PrepU ch20
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 does not have to worry about contracting new illnesses during pregnancy." "A pregnant woman with a chronic illness can put the fetus at risk." "A pregnant woman with a chronic condition can put herself at risk." "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." 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.
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? "Certain substances make me sneeze." "I sometimes get a feeling of euphoria." "I have trouble getting comfortable in bed." "I sometimes get a bit wheezy."
"I sometimes get a bit wheezy." 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 know I will be fine, but I worry about the fetus." "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." "I don't have to worry about this because I had the problem fixed before I became pregnant."
"I understand that my fetus and I both are at risk for complications." When a woman enters pregnancy with a preexisting condition, both she and her fetus can be at risk of developing complications.
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 1600 1400 1500
1500 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 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? 7.5% 8.0% 6.5% 8.5%
6.5% 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? 8.5% 7% 6.0% 5.5%
8.5% A glycosylated hemoglobin level of less than 7% indicates good control; a value of more than 8% indicates poor control and warrants intervention. Therefore, the nurse would need to revise the plan of care.
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 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 postpartum mother has the following lab data recorded: a negative rubella titer. What is the appropriate nursing intervention? Administer rubella vaccine before discharge. Assess the rubella titer of the baby. Notify the health care provider. No action needed
Administer rubella vaccine before discharge. Rubella is a virus, which when contracted during pregnancy has significant complications for the fetus. The illness is mild to the adult but can result in the infant being born deaf and blind. There is no cure; the CDC recommends all individuals be vaccinated against rubella. If the titer is negative, the mother does not have protection against rubella, and the next pregnancy would be at risk. She should receive the vaccination prior to discharge from the hospital. Assessing the rubella titer of the baby would not mean anything. The baby has not had rubella and has not received antibodies against rubella from the mother. Notifying the health care provider is not a priority, as most institutions have standing orders to administer the rubella vaccine if the mother's rubella titer is negative.
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? 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. 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. This client is pregnant for the first time later in life. The nurse must be supportive of this choice. Most women realize the increased risks for having giving birth after 35 years of age and do not need constant reminding of the potentially poor outcomes that can occur. The majority of pregnancies to women older than 35 years of age end with healthy newborns and mothers.
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 dominantly inherited. Sickle cell anemia has more than one polygenic inheritance pattern. Sickle cell anemia is not inherited; it occurs following a malaria infection. Sickle cell anemia is recessively inherited.
Sickle cell anemia is recessively inherited. 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 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." "You should wait until after you give birth to obtain the cat for your daughter." "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 deliver to obtain the cat for your daughter Toxoplasma gondii is a protozoan that can be transmitted via undercooked meat and through cat litter. Having a cat is not an issue, but cleaning the litter box may expose the mother to the infection and result in fetal anomalies. Exposure to the cat litter will not necessitate a cesarean section, and having a cat will not cut down on any jealousy the 2-year-old might feel when the new baby is born. The nurse would discourage the mother from getting cat until after the baby is born.
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? cesarean birth future pregnancies handling the infant with open sores breastfeeding
breastfeeding 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.
The nurse is assessing a 35-year-old woman at 22 weeks' gestation who has had recent laboratory work. The nurse notes fasting blood glucose 146 mg/dl (8.10 mmol/L), hemoglobin 13 g/dl (130 g/L), and hematocrit 37% (0.37). Based on these results, which instruction should the nurse prioritize? Include iron-enriched foods in the diet. Check blood sugar levels daily. Take daily iron supplements. the signs and symptoms of urinary tract infection
check blood sugar levels daily An elevated blood glucose is concerning for diabetes. A fasting blood glucose level of greater than 140 mg/dl (7.77 mmol/L) or random level of greater than 200 mg/dl (11.10 mmol/L) is concerning; this must be followed up to ensure the client is not developing gestational diabetes. The hemoglobin and hematocrit are within normal limits for this client. The values should be hemoglobin greater than 11 g/dl (110 g/L) and hematocrit greater than 33% (0.33). Values lower than that are possible indications of anemia and would necessitate further evaluation. An individual with higher than normal blood glucose levels is at risk for developing urinary tract infection. This will usually happen after the glucose levels are elevated. Anemia can be treated by increasing the consumption of iron-enriched foods and taking a daily iron supplement.
A pregnant woman tests positive for tuberculosis (TB). The nurse explains to the woman that additional tests are needed to confirm the diagnosis. When describing these tests, which one(s) would the nurse likely include? Select all that apply. sputum culture abdominal ultrasound whole-body CT scan chest x-ray spirometry
chest xray sputum culture If a TB screening test is positive, the woman will need a follow-up chest x-ray with lead shielding over the abdomen, as well as sputum cultures to confirm the diagnosis. A whole-body CT scan, spirometry, or abdominal ultrasound are not used to confirm the diagnosis.
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 gonorrhea toxoplasmosis chlamydia
cytomegalovirus The nurse would be alert for the development of cytomegalovirus infection. Pregnant women acquire active disease primarily from sexual contact, blood transfusions, kissing, and contact with children in day care centers. It can also be spread through vertical transmission from mother to child in utero (causing congenital CMV), during birth, or through breastfeeding. Chlamydia, gonorrhea, and toxoplasmosis are not spread through contact with children in day care centers.
What important instruction should the nurse give a pregnant client with tuberculosis? Avoid direct sunlight. Avoid red meat. Maintain adequate hydration. Wear light, cotton clothes.
maintain adequate hydration 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.
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? Repaired atrial septal defect Pulmonary hypertension Loud systolic murmur Secondary hypertension
pulmonary HTN 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 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? prophylactic antiretroviral therapy (ART) to the infant at birth the viral load amniocentesis results at 34 weeks' gestation the mother's age
the viral load A woman who has HIV during pregnancy is at risk for transmitting the infection to the fetus during pregnancy or childbirth and to the newborn while breastfeeding. The type of birth, vaginal or cesarean, depends on several factors, including the woman's viral load, use of ART during pregnancy (not waiting until the birth), length of time membranes have been ruptured, and gestational age (not mother's age). With prenatal ART and prophylactic treatment of the newborn, there is a reduced risk of perinatal HIV transmission. The amniocentesis results would not be a factor in preventing the spread of HIV to the infant and may actually lead to the fetus being infected through the puncture site and bleeding into the amniotic sac.
A nurse is assessing a newborn and suspects that newborn may have been exposed to alcohol during gestation. The nurse suspect this based on which newborn findings? Select all that apply. thin upper lip small head circumference limb abnormality large inset eyes macrocephaly
thin upper lip small head circumference limb abnormality Characteristics of a fetal alcohol spectrum disorder include craniofacial dysmorphia (thin upper lip, small head circumference, and small eyes), intrauterine growth restriction, microcephaly, and congenital anomalies such as limb abnormalities and cardiac defects.
