Deck 15: Pregnancy at Risk: Pregestational Problems

Question 1

A newly diagnosed type 1,well-controlled,insulin-dependent diabetic client at 20 weeks' gestation asks the nurse how her diabetes will affect her baby.The best explanation would include:

A)"Your baby might 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)"There are no effects until about 2 hours after birth,when your baby might have low blood sugar."

Answer 1

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

Question 2

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

A)Get pregnant,then begin on extra iron.
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.

Answer 2

Begin taking folic acid supplements daily.

Question 3

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,"I would notify my doctor if I have:

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

Answer 3

"A frequent cough."

Question 4

A client has a history of rheumatic heart disease as a child,with residual effects.She is concerned for her health and the safety of her current pregnancy.The client asks the nurse,"When am I most likely to experience problems related to my heart condition?" The nurse's best response is:

A)"12-16 weeks' gestation."
B)"20-24 weeks' gestation."
C)"28-32 weeks' gestation."
D)"36-40 weeks' gestation."

Question 5

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."

Question 6

A 26-year-old multigravida at 28 weeks' gestation has developed gestational diabetes.She has a program of regular exercise that 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 finger stick shows less than 120 mg/dL,ingest 20 g of carbohydrate.
D)If your finger stick shows more than 120 mg/dL,drink a glass of whole milk or other source of carbohydrate.

Question 7

A woman at 32 weeks' gestation .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

A 20-year-old woman is at 28 weeks' gestation.Her prenatal history reveals previous 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 9

A 26-year-old multipara is at 26 weeks' gestation.Her previous births include two large-for-gestational-age babies and one unexplained stillbirth.The nurse suspects gestational diabetes.Which tests would the nurse anticipate as being most definitive in making a diagnosis?

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

Question 10

A client admits to being HIV-positive,and that she is at about 16 weeks' gestation.Which statements made by the client indicate an understanding of the plan of care both during the pregnancy and postpartally? Select all that apply.

A)"I will take my Zidovudine (ZVD)at the same time every day."
B)"During labor and delivery,I can expect the Zidovudine (ZVD)to be given in my IV."
C)"After delivery,the dose of Zidovudine (ZVD)will be doubled to prevent further infection."
D)"My baby will be started on Zidovudine (ZVD)within 12 hours of delivery."

Question 11

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 if she would like to talk to a counselor.
C)Ask some questions about over-the-counter medications and avoid the mention of illicit drugs.
D)Explain how harmful drugs can be for her baby.

Question 12

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

A)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)Unusual fatigue and recurring candida vaginitis

Question 13

A 26-year-old multipara is at 24 weeks' gestation.Her previous births include two large-for-gestational-age babies and one unexplained stillbirth.With this history,what assessment is most important?

A)Breath sounds
B)Hemoglobin and hematocrit
C)Urine and blood glucose
D)Urine for bacteria

Question 14

The client has just been diagnosed as diabetic.The nurse knows teaching was effective when the client 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 15

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.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."