OB: High Risk 2

A pregnant client is diagnosed with syphilis. Which interviewing question would demonstrate respect for the client and therapeutic communication?

"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 pregnant woman with diabetes is having her glycosylated hemoglobin 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?

6.5% Explanation: A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. A glycosylated hemoglobin level of more than 8.0% indicates poor blood glucose control and the need for intervention, necessitating a revision in the woman's plan of care.

What important instruction should the nurse give a pregnant client with tuberculosis?

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 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?

physiological anemia 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 flu-like symptoms. This condition is most commonly seen in breastfeeding clients. Alterations in acid-base balance during pregnancy result in a state of respiratory alkalosis, compensated by mild metabolic acidosis.

Which factor would contribute to a high-risk pregnancy?

type 1 diabetes 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 does not increase risk, nor does type O-positive blood or environmental allergens.

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?

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.

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?

Continue taking iron supplements but increase fluids and high-fiber foods; exercise more. Explanation: Constipation is a common side effect of iron supplementation. The diagnosis of anemia indicates a true need for the iron supplementation; she needs to increase fluid and fiber to relieve the constipation associated with the iron preparations. The nurse should not advise this client to stop taking her iron supplements, even for a few days. The nurse should not advise the client to increase her iron supplementation, nor take the supplements on an every other day basis. These supplements are ordered by the primary care provider based on the client's hematologic status.

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 in a semi-recumbent position. Explanation: Semi-recumbent position is the best position for circulation of the mother and fetus. Lying flat on the back can induce supine hypotensive syndrome and fully recumbent impedes other circulation. The high Fowler's position would not be comfortable for sleeping, as well as possibly impede the blood flow through the hips and lower abdomen.

The nurse is caring for a patient who desires to become pregnant within a few months. Which outcome regarding folic acid intake would be appropriate for this patient?

The client will begin taking 400 μg of folic acid every day. Explanation: All patients expecting to become pregnant are advised to begin a supplement of 400 μg folic acid daily in addition to eating foods rich in folic acid. The folic acid supplement is not needed with each meal. Foods high in folic acid should be consumed in addition to the supplement. The patient should take folic acid supplements before becoming pregnant and not wait until pregnancy is confirmed.

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." Explanation: Women should take no medication during pregnancy except that prescribed by their primary care provider. The PCP will work with the mother to ensure the safest amount is given to adequately handle the mother's health issues and not injure the fetus. The PCP must weigh the risks against the benefits for both the mother and her fetus. The nurse should not encourage the client to stop her asthma medication as that may result in the client having an asthma attack, which could result in injury to the fetus or even miscarriage. The nurse should not tell the client a drug will not cause any defects, especially if it is known that it can. That could make the nurse liable for damages. The nurse should inform the PCP of the client's concerns; however, it is more important for the nurse to calm the client's anxiety and offer positive reinforcement that the PCP is working hard to protect the mother and infant from harm.