Medical Condition in Pregnancy Part I HTN GDM (Exam 4)

A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which finding would the lead the nurse to suspect that the client is having an adverse effect associated with this drug? a) sweating b) tachycardia c) gastrointestinal bleeding d) blurred vision

b) tachycardia Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision, or sweating. Magnesium sulfate may cause sweating.

In working with a pregnant woman who now weighs 55 kg and has developed gestational diabetes mellitus, how much should the nurse recommend that the patient eat? Approximately a) 900 kcals of carbohydrates, 330 kcals of protein, and 415 kcals of fat each day in three meals b) 900 kcals of carbohydrates, 330 kcals of protein, and 415 kcals of fat each day in three meals and three snacks c) 700 kcals of carbohydrates, 165 kcals of protein, and 210 kcals of fat each day in three meals d) 700 kcals of carbohydrates, 165 kcals of protein, and 210 kcals of fat each day in three meals and three snacks

b) 900 kcals of carbohydrates, 330 kcals of protein, and 415 kcals of fat each day in three meals and three snacks The diet for a patient with GDM may be diet controlled based on the following intake guidelines: Total caloric intake of 30 to 35 kcal/kg; recommended as 40 to 50% carbohydrate, 20% protein, and 30 to 40% from fat. Option A is incorrect because it does not include the snacks that most diabetics need daily. Options C and D are not adequate intakes for the patient in the scenario, and option C does not include snacks.

A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware that client is at risk for which perinatal complication? a) fetal nonimmune hydrops b) congenital anomalies c) maternal hypotension d) postterm birth

b) congenital anomalies Multiple gestation involves two or more fetuses. The perinatal complications associated with multiple pregnancy include preterm birth, maternal hypertension and congenital anomalies. Fetal nonimmune hydrops occurs in the infection of pregnant clients with parvovirus. Postterm birth, maternal hypotension, and fetal nonimmune hydrops are not seen as complications of multiple pregnancy.

A nurse is caring for a pregnant client with eclamptic seizure. Which is a characteristic of eclampsia? a) Coma occurs after seizure. b) Respiration fails after the seizure. c) Respirations are rapid during the seizure. d) Muscle rigidity is followed by facial twitching.

a) Coma occurs after seizure. The nurse should know that coma usually follows an eclamptic seizure. Muscle rigidity occurs after facial twitching. Respirations do not become rapid during the seizure; they cease. Coma usually follows the seizure activity, with respiration resuming.

A nurse is explaining to a group of nursing students that eclampsia or seizures in pregnant women are preceded by an acute increase in maternal blood pressure. What are features of an acute increase in blood pressure? Select all that apply. a) blurring of vision b) hyperglycemia c) hypereflexia d) proteinuria e) auditory hallucinations

a) blurring of vision c) hypereflexia d) proteinuria Eclampsia is usually preceded by an acute increase in blood pressure as well as worsening signs of multi-organ system failure seen as increasing liver enzymes, proteinuria, and symptoms such as blurred vision and hyperreflexia. Hyperglycemia and auditory hallucinations are not seen with an acute increase in maternal blood pressure.

A nurse is caring for a pregnant client with gestational diabetes. Which meal should the nurse recommend for this client? a) pizza, corn, and orange slices b) steak, baked potato with butter, and ice cream c) baked turkey, brown rice, and strawberries d) baked chicken, green beans, and chocolate cake

c) baked turkey, brown rice, and strawberries The nurse should recommend foods high in whole-grain, lean meats, high fiber, and naturally low in fat and sodium.

As a rule, women can receive chemotherapy in the second and third trimesters without adverse fetal effects. a) True b) False

a) True

The nurse is required to assess a client for HELLP syndrome. Which are the signs and symptoms of this condition? Select all that apply. a) hyperbilirubinemia b) oliguria c) blood pressure higher than 160/110 mm Hg d) epigastric pain e) upper right quadrant pain

a) hyperbilirubinemia d) epigastric pain e) upper right quadrant pain The signs and symptoms of HELLP syndrome are nausea, malaise, epigastric pain, upper right quadrant pain, demonstrable edema, and hyperbilirubinemia. Blood pressure higher than 160/110 mm Hg and oliguria are the symptoms of severe preeclampsia rather than HELLP syndrome.

