Deck 17: Pregnancy at Risk: Pregestational Problems

Question 1

A newly diagnosed insulin-dependent type 1 diabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. What would the best explanation include?

A) "Your baby could be smaller than average at birth."
B) "Your baby will probably be larger than average at birth."
C) "As long as you control your blood sugar, your baby will not be affected at all."
D) "Your baby might have high blood sugar for several days."

Answer 1

B

Question 2

The client has just been diagnosed as diabetic. The nurse knows teaching was effective when the client makes which statement?

A) "Ketones in my urine mean that my body is using the glucose appropriately."
B) "I should be urinating frequently and in large amounts to get rid of the extra sugar."
C) "My pancreas is making enough insulin, but my body isn't using it correctly."
D) "I might be hungry frequently because the sugar isn't getting into the tissues the way it should."

Answer 2

D

Question 3

Which of the following may be the main presenting symptom of iron deficiency anemia?

A) Frequent urination
B) Fatigue
C) Nausea
D) Headaches

Answer 3

B

Question 4

The maternal health nurse is caring for a pregnant client with obsessive-compulsive disorder (O C D). Which action will the nurse take when teaching the client, based on the client's psychological disorder?

A) Allow the client opportunity for repetitive rituals.
B) Ask the client to follow along with written material.
C) Repeat instructions as needed.
D) Provide multiple handouts with various photographs

Question 5

A 26-year-old client is 26 weeks pregnant. Her previous births include two large-for-gestational-age babies and one unexplained stillbirth. Which tests would the nurse anticipate as being most definitive in diagnosing gestational diabetes?

A) A 50g, 1-hour glucose screening test
B) A single fasting glucose level
C) A 100g, 1-hour glucose tolerance test
D) A 100g, 3-hour glucose tolerance test

Question 6

During the history, the client admits to being H I V-positive and says she knows that she is about 16 weeks pregnant. Which statements made by the client indicate an understanding of the plan of care both during the pregnancy and postpartally?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) "During labor and delivery, I can expect the zidovudine (Z D V) to be given in my Ⅳ."
B) "After delivery, the dose of zidovudine (Z D V) will be doubled to prevent further infection."
C) "My baby will be started on zidovudine (Z D V) for six weeks following the birth."
D) "My baby's zidovudine (Z D V) will be given in a cream form."
E) "My baby will not need zidovudine (Z D V) if I take it during my pregnancy."

Question 7

A 21-year-old at 12 weeks' gestation with her first baby has known cardiac disease, class Ⅲ, as a result of childhood rheumatic fever. During a prenatal visit, the nurse reviews the signs of cardiac decompensation with her. The nurse will know that the client understands these signs and symptoms if she states that she would notify her doctor if she had which symptom?

A) "A pulse rate increase of 10 beats per minute"
B) "Breast tenderness"
C) "Mild ankle edema"
D) "A frequent cough"

Question 8

Women with H I V should be evaluated and treated for other sexually transmitted infections and for what condition occurring more commonly in women with H I V?

A) Syphilis
B) Toxoplasmosis
C) Gonorrhea
D) Herpes

Question 9

A woman is 32 weeks pregnant. She is H I V-positive but asymptomatic. The nurse knows that what would be important in managing her pregnancy and delivery?

A) An amniocentesis at 30 and 36 weeks
B) Weekly non-stress testing beginning at 32 weeks' gestation
C) Application of a fetal scalp electrode as soon as her membranes rupture in labor
D) Administration of intravenous antibiotics during labor and delivery

Question 10

The client with thalassemia intermedia has a hemoglobin level of 9.0. The nurse is preparing an education session for the client. Which statement should the nurse include?

A) "You need to increase your intake of meat and other iron-rich foods."
B) "Your low hemoglobin could put you into preterm labor."
C) "Increasing your vitamin C intake will help your hemoglobin level."
D) "You should not take iron supplements."

Question 11

The nurse is caring for a pregnant woman who admits to using cocaine and ecstasy on a regular basis. The client states, "Everybody knows that alcohol is bad during pregnancy, but what's the big deal about ecstasy?" What is the nurse's best response?

