OB Chapt 20 Nursing Management of the Pregnancy at Risk
A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA). What does the nurse tell the patient is a normal level for this test? a) 8% b) 6% c) 12% d) 14%
6% Correct Explanation: The upper normal level of HbA is 6% of total hemoglobin.
Which factor would contribute to a high-risk pregnancy? a) First pregnancy at age 33 b) History of allergy to honey bee pollen c) Blood type O positive d) Type 1 diabetes
Type 1 diabetes Correct Explanation: A woman with a history of diabetes has an increased risk for perinatal complications, including hypertension, preeclampsia, and neonatal hypoglycemia. The age of 33 without other risk factors doesn't increase risk, nor does type O-positive blood or environmental allergens.
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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 patient that the best position for this rest is which of the following? a) right lateral recumbent b) left lateral recumbent c) on her back d) prone
left lateral recumbent Correct Explanation: The pregnant woman should rest in the left lateral recumbent position to prevent supine hypotension syndrome and increased heart effort.
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) Heparin b) Cephalosporins c) Ampicillin d) Sulfonamides e) Tetracyclines f) Amoxicillin
• Cephalosporins • Ampicillin • Amoxicillin Correct Explanation: 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.
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) 120 mg/dl b) 85 mg/dl c) 136 mg/dl d) 45 mg/dl
85 mg/dl Correct 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.
A pregnant woman with diabetes is having a glycosylated hemoglobin level drawn. Which result would require the nurse to revise the client's plan of care? 1. 6.0% 2. 8.5%
8.5% Explanation: A glycosylated hemoglobin level of more than 8% indicates poor control and the need for intervention, necessitating a revision in the woman's plan of care.
A pregnant client with sickle cell anemia is at an increased risk for having a sickle cell crisis during pregnancy. Aggressive management for a client experiencing a sickle cell crisis with severe pain includes which measure? a) Diuretic drugs b) Antihypertensive drugs c) I.V. fluids d) Acetaminophen (Tylenol) for pain
I.V. fluids Correct Explanation: A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and I.V. fluids. Antihypertensive drugs usually aren't necessary. Diuretics wouldn't be used unless fluid overload resulted. The client usually needs a stronger analgesic than acetaminophen to control the pain of a crisis.
A nursing instructor is teaching students about anemia during pregnancy. Which type of anemia does the instructor teach students is most prevalent during pregnancy? a) sickle-cell anemia b) pernicious anemia c) iron-deficiency anemia d) folic acid anemia
iron-deficiency anemia Correct 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.
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quizlets
A young patient with a cardiac problem wants to get pregnant and tells the nurse that she is sad that she will never be able to have a baby. What is the best response by the nurse? a) "Women with your problem should never get pregnant, because the risks and dangers are too high for you and the fetus." b) "If you get pregnant, you are likely to face many complications." c) "Because of improved management, more women with cardiac problems can complete pregnancies successfully." d) "Cardiovascular problems are not a concern during pregnancy."
"Because of improved management, more women with cardiac problems can complete pregnancies successfully." Correct Explanation: Because of improved management of cardiac disease, women who might never have risked pregnancy in the past can complete pregnancies successfully today.
A client in her fifth month of pregnancy is having a routine clinic visit. The nurse should assess the client for which common second trimester condition? a) Physiological anemia b) Respiratory acidosis c) Mastitis d) Metabolic alkalosis
Physiological anemia Correct Explanation: Hemoglobin level and hematocrit decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production. Mastitis is an infection in the breast characterized by a swollen tender breast and flulike symptoms. This condition is most commonly seen in breast-feeding clients. Alterations in acid-base balance during pregnancy result in a state of respiratory alkalosis, compensated by mild metabolic acidosis.
