Deck 19: Pregnancy at Risk: Pregestational Problems

Question 1

The nurse is assessing a woman at 10 weeks' gestation who is addicted to alcohol. The woman asks the nurse, "What is the point of stopping drinking now if my baby probably has been hurt by it already?" What is the best response by the nurse?

A) "It won't help your baby, but you will feel better during your pregnancy if you stop now."
B) "If you stop now, you can still have a normal pregnancy."
C) "If you limit your drinking to once a week, your baby will be okay."
D) "You might as well stop it now, because once your baby is born, you'll have to give up alcohol if you plan on breastfeeding."

Answer 1

"If you stop now, you can still have a normal pregnancy."

Question 2

A diabetic patient goes into labor at 36 weeks' gestation. Provided that tests for fetal lung maturity are successful, the nurse will anticipate:

A) Administration of tocolytic therapy.
B) Beta-sympathomimetic administration.
C) Allowance of labor to progress.
D) Hourly blood glucose monitoring.
E) Cesarean birth if the HgbA1c is 7%.

Answer 2

Allowance of labor to progress.
Hourly blood glucose monitoring.

Question 3

A newly diagnosed nsulin-dependent type 1 idiabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. The best explanation would 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 3

"Your baby will probably be larger than average at birth."

Question 4

The patient with insulin-dependent type 2 diabetes and an HbA1c of

A) Insulin needs decrease in the first trimester and increase during the third trimester.
B) The risk of ketoacidosis decreases during the length of the pregnancy.
C) Vascular disease that accompanies diabetes slows progression.
D) The baby is likely to have a congenital abnormality because of the diabetes.
E)0% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this patient?

Question 5

The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which statement made by the patient indicates to the nurse that the patient 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, since it doesn't pass into breast milk."

Question 6

A woman asks her nurse what she can do before she begins trying to get pregnant to help her baby, since she is prone to anemia. The nurse correctly advises her to:

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 7

A woman is 32 weeks pregnant. She is HIV-positive but asymptomatic. What would be important in managing her pregnancy and delivery?

A) An amniocentesis at 30 and 36 weeks
B) Weekly nonstress 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 8

During the history, the patient admits to being HIV-positive and says she knows that she is about 16 weeks pregnant. Which statements made by the patient indicate an understanding of the plan of care both during the pregnancy and postpartally?

A) "During labor and delivery, I can expect the zidovudine (AZT) to be given in my IV."
B) "After delivery, the dose of zidovudine (AZT) will be doubled to prevent further infection."
C) "My baby will be started on zidovudine (AZT) within 12 hours of delivery."
D) "My baby's zidovudine (AZT) will be given in a cream form."
E) "My baby will not need zidovudine (AZT) if I take it during my pregnancy."

Question 9

The patient has just been diagnosed as diabetic. The nurse knows teaching was effective when the patient says:

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."

Question 10

A 26-year-old multigravida 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 patient?

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 mg/dl, eat 20 g of carbohydrate."
D) "If your blood sugar is more than 120 mg/dl, drink a glass of whole milk."

Question 11

A patient with type 1 diabetes is receiving preconception counseling. The nurse will emphasize that during the first trimester, the woman might experience:

A) The need for less insulin than she normally uses.
B) An increased risk for hyperglycemic episodes.
C) Signs and symptoms of hydramnios.
D) A need to be hospitalized for fetal testing.

Question 12

The nurse is working with a woman who abuses stimulants. The nurse is aware that the fetus is at risk for:

A) Withdrawal symptoms.
B) Cardiac anomalies.
C) Sudden infant death syndrome.
D) Being small for gestational age.
E) Fetal alcohol syndrome.

Question 13

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

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 14

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

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

Question 15

A 26-year-old multipara 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 16

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

A) "I cannot take the medications that control HIV during my pregnancy, because they will harm the baby."
B) "My baby will probably be born with anti-HIV antibodies, but that doesn't mean my baby is infected."
C) "The pregnancy will increase the progression of my disease and will reduce my CD4 counts."
D) "The HIV won't affect my baby, and I will have a low-risk pregnancy without additional testing."

Question 17

The clinic nurse is teaching a pregnant patient about her iron supplement. Information in the teaching plan includes:

A) Iron does not affect the gastrointestinal tract.
B) A stool softener might be needed.
C) Start a low dose, and increase it gradually.
D) Expect the stools to be black and bloody.
E) Iron absorption is poor if taken with meals.

Question 18

A woman's history and appearance suggest drug abuse. The nurse's best approach would be to:

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 19

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:

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

Question 20

The nurse has written the nursing diagnosis Risk for Injury for a diabetic pregnant patient. Interventions for this diagnosis include:

A) Assessment of fetal heart tones.
B) Perform oxytocin challenge test, if ordered.
C) Refer the patient to a diabetes support group.
D) Assist with the biophysical profile assessment.
E) Develop an appropriate teaching plan.

Question 21

The nurse is reviewing prenatal charts. A patient at 24 weeks' gestation has a history of class II heart disease secondary to rheumatic fever. What would the nurse expect to see in the chart?

A) Dyspnea and chest pain with mild exertion
B) Elective cesarean birth scheduled for 37 weeks
C) Discussed need for labor epidural and vacuum extraction
D) Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally

Question 22

While doing a prenatal assessment on a woman who has hepatitis B and intends to become pregnant, the nurse explains the impact of the hepatitis B on pregnancy and birth. Which statement does the nurse include in the teaching?

A) "Your baby contracted hepatitis B from you when she was conceived."
B) "Don't worry about your baby during the birth. You're more likely to be affected then by the hepatitis B."
C) "Your baby will be immune to your hepatitis B."
D) "Hepatitis B does not usually affect the course of pregnancy."

Question 23

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

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

Question 24

A patient 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. The nurse's response should be:

A) "Heparin may be given by mouth, while Coumadin must be injected."
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 25

A pregnant asthmatic patient is being seen for her initial prenatal visit. The nurse knows that the fetal implications of maternal asthma are:

A) Prematurity.
B) Low birth weight.
C) Hypoxia with maternal exacerbation.
D) Congenital anomalies from the medications.
E) Perinatal transfer of the asthma.

Question 26

The nurse is evaluating the plan of care for a pregnant patient with a heart disorder. The nurse concludes that the plan was successful when data indicate that the woman:

A) Gave birth to a healthy baby.
B) Did not develop congestive heart failure.
C) Developed thromboembolism.
D) Identified manifestations of potential complications.
E) Can identify her condition and its impact on her pregnancy, labor and birth, and postpartum period.

Question 27

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 patient understands these signs and symptoms if she states, "I would notify my doctor if I had:

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

Question 28

The nurse is working with a pregnant woman who has systemic lupus erythematosus (SLE). The nurse anticipates the infant might be born with:

A) A tendency to bleed excessively.
B) An increased chance of developing infections.
C) A hemoglobin less than optimal for good health.
D) Problems with vision.
E) Hearing loss.

Question 29

The clinic nurse is following the progress of a HIV-positive infant. The nurse will assess the infant for:

A) Recurrent infections.
B) Cancer.
C) Delayed development.
D) Epstein-Barr manifestations.
E) Intact, normal central nervous system.

Question 30

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 patient 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."