A) "Ecstasy can cause a high fever in you and therefore cause the baby harm."
B) "Ecstasy leads to deficiencies of thiamine and folic acid, which help the baby develop."
C) "Ecstasy produces babies with small heads and short bodies with brain function alterations."
D) "Ecstasy produces intrauterine growth restriction and meconium aspiration."

Question 12

The client at 9 weeks' gestation has been told that her H I V test was positive. The client is very upset, and tells the nurse, "I didn't know I had H I V! What will this do to my baby?" The nurse knows teaching has been effective when the client makes which statement?

A) "I cannot take the medications that control H I V during my pregnancy, because they will harm the baby."
B) "My baby can get H I V during the pregnancy and through my breast milk."
C) "The pregnancy will increase the progression of my disease and will reduce my C D4 counts."
D) "The H I V won't affect my baby, and I will have a low-risk pregnancy without additional testing."

Question 13

A 26-year-old client is 28 weeks pregnant. She has developed gestational diabetes. She is following a program of regular exercise, which includes walking, bicycling, and swimming. What instructions should be included in a teaching plan for this client?

A) "Exercise either just before meals or wait until 2 hours after a meal."
B) "Carry hard candy (or other simple sugar) when exercising."
C) "If your blood sugar is 120 m g/d L, eat 20 g of carbohydrate."
D) "If your blood sugar is more than 120 m g/d L, drink a glass of whole milk."

Question 14

A woman's history and appearance suggest drug abuse. What is the nurse's best approach?

A) Ask the woman directly, "Do you use any street drugs?"
B) Ask the woman whether she would like to talk to a counselor.
C) Ask some questions about over-the-counter medications and avoid mention of illicit drugs.
D) Explain how harmful drugs can be for her baby.

Question 15

A woman asks her nurse what she can do before she begins trying to get pregnant to help her baby, as she is prone to anemia. What would the nurse correctly advise her to do?

A) Get pregnant, then start iron supplementation.
B) Add more carbohydrates to her diet.
C) Begin taking folic acid supplements daily.
D) Have a hemoglobin baseline done now so her progress can be followed.

Question 16

A client is at 12 weeks' gestation with her first baby. She has cardiac disease, class Ⅲ. She states that she had been taking sodium warfarin (Coumadin), but her physician changed her to heparin. She asks the nurse why this was done. What should the nurse's response be?

A) "Heparin is used when coagulation problems are resolved."
B) "Heparin is safer because it does not cross the placenta."
C) "They are the same drug, but heparin is less expensive."
D) "Coumadin interferes with iron absorption in the intestines."

Question 17

A pregnant woman is married to an intravenous drug user. She had a negative H I V screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for H I V?

A) Hemoglobin of 11 g/d L and a rapid weight gain
B) Elevated blood pressure and ankle edema
C) Shortness of breath and frequent urination
D) Persistent candidiasis

Question 18

A 20-year-old woman is at 28 weeks' gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used heroin. The nurse should recognize that the woman is at increased risk for which condition?

A) Erythroblastosis fetalis
B) Diabetes mellitus
C) Abruptio placentae
D) Pregnancy-induced hypertension

Question 19

The client at 20 weeks' gestation has had an ultrasound that revealed a neural tube defect in her fetus. The client's hemoglobin level is 8.5. The nurse should include which statement when discussing these findings with the client?

A) "Your low iron intake has caused anemia, which leads to the neural tube defect."
B) "You should increase your vitamin C intake to improve your anemia."
C) "You are too picky about food. Your poor diet caused your baby's defect."
D) "You haven't had enough folic acid in your diet. You should take a supplement."

Question 20

The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which statement made by the client indicates to the nurse that the client has understood the teaching?

A) "I can continue to drink alcohol until I am diagnosed as pregnant."
B) "I need to stop drinking alcohol completely when I start trying to get pregnant."
C) "A beer once a week will not damage the fetus."
D) "I can drink alcohol while breastfeeding because it doesn't pass into breast milk."

Question 21

A patient in the second trimester of pregnancy with gestational diabetes is counseled to ingest 35 calories/k g of ideal body weight. The patient's ideal weight is 154 l b s. How many calories should the patient ingest every day?

Question 22

The nurse is providing care to a client in labor who admits to using heroin throughout the pregnancy. Which will the neonate be at risk for following birth?