A woman with a long history of controlled asthma has just had her first antenatal visit for her fourth child. She is late for a meeting and says she knows what to do. What is the best action the nurse can take? a) Note in the chart that the woman was not counseled about her asthma. b) Remind her to continue taking her asthma medications, to monitor her peak flow daily, and to monitor the baby's kicks in the second and third trimesters. c) Acknowledge her need to leave but ask her to demonstrate the use of her inhaler and her peak flow meter before she goes; make any necessary corrections to her technique. Remind her to take her regular medications. d) Schedule an appointment for her to return to discuss her asthma management.
Acknowledge her need to leave but ask her to demonstrate the use of her inhaler and her peak flow meter before she goes; make any necessary corrections to her technique. Remind her to take her regular medications. Correct Explanation: Management of asthma during pregnancy is very important, the nurse must document the patient has the proper ability to manage her asthma for her health and the health of the fetus. Reminding the patient to continue taking her prescribed medication to monitor her peak flow daily is not enough. It is the nurse's responsibility to KNOW that the patient knows how to take her medications. Monitoring the baby's kicks in the second and third trimester is an appropriate action. Scheduling a return appointment to discuss asthma management is not appropriate. She could have an asthma attack between the time you see her and the time you schedule a return appointment. Noting in the chart that the woman was not counseled does not relieve the nurse of her obligation to ensure that the woman knows how to use her inhaler and her peak flow meter
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 make her infant at risk for? a) Neonatal laryngeal papillomas b) Blindness c) Chicken pox d) Deafness
Blindness Correct Explanation: A pregnant woman who contracts chlamydia is at increased risk for spontaneous abortion (miscarriage), pre-term rupture of membranes, and pre-term labor. The postpartum woman is at higher risk for endometritis (Fletcher & Ball, 2006). The fetus can encounter bacteria in the vagina during the birth process. If this happens, the newborn can develop pneumonia or conjunctivitis that can lead to blindness.
A woman with cardiac disease is 32 weeks gestation and alerts the nurse she has been having spells of light-headedness and dizziness every few days. The nurse provides which of the following interventions as an option to the patient? a) The patient needs to discuss induction of labor with the physician. b) Bed rest and bathroom privileges only until delivery. c) Increase fluids and take more vitamins. d) Decrease activity and rest more often.
Decrease activity and rest more often. Explanation: If the patient is developing symptoms associated with her heart condition, the first intervention is to monitor activity levels, decrease activity and treat the symptoms. At 32 weeks gestation, the suggestion to induce labor is not appropriate and without knowledge of the type of heart condition one would not recommend increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity. Therefore options B, C, and D are incorrect,
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? a) Long-acting insulin b) Diet c) Oral hypoglycemic drugs d) Glucagon
Diet Correct Explanation: Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually isn't needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are contraindicated in pregnancy. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.
Which of the following changes in pregnancy would the nurse identify as a contributing factor for arterial thrombosis, especially for the woman with atrial fibrillation? a) Hypercoagulable state b) Increase in blood volume c) Increased cardiac output d) Elevation of diaphragm
Hypercoagulable state Correct Explanation: The nurse should identify that the increased risk of arterial thrombosis in atrial fibrillation is due to hypercoagulable state of pregnancy. During pregnancy there is a state of hypercoagulation. This increases the risk of arterial thrombosis in clients having atrial fibrillation and artificial valves. Increased cardiac output and blood volume do not cause arterial thrombosis. Elevation of the diaphragm is due to the uterine distension and it causes a shift in the QRS axis and is not a associated with arterial thrombosis.
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 of the following? a) Milk b) Legumes c) Orange juice d) Meals high in iron
Orange juice Correct Explanation: Anemia is a condition in which the blood is deficient in red blood cells, from an underlying cause. The woman needs to take iron to manufacture enough red blood cells. Taking an iron supplement will help improve her iron levels, and taking iron with foods containing ascorbic acid, such as orange juice, improve the absorption of iron. Eating meals high in iron, drinking milk, and eating legumes does not improve the absorption of iron.
