
3 Postpartum insulin requirements are usually significantly lower than prepregnancy requirements. Occasionally, clients may require little to no insulin during the first 24 to 48 hours postpartum
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 beta-thalassemia 3 Tay-Sachs disease 4 Down syndrome
3 Tay-Sachs disease occurs most often in people of Jewish ancestry. NOT 1 Sickle cell anemia occurs most often in African Americans. 2 Beta-thalassemia is a blood dyscrasia that occurs frequently in families of Greek or Italian heritage. 4 Down syndrome is not attributed to Jewish ancestry.
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? 1 limiting sodium intake 2 inspecting the extremities for edema 3 ensuring that the client consumes a high fiber diet 4 assessing for cardiac decompensation
4 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. NOT 1.2.3. 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
The nurse is educating a client with type 1 diabetes about the complications associated with diabetes and pregnancy. Which problems would the nurse include in her teaching? Select all that apply. 1 Decreased birth weight 2 Increased risk of spontaneous abortion (miscarriage) 3 Polyhydramnios 4 Hypertension 5 Cystic fibrosis
Women with pregestational diabetes, which is type 1 diabetes, are at a higher risk of having an infant with complications during the pregnancy and at the birth. 2 Spontaneous abortion (miscarriage) is higher in women who have pregestational diabetes. 3.4. Also, they run a higher risk of having a pregnancy with polyhydramnios, and of developing maternal hypertension. NOT 1 The birth weight of an infant born to a mother with diabetes is increased, not decreased. 5 Cystic fibrosis is not associated with maternal diabetes.