During a routine prenatal check up, the nurse interviews a pregnant client to identify possible risk factors for developing gestational diabetes. Which factors would alert the nurse to an increased risk? Select all that apply. a) previous birth of small for gestational age baby b) client of African-American lineage c) previous history of spontaneous abortion d) younger maternal age at pregnancy e) maternal obesity with body mass index more than 35

a) previous birth of small for gestational age baby c) previous history of spontaneous abortion e) maternal obesity with body mass index more than 35 The risk factors for gestational diabetes include previous history of spontaneous abortion, maternal obesity with body mass index (BMI) more than 35, and client of African-American lineage. The other risk factors for gestational diabetes are previous history of stillbirth, birth of large for gestational age infant, and advancing maternal age. High-risk ethnic groups include African American, Hispanic, and Native North American.

A client with preeclampsia is receiving magnesium sulfate to suppress or control seizures. Which nursing intervention should a nurse perform to determine the effectiveness of therapy? a) Assess the client's skin turgor. b) Assess deep tendon reflexes. c) Monitor intake and output. d) Assess the client's mucous membrane.

b) Assess deep tendon reflexes. If the client is receiving magnesium sulfate to suppress or control seizures, assess deep tendon reflexes to determine the effectiveness of therapy. Common sites utilized to assess deep tendon reflexes are the biceps reflex, triceps reflex, patellar reflex, Achilles reflex, and plantar reflex. Assessing the mucous membranes for dryness and skin turgor for dehydration are the required interventions hen caring for a client with hyperemesis gravidarum. Monitoring intake and output will not help to determine the effectiveness of therapy.

Which nursing diagnosis would be most appropriate for a woman diagnosed with gestational hypertension? A) Imbalanced nutrition related to decreased sodium levels b) Deficient fluid volume related to vasospasm of arteries c) Ineffective tissue perfusion related to poor heart contraction d) Risk for injury related to fetal distress

b) Deficient fluid volume related to vasospasm of arteries Gestational hypertension is caused by vascular spasm. This leads to increased blood pressure and edema. Extensive edema leads to a deficiency of fluid volume.

A pregnant client with severe preeclampsia has developed HELLP syndrome. In addition to the observations necessary for preeclampsia, what other nursing intervention is critical for this client? a) administration of a tocolytic, if prescribed b) maintaining a patent airway c) observation for bleeding d) monitoring for infection

c) observation for bleeding Because of the low platelet count associated with this condition, women with HELLP syndrome need extremely close observation for bleeding, in addition to the observations necessary for preeclampsia. Maintaining a patent airway is a critical intervention needed for a client with eclampsia while she is having a seizure. Administration of a tocolytic would be appropriate for halting labor. Monitoring for infection is not a priority intervention in this situation.

A pregnant woman at 4 weeks' gestation who has preexisting diabetes mellitus visits her primary care provider for a check up. Which fetal complications might occur because of this maternal condition? Select all that apply. a) fetus with juvenile diabetes b) smaller than gestational age baby c) respiratory disorder d) macrosomia (oversized fetus) e) congenital malformations

c) respiratory disorder d) macrosomia (oversized fetus) e) congenital malformations Potential problems during pregnancy involving maternal diabetes mellitus include fetal death, macrosomia (oversized fetus), a fetus with a respiratory disorder, difficult labor, preeclampsia or eclampsia, polyhydramnios, and congenital malformations.

A woman in week 40 of her pregnancy has developed a urinary tract infection (UTI). The nurse recognizes that which of the following treatments would be safe and appropriate to use with this client? (Select all that apply.) a) Tetracyclines b) Sulfonamides c) Heparin d) Amoxicillin e) Cephalosporins f) Ampicillin

d) Amoxicillin e) Cephalosporins f) Ampicillin Amoxicillin, ampicillin, and cephalosporins are effective against most organisms causing UTIs and are safe antibiotics during pregnancy. The sulfonamides can be used early in pregnancy but not near term because they can interfere with protein binding of bilirubin, which then leads to hyperbilirubinemia in the newborn. Tetracyclines are contraindicated during pregnancy as they cause retardation of bone growth and staining of the fetal teeth. Heparin is an anticoagulant and is used to prevent clot formation; it would not be prescribed for a UTI.

For which problem would the nurse be alert in a pregnant woman with gestational diabetes? a) hypotension related to glucose/insulin imbalance b) cerebral vascular accident related to diabetes mellitus c) placenta previa related to diabetes mellitus d) hydramnios related to glucose/insulin imbalance

d) hydramnios related to glucose/insulin imbalance Hyperglycemia tends to lead to excessive amniotic fluid (hydramnios) because of osmotic pressure fluid shifts.

The clinic nurse routinely assesses all pregnant clients for signs of hypertension. Which symptoms experienced by the client would the nurse document as diagnostic signs of preeclampsia? Select all that apply. a) elevated liver enzymes b) edema c) blood pressure of 140/90 mm Hg d) +1 proteinuria

a) elevated liver enzymes c) blood pressure of 140/90 mm Hg d) +1 proteinuria Clinical manifestations of preeclampsia include blood pressure elevated to 140/90 mm Hg or higher, 15% increase in baseline blood pressure, +1 proteinuria, elevated liver enzymes. Although no longer considered a diagnostic sign of preeclampsia, edema may be present.

