Deck 15: Pregnancy at Risk: Pre-Existing Conditions

Question 1

With which heart condition is pregnancy usually contraindicated?

A) Pre-existing hypertension
B) Eisenmenger syndrome
C) Heart transplant
D) Aortic valve stenosis

Answer 1

Eisenmenger syndrome

Question 2

Which is attributable to poor glycemic control before and during early pregnancy?

A) Frequent episodes of maternal hypoglycemia
B) Congenital anomalies in the fetus
C) Polyhydramnios
D) Hyperemesis gravidarum

Answer 2

Congenital anomalies in the fetus

Question 3

Which should the nurse know in terms of the incidence and classification of diabetes?

A) Type 1 diabetes is most common.
B) Type 2 diabetes often goes undiagnosed.
C) Gestational diabetes mellitus (GDM)means that the woman will be receiving insulin treatment until 6 weeks after birth.
D) Type 1 diabetes may become type 2 during pregnancy.

Answer 3

Type 2 diabetes often goes undiagnosed.

Question 4

Which statement is accurate in providing perinatal care for women who use substances?

A) A decision to stop using substances must be made by the family.
B) Harm reduction practices are not effective with pregnant women.
C) Effects of perinatal substance use in pregnancy and postpartum must be reviewed.
D) Use of community resources for women to eliminate a social bias for perinatal care must be avoided.

Question 5

What normal fasting glucose level should the nurse recommend for a woman with pregestational diabetes?

A) 2.5-3.5 mmol/L
B) 3.8-5.2 mmol/L
C) 5.5-7.7 mmol/L
D) 5.0-6.6 mmol/L

Question 6

The nurse must be alert for which signs and symptoms of cardiac decompensation when caring for a pregnant woman with cardiac problems?

A) A regular heart rate and hypertension
B) An increased urinary output,tachycardia,and slow respirations
C) Shortness of breath,bradycardia,and hypertension
D) Frequent cough;crackles;and an irregular,weak pulse

Question 7

According to statistics,cystic fibrosis occurs once in how many live Caucasian births?

A) 1500
B) 2000
C) 2500
D) 3000

Question 8

Which factor increases the risk of mother-to-child perinatal HIV transmission?

A) Treatment with antiretroviral
B) Presence of chorioamnionitis
C) Bottle-feeding after delivery
D) Maternal plasma viral level less than 1000 copies per mL

Question 9

A woman with asthma is experiencing a postpartum hemorrhage.Which drug would be recommended to treat her bleeding that would not exacerbate her asthma?

A) Prostaglandin E₂
B) Ergonovine
C) Hemabate
D) Methylergonovine

Question 10

In assessing the knowledge of a pregestational woman with type 1 diabetes about changing insulin needs during pregnancy,which information is accurate?

A) Insulin dosage during the first 3 months of pregnancy needs to be increased.
B) Insulin dosage will likely need to be decreased during the second and third trimesters.
C) Episodes of hypoglycemia are more likely to occur during the last 3 months.
D) Insulin needs should return to normal within 7 to 10 days after birth if bottle-feeding.

Question 11

What should the nurse be aware of in relation to diabetes in pregnancy?

A) With good control of maternal glucose levels,sudden and unexplained stillbirth is no longer a major concern.
B) The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.
C) Infants of mothers with diabetes have the same risks for central nervous system (CNS)defects as infants of mothers that do not have diabetes.
D) At birth the newborn of a diabetic mother is no longer at any risk.

Question 12

Which should the nurse know regarding drug testing during pregnancy in Canada?

A) It is required at the first prenatal visit.
B) Only those drugs disclosed by the woman are tested for.
C) There is no legal requirement to test the mother or the newborn child.
D) Testing is required before labour and delivery.

Question 13

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels.She shows the nurse her readings for the past few days.Which reading should the nurse tell her is not within the normal limits for blood glucose levels?

A) 3.2 mmol/L
B) 3.8 mmol/L
C) 4.2 mmol/L
D) 4.8 mmol/L

Question 14

In planning for the care of a 30-year-old woman with pregestational diabetes,what does the nurse recognize as the most important factor affecting pregnancy outcome?

A) Mother's age
B) Number of years since diabetes was diagnosed
C) Amount of insulin required prenatally
D) Degree of glycemic control during pregnancy

Question 15

What is the greatest risk for a fetus of a pregnant woman who has gestational diabetes mellitus (GDM)?