A 40-year-old woman comes to the clinic complaining of having missed her period for two months. A pregnancy test is positive. What is she and her fetus at increased risk for? a) Type II diabetes Mellitus b) Type I diabetes Mellituus c) Post-term delivery d) Placental abnormalities
Placental abnormalities Correct Explanation: A woman older than 35 years is more likely to conceive a child with chromosomal abnormalities, such as Down syndrome. She is also at higher risk for spontaneous abortion (miscarriage), preeclampsia-eclampsia, gestational diabetes, pre-term delivery, bleeding and placental abnormalities, and other intrapartum complications.
A woman who has sickle cell anemia asks you if her infant will develop sickle cell disease. You would base your answer on which of the following? a) Sickle cell anemia is dominantly inherited. b) Sickle cell anemia has more than one polygenic inheritance pattern. c) Sickle cell anemia is recessively inherited. d) Sickle cell anemia is not inherited; it occurs following a malaria infection.
Sickle cell anemia is recessively inherited. Correct Explanation: 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.
Working with pregnant teenagers as a special population requires the nurse to have knowledge of adolescent development. Which of the following is crucial for a positive pregnancy and outcome for the mother and fetus? a) Involvement of the father b) Acceptance by peers c) Support network d) Cultural sensitivity
Support network Correct Explanation: One crucial part of management of teenage adolescent pregnancy includes helping the teens to develop an adequate support network. The network may include parents, teachers, friends and the father of the baby in addition to resources needed to provide care for the infant and self. Cultural sensitivity, involvement of the father, and acceptance by peers are important to the teenager who is pregnant, but they are not considered crucial for a positive pregnancy and outcome for the mother and fetus.
A pregnant woman with sickle cell anemia comes to the emergency department in crisis. Which of the following would the nurse expect to find? Select all that apply. a) Increased skin turgor b) Joint pain c) Fever d) Fatigue e) Pallor
• Joint pain • Fever Correct Explanation: Signs and symptoms of a sickle cell crisis commonly include severe abdominal pain, muscle spasm, leg pains, joint pain, fever, stiff neck, nausea and vomiting, and seizures. Skin turgor would most likely be poor because the client would probably be dehydrated. Pallor and fatigue are associated with sickle cell anemia and would not help identify a crisis.
A client in week 38 of her pregnancy arrives at the emergency room reporting a sharp pain between her umbilicus and the iliac crest in her lower right abdomen that is increasing. She reports having experienced intense nausea and vomiting for the past 3 hours. Given these symptoms, the nurse suspects which of the following conditions? a) Left-sided heart failure b) Ectopic pregnancy in conjunction with morning sickness c) Appendicitis d) Pulmonary embolism
Appendicitis Correct Explanation: With appendicitis, the nausea and vomiting is much more intense than with morning sickness and the pain is sharp and localized at McBurney's point (a point halfway between the umbilicus and the iliac crest on the lower right abdomen). With a ruptured ectopic pregnancy, a woman may experience abdominal pain that is either diffuse or sharp, but it is less likely to occur precisely at McBurney's point. The symptoms described do not match those of pulmonary embolism or left-sided heart failure.
You are doing patient teaching with a 28 weeks' gestation woman who has tested positive for gestational diabetes mellitus (GDM). What would be important to include in your patient 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.
She is at increased risk for type II diabetes mellitus after her baby is born. Correct Explanation: The woman who develops GDM is at increased risk for developing type 2 DM after pregnancy.
A nursing instructor is teaching students about pre-existing 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) "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy." b) "A pregnant woman with a chronic condition can put herself at risk." c) "A pregnant woman does not have to worry about contracting new illnesses during pregnancy." d) "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." Correct 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.
You are the clinic nurse caring for a pregnant woman in her third trimester. The woman is HIV positive and voices concerns about passing the infection on to her baby. What is your best response? a) Perinatal transmission of the virus is a real fear. Would you like to talk to a social worker? b) Do you have other children? Your baby has a one-in-four chance of having HIV at birth, so if you have three other children who are not HIV positive, then this one will be HIV positive. c) If you are taking antiretroviral medications and you don't breastfeed your baby, you greatly reduce the risk of perinatal transmission of the disease. d) There is nothing you can do. You will just have to wait and see if your baby is born HIV positive.
