Deck 26: Concurrent Disorders During Pregnancy

Question 1

Which postpartum client requires further assessment?

A) G4 P4 who has had four saturated pads during the last 12 hours
B) G1 P1 with Class II heart disease who complains of frequent coughing
C) G2 P2 with gestational diabetes whose fasting blood sugar level is 100 mg/dL
D) G3 P2 postcesarean client who has active herpes lesions on the labia

Answer 1

G1 P1 with Class II heart disease who complains of frequent coughing

Question 2

Which form of heart disease in women of childbearing years usually has a benign effect on pregnancy?

A) Cardiomyopathy
B) Mitral valve prolapse
C) Rheumatic heart disease
D) Congenital heart disease

Answer 2

Mitral valve prolapse

Question 3

The most important instruction to include in a teaching plan for a client in early pregnancy who has Class I heart disease is she:

A) must report any nausea or vomiting.
B) may experience mild fatigue in early pregnancy.
C) must report any chest discomfort or productive cough.
D) should plan to increase her daily exercise gradually throughout pregnancy.

Answer 3

must report any chest discomfort or productive cough.

Question 4

When planning intrapartum care for a client with heart disease, the nurse should include:

A) taking vital signs according to standard protocols.
B) continuously monitoring cardiac rhythm with telemetry.
C) massaging the uterus to hasten birth of the placenta.
D) maintaining the infusion of intravenous fluids to avoid dehydration.

Question 5

A client has tested HIV-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis?

A) "I know I will need to have an abortion as soon as possible."
B) "Even though my test is positive, my baby might not be affected."
C) "My baby is certain to have AIDS and die within the first year of life."
D) "This pregnancy will probably decrease the chance that I will develop AIDS."

Question 6

For which of the following infectious diseases can a woman be immunized?

A) Rubella
B) Toxoplasmosis
C) Cytomegalovirus
D) Herpesvirus type 2

Question 7

Which client teaching instructions are necessary for a pregnant client who is to undergo a glucose challenge test (GCT) as part of a routine pregnancy treatment plan?

A) Consume a low-fat diet for 48 hours prior to testing.
B) Fast for 12 hours prior to testing.
C) There are no dietary restrictions prior to testing.
D) Consume a consistent carbohydrate diet (60 g) prior to testing.

Question 8

Which factor is most important in diminishing maternal, fetal, and neonatal complications in a pregnant client with diabetes?

A) Evaluation of retinopathy by an ophthalmologist
B) The client's stable emotional and psychological status
C) Degree of glycemic control before and during the pregnancy
D) Total protein excretion and creatinine clearance within normal limits

Question 9

When a pregnant client with diabetes experiences hypoglycemia while hospitalized, which should the nurse have the client do?

A) Eat a candy bar.
B) Eat six saltine crackers or drink 8 oz of milk.
C) Drink 4 oz of orange juice followed by 8 oz of milk.
D) Drink 8 oz of orange juice with 2 teaspoons of sugar added.

Question 10

Which factor is known to increase the risk of gestational diabetes mellitus?

A) Previous birth of large infant
B) Maternal age younger than 25 years
C) Underweight prior to pregnancy
D) Previous diagnosis of type 2 diabetes mellitus

Question 11

Nursing intervention for pregnant clients with diabetes is based on the knowledge that the need for insulin is:

A) varied depending on the stage of gestation.
B) increased throughout pregnancy and the postpartum period.
C) decreased throughout pregnancy and the postpartum period.
D) should not change because the fetus produces its own insulin.

Question 12

A client, who delivered her third child yesterday, has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her?

A) Her two children should be treated with acyclovir before she goes home from the hospital.
B) The baby will acquire immunity from her and will not be susceptible to chickenpox.
C) The children can visit their mother and baby in the hospital as planned but must wear gowns and masks.
D) She must make arrangements to stay somewhere other than her home until the children are no longer contagious.

Question 13

The labor nurse is providing care to a patient at 37 weeks' gestation who is an insulin-dependent diabetic. The health care provider prescribes an infusion of insulin throughout her induction to be titrated to keep her blood glucose levels below 110 mg/dL. What type of insulin will the nurse select to prepare the infusion?