A) Macrosomia
B) Congenital anomalies of the central nervous system
C) Postterm birth
D) Low birth weight

Question 16

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand.Which is important for the nurse to know?

A) Insulin crosses the placenta to the fetus only in the first trimester,after which the fetus secretes its own.
B) Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar.
C) During the second and third trimesters pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.
D) Maternal insulin requirements steadily decline during pregnancy.

Question 17

What should the nurse be aware of with regard to postpartum care of the woman with cardiac disease?

A) It should be the same as that for any pregnant woman.
B) It includes rest,stool softeners,and monitoring of the effect of activity.
C) It includes ambulating frequently,alternating with active range of motion.
D) It includes limiting visits with the infant to once per day.

Question 18

Which is important to include in nursing care when caring for a pregnant woman at risk for the development of a thromboembolism?

A) Monitor the patient for loss of deep tendon reflexes.
B) Massage her calves when the woman complains of pain.
C) Apply compression stockings.
D) Maintain a restriction on fluid intake.

Question 19

What should the nurse be aware of with regard to maternal diabetes affecting the mother and fetus?

A) Diabetic ketoacidosis (DKA)can lead to fetal death at any time during pregnancy.
B) Hydramnios occurs less often in diabetic pregnancies.
C) Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies.
D) Even mild-to-moderate hypoglycemic episodes can have significant effects on fetal well-being.

Question 20

The nurse providing care for a woman with gestational diabetes understands which about a laboratory test for glycosylated hemoglobin Alc?

A) The test is now done for all pregnant women,not just those with or likely to have diabetes.
B) The test is a snapshot of glucose control at the moment.
C) The test is completed to evaluate recent glycemic control.
D) The test is done on the patient's urine,not her blood.

Question 21

What is the most common neurological disorder accompanying pregnancy?

A) Eclampsia
B) Bell's palsy
C) Epilepsy
D) Multiple sclerosis

Question 22

During a physical assessment of an at-risk patient,what is the most likely cause of assessment findings that include generalized edema,crackles at the base of the lungs,and some pulse irregularity?

A) Euglycemia
B) Rheumatic fever
C) Pneumonia
D) Cardiac decompensation

Question 23

Which cardiac diseases have the highest mortality rate and are classified as group III? Select all that apply.Express answer with small letters,followed by a comma and a space-e.g. ,a,b,C

A) Pulmonary hypertension
B) Endocarditis
C) Atrial septal defect
D) Aortic stenosis
E) Eisenmenger's syndrome
F) Bioprosthetic valve

Question 24

While providing care to a patient with Marfan syndrome early in her pregnancy,which intervention should the nurse initially anticipate?

A) Antibiotic prophylaxis
B) Beta-blockers
C) Surgery
D) Regional anaesthesia

Question 25

Which are target blood glucose levels during pregnancy for a 2-hour postprandial plasma glucose? Select all that apply.Express answer with small letters,followed by a comma and a space-e.g. ,a,b,C

A) 3.8 mmol/L
B) 4.3 mmol/L
C) 4.8 mmol/L
D) 5.3 mmol/L
E) 5.8 mmol/L
F) 6.3 mmol/L
G)6.8 mmol/L

Question 26

What should the nurse caring for antepartum women with cardiac conditions be aware of?

A) Stress on the heart is greatest in the first trimester and the last 2 weeks before labour.
B) Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
C) Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework,shopping,and exercise.
D) Women with class I cardiac disease need bedrest through most of the pregnancy and face the possibility of hospitalization near term.

Question 27

Which signs assessed in a pregnant patient are indicative of cardiac decompensation? Select all that apply.Express answer with small letters,followed by a comma and a space-e.g. ,a,b,C

A) Frequent cough
B) Difficulty breathing
C) Bradycardia
D) Tachypnea
E) Generalized edema
F) Increased energy

Question 28

Which congenital anomaly may occur with the use of anticonvulsant medication?

A) Gastroschisis
B) Congenital heart disease
C) Diaphragmatic hernia
D) Intrauterine growth restriction

Question 29

What should nurses be aware of with regard to anemia?

A) It is the most common medical disorder of pregnancy.
B) It can trigger reflex brachycardia.
C) The most common form of anemia is caused by folate deficiency.
D) Thalassemia is a European version of sickle cell anemia.