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply. a) previous large for gestational age (LGA) infant b) genitourinary tract abnormalities c) obesity d) hypertension e) maternal age less than 18 years

a) previous large for gestational age (LGA) infant c) obesity d) hypertension Obesity, hypertension, and a previous infant weighing more than 9 lb (4 kg) are risk factors for developing gestational diabetes. Maternal age less than 18 years and genitourinary tract abnormalities do not increase the risk of developing gestational diabetes.

A nurse is assessing a client diagnosed with mild preeclampsia. The nurse suspects that the client has developed severe preeclampsia based on which finding? a) urine output of less than 400 mL/24 hours b) proteinuria of 300 mg/24 hours c) mild hand edema d) mild facial edema

a) urine output of less than 400 mL/24 hours Severe preeclampsia may develop suddenly and bring with it high blood pressure of more than 160/110 mm Hg, proteinuria of more than 5 g in 24 hours, oliguria of less than 400 mL in 24 hours, cerebral and visual symptoms, and rapid weight gain. Mild facial edema or hand edema occurs with mild preeclampsia. Proteinuria in severe preeclampsia is greater than 500 mg/24 hours.

A nurse is client teaching with a 28 weeks' gestation woman who has tested positive for gestational diabetes mellitus (GDM). What would be important for the nurse to include in the client teaching? a) She is at increased risk for type I diabetes mellitus after her baby is born. b) She is at increased risk for type II diabetes mellitus after her baby is born. c) Her baby is at increased risk for type I diabetes mellitus. d) Her baby is at increased risk for neonatal diabetes mellitus.

b) She is at increased risk for type II diabetes mellitus after her baby is born. The woman who develops GDM is at increased risk for developing type 2 diabetes mellitus after pregnancy.

A pregnant woman is determined to be at high risk for gestational diabetes. At which time would the nurse expect the client to undergo rescreening? a) 16 to 20 weeks b) 20 to 24 weeks c) 24 to 28 weeks d) 28 to 32 weeks

c) 24 to 28 weeks A woman identified as high risk would undergo rescreening between 24 and 28 weeks.

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. a) Assess serum electrolyte levels of the client at each visit. b) Instruct the client to consume protein-rich food. c) Assess hydration status of the client at each visit. d) Teach the client meticulous handwashing. e) Urge the client to drink 8 to 10 glasses of fluid daily.

c) Assess hydration status of the client at each visit. d) Teach the client meticulous handwashing. e) Urge the client to drink 8 to 10 glasses of fluid daily. The nurse caring for a pregnant client with sickle cell anemia should teach the client meticulous hand-washing to prevent the risk of infection, assess the hydration status of the client at each visit, and urge the client to drink 8 to 10 glasses of fluid daily. The nurse need not assess serum electrolyte levels of the client at each visit or instruct the client to consume protein-rich food.

After reviewing a client's history, which factor would the nurse identify as placing her at risk for gestational hypertension? a) This is the client's second pregnancy. b) Client has a twin sister. c) Her mother had gestational hypertension during pregnancy. d) Her sister-in-law had gestational hypertension.

c) Her mother had gestational hypertension during pregnancy. A family history of gestational hypertension, such as a mother or sister, is considered a risk factor for the client. Having a twin sister or having a sister-in-law with gestational hypertension would not increase the client's risk. If the client had a history of preeclampsia in her first pregnancy, then she would be at risk in her second pregnancy.

A woman has been diagnosed as having gestational hypertension. Which symptom for this condition is the most typical? a) weight loss b) increased perspiration c) blood pressure elevation d) susceptibility to infection

c) blood pressure elevation The symptom of gestational hypertension is blood pressure elevation (140/90 mm Hg) identified after 20 weeks' gestation without proteinuria.

Which change in insulin is most likely to occur in a woman during pregnancy? a) not released because of pressure on the pancreas b) unavailable because it is used by the fetus c) less effective than normal d) enhanced secretion from normal

c) less effective than normal Somatotropin released by the placenta makes insulin less effective. This is a safeguard against hypoglycemia.

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication? a) urinary output of 20 mL per hour b) difficulty in arousing c) respiratory rate of 10 breaths/minute d) deep tendons reflexes 2+

d) deep tendons reflexes 2+ With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respiratory rate of less than 12 breaths/minute, and a diminished level of consciousness would indicate magnesium toxicity.