A) Seizure activity
B) Congenital anomalies
C) Large for gestational age
D) Cardiac anomalies

Question 23

The nurse is caring for a postpartum client who is experiencing a sickle cell crisis. Which is the priority assessment by the nurse?

A) Blood pressure
B) Lochia
C) Temperature
D) Fundal height

Question 24

Which of the following symptoms, if progressive, are indicative of C H F, the heart's signal of its decreased ability to meet the demands of pregnancy?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Palpitations
B) Heart murmurs
C) Dyspnea
D) Frequent urination
E) Rales

Question 25

The nurse is providing care to a pregnant client who is diagnosed with iron deficiency anemia. Which teaching statement from the nurse to the client is appropriate?

A) "You will need to begin iron supplements at 30 m g/day."
B) "You will need to increase your intake of bananas."
C) "You will need to increase your intake of green leafy vegetables."
D) "You will need to begin iron supplements at 150 m g/day."

Question 26

During a routine prenatal visit, the nurse suspects that the patient is experiencing undiagnosed depression. What findings did the nurse use to make this clinical determination?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Insomnia
2. Headaches
3. Fear of labor
4. Ritualistic behavior
5. Lack of interest in the pregnancy

Question 27

The nurse is conducting an admission assessment for a pregnant client who is in labor. Which finding would cause the nurse to expect that the client has been abusing an illegal substance?

A) The client is asking for an epidural and rates pain as an 8 on a 0 to 10 numeric scale.
B) The client is diaphoretic during the transition stage of labor.
C) The client has constricted pupils and inflamed nasal mucosa.
D) The client has a history of precipitous labor.

Question 28

The nurse is providing care to a laboring pregnant client who is diagnosed with sickle cell disease. What will the nurse prepare for upon delivery of the client's newborn, based on this diagnosis?

A) Hemorrhage
B) Intrauterine growth restriction
C) Neonatal resuscitation
D) Cesarean birth

Question 29

The nurse is providing care to a client who would like to become pregnant within the next year. The client has a history of folic acid deficiency anemia and asks, "What can I do to decrease the risk of neural tube defects?" Which response by the nurse is most appropriate?

A) "You will need to have genetic testing done to identify your risk."
B) "Do you have a family history of these disorders?"
C) "Daily consumption of orange juice decreases your risk."
D) "You will be prescribed an iron supplement, which decreases your risk."

Question 30

The nurse is preparing teaching material for a patient with multiple sclerosis who is in the third trimester of pregnancy. What information should the nurse emphasize with this patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Plan for frequent rest periods
2. Breastfeeding should be avoided
3. Plan to experience heightened pain during labor
4. Determine the need for childcare help after delivery
5. Relapses may increase during the first 3 months after delivery

Question 31

A patient in the 10^th week of pregnancy is diagnosed with gestational diabetes. The dietician determines that the patient's daily caloric intake should be 2200 calories and instructs the patient to ingest 40% of calories from carbohydrates, 20% of calories from protein, and 40% of calories from fats. How many calories should the patient ingest of protein each day?

Question 32

The prenatal clinic nurse has received four phone calls. Which client should the nurse call back first?

A) Pregnant woman at 28 weeks with history of asthma who is reporting difficulty breathing and shortness of breath
B) Pregnant woman at 6 weeks with a seizure disorder who is inquiring which foods are good folic acid sources for her
C) Pregnant woman at 35 weeks with a positive H B s A G who is wondering what treatment her baby will receive after birth
D) Pregnant woman at 11 weeks with untreated hyperthyroidism who is describing the onset of vaginal bleeding

Question 33

A patient with gestational diabetes (G D M) is instructed to measure capillary blood glucose levels 4 times a day. If the patient eats meals at 8 a.m., 1 p.m., and 7 p.m., at which times should the nurse reinforce glucose testing to occur?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. 10 a.m.
2. 12 noon
3. 4 p.m.
4. 3 p.m.
5. 9 p.m.

Question 34

A 21-year-old woman is at 12 weeks' gestation with her first baby. She has cardiac disease, class Ⅲ, as a result of having had childhood rheumatic fever. Which planned activity would indicate to the nurse that the client needs further teaching?

A) "I will be sure to take a rest period every afternoon."
B) "I would like to take childbirth education classes in my last trimester."
C) "I will have to cancel our trip to Disney World."
D) "I am going to start my classes in water aerobics next week."