If you are taking antiretroviral medications and you don't breastfeed your baby, you greatly reduce the risk of perinatal transmission of the disease. Correct Explanation: Receiving appropriate antiretroviral treatment during pregnancy and childbirth and refraining from breastfeeding substantially reduce the risk of perinatal transmission.
A nurse is assessing a client in her seventh month of pregnancy who has an artificial valve prosthesis. The client is taking an oral anticoagulant to prevent the formation of clots at the valve site. Which of the following nursing interventions is most appropriate in this situation? a) Instruct the client to avoid wearing constrictive knee-high stockings b) Observe the client for signs of petechiae and premature separation of the placenta c) Put the client on bed rest d) Urge the client to discontinue the anticoagulant to prevent pregnancy complications
Observe the client for signs of petechiae and premature separation of the placenta Correct Explanation: Subclinical bleeding from continuous anticoagulant therapy in the woman has the potential to cause placental dislodgement. Observe a woman who is taking an anticoagulant for signs of petechiae and signs of premature separation of the placenta, therefore, during both pregnancy and labor. The nurse should not urge the client to discontinue the anticoagulant, as this is not within the nurse's scope of practice and, in any case, the client still needs the anticoagulant to prevent clots. Bed rest is prescribed for clients with a thrombus, to prevent it from moving and becoming a pulmonary embolus. Avoiding the use of constrictive knee-high stockings is to prevent thrombus formation.
A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. Which of the following does the nurse anticipate in this woman's pregnancy? a) Potential for greater than usual back pain b) Cesarean birth c) Increased risk of miscarriage d) Increased risk of fetal trauma
Potential for greater than usual back pain Explanation: Surgical correction of scoliosis (lateral curvature of the spine) involves implanting stainless-steel rods on both sides of the vertebrae to strengthen and straighten the spine. Such rod implantations do not interfere with pregnancy; a woman may notice more than usual back pain, however, from increased tension on back muscles. If a woman's pelvis is distorted due to scoliosis, a cesarean birth may be scheduled to ensure a safe birth, but this is not required in this scenario. Vaginal birth, if permitted, requires the same management as for any woman. With the improved management of scoliosis, the high maternal and perinatal risks associated with the disorder reported in earlier literature no longer exist
A woman is pregnant and has asthma. Her physician 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? a) Prednisone is a teratogenic drug, but she may need it to control her asthma symptoms. b) You would recommend she omit the drug during pregnancy. c) She should half her dose during the first 3 months of pregnancy. d) Prednisone is considered safe in the doses prescribed by her physician.
Prednisone is considered safe in the doses prescribed by her physician. Correct Explanation: Women should take no medication during pregnancy except that prescribed by their primary care provider. Prednisone may be prescribed safely because, although it may be teratogenic in animal models, it does not appear to be teratogenic in humans. The nurse would not recommend changing the dosage of any medication prescribed by the woman's physician. Nor would the nurse recommend that the woman stop taking the drug during pregnancy. These are decisions made between the woman and her physician. The woman's need to control her asthma symptoms is not related to the fact that prednisone is teratogenic in animal models, since it does not appear to be teratogenic in humans.
Which of the following is recommended to prevent transmission of HIV to a newborn if the mother has AIDS? a) Admit infant to NICU after delivery. b) Prepare for cesarean delivery. c) Perform amniotomy. d) Avoid scalp electrodes for internal fetal monitoring.
Prepare for cesarean delivery. Correct Explanation: When a patient is HIV positive, the method of delivery preferred is cesarean. This method has the lowest transmission rate for passage of the HIV infection to the infant. The nurse should educate the woman on the standard of care for delivery in an HIV or AIDS positive mother. Avoiding scalp electrodes for internal fetal monitoring, admitting the infant to NICU, and performing an amniotomy are not recommended methods for preventing transmission of HIV to a newborn.