A) NPH insulin
B) Regular insulin
C) Lispro (Humalog)
D) Aspart (Novolog)

Question 14

A client has a history of drug use and is screened for hepatitis B during the first trimester. Which action is appropriate?

A) Practice respiratory isolation.
B) Plan for retesting during the third trimester.
C) Discuss the recommendation to bottle feed her baby.
D) Anticipate administering the vaccination for hepatitis B as soon as possible.

Question 15

Antiinfective prophylaxis is indicated for a pregnant client with a history of mitral valve stenosis related to rheumatic heart disease because the client is at risk of developing:

A) hypertension.
B) postpartum infection.
C) bacterial endocarditis.
D) upper respiratory infections.

Question 16

Which disease process improves during pregnancy?

A) Epilepsy
B) Bell's palsy
C) Rheumatoid arthritis
D) Systemic lupus erythematosus (SLE)

Question 17

Which instructions should the nurse include when teaching a pregnant client with Class II heart disease?

A) Advise her to gain at least 30 pounds.
B) Instruct her to avoid strenuous activity.
C) Inform her of the need to limit fluid intake.
D) Explain the importance of a diet high in calcium.

Question 18

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

A) Hypoglycemia
B) Hypercalcemia
C) Hypoinsulinemia
D) Hypobilirubinemia

Question 19

Examination of a newborn in the birth room reveals bilateral cataracts. Which disease process in the maternal history would likely cause this abnormality?

A) Rubella
B) Cytomegalovirus (CMV)
C) Syphilis
D) HIV

Question 20

A client who has type 2 diabetes is pregnant with her second child. She was not diagnosed with diabetes until after her first pregnancy. Past obstetric history is unremarkable-spontaneous vaginal birth of a male weighing 7 pounds, 15 ounces. The client is now concerned over what will happen during this subsequent pregnancy as a result of her disease process. What impact could the disease process have on her upcoming birth?

A) Client will not be able to receive an epidural for pain management.
B) Client will not be able to have a vaginal birth.
C) A planned birth will be instituted by her health care provider.
D) It is likely that she will deliver a fetus who is small for gestational age (SGA).

Question 21

A pregnant patient with acquired immunodeficiency syndrome (AIDS) is reviewing infant care instructions with the prenatal nurse. Which patient statement indicates to the nurse that the teaching was effective?

A) "I will bathe my baby twice a day."
B) "I will use premixed formula to feed my baby."
C) "I will use gloves to change my baby's diapers."
D) "I will use alcohol wipes six times a day on the baby's cord until it falls off."

Question 22

The labor nurse is admitting a patient in active labor with a history of genital herpes. On assessment, the patient reports a recent outbreak, and the nurse verifies lesions on the perineum. What is the nurse's next action?

A) Ask the patient when she last had anything to eat or drink.
B) Take a culture of the lesions to verify the involved organism.
C) Ask the patient if she has had unprotected sex since her outbreak.
D) Use electronic fetal surveillance to determine a baseline fetal heart rate.

Question 23

An infant of a diabetic mom arrives in the nursery unit for observation. The infant is term at 38 weeks' gestation and weighs 10 pounds. The maternal hemoglobin A1c level is noted at 10%. Which findings would the nurse suspect as being present? (Select all that apply.)

A) Fetus is jittery, temperature is decreased
B) Nasal flaring and retractions
C) Slight jaundice noted on blanching of nose
D) Calcium level of 10 mg/dL

Question 24

The results of a pregnant patient's glucose tolerance test (GTT) were 158 mg/dL. What is the next test that the nurse will include in the patient's teaching plan?

A) Urinalysis
B) Amniocentesis
C) Nonstress test
D) Oral glucose tolerance test (OGTT)

Question 25

The nurse is reviewing the instructions given to a patient at 24 weeks' gestation for a glucose tolerance test (GCT). The nurse determines that the patient understands the teaching when she makes which statement?

A) "I have to fast the night before the test."
B) "I will drink a sugary solution containing 100 grams of glucose."
C) "I will have blood drawn at 1 hour after I drink the glucose solution."
D) "I should keep track of my baby's movements between now and the test."