PREPU Chapter 19: Conditions Existing Before Conception

A pregnant client diagnosed with depression has been prescribed a selective serotonin reuptake inhibitor (SSRI) as part of the treatment regimen. The client tells the nurse "I am not taking this medication. I am afraid it could cause problems with my baby!" How will the nurse respond?

"I understand your concern for your baby. This type of medication is not known for adverse fetal effects. "

A pregnant client asks why a maternal serum alpha-fetoprotein level has been ordered. What should the nurse explain to the client about this test? A. It may reveal chromosomal abnormalities. B. It measures the fetal liver function. C. It screens for placenta function. D. It tests the ability of the client's heart to accommodate the pregnancy.

A Alpha-fetoprotein (AFP) is a substance produced by the fetal liver that can be found in both amniotic fluid and maternal serum. The level is abnormally high if the fetus has an open spinal or abdominal wall defect because the open defect allows more AFP to enter the mother's circulation. The alpha-fetoprotein level is not used to screen for placenta functioning, measure fetal liver function, or test the ability of the client's heart to accommodate the pregnancy.

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? A. "Your primary care provider will order safe doses of your medication." B. "They won't cause any major defects." C. "It's OK to not use them if you would feel more comfortable." D. "I'll let your primary care provider know how you feel about it."

A 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 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

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: A. check her blood sugars frequently and adjust insulin accordingly. B. exercise for 1 to 2 hours each day to keep the blood glucose down. C. limit weight gain to 15 pounds during the pregnancy. D. begin oral hyperglycemic medications along with the insulin she is currently taking.

A 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 is caring for a pregnant client admitted for abdominal trauma following an assault. The nurse will monitor the client for which potential complications? Select all that apply. A. Uterine rupture B. Spontaneous abortion (miscarriage) C. Placental abruption (abruptio placentae) D. Preterm labor E. Gestational hypertension

A,B,C,D Miscarriage, placental abruption, uterine rupture, and preterm labor are all potential complications of abdominal trauma during pregnancy. Gestational hypertension is not related to or caused by trauma.

A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron supplement. After teaching her about the prescribed iron supplement, which statement indicates successful teaching? A. "I will call the health care provider if my stool is black and tarry." B. "I need to drink plenty of fluids to prevent constipation." C. "I should take my iron with milk." D. "I should avoid drinking orange juice."

B Iron can lead to constipation, so the woman needs to increase her intake of fluids Milk inhibits absorption and should be discouraged Vitamin C-containing fluids are encouraged they promote absorption Ideally the woman should take the iron on an empty stomach to improve absorption, but many women cannot tolerate the GI discomfort it causes the woman should take it with meals Iron causes the stool to become black and tarry; there is no need for the woman to notify the health care provider.

A nurse is interviewing a couple at a preconception counseling session. The couple is of Greek heritage and are concerned about the possibility of their children being born with a genetic disorder. Based on the nurse's understanding of genetic disorders, the nurse would identify this couple as being at risk for which condition? A. sickle cell anemia B. β-thalassemia C. α-thalassemia D. Tay-Sachs disease

B The blood disorder β-thalassemia, for example, occurs most frequently in families of Greek or Mediterranean heritage, whereas α-thalassemia occurs most often in persons from the Philippines or southeast Asia. Sickle-cell anemia occurs most often in people with an African ancestry. Tay-Sachs disease, a deterioration of muscle and mental facilities, occurs most often in people of eastern Jewish ancestry.

The health care provider of a newly pregnant client determines the woman also has mitral stenosis and will need appropriate therapy. Which medication should the nurse prepare to teach this client to provide her with the best possible care? A. digoxin B. heparin C. aspirin D. warfarin

B This client has an increased risk for developing blood clots. If an anticoagulant is required, heparin is the drug of choice as it does not cross the placenta barrier. Warfarin crosses the placenta and may have teratogenic effects. Aspirin is not recommended in this situation. Digoxin is not used to prevent blood clots.

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. A. Cystic fibrosis B. Increased risk of spontaneous abortion (miscarriage) C. Decreased birth weight D. Hypertension E. Polyhydramnios

B,D,E 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. Spontaneous abortion is higher in women who have pregestational diabetes Also, they run a higher risk of having a pregnancy with polyhydramnios, and of developing maternal hypertension. The birth weight of an infant born to a mother with diabetes is increased, not decreased. Cystic fibrosis is not associated with maternal diabetes.

A woman's OB prescribes vitamin K supplements for a client who is on antiepileptic medications beginning at 36 weeks' gestation. The mother asks the nurse why she is taking this medication. The nurse's best response would be A. vitamin K helps in keeping the placenta healthy B. administration of vitamin K aids in lung maturity of the fetus C. antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn D. The antiepileptic medications can cause the mother's platelets to dr

C Antiepileptic therapy may cause vitamin K-deficient hemorrhage of the newborn. The vitamin K injection the newborn receives following birth can't fully correct this, so some physicians recommend a vitamin K supplement for their pregnant clients beginning at 36 weeks' gestation. If the mother should go into preterm labor, the newborn will have received the vitamin K prior to delivery. However, many physicians now question the usefulness of the prophylaxis.

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? A. My baby may be very large and I may need a cesarean birth to have him B. I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born C. If my blood sugars are elevated, my baby's lungs will mature faster, which is

C 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. Doing fetal movement (kick) counts is standard practice, as is the possibility of an amniocentesis to determine lung maturity during the third trimester. Health care personnel should also prepare the mother for the potential of a cesarean birth if the infant is too large.

A client at 20 weeks' gestation experiences a miscarriage. For the use of which substance should the nurse assess this client? A. vitamin supplements B. alcohol C. cocaine D. caffeine

C Miscarriage is an obstetrical risk for the use of cocaine. Alcohol can cause low birth weight, small for gestational age, preterm birth, and stillbirth. Caffeine is not associated with any particular obstetrical risk. Vitamin supplements are not identified as causing any specific obstetrical risk.

A pregnant client with deep vein thrombosis has been diagnosed as having systemic lupus erythematosus (SLE). The nurse would monitor the client closely for the development of which complication? A. fetal macrosomia B. postterm birth of infant C. fetal malnutrition D. increased placental weight

C SLE is an autoimmune disorder in which there is a deposition of immune complexes in the capillaries and visceral structures Clients with SLE are at an increased risk of fetal malnutrition due to decreased placental circulation Pregnancy-related problems in SLE include prematurity, stillbirth, decreased placental weight, and thinner placental villi In clients with SLE, there is preterm birth and decreased placental weight Fetal macrosomia is seen in clients having gestational diabetes, not SLE

The nurse is caring for a client with sickle cell disease who is in the 24th week of pregnancy. Which response will the nurse make when the client asks why weekly examinations are needed for the remainder of the pregnancy? A. "Your baby is at risk for having sickle cell disease." B. "Your baby is growing too large and you might need to give birth sooner." C. "Your risk of having a crisis increases as the pregnancy progresses." D. "You are at risk for bleeding and need to be monitored."

C Sickle effects almost all organ systems of the body Because approximately half of pregnant clients with sickle cell disease experience a crisis related to pregnancy usually in the last months of pregnancy an increase in examinations would be warranted The fetus's risk of having sickle cell disease will depend on the results of preconception genetic counseling Clients with sickle cell disease have a lower risk of postpartum hemorrhage Obstetrical risks include fetal growth restriction

A client has cardiac disease is at 36 wks. Assessment: moist cough, leg and finger swelling, heart palps, fatigue, BP128/90 HR106 RR30 FHR52. Which is the appropriate action for the nurse to take? A. Document the assessment as normal findings during late pregnancy B. Extend the nonstress test for an additional 40 minutes C. Notify the health care provider of the findings for further assessment D. Explain that the swelling and increased fatigue are normal findings during pregnancy

C The nurse will notify the health care provider of the findings, because the client's swelling, palpitations, increased fatigue, cough, and vital signs are suggestive of cardiac decompensation. Fatigue and swelling of the fingers and lower extremities are normal findings in late pregnancy but coupled with the heart rate, respirations, cough, and palpitations are abnormal findings. A reactive nonstress test is a normal finding that does not require extending the test.

A young adult client with anorexia nervosa is concerned about missing menstrual periods for several months. How will the nurse respond? A. "Being pregnant will help cure the eating disorder." B. "It is unlikely that you are pregnant." C. "You may still ovulate and can be pregnant." D. "Spontaneous abortions are common with your condition."

C A client with anorexia nervosa may not menstruate or may menstruate irregularly. The nurse should inform clients with eating disorders who do not menstruate regularly that a lack of menses does not necessarily indicate a lack of ovulation and that they may still be fertile. The nurse has no way of knowing if the client is pregnant. There is no evidence that clients with anorexia nervosa experience spontaneous abortions.

A mother concerned about managing her asthma while she is pregnant. Which response indicates the woman needs further instruction? A. I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on B. I need to be aware of my triggers, avoid them as much as possible C. Its fine for me to use my albuterol inhaler if I feel tight D. I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring

D A pregnant woman with a history of asthma needs to be proactive, taking her inhalers and other asthma medications to prevent an acute asthma attack. It is far more dangerous to not take the medications and have an asthma attack. She also needs to monitor her peak flow for decreases, be aware of triggers, and avoid them if possible. However, a pregnant woman should never begin allergy shots if she has not been taking them previously, due to the potential of an adverse reaction

A client who is 18 weeks' pregnant has a history of depression. For which potential effect should the nurse plan care for this client? A. placental abruption B. large for gestational age C. fetal demise D. preterm birth

D Preexisting depression and antepartum depression are associated with a small increased risk for preterm birth. Fetal demise, large for gestational age, and placental abruption are not associated with preexisting or antepartum depression.

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? A. inspecting the extremities for edema B. ensuring that the client consumes a high fiber diet C. limiting sodium intake D. assessing for cardiac decompensation

D 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. 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 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? A. shortness of breath, bradycardia, and hypertension B. increased urinary output, tachycardia, and dry cough C. regular heart rate and hypertension D. dyspnea, crackles, and irregular weak pulse

D 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. The heart rate would not be regular, and a cough would not be dry. The heart rate would increase rather than decrease.

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? A. Refer her for drug and alcohol counseling. B. Reassure her that ambivalence is normal. C. Give her printed material to read at home. D. Alert the RN or health care provider.

D A client on an SSRI 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. Reassurance is good practice, but not enough in this case. You do not have enough information to refer her for drug and alcohol counseling. She is under the care of another provider for her mental disorder, so do not confuse her with more material to read.

A woman with an artificial mitral valve develops heart failure at the 20th week of pregnancy. Which measure would the nurse stress with her during the remainder of the pregnancy? A. discontinuing her prepregnancy anticoagulant B. maintaining a high fluid intake C. beginning a low-impact aerobics program D. obtaining enough rest

D As the blood volume doubles during pregnancy, heart failure can occur. The pregnant woman needs to obtain adequate rest to prevent overworking the heart. Fluid may need to be restricted.

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 recessively inherited.

The nurse reviews the note for a client who is 16 weeks' pregnant (above). For which potential condition will the nurse assess this client?

eating disorder

Which factor would contribute to a high-risk pregnancy?

type 1 diabetes